There’s nothing ‘better’ about Better Care Act

Senate Republican leaders on Thursday released the “Better Care Reconciliation Act of 2017,” legislation that would undermine the benefits of the Affordable Care Act. While we won’t know the exact numbers until the Congressional Budget Office analyzes the bill, we do know there will be many disturbing consequences. These include a phase-out of the Medicare expansion beginning in 2021 with millions expected to lose their health insurance coverage. The bill also caps federal Medicaid funding that will ultimately result in shifting responsibility to the states and counties — leaving governors, state legislatures and local governments facing tight budgets with limited choices other than reducing coverage for millions of seniors, low-income families, people with disabilities and children. The bill addresses the opioid epidemic by providing some modest additional funding, but at the same time limitations on Medicaid access would potentially deny substance abuse treatment for 1.3 million people who need it.

The Better Care Act would also allow states to opt out of ACA protections that require insurers cover 10 essential health benefits including maternity care, prescription drugs and mental health and substance use-disorder services. With recent legislative history as a guide, I think we can all agree that Texas is likely to be one of these states cutting benefits. What won’t be cut is costs, as lack of insurance forces people to use emergency departments as their health care provider, the most expensive and least effective way to provide medical care for chronic, nonacute conditions. While the bill limits health care coverage for low and middleincome families, it does provide tax cuts to the wealthy.

However, there is another equally disturbing aspect of the Better Care Act of which people may not be aware. Starting next year, it would repeal the Prevention and Public Health Fund meant to expand and sustain national investment in public health programs. The Prevention Fund represents one-eighth of the U.S. Centers for Disease Control and Prevention’s total budget; this is on top of the cuts proposed in President Donald Trump’s budget. The Prevention Fund is absolutely necessary to improve the health of Texans and to slow the rise of health care costs.

Texas faces significant health and fiscal challenges that could be mitigated by a better and more reliably funded public health system. The Prevention Fund is a vital part of the effort to create such a system. Since 2010, the Prevention Fund has provided Texas with more than $150 million ($29 million in 2016 alone) to support a variety of public health activities. Repealing the Prevention Fund would result in a major loss of funding for core public health programs in Texas.

The resources that the Prevention Fund sends to Texas are crucial for improving the health of Texans. It supports programs to reduce tobacco use including the 1-800QUIT NOW telephone line with tips on quitting from former smokers. A recent study found that the campaign led to more than 1.5 million smokers attempting to quit and prevented more than 17,000 premature deaths. It is worth noting here that tobacco use is the No. 1 cause of preventable deaths. The Prevention Fund also provides funds to help Texans prevent diabetes and obesity as well as heart disease through programs promoting healthy nutrition and physical exercise. Texas receives money to immunize children and low-income adults.

Still not convinced? The Texas Department of State Health Services received almost $1 million to upgrade the laboratories that detect outbreaks of disease and food-borne illnesses and bioterrorism events.

Another program the Prevention Fund supports in Texas is the Preventive Health and Health Services Block Grant (over $6 million to Texas in 2016 alone). These funds give Texas flexibility to respond rapidly to emerging health issues (think Zika) and to fill funding gaps that are leading causes of death and disability in Texas.

While personal responsibility for health is certainly part of the equation, the Prevention Fund is intended to ensure a coordinated, comprehensive, sustainable and accountable approach to improving our country’s health outcomes through the most effective, evidence-based programs. It empowers states and communities to address their most pressing health needs. Loss of the Prevention Fund would make it harder for public health professionals to help protect Texans’ health and to respond to public health emergencies.

We are better than this. The inappropriately named “Better Care Act” is a bad bill. Public support for its predecessor, the American Health Care Act, was extremely low, with a Quinnipiac University poll finding only 20 percent of Americans approved of it and vastly preferred the current Obamacare/Affordable Care Act. There is no state — including Texas — in which a majority of its residents approved of the bill. We all — businesses, schools, nonprofits, hospitals and insurers as well as individuals — need to come together to oppose the Better Care Act and support the Prevention Fund and the health of all in our state. Call our Senators John Cornyn and Ted Cruz before next Tuesday, when a vote on this bill is expected. Ask them why they support a bill that pushes people off insurance plans, may not cover essential health benefits for those who do have insurance and will cost Texans more in taxes. Tell them a bipartisan approach to tweaking the ACA is a better option than this mean, drastic bill. Lastly, remind them we can repeal and replace in the next senatorial election.