How the Prevention Fund is being spent
House Republicans want to use money earmarked for health reform’s Prevention and Public Health Fund to hold down interest rates on student loans. The White House has threatened to veto the bill. So what’s that money doing now?
Over the past two years, Health and Human Services has used $1.25 billion of Prevention Fund dollars to fund a pretty sweeping variety of health-related programs, according to data compiled by the Trust for America’s Future. Another $1 billion is set to go out the door in 2012.
The Prevention Fund’s biggest investments have been in two areas: Increasing the size of the health care workforce and implementing community-based, health care interventions.
On the workforce front, the federal government spent $198 million last year to create new residency positions for primary care doctors and ramp up training capacity for physicians. The hope, on the administration’s part, is that these kinds of investments will better ready the health care system to absorb the millions of Americans expected to gain coverage in 2014.
This investment is expected to train about 1,000 new doctors (a program I wrote about here) and 600 physician assistants. While that’s not nothing, it’s a drop in the bucket when you look at the workforce shortage that we currently face. The Association of American Medical Colleges projects we’ll be short 30,000 primary care doctors within three years, by 2015.
The other big Prevention Fund investment has been in community-level health interventions. These are programs that try to reduce obesity and tobacco use by targeting environmental factors -- things like providing safe walking paths for exercise or access to smoking cessation programs. These kind of programs are run as grants to cities and states. They began with stimulus funds and were then bolstered by the Prevention Fund to the tune of $425 million for 2011 and 2012.
I visited one of grant sites, in Philadelphia, last week. There, the grant is being used partially to address food access issues. Philadelphia built a network of 600 healthy corner stores in lower income areas that now provide healthier options alongside the typical array of chips and candy. The city has worked with its school districts to improve the nutritional quality of snacks served at after-school programs and set up farmers markets in lower-income areas of the city.
“We were committed to using this opportunity to change the way Philadelphia thought about government’s role in obesity care and prevention,” says Donald Schwarz, the city’s health commissioner. “We’ve done a lot of work around that in terms of food access.”
Government funding for these programs, Schwartz says, means there’s “a framework for thinking about how environments can promote healthy living. We’ve tried to look for what are, in some ways, likely effective practices that can be done through policy change or intervention with programs.”
Philadelphia is now engaged in a study of whether its programs are working - if it’s making city residents healthier. To that end, it’s now working with a local university to determine if the government-funded expansion of healthy corner stores has changed what individuals purchase.
There are other programs in the Prevention Fund - the full list is here - but these two stand out as its biggest investments. And when we talk about eliminating the Prevention Fund, its programs like these that are on the chopping block.