Budget ax hangs over public health programs

WASHINGTON — Tucked into the bill that House Republicans are pushing to replace the 2010 Affordable Care Act is a provision that would eliminate nearly $115 million to Ohio public health programs over the next five years.

The Prevention and Public Health Fund was created to pump money into the federal Centers for Disease Control and Prevention — and, by extension, state and local public health departments — during passage of Obamacare. It’s been used for

everything from immunizations to smoking cessation to helping states deal with the opioid epidemic. It accounts for about 12 percent of the CDC’s budget.

And now it’s at risk of elimination — a fact that alarms public health officials in Ohio. Under a bill that passed two House committees last week, the fund would be eliminated beginning in October of next year.

“We are concerned,” said Jose Rodriguez, a spokesman for Columbus Public Health. He said about a third of the department’s funding comes from federal dollars.

He said the state already lags behind others in funding. “One of the reasons we have challenges with health outcomes is because we don’t invest the same amount other states do,” he said. “Anytime you get a cut, it could have an impact.”

Adding to those fears are worries that President

Donald Trump’s upcoming budget will further pare public health funds. Trump’s budget, which will be released Thursday, will include cuts to discretionary programs but additional federal dollars for defense programs.

Taken together, the reductions could prove disastrous for public health programs, which aim not only to prevent disease but to respond to outbreaks, such as the recent Zika virus and the Ebola virus.

There is about $1 billion in the Prevention and Public Health Fund each year, with $625 million of that spread among the 50 states and the District of Columbia. It’s been criticized by some conservatives as a “slush fund” that has been used for items such as helping a county in California ban new fast-food restaurants or building community gardens and jungle gyms.

But a CDC chart on the distribution of the dollars reflects more-meaty public health issues: The fund paid out $72 million in fiscal 2017

in grants for diabetes prevention; $14.7 million for Alzheimer’s disease prevention, education and outreach; $324 million to increase access to immunization; and $17 million for lead-poisoning prevention.

Rich Hamburg, executive vice president and chief operating officer for the Trust for America’s Health, said the sweeping nature of the cuts likely will mean other resources get shifted, meaning even programs not under the umbrella of the prevention fund will get hit.

“This is not a good thing, any way you look at it,” he said.

Rodriguez said that while it’s hard to separate that fund from other federal dollars, any cuts will hurt.

According to a 2015 report by the Trust for America’s Health, Ohio ranked 42nd in state investment in public health in fiscal years 2013 and 2014, paying $14.59 per capita while the national average was $31.06.

The cuts, said Rodriguez, “trickle down.”

And the public health needs are vast. Columbus lost about 150 babies to infant mortality and 300 to opiates in 2016, he said. When funding is cut, health needs spike.

“Any time you eliminate prevention or lower dollars in prevention, you have a higher incidence of disease,” he said.

Amy Bush Stevens, vice president of prevention and public health policy at the Health Policy Institute of Ohio, said prevention “is an area where we struggle.” The state ranks 46th in the institute’s latest “Health Value Dashboard,” which ranks states on a combination of public health and health spending metrics. Among the state’s biggest problems, the report found, was its high smoking rate.

The state performs poorly on public health and prevention overall, ranking 50th out of the states and District of Columbia. Still, Ohio spends more on health care than 30 other states.

WASHINGTON — Donald Trump’s aides are contacting Republican leaders in all 50 states, seeking help to fight a barrage of attacks on the congressional health care proposal from members of both parties as the president’s first major legislative initiative appears in peril.

The White House’ Office of Political Affairs and the Republican National Committee are arming state parties — as well as key groups and individuals in states — with talking points and suggesting surrogates to appear on TV to pressure opponents of the legislation, people familiar with the plans said.

The goal is to send the message that Democrats broke the health care system with the Affordable Care Act, and to garner positive news coverage in state and local media for the replacement, which has sparked opposition not just from Democrats but also from a variety of Republicans.