The Washington PostDemocracy Dies in Darkness

Obamacare repeal guts crucial public health funds

A laboratory technician at the Minnesota Department of Health packages cerebrospinal fluid of three confirmed meningitis cases detected in the state to send to the Centers for Disease Control and Prevention for testing during the 2012 fungal meningitis outbreak linked to tainted steroid injections from a Massachusetts pharmacy. (Hannah Foslien/AP)

The latest Republican health-care bill to repeal the Affordable Care Act would eliminate funds for fundamental public health programs, including for the prevention of bioterrorism and  disease outbreaks, as well as money to provide immunizations and heart-disease screenings.

As part of the ACA, or Obamacare, the Prevention and Public Health Fund provides almost $1 billion annually to the Centers for Disease Control and Prevention. Since 2010, the fund has been an increasingly important source of money for core CDC programs, today accounting for about 12 percent of the CDC’s total budget.

The GOP bill would eliminate the Prevention and Public Health Fund starting in October of next year. No clear replacement has been proposed.

“This is about protecting Americans, so this is about saving lives,” Anne Schuchat, acting CDC director, said in an interview Tuesday, referring to the proposed elimination of the fund. She and other public health experts held a briefing at the Capitol on Tuesday on the growing threat of drug-resistant superbugs.

“An outbreak can happen anywhere,” she said. “It’s not a red- or blue-state kind of thing. And we want to sustain the defense of Americans’ health from these new emerging threats.”

The CDC’s former director, Tom Frieden, said that if the prevention funding is lost, “Americans will be at greater risk from vaccine-preventable disease, food-borne infections, and deadly infections contracted in hospitals.”

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Most of the prevention and public health funds are sent to state and local health departments, with more than $625 million distributed among the 50 states and the District of Columbia last year. Public-health-advocacy groups and state and local public health officials are warning the Trump administration and Congress of what they describe as the disastrous consequences of eliminating the fund without a corresponding budget increase to compensate for the loss.

State and local public health officials plan to meet with members of Congress and administration officials this week to make the case for continued investments in public health and prevention. Cuts in those funds, combined with potential federal budget cuts at the CDC and other health agencies, “could amount to a catastrophic year for public health funding,” according to a statement from the Association of State and Territorial Health Officials, which represents U.S. public health agencies.

More than 500 public health organizations, children’s advocacy groups, universities and local health departments sent a letter to President Trump last week warning of the consequences of eliminating the prevention fund. Advocates and public health officials are hopeful that the money will be replaced, but there have been few indications that that is forthcoming.

“We haven’t heard that expressed by the leadership either in the House or Senate,” said John Auerbach, president and chief executive of the Trust for America’s Health, a public-health-advocacy organization that led the letter-writing effort.

Most of the attention of the ACA repeal has been on health insurance coverage, he said.

But if the CDC loses close to $1 billion in prevention funding, “we will see the loss of very important services that Americans in every city and town across the country have come to rely upon,” Auerbach said.

Among the personnel and programs that receive money from the prevention fund are the front-line workers in laboratory and epidemiology programs who must respond to “a new scary germ,” and health departments across the country that help them detect, respond to and control health-care associated infections, Schuchat said.

One of the biggest recipients of the prevention fund is the CDC’s immunization program, which last year received $324 million. The money is sent directly to states and local communities to improve immunization infrastructure, such as registries that allow providers to know which patients have received what vaccines. Money from the prevention fund accounted for about 40 percent of the CDC’s total immunization program funding last year.

Losing this funding would “cripple CDC’s ability to detect, prevent and respond to vaccine-preventable respiratory and related infectious diseases threats, including pandemic influenza,” according an agency summary on the impact of the prevention fund.

The prevention fund also supports a CDC-led surveillance program to monitor children at highest risk for exposure. For situations such as the recent lead-in-water crisis in Flint, Mich., “it’s the tool that allows you to identify when there’s a cluster of lead cases,” Auerbach said.

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