NATIONAL. New administration raises worries about public health: ACA, climate change, gains under threat (The Nation's Health)

Kim Krisberg

As a new president and Congress settle into office, many advocates are doing what front-line public health workers do every day: hoping for the best while preparing for the worst.

Work under President Donald Trump and the new Congress has just begun, but advocates say that based on statements during the presidential campaign, the histories of people chosen to serve in Trump’s cabinet and backgrounds of new congressional leaders, core public health activities and priorities likely face a challenging future.

The most imminent threat to America’s health under the new administration are attacks on the Affordable Care Act and a reversal of historic gains in insurance coverage. But in addition to insurance losses, the strategy that opponents are using to repeal the ACA — a budgetary process that targets spending and revenue associated with the law — could also mean elimination of the Prevention and Public Health Fund. Created under the ACA, the vital fund provides almost $900 million annually to the Centers for Disease Control and Prevention and has become entwined with CDC’s base budget, said Emily Holubowich, MPP, executive director of the Coalition for Health Funding and an APHA member...

Beyond ACA-related issues, Hasbrouck called for “sustained funding” for planning, preparedness and surge capacity, noting that the Zika and Ebola outbreaks highlighted how “cumbersome” it can be to get resources through Congress. NACCHO is also calling on the new administration to support local public health as “chief community health strategists,” which is in line with the U.S. Department of Health and Human Services’ new Public Health 3.0 vision. APHA member Chrissie Juliano, MPP, director of the Big Cities Health Coalition, whose health agencies serve 1 in every 6 Americans, echoed many of Hasbrouck’s hopes and concerns.

Juliano said metropolitan health departments face serious health threats that require federal attention. Such agencies are on the front of the opioid abuse and overdose epidemic, which took the lives of 33,000 Americans in 2015. In December, President Barack Obama signed the 21st Century Cures Act, which provides $1 billion to help states address opioid treatment. But no money has been appropriated for prevention. Juliano said that Trump talked about opioid addiction during his campaign, so “we’re hopeful that we can work with him on that.”

Overall, Juliano, like other advocates, is bracing for shrinking public health resources.

“(Trump) has talked about a hiring freeze, but he did make an exception for public health,” Juliano told The Nation’s Health, referring to November reports that Trump would institute a hiring freeze for civilian federal jobs that do not involve public safety or public health. “So I’m hopeful that he understands the needs of this sector.”

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