Centers for Disease Control and Prevention

NATIONAL. ACA Repeal Would Mean Massive Cuts To Public Health, Leaving Cities And States At Risk

Chrissie Juliano

This blog originally appeared in Health Affairs on March 7, 2017

When the Affordable Care Act (ACA) was passed a little over six years ago, it brought with it the promise of health insurance for all Americans. It also sought to begin to shift the paradigm for health care in this country, emphasizing value over volume, and recognizing the importance of prevention coupled with appropriate access to care.

By now, it is well known that repealing the ACA could leave nearly 20 million Americans uninsured and simultaneously result in millions of job losses across the country. An associated cost that has been less discussed, but no less relevant, is what repeal could mean for the nation’s already-fragile governmental public health system. As the director of the Big Cities Health Coalition (BCHC), a membership organization of 28 governmental public health departments in the largest, most urban areas of the country, I cannot underscore the importance of these funds enough.

Without a comparable replacement, or appropriation of additional funds, at least $3 billion will be cut from state and local public health departments alone over the next five years through funds allocated by the U.S. Centers for Disease Control and Prevention (CDC). An additional $2 billion in federal resources would be lost to a number of other prevention-oriented activities across the entire public health enterprise. This $5 billion is essential to core public health programs that keep Americans healthy and safe every day and makes up 12 percent of CDC’s annual budget, supporting disease tracking, access to immunizations for those most in need, and preventing and addressing lead poisoning, among other priorities.

The Prevention and Public Health Fund was designed to provide additional dollars to support the programs that prevent disease in communities across the country, including addressing many of the leading causes of death. These are the same conditions that drive our rising health care costs, including cancer, heart disease and stroke, diabetes, and asthma. These conditions are so prevalent that they now touch almost every family in every community across the country.

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NATIONAL. GOP Health Care Plan Would Eliminate an Important Disease Prevention Fund (Route 50)

By Quinn Libson,
Staff Correspondent

MARCH 8, 2017

State and local public health departments alone stand to lose as much as $3 billion over the next five years.

WASHINGTON — Amid discussions surrounding the new health care proposal introduced by U.S. House Republicans this week, a lot of attention has been paid to the future of Medicaid, the Planned Parenthood funding freeze, and the implications of eliminating the individual mandate. But there’s one subtler—and no less crucial—change that will impact the entire fabric of the American public health system that state and local governments shouldn’t overlook.

As part of their proposal, House Republicans intend to eliminate the Prevention and Public Health Fund, the largest individual federal funding source set aside for disease prevention, by 2019.

This isn’t the first time the fund—which was established by the Affordable Care Act in 2010—has come under attack from the GOP. In 2012, House Republicans proposed a plan that would maintain a low interest rate for Stafford student loans by cutting funds from the PPHF. And, earlier that same year Congress dipped into the fund to use $5 billion to pay for a payroll tax extension. In fact, since its creation, the PPHF’s original allocation has already been cut by 50 percent.   

Setting aside the vast implications of the fact that the fund accounts for 12 percent of the U.S. Centers for Disease Control and Prevention’s entire budget, the loss of that money would be felt in communities across the country.

According to Chrissie Juliano, the director of the Big Cities Health Coalition, which is part of the National Association of County and City Health Officials, without an alternative funding source, state and local public health departments alone stand to lose as much as $3 billion over the next five years. And, an additional $2 billion could be lost to the entire public health system in that same time period.

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