Impact of New York State Budget Cuts on Rural Communities

Impact of the New Impact of the New York State Budget on York State Budget on Rural Communities Rural Communities New York State Association for Rural Health 2018 Annual Conference Greek Peak Resort Cortland, New York Dr. Casey Harrison Certified Nurse Midwife

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Background Problem Statement Approach Session Agenda Session Agenda Methods Initial Results Status Q&A

Identify and understand the purpose of key New York State health-related funding streams within selected rural communities Understand and identify the discrete categories of direct, indirect, and induced economic impact of outside funding by looking at selected health and social entities Objectives Identify and discuss the economic impact of cuts in funding on rural infrastructure and communities, through the use of IMPLAN when applied to New York State 2016-2017 to 2017-2018 fiscal year budget reductions

In 2017, NYSARH administered a member survey regarding the impact of NYS DOH funding cuts Key findings included: Background Background 20% reduction in funding allocation from NYS DOH Resultant reduction in workforce Reduction in community outreach and engagement

A reduction in worker training, professional development, and/or continuing education A reduction in programming related to outreach, education and health promotion What does What does that mean? that mean? A significant decrease in the ability to leverage other funding Significantly compromised ability to recruit and retain healthcare professionals in their communities

Survey findings were presented and discussed at the Rural Health Network Meeting during the NYSARH 2017 Annual Conference one year ago Discussion surrounded the fact that each and every year is a struggle to remain whole in the NYS DOH budget, let alone get reinstated to previous levels Broader Issues Broader Issues As a collective of RHNs and other public health-related programs, this has been, and continues to be, the most serious problem to address

The Challenge The Challenge Approximately 31 public health-related programs, which rely on NYS DOH funding to survive and serve rural communities, have experienced funding cuts and remain under further funding cuts on an annual basis. Efforts thus far to influence lawmakers and NYS DOH to not make funding cuts to these programs and to reinstate funding that has already been cut have been only marginally effective

Advance the New York State Prevention Agenda, Women s Agenda, Delivery System Reform Incentive Payment Program (DSRIP), and Health Across All Policies and Ages Increase in Social Determinants of Health Compromise of NYS Agenda Priorities 31 NYS Public Health Programs Reduction in Cuts and Consolidation Programs and Rural Economy

GOAL Inform and educate decision-makers Funding to 31 public health programs has a direct and significant impact on: Health of people in rural communities Economic health of those communities This increases the devastating effects of social determinants of health which makes for a sicker population Credible evidence must provided decision-makers regarding the multiplied economic impact of funding cuts on rural communities

RuralPrep Microgrant RuralPrep Microgrant Community based approach with small seed grant funding to generate locally implemented projects in underserved communities, resulting in big impacts RuralPrep provides multiple $4000 awards to students in health professions aiming to provide research that is collaborative and community engaged This funding was used to purchase a 1 yr subscription to IMPLAN software

What is the economic impact of state-based rural health funding cuts in rural regions? Impact is a standardized multiplier formula Rural regions are counties and legislative districts State-based rural health funding cuts are reductions in funding from one year to the next in discrete rural funding areas Research Research Question Question

Rural Americans face unique challenges when it comes to addressing the needs of local and regional public health infrastructure, as they are generally older and sicker than their urban counterparts There are higher rates of poverty to include children living in poverty, disparities in healthcare equity and access, lower education rates and secondary schooling, greater risks for on-the-job injuries, and higher rates of uninsured Project Project Background Background Access to quality health services was identified by Rural Healthy People 2020, Healthy People s companion document, as the single most important rural health priority for the decade

The health and social sector provides a foundation for the health and well-being of rural communities. Rural residents are more likely to derive their income from the healthcare industry both directly and indirectly, and health and wellness of rural communities lies heavily on the Health and Social sector Background Continued As such, cuts to the primary source(s) of funding to rural health programs/services increase the negative impact of the social determinants of health and are devastating to the health of the rural residents, and the communities within which they live and work.

IMPLAN IMPLAN Software Software Maria Lucas

Collaboration with Area Health Education Centers and Rural Health Networks to determine the exact amount of state funding cuts made to each of these entities between the 2016-2017 and the 2017-2018 New York State fiscal year. Methods Methods Results were segregated by State legislative districts and analyzed using the IMPLAN system to generate understanding of the wide spread impact of funding loss at all levels.

Focus Areas Focus Areas District 45 District 51 Clinton Essex Franklin St. Lawrence Washington Cayuga Chenango Delaware Herkimer Ostego Schoharie

The North American Industry Classification System (NAICS) is the standard used by Federal statistical agencies in classifying business establishments for the purpose of collecting, analyzing, and publishing statistical data related to the U.S. business economy. The NAICS codes used to for our example were: 624190 (RHN) Other Individual and Family Services 611699 (AHEC) All Other Miscellaneous Schools and Instruction NAICS

IMPLAN Sectors IMPLAN sectors are a way to describe an Industry Based on NAICS codes and spending patters derived from the BEA (Bureau of Economic Analysis) expenditure patterns AHEC 474 Gasoline stores, building material and garden equipment, US Postal service, public transit, food and beverage, pallets, electronic connectors, etc RHN 485 Gasoline stores, libraries and archives, Coal, Flour, peanut butter, milk, concrete pipes, tires, preserved wood products, adhesives, etc

Direct Effects Funding cuts Indirect Effects Business to business activity Induced effects Home maintenance and rent, gas, groceries, healthcare, clothing, etc.. Employment Full or part time Labor Income Employee wage and benefits Value Added Output minus input or GDP Output Total combined Definitions

INDIRECT DIRECT INDUCED

District 51 Combined Impact Type Employment Labor Income ($) Value Added ($) Output ($) Direct Effect Indirect Effect Induced Effect -4.45 -164,893 -164,893 -237,545 -0.22 -6388 -12,944 -26,087 -0.67 -23,599 -49,380 -84,555 Total Effect -5.34 -194,880 -227,217 -348,187 Multipliers 1.20 1.18 1.38 1.47

District 45 Combined Impact Type Employment Labor Income ($) Value Added ($) Output ($) Direct Effect -4.74 -169877 -169877 -254,962 Indirect Effect -0.28 -8,385 -15,114 -32,327 Induced Effect -0.76 -27,759 -54,663 -94,461 Total Effect -5.78 -206,022 -239,654 -381,751 Multipliers 1.22 1.21 1.41 1.50

District 51 Employment Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -4.45 -0.22 -0.67 -5.34 1.20 District 45 Employment Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -4.74 -0.28 -0.76 -5.78 1.22

District 51 Labor Income Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -164,893 -6,388 -23,599 -194,880 1.18 District 45 Labor Income Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -169,877 -8,385.52 -27,759 -206,022 1.21

District 51 Value Added Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -164,893 -12,944 -49,380 -227,217 1.38 District 45 Value Added Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -169,877 -15,114 -54,663 -239,654 1.41

District 51 Output Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -237,545 -26,087 -84,555 -348,187 1.47 District 45 Output Direct Effect Indirect Effect Induced Effect Total Effect Multipliers -254,962 -32,327 -94,461 -381,751 1.50

Top 10 Sectors Impacted by total output Top 10 Sectors Impacted by total output reduction reduction District 51 Owner-occupied dwellings Real estate Hospitals Monetary authorities and depos... Insurance carriers Wholesale trade Restaurants Wired telecommunications Office of Physicians Retail District 45 Owner occupied dwellings Real estates Hospitals Monetary authorities and depos Wholesale trade Restaurants Other local government enterprises Office of physicians Retail Financial institutions

When we lose funding everyone is impacted in the community Preliminary Preliminary Results Results Detrimental impact on rural communities from funding loss is just a piece of the healthcare sector as a whole The numbers used today are part of a small discrete cohort of these big cuts. Utilizing IMPLAN to reflect ALL of the cuts would only amplify these results.

More precision in data per senate district Expert use of IMPLAN software and analysis on a larger scale Stakeholder involvement result dissemination Passing the torch it is up to you to carry this on. Detailed numbers and analysis can make a dramatic real time case for detrimental impact on rural infrastructure with funding loss to health and social sector What Next?

Q&A Q&A

Dr. Casey Harrison, CNM 11224 Beauclaire Blvd. Fredericksburg, VA 22408 caseyharrison222@gmail.com Contact Contact Information Information