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'Sequester' cuts to hit healthcare hard

Expected Medicare payment cuts have hospitals and doctors worried. Public health and medical research programs may suffer a disproportionately - The  effect on areas of the health system already hobbled by years of retrenchment or underfunding, including public health and medical research.

Although the Medicare program will account for the largest chunk of dollars cut from healthcare simply because of its great size, the scheduled 2% reduction in its payments to doctors and hospitals is significantly smaller than what many public health and research programs face.

Laboratories at major universities and medical centers are already laying off scientists, even before the latest round of cuts is scheduled to take effect. And local public health officials, hit by years of cutbacks, are scaling back immunization campaigns and other efforts to track and control infectious diseases.

"They are doing cuts on top of cuts on top of cuts," said Eric Hoffman, director of the Center for Genetic Medicine Research at Children's National Medical Center in Washington. Hoffman's labs have had to delay several major projects, including new research into muscular dystrophy in children.

Also threatened are new initiatives sparked by public health crises such as mass shootings — which have generated calls for strengthening the nation's mental health system — and outbreaks of food-borne illness.

Compounding the challenges is a lack of direction from Washington. Obama administration health officials have provided little guidance about how they plan to implement many of the cutbacks and when precisely they will hit.