ACA repeal, Trump budget threaten expanded spending on public health

The House’s ACA repeal bill finally passed last week. It potentially will have a significant impact on public health if the Senate’s version runs along the same lines.

That’s because the Obama-era Affordable Care Act had a big impact on the Centers for Disease Control and communities, even if it was overshadowed by the ongoing national debates about coverage and the role of government in providing health care.

Tucked into the GOP’s American Health Care Act is a provision to repeal the Public Health and Prevention Fund that was part of the 2010 health law. The fund has been a frequent target of the GOP, which characterizes it as a public health slush fund. This CDC chart shows how the money has been spent, which includes expansion of immunization programs, disease outbreak monitoring, tracking antibiotic resistance, helping hospitals reduce infection risk, and community-based health and prevention programs. (A recent Trust for America’s Health report has more detail on public health investment – and the lack thereof – as well as some state-by-state breakdowns.)

The proposed AHCA would cut 12 percent of the CDC budget, or $931 million for 2017. The House bill won’t pass the Senate in its current form – but it is too soon to know what public health funding will survive. As of now, the Public Health Fund will still exist.

However, President Trump in his budget proposal spelled out further deep cuts to public health. The House and Senate so far have not embraced them. The $1 trillion spending bill for the rest of fiscal 2017 includes funding for the Prevention and Public Health Fund and a small $22 million bump in CDC funding.

But public health officials and advocates are deeply worried.

“This is about protecting Americans, so this is about saving lives,” CDC Acting Director Anne Schuchat told Lena Sun of the Washington Post after a briefing on the threat of drug-resistant superbugs that took place shortly after the bill was made public. Sun wrote a good wrap-up of the cuts at the time.

“An outbreak can happen anywhere,” Schuchat noted. “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 prevention fund last year allocated $324 million to the CDC’s immunization program. “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,” Sun wrote. “Money from the prevention fund accounted for about 40 percent of the CDC’s total immunization program funding last year.”

It is not at all clear how states would keep up immunization levels and surveillance if these funds were to disappear.

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