Gov. Andrew M. Cuomo’s decision to create competition for coveted state funding worked well in regional councils and education reform, but is misguided when it comes to public health programs.
The governor is proposing to end direct funding for 89 public health programs in favor of a competitive grant system. The programs would be divided into six general categories. The state would fund the categories and each program would bid on a piece of that pie – essentially setting up a “Hunger Games” scenario among disparate groups.
For example, the new Chronic Disease Prevention and Treatment category would include the state’s two most successful cancer-fighting efforts, Tobacco Control and Cancer Services. Those programs would compete with others in that category, including Alzheimer’s community service programs and osteoporosis prevention. Some programs could end up big winners, or big losers. Although the state budget is due by April 1, the competition for health funds will take months, during which the organizations will have no idea how much funding to expect. If any.
Programs included in the Chronic Disease Prevention and Treatment category received a total of $70 million in the last budget. The governor proposes reducing that to $63 million next year.
New York’s Tobacco Control Program would almost certainly take another big hit. About $32 million of the $41.4 million in last year’s anti-tobacco funding will be subject to the competitive approach. Tobacco control spending in the state is now half of what it was just a few years ago.
The money spent weaning smokers off cigarettes or preventing them from starting in the first place has a huge payback in a healthier population and reduced spending on Medicaid and other health services.
And consider that the money is there for tobacco control. The state takes in nearly $2.5 billion each year in tobacco revenues, according to the American Cancer Society Cancer Action Network. A tiny percentage goes to anti-smoking efforts; the rest goes into the state’s budget.
The New York State Tobacco Control Program has been a model for addressing the tobacco problem. But the constant budget cuts have hurt that work. And the governor’s proposal for health competition will take another 10 percent out of the pool that includes the anti-smoking programs.
Any cut in anti-smoking funds will have repercussions at Roswell Park Cancer Institute, which runs the New York State Smokers’ Quitline and helps about 100,000 New Yorkers trying to kick the habit. Also in the cross hairs would be a local smoking cessation center working with medical professionals to help implement better methods, and the Erie-Niagara Tobacco-Free Coalition, which works with community leaders to educate the public.
Roswell Park won a national competitive process for the contract to operate the Quitline; under the proposed scenario the Quitline and other anti-smoking programs would have to compete for funding inside the chronic disease and prevention pool. “This sets the stage for competition, rather than collaboration, among New York State health care organizations,” said Dr. Andrew Hyland, chairman of the Department of Health Behavior at Roswell Park and also director of the Quitline.
Smoking rates have declined among youths and in the general population, but rates remain unchanged among the poor and less-educated. Education and intervention are the keys to driving down smoking rates, and the state should not shortchange the effort.
Consolidating 89 programs into six competitive pools appears designed to ease the sting of cutting health spending by 10 percent. But it also puts anti-tobacco programs on the chopping block, even though those programs have a source of funding and in the long run save the state on health care.
The Legislature should reject this approach and, instead, increase its anti-tobacco funding with the money that’s already available.