Frontline Blog

The ACA Replacement Would Devastate America’s Health

March 2017


By Leana Wen, Leana Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

This blog originally appeared on 

As a physician who has treated patients in the emergency department before and after the Affordable Care Act was instituted, I have seen firsthand how it has transformed the lives of many of my patients. And as the health commissioner for Baltimore city, I have seen how it has safeguarded the lives of more than 40,000 residents in my city, and millions more around the country, who would otherwise be uninsured.

But there is more to the repeal of the ACA and its replacement with the American Health Care Act than the potential loss of health insurance by tens of millions of Americans. The act also includes a sustained mechanism to safeguard a healthier, more secure, and financially stable future for America: the Prevention and Public Health Fund.

Created in 2010, this is the first federal funding source dedicated to public health. It directly empowers communities to prevent chronic conditions and helps local jurisdictions be more agile in responding to health crises while reducing long-term health costs.

More specifically, these funds are used to prevent heart disease, cancer, diabetes, and other chronic conditions that are major causes of death in the United States. The fund also provides support for cities to prevent disease outbreaks, ensuring that our nation is prepared to face developing threats such as bioterrorism and Ebola and other infectious diseases.

Through the ACA, the Prevention and Public Health Fund accounts for nearly one-seventh of the budget for the Centers for Disease Control and Prevention — approximately $1 billion a year.

But the American Health Care Act, the proposed “repeal and replacement” plan, would eliminate the fund, putting the health, well-being, and security of Americans at immediate risk. When it comes to protecting our citizens, this so-called strategy is unscientific, irresponsible, and inhumane.

There are three key areas that, if cut, would result in especially drastic consequences to our nation’s health.

Outbreak preparedness and infectious disease prevention

With the recent emergence of diseases such as Ebola and Zika, local public health agencies have needed to put into place effective, agile strategies to address threats to public welfare. Local health departments were immediately on the front line of addressing the threat of Zika well before Congress answered the call for additional resources, which took 220 days.

The Prevention and Public Health Fund currently provides nearly half of the funding for the Epidemiology and Laboratory Capacity program. It supports the efforts of state and local health departments to track outbreaks for conditions like meningitis and foodborne illness. It also helps develop rapid responses to evolving threats such as Ebola and the West Nile virus.

The fund also supports more than 40 percent of the CDC’s immunization program, which protects Americans from contagious illnesses, including outbreaks of measles and the flu. As part of this funding, my state of Maryland received nearly $1 million to build a vaccine safety net for uninsured people to keep them and their communities healthier.

Without these resources, the local capacity to provide emergency services to residents during times of extreme need will be decimated, putting all Americans at risk.

Chronic disease prevention

The US spends more than three of every four health care dollars on treating chronic diseases such as heart disease, cancer, and lung disease, the top three causes of death in the US.

In 2017, the Prevention and Public Health Fund will invest nearly $1 billion in programs across the country to support evidence-based prevention programs. During the last fiscal year, it provided Maryland with $3.5 million to fight obesity, smoking, and high blood pressure, risk factors that contribute to the leading causes of death.

These resources reduce the short-term burden on the American health care system, limit the long-term personal and societal costs associated with these chronic conditions and, most important, save lives.

The responsibility of providing these crucial services — and absorbing any potential cuts — would fall to the limited budgets of state and local health departments.

Childhood lead poisoning prevention

As shown by the ongoing tragedy in Flint, Mich., lead poisoning remains an important health issue for communities across the country.

Using Prevention and Public Health Fund resources, the CDC has given millions of dollars to support childhood lead poisoning prevention in nearly 30 states, including $17 million in fiscal year 2016. Such public health funds have enabled the city of Baltimore to reduce the number of children with elevated blood levels by 98 percent between 2002 and 2015. While we celebrate this immense progress, we acknowledge that our work is not done: Any level of lead in any of our children is unacceptable. Without these funds to monitor blood-lead levels or eliminate sources of lead, countless children will continue to suffer from this devastating and ultimately preventable disease.

Those of us on the front line of health must remain vigilant in responding to both long-term challenges and emerging health threats.

The proposed replacement for the ACA will roll back gains for millions of Americans and worsen the health of our nation. In addition to punishing many of our society’s most vulnerable individuals, its elimination of the Prevention and Public Health Fund without offering any replacement would endanger national security and raise long-term costs to the detriment of taxpayers and insurers.

Approving the AHCA and losing the Prevention and Public Health Fund would put into jeopardy the safety of our country and that of generations to come.

Leana Wen, MD, is the commissioner of health in Baltimore city.