Sequestration is here. With budget cuts starting March 1, 9 percent of all federal agency funding must go over the next seven months, with little to no discretion on the part of department heads (see ADAW, March 4). But there is still no detail on how the cuts will affect the treatment providers who get block grants (those will be cut), the coalitions that do prevention (those will be cut) and more.

At the Department of Justice, which funds Drug-Free Communities (DFC) programs, Attorney General Eric H. Holder has decided that all of the cuts will come out of programs and none out of the bureaucracy. Exactly how the DFC cuts will play out, however, is not clear. For example, there could be fewer grantees — or each grantee could get less money. “No one knows what will happen,” said Sue Thau, public policy consultant for Community Anti-Drug Coalitions of America.

The topline numbers are available from the Office of Management and Budget (OMB), but how these will be spread throughout a department or an agency is not available yet.

“It’s too early to see an effect,” said Thau. “Now that they have the topline numbers, the next step is to see what departments do.”

No details from SAMHSA

Attempts to find out what the Substance Abuse and Mental Health Services Administration (SAMHSA) planned in terms of apportioning cuts were fruitless. There is some concern in the field that the sequester could be used to try to accomplish some of SAMHSA’s desired cuts that Congress had not approved, such as cuts to substance abuse prevention. Working with the states will be a big part of the process as well.

Although most people assume the cuts will be gradual through the remainder of the fiscal year, this isn’t guaranteed. It’s possible that the cuts could all take place at the end of the fiscal year, with money simply running out for the last month or two, for example.

Andrew Kessler, principal with treatment and prevention lobbying firm Slingshot Solutions, pointed out that the state-by-state figures released by the White House on the sequester cuts reflect calculations based on block grant cuts. “Not included was the impact on programs such as safe and drug-free schools, drug courts, the EUDL [Enforcing Underage Drinking Laws] program, employee assistance programs and other programs run out of departments such as Justice, Labor, Agriculture and HUD,” said Kessler. “Until action is taken, the impact will be even harsher than initially predicted.”

That “action” that is hoped for by many is a fix of the sequester in a Continuing Resolution (CR) designed to keep the government running past March 27. But based on the House version of that CR, passed on March 6, the sequester is included, with the money lost permanently.

Treatment gap underestimated

“When I saw the estimate for treatment slots and remembered that the czar says we treat one out of every ten who need treatment, I was surprised that ONDCP did not say more about the treatment gap and how sequestration threatens it,” said John Carnevale, Ph.D., a public policy consultant who worked at the ONDCP for three administrations. “My calls to agencies like SAMHSA tell me that no one really knows how such cuts will actually translate into cuts at the local level. No one has any answers.”

As Carnevale wrote in his report on sequestration (see ADAW, Dec. 12, 2011), sequestration threatens implementation of the National Drug Control Strategy. “Looking at federal drug control policy through the budget lens, sequestration will do more damage to demand-reduction programs than to supply-reduction programs,” he told ADAW March 6. “This is exactly the opposite of what ONDCP needs to implement — which is a public health approach.”

Who gets the blame?

President Obama did take the step of shutting down White House tours to the public, citing the sequester, Politico reported March 6. This is a public way of showing that the sequester is having an effect. House Speaker Rep. John Boehner (R-Ohio) pointedly kept the tours of the Capitol open and called the president’s tour closing politically motivated. (In the 1980s, whenever there was a budget-threatening exercise, people in Washington called it “shutting the Washington Monument,” to display the fact that Congress wasn’t cooperating.)

Both sides are to blame for the cuts, one insider said. “Truth be told, agencies will have some discretion with some of the cuts,” he told ADAW. “But the bottom line is — there is no bottom line. Sequestration is a failure of leadership by Congress and the Executive Branch.”

Rafael Lemaitre, spokesman for the ONDCP, did have something to say about sequestration. “The president has put forward a specific plan that will avoid sequestration's harmful budget cuts and reduce the deficit in a balanced way — by cutting spending, finding savings in entitlement programs and closing tax loopholes,” he told ADAW on March 4. “Only Congress can avoid this self-inflicted wound to public health. There is a smarter way to do this — to reduce our deficits without harming our economy. But Congress has to act in order for that to happen.”

But many House Republicans said that sequestration accomplished the goal of beginning to reduce the deficit. And Representative Boehner said March 3 on NBC’s “Meet the Press” that the sequester might not be as bad as everyone — including him — had predicted. “I don’t know whether it’s going to hurt the economy or not,” he said. “I don‘t think anyone quite understands how the sequester is really going to work.”

Medicaid is exempt from sequestration. But the many other parts of the safety net that affect substance abuse program patients are not. Whether there will be action to fix this is unclear. Stay tuned.

Bottom line

The budget-cutting axe of sequestration has fallen, but nobody is sure exactly how the cuts will take place. They will, however, probably be worse than expected.