We’re focusing a lot on the 22 million people who could lose their health insurance if the Affordable Care Act is repealed. And for good reason: Many Americans’ lives and finances could be on the line depending on the fate of the act.
But there’s another, quieter health tragedy that could play out if the ACA is gutted: States could lose critical money they use to respond to outbreaks, vaccinate children, and fight smoking and obesity. It would be a disaster for public health — and it’s going almost unnoticed.
When the ACA was enacted in 2010, the law established the Prevention and Public Health Fund, the first time Congress guaranteed annual funding to improve America’s public health infrastructure. At $14.5 billion over 10 years, it’s also the biggest single fund dedicated to disease prevention in the federal budget.
The goal of the fund was simple: to boost public health funding, much of it for the Centers for Disease Control and Prevention (CDC), to help prevent people from getting sick from cancer, diabetes, lead poisoning, heart disease, Alzheimer’s, and infections. Because Americans would be gaining insurance under the ACA, finding ways to keep people healthy and away from the health care system carried extra appeal for lawmakers.
But over the years, the fund has been subject to a slew of cuts. It’s been a prime target for Republicans, who generally regard public health as paternalistic and have called the program a “slush fund for jungle gyms.”
If the ACA is repealed, or a reconciliation vote eliminates the prevention fund, the money could be gone immediately.
Here’s what’s at stake in those funding cuts, courtesy of John Auerbach, the president and CEO of the public health nonprofit the Trust for America’s Health:
1) 50 percent of the funding for a large federal vaccines program. The Section 317 vaccines program has been called “the backbone of our nation’s immunization infrastructure.” It ensures doctors get the vaccination doses they need, helps people who can’t afford vaccines gain access, and mobilizes responses to outbreaks like measles, among other things. It’s poised to get sliced in half, which is frightening at a time when vaccination rates are already down in some states.
2) 80 percent of the funding to control heart disease, the No.1 cause of death in America. Funding for evidence-based education and health programs about reducing the risk of heart disease will disappear.
3) 100 percent of money that goes to helping hospitals reduce health-care-associated infections. Patients who go to hospitals and clinics to be treated too often end up picking up nasty or deadly bugs. That’s why the CDC has made a major push in recent years to work with hospitals to reduce these risks. Because 100 percent of the money for this program comes from the fund, the program to reduce health-care-associated infections will also die with the fund.
4) 12 percent of the CDC’s budget. Over the years, items in CDC’s core budget have been shifted over and paid for by the fund, so with the fund’s disappearance will also go $890 million (or about 12 percent) of the CDC’s annual budget. Within the next five years, states will lose more than $3 billion, according to a recent analysis by the Trust for America’s Health.
“A simple 50 votes could have a significant deleterious impact on public health in the country, and that’s a major concern,” Auerbach said. And public health funding has already been decreasing: Today there are 50,000 fewer public health jobs at the federal, state, and local levels compared with 2008.
At a time when life expectancy in the US has declined for the first time in decades, we could use strong public health efforts more than ever. Instead, we may be moving in the opposite direction.
Cancer survivors are hitting the airwaves to fight repeal
The Save My Care movement — which is organized against ACA repeal — is bringing its campaign to the airwaves. Today, the movement released new testimonial television ads featuring cancer survivors — including one who happens to be a Trump voter. The idea: These people got coverage under the ACA, and their lives are on the line if Republicans repeal the law.
Today’s top three health policy reads
“Cancer can bankrupt its victims. Obamacare was designed to stop that”: “The Affordable Care Act provided some much-needed inoculation from this financial stress and hardship [that comes with a cancer diagnosis]. Many provisions in the 1,300-page law seemed to be designed for cancer patients like Edwards. ... But many of these provisions are now on the chopping block under Republican health reform plans.” —Julia Belluz, Vox
“Boehner: Republicans won't repeal and replace Obamacare”: “Former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not going to happen. ... He said changes to former President Barack Obama’s signature legislative achievement would likely be relatively modest. “[Congressional Republicans are] going to fix Obamacare — I shouldn’t call it repeal-and-replace, because it’s not going to happen,” he said.” —Darius Tahir, Politico
“Hill GOP asks governors to help save Obamacare repeal”: “Congressional Republicans struggling over how to repeal Obamacare are stuck on a key problem: what to do with the millions of people in 31 states covered under the dramatic expansion of Medicaid the law enabled. So they have privately turned to a handful of governors to help resolve the issue.” —Manu Raju, CNN
Correction: The headline on this article clarifies the cuts to vaccine funding are for one federal program.