The federal budget is a reflection of our nation’s health values
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One of the major shortcomings of the American public policy process is that policies are often created in isolation, without adequate opportunity to consider potential cascading negative impacts.

Our systems, just like families and communities, don’t operate in silos — they are interdependent. This means that policies made by one congressional committee of jurisdiction or one federal agency intended to impact one area can have unintended consequences on many others.

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Take for example, the department of Health and Human Services (HHS), which is comprised of both government agencies and community-based organizations working in partnership to promote the health and well-being of individuals, families, and communities across our nation.

Whether you are talking about access to quality healthcare, housing, transportation, education, nutrition, job training and jobs, safety and permanency — these are all interconnected and necessary for individuals to reach their fullest potential.

In fact, access to these building blocks of well-being makes up what science calls the social determinants of health and, according to researchers, these social determinants of health are more important to determining our health and well-being than the primary health care we receive.

Policy changes that don’t take into account these factors or how they are interconnected run the risk of resulting in a set of decisions that could actually impede the very progress our nation is working toward as it seeks to grow our economy and ensure all people can succeed in their lives. Our nation can’t afford to leave anyone behind.

This is, in fact, the situation we find ourselves in today, as the HHS nonprofit sector is facing a triple hit of current policy proposals that, if passed as proposed, pose a substantial threat to the system’s infrastructure and the ability of community-based health and human services organizations, like those in our national network, to provide important life changing support and services to individuals, families and communities.

First, the proposed changes in the way Medicaid is financed, as outlined in the administration’s budget (and the recent House and Senate healthcare bills), could result in millions of low-income people nationwide who no longer have access to healthcare coverage.

The proposed reductions in federal financial support for Medicaid will shift costs directly to state budgets, with substantial ripple effects throughout state economies. Governors and state legislatures will struggle to preserve essential services defined under the Affordable Care Act (ACA), including access to maternity and newborn care, mental health and substance abuse treatment, preventive and wellness services, and more. An analysis from one state alone, Connecticut, estimates that, by 2026, the Senate’s Better Care Reconciliation Act would have shifted up to $2.9 billion in current annual costs to the state.

Secondly, the administration’s budget, which proposes a cut of more than $15 billion in federal health and human services spending, would further undermine the capacity of the nation’s health and human services infrastructure and negatively impact our ability to ensure all people in our nation have opportunity in their lives.

While the House appropriations committee budget levels for health and human services do not reflect cuts as drastic as the administration’s, funding for vital programs such as home visiting and the Children’s Health Insurance Program (CHIP) remain uncertain. Furthermore, the administration has recently announced further cuts to grant-funded programs, including programs to stem teen pregnancy.

Current tax reform proposals from the administration and the House bring a third potential hit. By changing incentives to itemized charitable deductions, the current proposal could reduce the use of the charitable tax deduction and result in an estimated $13 billion less in charitable giving each year, according to a recent Indiana University study commissioned by Independent Sector.

If even one of these proposed policy changes took effect, it would have negative consequences for individuals, families, communities and our economy as a whole. Taken together, all three represent a perfect storm of policies that could have devastating consequences for the sector as a whole.

All of this occurs at a time when our nation is mobilizing to meet employer demands for a well-prepared workforce, respond to an aging population, and address the impact of a nationwide opioid crisis.

As leaders in the health and human services sector, we know that individuals, families and communities are more likely to achieve their full potential when they have a strong foundation that enables them to thrive, no matter their current situation, socio-economic status, or geographic location.

That means having access to key building blocks, like gainful employment, affordable and preventive healthcare, safe and nurturing relationships and environments, and quality education are essential.

Our work to build, restore and sustain that foundation is now in jeopardy across too many fronts. We must reverse this course and recognize the cumulative impact these proposed policies will have for families and communities, not just today but well into the future.

The federal budget is a reflection of our nation’s values — and those values must include: investments in our human capital and the social determinants of health; increased incentives for charitable giving; and access to quality, preventive, and affordable healthcare for everyone.

As vital partners to government, community-based health and human services organizations serve as beacons of light in tens of thousands of communities across America. Policies and financial investments that strengthen the health and human services system and recognize the vital role our sector plays will lead to better outcomes for the families and communities we serve, which in turn, will lead to a stronger economy and healthier America.

Susan N. Dreyfus is president and CEO of the Alliance for Strong Families and Communities. The Alliance for Strong Families and Communities is a strategic action network of thousands of committed health and human services sector leaders who through their excellence, distinction and influence are working to achieve a healthy and equitable society.


The views expressed by contributors are their own and not the views of The Hill.