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Senate GOP bill would gut critical public health funding this fall

Knema Rezaei Bazazidad, a pediatrician at the Austin Regional Clinic in Texas, examines Evolet Garcia before updating her immunizations. (Courtesy of Austin Regional Clinic and Leindani Creative)

This post has been updated. 

The health-care bill that Senate Republicans released Thursday would eliminate critical funds for core public health programs that make up about 12 percent of the budget for the Centers for Disease Control and Prevention. The money supports programs to prevent bioterrorism and disease outbreaks, as well as to provide immunizations and screenings for cancer and heart disease.

The Senate bill would end funding starting in fiscal 2018, which begins in October. That’s more quickly than the House GOP legislation, which would gut funding for the Prevention and Public Health Fund starting in October 2018.

As a provision of the Affordable Care Act, also known as Obamacare, the Prevention and Public Health Fund provides the CDC almost $1 billion annually. Since the ACA's passage in 2010, it has been an increasingly important source of money for fundamental CDC programs.

About $625 million goes directly to states and communities to address their most pressing health needs, including drug misuse, infectious diseases, lead poisoning, obesity, diabetes, hypertension, cancer and tobacco use.

The CDC’s former director, Tom Frieden, has 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.”

In a statement Thursday, the advocacy organization Trust for America’s Health said the Senate Republicans' bill “is no better than what the House proposed and in no way improves upon the Affordable Care Act.”

Public-health advocacy groups and state and local public health officials have been warning the Trump administration and Congress of what they describe as disastrous consequences if the fund is eliminated without a corresponding budget increase to compensate for the loss.

“This move will leave states and territories unable to adequately address public health and health care needs and undermine efforts to prevent disease and promote health in every state and territory nationwide,” said Michael Fraser, executive director of the Association of State and Territorial Health Officials.

States would lose a preventive health services block grant that they rely on to respond to their own health priorities and needs. These include preventing diabetes, heart disease and stroke, providing emergency medical services, collecting vital statistics and health data, and monitoring and preventing health-care associated infections and infectious disease outbreaks.

“The outright elimination of some programs will have catastrophic consequences,” said Carolyn Mullen, chief of government affairs for ASTHO.

The timing of the Senate bill’s cut would be particularly disastrous, too, advocates say. Given the separate fight looming over the fiscal 2018 budget, Congress will likely have to rely on stopgap funding to keep the government operating, and that will mean no opportunity to backfill monies lost in the prevention fund, assuming the GOP bill is enacted.

John Auerbach, president and chief executive of Trust for America's Health, called the Senate bill “irredeemable.” Given other bill provisions that would phase out Medicaid expansion and allow states to jettison essential health benefits, insurers no longer would be required to cover effective preventive services, he said.

Among the personnel and efforts that get money from the prevention fund are front-line workers in laboratory and epidemiology programs who must respond to new disease threats such as Zika, as well as health departments across the country that help them detect, respond to and control outbreaks.

The CDC’s own immunization program received $324 million from the fund last year, dollars that were sent directly to states and local communities to improve immunization registries and infrastructure. Money from the prevention fund accounted for about 40 percent of the CDC’s total immunization program budget last year.

That support has been especially crucial given the increase in recent years of vaccine-preventable diseases outbreaks such as measles, mumps, and whooping cough. An ongoing measles outbreak in Minnesota has already exceeded the total number of measles cases reported in the entire United States last year.

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

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