WASHINGTON As Congress sifts through a growing number of requests for targeted relief from automatic spending cuts in coming weeks, advocates seeking funding shifts likely will need to tell a compelling story with potential life-or-death consequences.
Requests without such a strong selling point may find it impossible to gain enough bipartisan support as lawmakers vow not to repeat a swift and controversial action last week to save airline travelers from flight delays caused by automatic "sequestration" spending cuts.
Congress was worried about a toxic public backlash when it moved quickly to allow the Federal Aviation Administration to use some airport improvement funds to pay salaries of air traffic controllers, ending furloughs that had delayed thousands of flights across the country.
When members of Congress return from a recess on Monday, there will be no shortage of other requests to shift funds from other budget accounts awaiting them.
The National Park Service faces closures and cutbacks that will cost jobs in communities that depend on the parks as the summer travel season begins. Some 70,000 children may be shut out of the Head Start preschool program for low-income families while funding for Meals on Wheels, cancer research and some treatments for Medicare patients will be cut.
The Pentagon is expected to ask for more authority to move up to $7.5 billion within its budget to cover costs for training and military operations in Afghanistan. With troops still in harm's way, that request likely will face few objections.
More needs will pile up As the across-the-board spending cuts - $85 billion through September 30 - take hold. But most will fall on deaf ears as lawmakers insist that a comprehensive budget deal is needed to resolve sequester cuts, not individual fixes.
"With the possible exception of life-threatening issues, there will be plenty of pleas from people who represent worthy causes that get ignored," said Greg Valliere, chief political strategist at Potomac Research, an investment consulting firm.
"It's extremely unlikely that House Republicans will be willing to grant exceptions for national parks, Meals on Wheels or teachers," he said.
The sequester cuts that took effect March 1 were conceived in 2011 as a way to force the White House and Congress to find an alternative budget deal rather than have spending cuts kick in automatically. Policymakers failed to reach such an agreement and now must deal with the fallout from the cuts, which total will total $1.2 trillion over 10 years unless replaced.
Last month's flight delays created a mix of pressure from the airline industry and constituents facing a universally loathed problem that both parties could rally around.
Senate Majority Leader Harry Reid, however, is not inclined to pursue additional one-off measures to deal with sequester, a Democratic leadership aide said. Reid would prefer to press forward with his proposal to simply delay the cuts through September 30 in order to buy more time for a broader budget deal.
"I just don't see another one-off bill that's going to rise to the same level as flight delays," a senior House Republican aide said.
Many House Republicans also are concerned about giving the Obama administration more authority to move money between budget accounts at federal agencies, which circumvents Congress' constitutional powers to direct spending.
In the case of the Department of Health and Human Services, the Republican aide said there is concern that such budget shifts could inadvertently give the agency power to help fund implementation of Obama's healthcare reform law, which many Republicans deeply despise and want to repeal.
SAY NO TO CANCER PATIENTS?
But funding cutbacks for some Medicare cancer treatments and cancer research studies also could be difficult for many lawmakers to resist.
The most concerted effort in this area is a Republican House bill that would exempt Medicare reimbursements on expensive cancer drugs administered at doctors' offices and clinics - one of the few portions of the healthcare program for the elderly that is subject to the sequester. The Centers for Medicare and Medicaid Services (CMS) would have to shift cuts in these reimbursement rates elsewhere under the measure.
The bill's author, Representative Renee Ellmers of North Carolina, a Tea Party favorite, argues that because of the sequester, oncology clinics have been sending patients to hospitals to get their drugs.
But hospital treatment costs, which are not subject to sequester, are far higher - an average increase of $6,500 per patient per year, according to one study. Ellmers argues that this circumvents the whole point of sequester spending cuts.
"We don't want to see treatments delayed, and some patients on fixed incomes might skip treatment altogether if they are forced to go across town to a hospital," said Ellmers, who spent two decades as a surgical nurse before winning a seat in Congress in 2010.
The measure has substantial bipartisan support, with 51 cosponsors including 11 Democrats. Separately, 124 House members from both parties signed a letter to the CMS director asking that "any available flexibility be used to direct the cuts away from patients."
A spokesman for House Speaker John Boehner declined to comment on the bill's prospects for passage, referring questions about it to the House Energy and Commerce Committee.
THREAT TO CANCER TRIALS
Cancer research doctors also say further sequester funding cutbacks could ultimately cost lives.
Dr. Scott Lippman, director of the University of California-San Diego Moores Cancer Center, said the sequester will mean fewer clinical trials for promising therapies, and some patients ultimately will be turned away from these trials. Research on new treatments also could be slowed.
"This going to harm patients," Lippman said. "This is going to prevent patients from getting treatments that could save their lives."
At a time when advancements in cancer research are moving very quickly with new gene-based discoveries, he said now is "not the time to be slamming on the brakes."
While no trials have been canceled yet due to sequester alone, research centers are working hard to try to cut everything else that they can, said Dr. Edward Partridge, director of the University of Alabama-Birmingham's Comprehensive Cancer Center. But the choices will be difficult.
"We will do everything we can to maintain our current clinical trial volume," he said. "Even if it's at the expense of new discovery. I hope (sequester) doesn't last too long so that we have to withdraw the possibility of clinical trials for patients. That would be a disaster."
(Reporting By David Lawder; Editing by Fred Barbash and Bill Trott)