If the sequester goes through on March 1, it could mean massive cuts to emergency services, mental health services, school funding, senior citizen services and more.
Locally, the various National Alliance on Mental Illness programs continue to advocate for change before March 1.
If sequestration goes into effect, more than 373,000 mentally ill adults and children could go untreated. The result could be homelessness, increased crime and increased hospitalizations.
Carol Caruso, executive director of NAMI Montgomery County, said mental health and substance abuse programs could be cut by about 5 percent. Tack that onto the 10 percent cut that occurred in the Pennsylvania budget.
"There is more slicing away at services in that area that are needed out there in the community," said Caruso. "Without them, people won't have the support and resources that they need to manage their illnesses, get their medications and get their treatment programs. It's going to be a heavy burden on our ERs and hospitals."
Caruso said the result would be more patients thrown into crises, due to a lack of clinical services and medications.
NAMI does not bill clients for services, Caruso said. Everything is provided free of charge to anyone who asks for them.
"We do fundraising to support our educational and support programs. We do get some money from the Montgomery County Mental Health Department and, of course, we rely on that money to keep our operations going," she said. "If that funding is cut, yes, it will hurt us quite a bit."
The mostly-volunteer organization does pay to train its volunteers on services.
"We would never turn anybody away," said Caruso, "but it will still be a hardship to not have the financial support for our operation."
Caruso said NAMI must train its teachers and provide all materials for courses that are given to clients free of charge, like student manuals.
"Our support groups are the same way: we train the facilitators of the support groups. They are out in communities for parts of Montgomery County every month. They bring the resources and materials out there to families and individuals that live with mental illnesses," Caruso said.
Aside from potentially throwing more clients into harsher crises, a sequester would increase the NAMI workload in resolving crises out there.
"It burdens folks who aren't able to access services they need," said Caruso. "It creates more chaos altogether."
For now, NAMI will continue to advocate through legislators.
"If the sequester goes through, it's a done deal," she said. "We can ask them to come to an agreement by Friday, but time is ticking away quickly."
NAMI has a main office in Lansdale, and it provides services in Lansdale, Norristown, Abington, Pottstown and Lafayette Hill. It has been helping those with mental health issues since 1977.
"We'll keep going no matter what," said Caruso. "We can do a better job when we have the financial resources behind us to do it."
Local emergency responders are also threatened by the sequester. There is a chance that FEMA would reduce its state and local grant funding for firefighters and local emergency management personnel.
Jonathan Detwiler, battalion chief for Volunteer Medical Service Corps of Lansdale, said the impending sequester has left many people uncertain about the future.
"The public safety world, specifically EMS, has shared some of the same concerns. This EMS community in Pennsylvania is funded heavily through donations and billing for service," Detwiler said. "Less than 1 percent of the annual operation for the VMSC of Lansdale is funded through grant monies."
Detwiler said of that 1 percent, grants come from state agencies like the Pennsylvania State Fire Commissioners Office and Emergency Medical Services Operating Fund.
"No federal money is received directly by the organization," he said. "This arrangement for operations funding is typical of many rural and suburban systems throughout the Commonwealth."
The sequester, he said, would affect fund distribution to federal programs. As such, EMS services like VMSC would not see an immediate effect.
"The long-term effects could be more detrimental," he said. "The biggest concern is Medicare reimbursements and the far reaching effects that government cutbacks could potentially have."
About half of reimbursements come from Medicare or Medicaid programs, he said.
"Any program cutbacks will eventually be passed down the lane to the end user, in our case, the EMS organizations providing service," Detwiler said. "Private medical insurance will follow suit with changes and cutbacks in reimbursements."
Medicare rules, he said, typically govern the private section policies regarding reimbursement. Ultimately, if state agencies see cutbacks in funding, grant programs offered may see cutbacks as well.
Another area where long-term effects would occur is donations. Detwiler said that as the general public feels the pain of higher tax burdens and fewer programs, the public will be less likely to provide critical donations to local organizations.
"Donations, in the form of an annual ambulance subscription drive, have seen seen drastically diminishing responses since the 2007-2008 economic crisis," he said.
North Penn School District, and other state districts, are not safe either with the potential sequestration.
Pennsylvania faces $26.4M in funding for primary and secondary schools, and 360 teacher job cuts.
In a brief statement to Montgomeryville-Lansdale Patch, district business director Robert Schoch said the district has budgeted an 8.2 percent reduction from the prior year on all federal programs, in case of a sequester.