ACA

NATIONAL. Healthcare.done: ACA open enrollment comes to an end in 39 states (Politico Pulse)

By DAN DIAMOND (ddiamond@politico.com@ddiamond)

12/15/2017 10:00 AM EST

State, local public health officials sound alarms over House spending bill. The bill would slash the ACA's Prevention and Public Health Fund, which represents about 12 percent of the CDC's budget, by $6.35 billon over eight years.

That's sparked a furious response from the nation's largest public health groups — the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO) and the Big Cities Health Coalition — who warn that immunization programs, anti-smoking campaigns and other key public efforts will be sacrificed.

“You are just trading off one part of the health safety net for another and it will cost you more in the end by disinvesting in programs that prevent people from getting sick in the first place,” NACCHO Interim Executive Director Laura Hanen said in a statement.

Read more.

NATIONAL. Republicans Are Remarkably Good At Uniting Opposition Against Themselves (The New York Times)

By VIKAS BAJAJ and STUART A. THOMPSON SEPT. 25, 2017

Despite the likely demise of the latest Republican health care bill, it achieved one stunning feat: it united patient advocacy groups and most of the health care industry in opposition to it.

Four Republican senators have declared their opposition to the bill, one more than is needed to defeat it. Some of them were no doubt swayed by the size and diversity of groups that quickly stood up to oppose the legislation. Hospitals joined ranks with insurance companies, while insurers banded together with patient groups like the AARP. The legislation sponsored by senators Lindsay Graham, Bill Cassidy, Dean Heller and Ron Johnson was so objectionable that these disparate groups found common cause in opposing the bill.

Below, we list those we’ve been able to identify as for and against the bill. Conservative religious and anti-abortion groups favored the bill because it prevented people on Medicaid from using their insurance at Planned Parenthood clinics and prevented health care plans sold on the federal health care marketplace from covering abortion beyond existing limitations. This list is not complete, and we invite organizations that would like to be listed to contact us here.

ORGANIZATIONS

4SUPPORT

Christian Coalition of America

Family Research Council

National Right to Life

Susan B. Anthony List

Have we missed any? Let us know

110OPPOSE

Asthma and Allergy Foundation of America

AARP

Adult Congenital Heart Association

ALS Association

Alzheimer's Association

Alzheimer's Impact Movement

Academy of Nurtition and Dietetics

America's Essential Hospitals

America’s Health Insurance Plans

American Academy of Family Physicians

American Academy of Pediatrics

American Cancer Society Cancer Action Network

American College of Emergency Physicians

American Psychological Association

American College of Physicians

American College of Preventive Medicine

American College of Rheumatology

American Congress of Obstetricians and Gynecologists

American College of Surgeons

American Diabetes Association

American Foundation for the Blind

American Health Care Association

American Heart Association

American Hospital Association

American Liver Foundation

American Lung Association

American Medical Association

American Nurses Association

American Occupational Therapy Association

Academy on Violence and Abuse

American Osteopathic Association

American Psychiatric Association

American Public Health Association

American Society for Addiction Medicine

American Society for Radiation Oncology

American Society of Clinical Oncology

American Speech-Language-Hearing Association

Amputee Coalition

Arthritis Foundation

Association for Community Affiliated Plans

Association of American Medical Colleges

Association of Oncology Social Work

Association of Public Health Associations

Association of University Centers on Disabilities

Autism Society

Autism Speaks

Autistic Self Advocacy Network

Big Cities Health Coalition

Read more.

NATIONAL. Here’s a list of medical groups opposing the Cassidy-Graham health-care bill (The Washington Post)

By Christopher Ingraham September 22

The Senate is having yet another go at repealing Obamacare, this time via legislation known as the Cassidy-Graham proposal. The bill was on life support Friday after Sen. John McCain signaled he would oppose the bill, lengthening the already long odds for its passage.

Among other things, the bill would remove protections for preexisting conditions, make deep cuts to Medicaid and end the Affordable Care Act's tax credits and cost-sharing subsidies.

The net result, according to a Brookings Institution analysis released Friday? Thirty-two million more people uninsured by 2027, relative to the current baseline...

This list is almost certainly incomplete, given the huge universe of advocacy groups focusing their efforts on conditions that sometimes affect only small numbers of people. But it gives a sense of the breadth and depth of the medical community's opposition to Republicans' latest attempt to repeal Obamacare.

Read more.

NATIONAL. Doctors, public health workers, patient advocates — even insurers — oppose latest ACA repeal (Science Blogs)

By Kim Krisberg

Senate Republicans are again trying to ram through an Affordable Care Act replacement that threatens the health and well-being of millions of Americans. It’s shameful. But don’t take my word for it. Let’s look at what people who actually work in health care are saying about the Graham-Cassidy-Heller-Johnson bill.

In this interview, Sen. Bill Cassidy insists that his bill would protect people with pre-existing conditions. Blue Cross Blue Shield Association disagrees. (Cassidy also says in that same interview that his bill would work through the Children’s Health Insurance Program (CHIP), which he said has been reauthorized. That’s totally false — CHIP has not been reauthorized and its funding expires Sept. 30.) But back to pre-existing conditions — here’s what Blue Cross Blue Shield had to say:

Although we support providing states with greater flexibility in shaping health care options for their residents, we share the significant concerns of many health care organizations about the proposed Graham-Cassidy bill. The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions. The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans...

And let’s not forget public health. The ACA’s Prevention and Public Health Fund (PPHF) has become an absolutely critical source of funding for the nation’s public health agencies. Cassidy’s bill would eliminate that fund. Here’s what the Big Cities Health Coalition, a forum for the country’s largest metropolitan health departments, had to say about the fund’s potential elimination:

Among the programs at risk at the CDC are the 317 Immunization Program, Epidemiology and Laboratory Capacity Grants, the Childhood Lead Poisoning Prevention Program, and a host of chronic disease programs. The PPHF provides vital resources to governmental public health at all levels, and its elimination will further erode our fragile health system.

Eliminating public health programs that are now funded by the ACA would seriously undermine the ability of cities and counties to protect and promote health. The loss of hundreds of millions of dollars would hamper efforts to respond to food borne illness outbreaks, prevent emerging infectious diseases like Ebola and Zika, and respond to natural disasters like Hurricanes Irma and Harvey.

And in a letter to senators from the American Public Health Association, Executive Director Georges Benjamin writes:

The Graham-Cassidy plan would also eliminate the Prevention and Public Health Fund, the first and only mandatory funding stream specifically dedicated to public health and prevention activities. The fund has already provided more than $6 billion to support a variety of public health activities in every state including tracking and preventing infectious diseases like the Ebola and Zika viruses, community and clinical prevention programs, preventing childhood lead poisoning and expanding access to childhood immunizations. Eliminating the fund would devastate the budget of the Centers for Disease Control and Prevention. The fund currently makes up 12 percent of CDC’s budget and eliminating this funding stream would force Congress to replace the funding through the regular appropriations process where resources for nondefense discretionary programs are already too low.

Graham-Cassidy-Heller-Johnson is a threat to America’s health. If you’d like to voice your opinion, the American Public Health Association has an easy-to-use template to help you reach your representatives in Congress. For more information on the ACA replacement, NPR has a fantastic explainer.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

Read more.

NATIONAL. NYC health commissioner Mary Bassett and Chicago health commissioner Julie Morita (Pulse Check)

The nation heard from President Donald Trump on Wednesday, who again urged Republicans to repeal the ACA. Congress continues to loudly battle over the law, and governors have spoken out too.

But one voice that’s been largely ignored: Local health leaders. And on this episode of PULSE CHECK, two big city health commissioners — New York City commissioner Mary Bassett and Chicago commissioner Julie Morita — join POLITICO’s Dan Diamond to explain how Republicans’ plan would hit their cities, why they prioritize "health" over "health care" and how they're addressing persistent social inequality. They also walk through what it’s like to be a city health commissioner — a role that both describe as their dream job.

Listen here.

SEATTLE. Four ways we are measuring Affordable Care Act proposals (Public Health Insider)

By Patty Hayes, Director, Public Health—Seattle & King County

This post originally appeared in Public Health Insider

As various proposals to replace the Affordable Care Act continue to circulate, here is the yardstick Public Health—Seattle & King County will use to measure any proposals and the potential impacts.

Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal. Read more. 

NATIONAL. More than the ACA: We Can’t Stop Fighting Now. (Huffington Post)

By Dr. Oxiris Barbot, First Deputy Commissioner, NYC Health Department

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Not one of us should have the delusion that an insurance card will be a game changer when it comes to addressing longstanding and dire health inequities. If we truly want to ensure America’s health, activists, physicians and medical organizations can’t just mobilize for preservation of the Affordable Care Act. We must respond with equal vigor to immigration reform, housing quality and segregation, civil rights and other policies that could shape the nation for generations. When 80 percent of health is determined by the context of our lives, confining advocacy to access to medical care is reckless and irresponsible.

In a brave new world, here’s how we move forward:

#1 Collect Data for Action

Medicine and health rely on facts. There can be no alternatives. The need to collect robust data and shape the narrative of health has never been more urgent. By quantifying the human toll of defunding Planned Parenthood, reducing SNAP benefits through the Farm Bill and block-granting Medicaid, we proactively treat more patients than a doctor could during a shift in the ER, or an entire career. Read more. 

CHICAGO. Chicago health commissioner: The ACA saves lives and we shouldn't abandon it (The Hill)

Op-ed by Julie Morita, Commissioner, Chicago Department of Public Health

For many people, the signature accomplishment of the Affordable Care Act (ACA) is the 20 million additional Americans that gained access to health insurance.

But what is less recognized is the ACA's transformation of the entire health system. These changes included a sharper focus on preventive care, a departure from the fee for service payment models that incentivize procedures, and the adoption of payment to quality, not quantity, of care.

While we are hopeful that much of this remains in place regardless of what the future of ACA looks like, one key lever must be retained to continue the progress made toward prevention of many serious and costly diseases: the Prevention and Public Health Fund (PPHF).

This fund directs federal dollars to state and local public health agencies to conduct vital prevention initiatives ranging from preventing lead poisoning in homes, to detecting and controlling infectious disease outbreaks before they can spread.

These funds have played a critical role in combating a little recognized public health threat known as Human Papillomavirus (HPV) here in Chicago. Guided by the Centers for Disease Control and Prevention (CDC), our nation’s leading public health agency, recommendation that young girls and boys receive the first dose of the life-saving, cancer-preventing HPV vaccine at age eleven, Chicago has taken steps to protect our children from HPV-induced cancers. And we could not have done it without the PPHF funding that we received in 2013. Read more. 

BALTIMORE. Six reasons to fight the ACA replacement plan (Baltimore Sun)

By Dr. Leana Wen

For months, I have received questions from concerned residents about how repeal of the Affordable Care Act (ACA) would impact their health. My patients were worried about whether they could still get medications to treat their heart disease and diabetes, whether they would they lose coverage for mental health and addiction services, and whether they would continue to get basic preventive services such as mammogram, pap smears and blood pressure screenings.

This week, House Republicans issued their proposed replacement. There are six particularly concerning provisions with drastic consequences to Baltimore's health:

First, the bill punishes those with lower wages by eliminating subsidies to help pay for insurance coverage based on a person's income. As a physician who has practiced medicine before and after the ACA, I have seen patients forced to make the impossible choice between basic needs, including food and housing, and critical medications. I have seen patients forgo paying for insurance coverage because it is too expensive. I have seen the consequences when people are forced to pay for this "choice" with their lives.

The policy also drives more people to use emergency departments as a source of primary care. As an emergency physician, I am proud to deliver excellent care when people need it — but this is an inappropriate safety. Studies have shown that patients without health insurance put off their medical needs until they become so severe that they can no longer be pushed aside. At that point, when patients are very ill, their care becomes unnecessarily expensive.

Second, the bill places a cap on Medicaid spending, which limits the amount states can pay per person. This leads to inevitable cuts in coverage and will hurt those who are the most vulnerable — including seniors, women, children, people with low incomes and individuals with disabilities. These are already populations who face a disproportionate share of health disparities, which will worsen if the Medicaid safety net is weakened. Read more.

NATIONAL. Threats to CDC Prevention Fund Draw Scrutiny (The American Journal of Managed Care)

By Mary Caffrey

Most of the early attention to the House Republicans’ American Health Care Act (AHCA) has focused on its potential effects on the individual market. But experts are now pointing to a cut of $931 million to the CDC’s Prevention and Public Health Fund, which may not be well-known to the average consumer but, in the words of one House member, is “more important to the average American than … the Defense Department.”

US Representative Tom Cole, R-Oklahoma, offered that assessment to STAT while noting that the typical citizen was more likely to be exposed to a pandemic than a terrorist attack. Cole oversees CDC’s budget, and when interviewed this week was not yet sure what to do about the proposed cut contained within AHCA.

Some of his fellow Republicans call the prevention dollars, which are 12% of CDC’s budget, a “slush fund” that has been misspent on things like Zumba classes. They propose a new fund that offers flexibility to the states.

Chrissie Juliano of the Big Cities Health Coalition, writing in Health Affairswarns the CDC cut scheduled to be axed from core health programs, that cover everything from tracking diseases, providing immunizations, and preventing lead poisoning.

The CDC Prevention Fund, Juliano and others note, was one of several pieces of the Affordable Care Act designed to take the nation’s health system out of the reactive posture and toward a model of care that caught problems before they got out of hand. The CDC cuts affect the nation’s ability to battle the most common chronic conditions—heart disease, diabetes, stroke, and asthma. They set back scientists’ efforts to fight the Zika virus or to help the children in Flint, Michigan.

As Juliano writes, funds in prevention are dollars well spent, with returns on investment of $17 to $221, yielding savings of $181 million to $269 million. She wrote, “Even without considering the human cost, this investment makes good fiscal sense.”  Read more 

MINNEAPOLIS. Repeal of ACA would imperil a little-known part with a huge impact (Minneapolis Star Tribune)

By GRETCHEN MUSICANT
February 17, 2017

The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.

But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.

This part of the law, which benefits every American, helps to keep all healthy and safe; it will essentially be undone with the repeal of the ACA. If there is no comparable replacement, communities across the nation are poised to lose $3 billion in federal funds over the next five years through a mechanism called the Prevention and Public Health Fund, which is currently a component of the ACA.

The Prevention and Public Health Fund was designed as an important, complementary component to the promise of insurance coverage for most Americans. It was meant to help us prevent disease instead of just treating it when it strikes, and to address many of the other factors that make us ill and cause our health care costs to keep rising.

Researchers have found that our ZIP code is actually a greater predictor of our health than our genetic code. Strategies supported by the fund are aimed at addressing our nation’s sky-high rate of chronic disease, in particular diabetes, obesity, cancer, asthma, and heart disease. These health problems now touch almost every family in every community.

The resources that flow from the ACA are now being used to backfill funding cuts to support core public health programs by funding a large portion of the Centers for Disease Control and Prevention (CDC), the part of the federal government that works 24/7 to protect America from health, safety and security threats. It is responsible for ensuring access to vaccines to protect against flu and other diseases; supporting local and state first responders in mitigating the effects of outbreaks like Zika or Ebola; and preparing for and responding to natural disasters like hurricanes and earthquakes. The CDC works to protect every American, every single day. Without the funding provided by the Affordable Care Act, its reach will be dramatically reduced.

Read more.

NATIONAL. Trump’s Obamacare repeal could devastate public health and CDC funding (McClatchy)

BY TONY PUGH

Health care advocates fear a repeal of the Affordable Care Act could blow a $3 billion hole in state and local public health funding over the next five years and cost the Centers for Disease Control and Prevention nearly $1 billion a year, or about 12 percent of its annual budget.

That’s the potential forecast if the ACA’s Prevention and Public Health Fund is shuttered by repeal legislation that doesn’t replace the funding stream, according to the Trust for America’s Health.

Supporters are bracing for the worst...

“It was an influx of money to support these programs that had not really been supported in a significant way,” said Chrissie Juliano, director of the Big Cities Health Coalition, which represents health departments in the nation’s 28 largest cities.

But as budget tightening forced cuts in federal and state support for basic public health programs like child vaccinations, testing for lead poisoning and disease tracking, “dollars were taken from the prevention fund to support this work that is really core to public health,” Juliano said.

Now the fund helps pay for infectious-disease control and immunization programs, efforts to cut health-care-acquired infections and other varied initiatives.


Read more.

 

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.”

Read more.

CHICAGO. Vaccination funding may be cut if Obamacare ends, public health experts warn (Chicago Tribune)

Many worry that up to 1 million Illinois consumers could lose their health insurance if Obamacare is repealed.

But Chicago Department of Public Health leaders aren't just worried about that part of the Affordable Care Act being repealed. They're also concerned about the possible loss of funds used to vaccinate Chicagoans and deal with disease outbreaks.

The Prevention and Public Health Fund created under the health care law has distributed about $12.8 million to the city's Department of Public Health since 2012 for programs to vaccinate thousands of Chicagoans and educate consumers on diseases, among other things.

Statewide, Illinois health departments and organizations got $18.6 million last year, according to the Association of State and Territorial Health Officials.

"It really allowed public health systems throughout this nation to be stronger," said Dr. Julie Morita, Chicago public health commissioner. "It's a critical piece of the Affordable Care Act that really needs to be sustained."

"It would be a huge problem, ranging city-by-city and community-by-community," said Chrissie Juliano, director of the Big Cities Health Coalition, which includes as members officials from 28 city health departments across the U.S. "In a field that does not get a lot of money and has seen continual cuts, losing these dollars really makes it hard for them to do their jobs, which is keeping communities healthy and safe."

Read more.