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 does not replace the funding stream, according to the Trust for America’s Health.
Idaho has received more than $14.5 million through the fund since 2010. State and local public health departments have used the money for needs such as preventing diabetes, cutting tobacco use, stopping infectious-disease outbreaks and helping uninsured or underinsured women get screened for breast or cervical cancer, according to the trust.
If the fund disappears, Idaho could lose $22.4 million over the next five years, the organization says.
The Affordable Care Act also provided other public-health benefits through provisions such as those that have made insurance available to many Idahoans who previously could not afford it and that guaranteed coverage for preventive health care.
“There are numerous studies that show a direct relationship between individuals who have insurance and reduced morbidity disease and mortality, premature death,” said Russ Duke, director of the Central District Health Department in Boise. “We in local public health believe that having health insurance and having access to regular preventive and primary care improves health outcomes. ... If (the ACA is) repealed and not replaced with something similar, that for sure would be detrimental to population health.”
Also, as more Idahoans have health insurance, more public-health agencies can get paid for the services they provide, he said. That extra revenue has helped CDHD broaden its services — more oral-health care for children, longer clinic hours — that would have to be scaled back if the funding evaporates.
Supporters of the law’s public-health funding are bracing for the worst.
“In meetings that we’ve had with folks on Capitol Hill, the sense that we have gotten is that repeal of the Affordable Care Act will not continue the Prevention and Public Health Fund,” said Peter Kyriacopoulos, senior director of public policy at the Association of Public Health Laboratories.
Through grants from the CDC, the fund provides about $40 million a year to help state health labs add staff and buy testing equipment and computer systems, Kyriacopoulos said.
“It’s going to be hard on us and our member laboratories if we lose $40 million, but it’s going to be impossible on CDC if they lose (nearly) $1 billion,” he said.
The CDC gets more than $891 million from the fund each year.
The law created the prevention fund to support community-based disease-prevention programs that operate outside traditional health care settings. A study by the Trust for America’s Health found that every $10 per person per year invested in such programs could save the nation more than $16 billion a year within five years — a return of $5.60 for every $1.
“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.
An expanding mission — along with the fund’s generous financing and limited congressional oversight — have kept the fund on the GOP hit list since the health law was enacted in 2010. Congressional Republicans who have long wanted to cut or eliminate the fund aren’t likely to pass on the opportunity afforded by the ACA repeal effort.
Sen. Mike Enzi, R-Wyo., a member of the Senate Health, Education, Labor and Pensions Committee, which will draft possible ACA repeal legislation, once called it a “slush fund ... to build sidewalks, jungle gyms and swing sets.”
Rep. Mike Burgess, R-Texas, a member of the House Energy and Commerce Committee who will be heavily involved in the repeal-and-replace effort, was equally scornful, calling it a “slush fund” that health and human services secretaries could control with little oversight from Congress because its mandatory funding falls outside the appropriation process.
“This fund, the way it was set up, there were no controls that the legislative branch had over the secretary of HHS,” Burgess said this week. “So it was entirely skewed in whatever direction the administration wanted to go. ... If they had allowed us to direct it ... maybe we could talk about it. ... But I think it was abused so badly that I think it would be a hard sell.”
Tony Pugh: 202-383-6013, @TonyPughDC. John Gravois of the Star-Telegram in Fort Worth, Texas, and Karen Garloch of The Charlotte Observer in North Carolina contributed.