Yesterday, House Republicans released their plan for replacing Obamacare, giving Americans a sense, at long last, of how their health care might change under the Trump administration.
The American Health Care Act makes a number of changes to the Affordable Care Act that’ll likely disadvantage poorer and sicker Americans, and result in fewer people covered. But the plan also includes a subtler and very significant move for American health: the elimination of the largest fund for disease prevention in the federal budget, along with 12 percent of the budget for the Centers for Disease Control and Prevention, by 2019.
The ACA established the Prevention and Public Health Fund, which provides $14.5 billion over 10 years. The goal of the fund was simple: Boost public-health money, much of it for the US Centers for Disease Control and Prevention (CDC), to support activities that keep people from becoming sick with preventable chronic ailments like diabetes, heart disease, and cancer and infectious diseases that can be staved off with vaccines. (At a time when more Americans would be gaining insurance, keeping people healthy and out of the health care system carried extra appeal for lawmakers.)
Over the years, the fund has become a prime target for Republicans, who generally regard public health as paternalistic and have called the program a “slush fund for jungle gyms.” Congress has subjected it to a slew of cuts. So it’s not a surprise that the American Health Care Act plans to sever the fund altogether.
But, according to John Auerbach, president and CEO of the public health nonprofit the Trust for America’s Health, “Losing the fund will result in a significant increase in preventable illnesses and injuries.” Here are the details on a few of the key programs the bills would affect:
1) The 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 to them, and mobilizes responses to outbreaks like measles, among other things. It would lose half its funding, which is frightening at a time when vaccination rates are already down in some states.
2) Programs to prevent heart disease, the number one cause of death in America. Eighty percent of the funding for evidence-based education and health programs about reducing the risk of heart disease would disappear.
3) Programs to reduce the risk of health care-associated infections at hospitals. 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 would die with the fund.
4) More than a tenth of the CDC’s budget. Over the years, several items in the CDC’s core budget have been shifted over to the fund. With the fund’s disappearance, $890 million (or about 12 percent) of the CDC’s annual budget would be lost. Within the next five years, states will lose more than $3 billion, according to a recent analysis by the Trust for America’s Health.
So in addition to the potential fallout for individuals’ health care with changes to Obamacare, we are likely to see public health fallout, too.
“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, chronic diseases are affecting millions of Americans, and we are facing the risk of a new pandemic, America could use a strong public health force more than ever. Instead, Republicans are hoping to weaken public health.