Prevention and Public Health Fund

NATIONAL. Local Health Officials: GOP Tax Reform Jeopardizes Our Response to Infectious Disease Outbreaks. (Route50)

By Quinn Libson

Local health officials are sounding the alarm about the ways in which the GOP tax reform plan, which was passed by the U.S. House on Tuesday, might jeopardize our country’s response to outbreaks of infectious disease—like the hepatitis A outbreaks happening at this very moment around the country.

The National Association of County and City Health Officials, which represents nearly 3,000 local governmental health departments, warned during a call on Tuesday with reporters that proposed tax cuts have the potential to result in the near elimination of the Prevention and Public Health Fund—a source of money that was created by the Affordable Care Act—due to automatic spending reductions triggered by the Statutory Pay-As-You-Go Act of 2010. Aside from making up 12 percent of the U.S. Centers for Disease Control and Prevention’s total funding, the PPHF makes local infectious disease response possible in several crucial ways.  

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.

SACRAMENTO. GOP Obamacare repeal plan could hurt fight against Zika, hepatitis, other health problems (The Sacramento Bee)

By Sammy Caiola

A multibillion dollar federal fund that helps prevent disease outbreaks and fights chronic conditions may disappear with a Republican plan to revamp the Affordable Care Act, worrying local physicians and county officials who say they rely on the money to sustain community health.

The GOP legislation, as it was released Monday, proposes cutting a piece of the Affordable Care Act called the Prevention and Public Health Fund – a store of federal money created to bolster immunization rates, disease surveillance, workforce training and community health education, among other programs. If the replacement legislation passes, county and state agencies throughout California will lose millions of dollars they relied on for public health efforts. Those governments also used the grants to prepare for emergencies such as Ebola and Zika virus outbreaks, health officials said.

The Prevention and Public Health Fund has provided more than $4 billion nationally and about $290 million to California since its launch, including $4 million directly to groups in the Sacramento area. That money goes to government agencies such as the U.S. Centers for Disease Control and Prevention and the Administration for Community Living, who then distribute it to state and local health departments as well as hospitals, universities and nonprofit groups.

In the Sacramento area, the fund has supported major public health projects including:

▪ A $98,950 UC Davis effort to prevent the spread of viral hepatitis through early identification.

▪ A $101,999 project at Sierra College in Rocklin to fight suicide among college students.

▪ A $484,389 initiative from the California Center for Public Health Advocacy in Davis to reduce chronic disease in diverse communities.

▪ A $2,661,141 effort by the California Rural Indian Health Board in Sacramento to prevent diabetes among American Indians. In 2017, the fund will award more than $900 million to programs throughout the U.S. addressing Alzheimer’s disease, immunizationbreastfeedinglead poisoningyouth suicide and more.

The Republican plan proposes discontinuing the fund starting in fiscal year 2019. The Affordable Care Act, which went into effect in 2010, not only expanded insurance coverage but also started initiatives to address a range of health issues, such as high hospital readmission rates, electronic medical record adoption and rising drug prices for Medicare enrollees. 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 

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.

Read more.

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.

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.

 

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.