The MarbleRoad blog began in 2009 with a focus on rare diseases, public health and national service. Each of these things, in my view, is essential for building strong communities and achieving health equity across America. Those of you who know me well know that my career has reflected those interests and causes: beginning with two terms of service in an AmeriCorps program, Community HealthCorps, based out of community health centers and leading up to my current role as both the Director of Policy for the DC Primary Care Association and the Founder/CEO of MarbleRoad. Unfortunately, wearing so many hats has limited my ability to blog frequently… but with the number of things to discuss reaching critical mass, I share some thoughts with you this evening:


In the recent midterm elections, as many of you know, Republicans regained control of the House majority. The new House Speaker John Boehner (R-OH), House Majority Leader Eric Cantor (R-VA), and other Republicans have outwardly promised to find ways to reduce the Federal deficit by cutting spending and promoting philosophies of smaller government. I am not strongly opposed to this philosophy. Although, I do believe that, in practice, reducing Federal spending as dramatically as their recent proposals suggest brings about at least two “unintended” negative consequences that politicians (on a bipartisan level) and the American people would not stand for:

(1)    Some estimates suggest that the proposed budget cuts would eliminate 60,000 jobs.

(2)    Millions of people, in every congressional district (members of every Congressman’s constituency), would lose essential benefits and support services that provide opportunities for growth, opportunity, and wellness.

What you need to understand is that there will be budget cuts. However, the GOP is having some internal struggle over how deep those cuts will be… The Continuing Resolution (HR 3082) that held funding for most programs at the FY 2010 level will expire on March 4, 2011, and so we are looking at budget proposals for FY 2011. The question on the House floor will be: Do we cut $100 billion, as in their campaign promise, or $58 billion, as in Budget Chairman Paul Ryan’s recent proposal (R-WI), or any one of another set of proposals, such as President Barack Obama’s proposal (which he will send to Congress on Monday)?

I don’t believe we have seen what $100 billion in cuts looks like just yet, but in Ryan’s proposal we know a little bit about the impact that a $58 billion cut will have; and it will have a profound and devastating effect on the communities, programs, and colleagues I have met and worked with throughout my career including (but not limited to):

Community Health Centers [visit]

Among the recommendations from the House Appropriations Committee was a $1.3 billion cut to the Community Health Centers Program. If this cut were to be approved, it will mean that

America’s Health Centers will lose the capacity to serve 11 million patients over the next year, with well over 3.3 million current patients losing their care within the next few months. That is equivalent to terminating all health care to the entire population of Chicago, or to everyone living in the states of Wyoming, Vermont, North and South Dakota, and Alaska combined. Equally troubling is that these proposed cuts come at a time when many states – faced with their own budget problems – have reduced or eliminated Community Health Center funding, on the assumption that Federal funding for the program would grow.

Over the past 2 years, millions of families have lost their health insurance due to job losses. Indeed, many of these people have walked through the doors of health centers seeking care. Because they received care at a Community Health Center, these same patients were able to stay healthy and free up local hospital emergency rooms for the truly sick.


National Service [AmeriCorps] [visit]

AmeriCorps is a National Service program that offers opportunities to millions of people from a variety of backgrounds to give back to their communities. They volunteer, some full time, for a very small living stipend and an education award. Among the recommendations from the House Appropriations Committee was a complete elimination of the AmeriCorps State and National Program to save $373 million. But the cuts translate to much more, impacting thousands of Americans who serve and more than 1,840 national and local non-profit and community groups. Let’s take a look at the return on investment from AmeriCorps since 1994:


AmeriCorps Fast Facts:

  • 637,000: Number of people who have served as AmeriCorps members since 1994.
  • 774 Million: Total number of hours served by AmeriCorps members.
  • $1.77 Billion: Total amount of Segal AmeriCorps Education Awards earned by AmeriCorps members since 1994.
  • 2.4 Million: Number of community volunteers managed or mobilized by AmeriCorps members in 2008.
  • 3,300: Number of nonprofit, faith-based, and community organizations served by AmeriCorps members last year.
  • $6.3 Billion: Amount of AmeriCorps funds invested in nonprofit, community, educational, and faith-based community groups since 1994.


American Recovery and Reinvestment Act [ARRA – HITECH Act] [visit]


Jim Jordan (R-OH), Chairman of the Republican Study Committee and lead sponsor of the “Spending Reduction Act” has proposed eliminating any funds from the recovery act that have not yet been spent – some $45 billion in health information technology money. These include funds that have been allocated for investments in the adoption of Electronic Health Records (EHR). Investments in EHR and health information exchange allow providers to improve the quality of care that they offer and reduce cost. They also allow us access to better data for understanding the health system, how the American people utilize that system, and what exactly the $2.8 trillion we spend on health care is being spent on.

Rare Disease

Proposed cuts also include:

  • Centers for Disease Control – $755 million
  • Food and Drug Administration – $220 million
  • National Institutes for Health – $1 billion

I have less information in this moment about the potential impact these cuts to CDC, FDA, and NIH will have on orphan drug research, development, approval and distribution, but you can be certain that there will be an impact. Other institutions have yet to perform analysis or issue statements as I have illustrated above. As RARE DISEASE DAY 2011 [] approaches in a couple of weeks, I urge the rare disease community to come together with one voice and advocate against these budget cuts. I understand that many people are asking Congress to reduce Federal spending, and if we must take that path we must do so slowly and incrementally. Millions of people’s lives are at stake here.

If you have any information or stories you would like to share about how these budget cuts may impact you, or if you have any questions about anything I have discussed above, please email me at howard

I strongly urge Congress to reconsider the proposed budget cuts. The cuts will meet campaign promises, but they will cause more harm than good.

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