ACA repeal threatens states’ public health funds

Groups plead with Congress not to drain preventive care cash

The funding for many state public health and prevention programs is in jeopardy along with insurance for 20 million people as Congress moves to repeal the Affordable Care Act.

Though the ACA requires insurers to cover mammograms, colonoscopies and other preventive care, a less prominent provision authorized a federal fund to prevent the soaring incidence of chronic diseases, including diabetes and heart disease. It funds education targeting college suicides, smoking and low-income new mothers. The ACA’s Prevention and Public Health Fund has survived about 60 votes in Congress, and it was tapped to help pay for the recently enacted 21st Century Cures Act, which funds pharmaceutical research and development and opioid treatment.

Supporters worry an ACA repeal could eliminate the fund when it is needed to reduce the $3.2 trillion spent to treat illness and disease with medical services and drugs. Friday, the House passed legislation that would allow Republicans to repeal all or parts of the law without support from Democrats. House Speaker Paul Ryan said the law would be replaced in a “thoughtful, stepby-step process.”

Advocates said programs cov- ered by the fund are most needed to prevent and treat increasingly costly diseases. Diabetes affects nearly 10% of the population, or about 29 million people, according to the Centers for Disease Control and Prevention. Of those, more than 8 million people are undiagnosed. The prices for some brands of insulin have increased by as much as 60%.

More than 300 public health and patient groups, including the American Heart Association, signed a letter to congressional leaders last week that warned of the “dire consequences” of repealing the fund without including the nearly $1 billion in other appropriations. “Funding prevention not only saves lives but it saves money,” the letter said, citing research by Trust for Ameri- ca’s Health that shows every public health dollar leads to a savings of $5.60.

In Louisiana, $9 million from the prevention fund pays for programs including home visits for low-income new mothers that reduce costly premature births, lead testing for children under age 5 and education and surveillance for tuberculosis and sexually transmitted diseases, said physician Rebekah Gee, the state’s secretary of Health.

As public health funding has been cut in recent years, Southern states have seen increases in syphilis, Gee said.

Hughes Melton, chief deputy commissioner of Virginia’s Department of Health, said “it would be a major setback” for Virginia to lose its federal funding. As state funding for public health has decreased, Virginia has relied more on the prevention fund, he said.

“One of the reasons for the fund was to make up for years of chronic underfunding of public health,” said Richard Hamburg, deputy director of the non-profit Trust for America’s Health.

Community programs such as those supported by the fund tend to be favored by conservatives who say decisions about health care should be made farther from Washington. But the prevention fund has been criticized for acting as a “slush fund” for public health, economist Robert Graboyes said. “Emotionally, I tend to like decisions made at state and local level, but states have been as problematic as the federal government,” said Graboyes, senior research fellow at the freemarket Mercatus Center at George Mason University.

Graboyes said, “There’s a big difference between saying, ‘Public health funding is important’ and saying, ‘This fund is a great idea.’ ” He said it is too much to expect public health to “undo some of the damage” done by overly prescriptive laws, including the ACA.

“One of the reasons for the fund was to make up for years of chronic underfunding of public health.” Richard Hamburg, Trust for America’s Health