The Jair Bolsonaro government (PL) sent the Budget proposal for 2023 with a forecast of a 42% cut in the discretionary funds of the Ministry of Health, used in the purchase of materials, equipment and for investments.
To meet the minimum expenditure guaranteed by the Constitution, the Executive will depend on the so-called rapporteur’s amendments, an instrument used as a bargaining chip in negotiations with Congress.
In 2023, Health will be entitled to R$ 20.3 billion for non-compulsory expenses, according to the proposal released by the Ministry of Economy this Wednesday (31). At first glance, the amount seems higher than the initial R$ 17 billion indicated in the submission of the 2022 Budget project.
However, of the amount planned for next year, R$ 10.42 billion is in a reserve of amendments by the rapporteur, which are usually indicated by parliamentarians allied with the government and the presidents of the Chamber, Arthur Lira (PP-AL), and of the Senate, Rodrigo Pacheco (PSD-MG).
Even if they are intended for Health, these amendments will not necessarily include structural projects of the folder. In general, the rapporteur’s amendments are used by congressmen to irrigate actions in their electoral strongholds.
In addition, there is no legal rule that prevents parliamentarians from redirecting funds to spending in other areas.
The amount to be effectively controlled by the Ministry of Health in 2023 is estimated at BRL 9.84 billion – a drop of 42.2% compared to the BRL 17 billion initially programmed for 2022.
In a note, the ministry said that the government’s proposal “strictly observes the guarantee of regular funding for public health actions and services” and that it “will closely monitor” the Budget discussions in Congress in search of increased resources.
Other ministries have also seen significant cuts in their discretionary spending and will depend on rapporteur amendments to keep their operations going.
The biggest scissor fell on Regional Development spending, which has a forecast of R$ 2.2 billion for funding and investments — a drop of 48.2% compared to what was initially programmed for 2022, partially offset by R$ 1.5 billion. billion in rapporteur amendments. The second biggest reduction was precisely in Health. The details were released this Thursday (1st).
The Ministry of Economy’s justification is that the distribution of the rapporteur’s amendments among the bodies seeks to promote greater alignment between the indication of these resources and the public policies played by the Executive.
The strategy follows on from Congress’ decision to stamp the LDO (Budget Guidelines Law), a step prior to the formulation of the Budget, a larger volume for parliamentary amendments. The total to be nominated by deputies and senators reached R$ 38.8 billion.
Including the rapporteur’s amendments, the health expenditure that counts towards compliance with the minimum is estimated at R$ 149.9 billion for next year, exactly the same value as the floor for the area. Although the figure is BRL 15 billion higher than expected for 2022, the minimum was also higher.
A study carried out by Cosems-SP (Council of Municipal Health Secretaries of the State of São Paulo) points out that the Health budget has become increasingly hostage to parliamentary amendments — not only from the rapporteur, but also from the bench, and individuals.
In reaction to the increasing dominance of Congress over funds in the area, the Ministry of Health has been expanding, in the Bolsonaro government, the list of actions that can receive funds from amendments. The strategy ends up being a way to expand the range of programs capable of absorbing these resources, compensating for the cuts.
According to the study, the number of qualified areas increased from 4, in 2019 and 2020, to 8 in 2021, reaching 13 in 2022. Thus, the deputy or senator can choose to allocate the money to different fronts, from the fight against arboviruses , such as dengue and zika, to investments in animal health.
The technical advisor of Cosems-SP, Mariana Alves Melo, says that the change makes it difficult to plan the SUS (Unified Health System), since each congressman has the autonomy to choose how the money should be applied.
“There is a constitutional provision for this type of destination, the problem is the enlargement of the rapporteur’s amendments in the context of freezing resources because of the spending ceiling and reduced transparency”, he says.
She also points out that parliamentary costing amendments cannot be used for personnel expenses, one of the biggest challenges faced by city halls.
A survey carried out by the Brazilian Health Economics Association points out that the share of amendments in the Federal Budget for Public Health Actions and Services increased from R$ 2.9 billion in 2014 to R$ 16.9 billion in 2022.
The study by Cosems-SP states that the distortion was caused by the spending ceiling — which limits the growth of expenses to the variation of inflation —, added to the emergence of the rapporteur’s amendments and the congressional decision that forced the federal government to implement the amendments bench.
In an overview of the budget proposal, other ministries also saw significant cuts in their current expenditures and investments.
The Ministries of Mines and Energy (-35%), Communications (-30.8%), Economy (-28.3%), Tourism (-25.3%) and Science and Technology (-20, 9%).
On the other hand, there was an increase in their expected allocations to Citizenship (31.9%), Work and Social Security (25.64%), Agriculture (16.3%), in addition to regulatory agencies. Comparisons are always made with the initial 2022 Budget proposal.
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