The emergency management community appears to be hopeful regarding the president-elect’s plans and priorities for domestic preparedness.  

On the campaign trail throughout most of 2008, President-elect Obama hinted at the largest expansion of government programs since the New Deal. But a catastrophic financial crisis and unprecedented mounting national debt seem to be casting doubt on the viability of some government programs. In the face of an economy in crisis and pressing unattended issues such as a crumbling national infrastructure, could funding for critical programs such as emergency preparedness be in peril?

With less than a week till the first U.S. presidential transition since Sept. 11, current events have many wondering what the future holds for homeland security, as well as the incoming administration’s priorities for funding emergency preparedness programs in 2009 and beyond.

The challenges ahead

Current challenges specific to emergency preparedness could have an impact on the new administration’s avowed plans to bolster domestic security and improve health care for all Americans.

One key unresolved issue the new president will inherit is the current debate raging in Congress over the limited surge capacity of our hospitals, that is, their inability to absorb huge amounts of casualties, as well as the need to better integrate them into emergency response and preparedness planning. While there seems to be growing consensus to establish emergency-ready public health and healthcare entities across the nation working with the Department of Health and Human Services, National Institutes of Health, and Centers for Disease Control and Prevention, many lawmakers remain divided on how to achieve that.

As recently as last May, U.S. Rep. Henry Waxman held hearings on the lack of hospital emergency surge capacity, the adverse financial impact from Medicaid regulations and the ability of hospitals to respond to a mass-casualty event such as a terrorist attack. In those hearings, Waxman hinted about linking future Medicaid funding to a hospital’s surge planning. Hearings held a year earlier had revealed that emergency rooms across the nation were already operating at or over capacity, imperiling their ability to respond to a public health disaster.

In his closing statement during the 2008 hearings, Waxman noted what he observed to be “a complete breakdown in communications between the Department of Homeland Security and the Department of Health and Human Services” when it came to identifying regulatory barriers to public health and medical preparedness.

Another challenge will be increased scrutiny of federal agencies such as the Transportation Security Administration, Customs and Border Protection, and FEMA; the effectiveness of programs like aviation and port security; and natural disaster preparedness and their levels of funding.

There's also the issue of border security, which has become highly politicized in recent years. Some Democrats have criticized the DHS Secure Border Initiative and its inability to secure our southern border. One observer noted that the search for a balance between traditional physical security measures like the 700-mile fence and increased border patrol manpower, new technology and tactical infrastructure will be a critical part of the debate going forward.

Obama's priorities

Still, on paper at least, Obama has ambitious plans to bolster homeland security during his first term. Priorities the president-elect has outlined in his transition team report on homeland security include:

• Aggressive counterterrorism measures, including biosecurity and preventing nuclear terrorism, which lead among the highest concerns in the Justice Department. In fact, that agency’s Inspector General, Glenn A. Fine, has rated counterterrorism the most major challenge that department has faced since 2001.

• Protecting America’s information networks and bolstering federal leadership on cyber security. This includes appointing a national chief technology officer, providing greater technical assistance to local and state first responders and dramatically increasing funding for reliable, interoperable communications systems. One key issue will be the need for DHS and the FCC to work better together with first responders to implement a system that works.

• Protecting Americans from terrorist attacks and natural disasters. Obama is calling for more effective emergency response plans, as well as improved coordination among government agencies, creating better evacuation plan guidelines, ensuring prompt federal assistance to emergency zones, and increasing medical surge capacity. His plan also calls for increasing federal resources and logistic support to first responders and local emergency planning efforts.

• Securing and protecting the national homeland security infrastructure, including heightened security at chemical plants, power plants, public transportation networks, airports and ports. Obama’s plan also calls for creation of a “National Infrastructure Reinvestment Bank” that would provide $60 billion over 10 years to expand and enhance existing federal transportation investments.

Funding forecast

If the most recent approved federal appropriations bill for DHS is any indication, funding for critical emergency preparedness programs appears bright, at least in the short term. In fact, the department is one of the few federal agencies that has benefited from ongoing budget increases over the past few years.

On Nov. 6, 2008, two days after the general election, DHS announced that for fiscal year 2009, it will award more than $3 billion in grants to states, urban areas and transportation authorities under 14 programs to bolster national preparedness capabilities and protect critical infrastructure, an increase of $24 million from the previous year.

The biggest pieces of that funding go to the Homeland Security Grant Program (more than $1.7 billion) and various infrastructure protection programs (more than $845 million). New in 2009 will be what the department has called “targeted allocations” under the State Homeland Security Program and Urban Areas Security Initiative, which enhances regional preparedness by strengthening capabilities in 62 high-threat, high-density urban areas across the country.

Other programs for which funding has been secured include the Metropolitan Medical Response System Program, the State Homeland Security Program-Tribal, Nonprofit Security Grant Program, Operation Stonegarden (a program for states to enhance law enforcement and border security operations), the Freight Rail Security Grant Program, Intercity Passenger Rail (Amtrak), Port Security Grant Program, Buffer Zone Protection Program, Intercity Bus Security Grant Program, Trucking Security Program, Emergency Management Performance Grants, the Interoperable Emergency Communications Grant Program and the Regional Catastrophic Preparedness Grant Program, as well as dedicated funds for law enforcement terrorism prevention activities.

That said, Obama's national security team has indicated that the president-elect may reprioritize programs within existing budget levels. In his transition team report on homeland security, Obama has stated that he favors risk-based fund allocations. In sum, Obama would "allocate our precious homeland security dollars according to risk, not as pork-barrel spending or a form of general revenue sharing," and "eliminate waste, fraud and abuse that cost the nation billions of Department of Homeland Security dollars."

In a Nov. 6 article in Newsday, Homeland Security Secretary Michael Chertoff said the grant process "will spill over to the next presidential administration," but vowed to "make the transition as smooth as possible while also protecting against the vulnerability that comes with change."

So far, so good

While it's too early to predict exactly what the new federal administration’s role and commitment will be for healthcare emergency preparedness, many industry observers are at least cautiously optimistic.

According to the Nov. 11, 2008, issue of CQ Homeland Security, published by the well-respected Congressional Quarterly, emergency managers, former FEMA officials and academics agree that President-elect Obama's “priorities seem to be in order.” One former FEMA official cautioned, however, that "the devil's going to be in the details."