Health care advocates fear a repeal of the Affordable Care Act could blow a $3 billion hole in state and local public health funding over the next five years and cost the Centers for Disease Control and Prevention nearly $1 billion a year, or about 12 percent of its annual budget.
Supporters are bracing for the worst, including public health officials in the central San Joaquin Valley.
“In meetings that we’ve had with folks on Capitol Hill, the sense that we have gotten is that repeal of the Affordable Care Act will not continue the Prevention and Public Health Fund,” said Peter Kyriacopoulos, senior director of public policy at the Association of Public Health Laboratories.
Through grants from the CDC, the imperiled fund provides about $40 million a year to help state health labs add staff and buy testing equipment and computer systems, Kyriacopoulos said.
“It’s going to be hard on us and our member laboratories if we lose $40 million, but it’s going to be impossible on CDC if they lose (nearly) $1 billion,” Kyriacopoulos said.
The prevention fund was created by the health law to support community-based disease prevention programs that operate outside traditional health care settings. A study by the Trust for America’s Health found that every $10 per person per year invested in such programs could save the nation more than $16 billion a year within five years – a return of $5.60 for every $1.
The CDC gets more than $891 million from the fund each year, most of which goes back to states as grants to fund programs targeting obesity, suicide, stroke, diabetes, heart disease, maternal health and even prevention of falls among the elderly.
For a community like Merced, the prevention fund is “incredibly important,” said Kathleen Grassi, health director for Merced County. “It’s an infusion of investment in prevention that really enables us to do a lot of work with our health-care provider community, as well as our community-based organizations.”
In Merced, prevention funds have been used to reduce tobacco use and secondhand smoke exposure, Grassi said. The health department worked with Merced County’s housing authority to make its public housing smoke-free before the federal government adopted a no-smoking rule, she said. And it got the city of Merced to keep any new business that sells tobacco products from locating within 1,000 feet of schools, parks or other places where children spend time, she said.
The money even funded the CDC’s “Tips from Former Smokers” ad campaign, which helped an estimated 104,000 Americans kick the smoking habit.
“It was an influx of money to support these programs that had not really been supported in a significant way,” said Chrissie Juliano, director of the Big Cities Health Coalition, which represents health departments in the nation’s 28 largest cities.
In 2015, Fresno County was awarded $2.6 million over 3 1/2 years to reduce the risk of heart disease, stroke and diabetes among some of the county’s most vulnerable populations in medically underserved communities. Some of the funds were given to United Health Centers of the San Joaquin Valley to train staff to teach diabetes prevention classes to patients at risk. The classes are taught at clinics in Parlier, Kerman and Orange Cove, said Melanie Ruvalcaba, a health educator for the Fresno County Department of Public Health.
The weekly classes for six months are given in English and Spanish and are followed by six months of monthly support group meetings. In Kerman, 20 patients collectively lost about 136 pounds, she said. The goal is for patients to lose 5 to 7 percent of their body weight, she said.
“Without this funding, it’s highly unlikely any of the clinics would have funding to train their staff,” Ruvalcaba said.
But as budget tightening forced cuts in federal and state support for basic public health programs like child vaccinations, testing for lead poisoning and disease tracking, “dollars were taken from the prevention fund to support this work that is really core to public health,” Juliano said.
Now the fund helps pay for infectious-disease control and immunization programs, efforts to cut health care-acquired infections and other varied initiatives.
In California and other states, the funds gradually have supported a significant portion of the budget for immunizations, said Catalina Bautista, a spokeswoman for the Fresno County Department of Public Health. Fresno County is to receive $479,337 in prevention funds from July 2016 through this June, she said.
“The work public health does and the impact of immunizations in the overall protection of people’s lives is incredibly significant and continues to be a high priority for Fresno County,” Bautista said.
Butthat expanding mission – along with its generous financing and limited congressional oversight – have kept the fund on the GOP hit list since the health law was enacted in 2010. Congressional Republicans who have long wanted to cut or eliminate the fund aren’t likely to pass on the opportunity afforded by the ACA repeal effort.
Sen. Mike Enzi, R-Wyo., a member of the Senate Health, Education, Labor and Pensions Committee, which will draft possible ACA repeal legislation, once called it a “slush fund … to build sidewalks, jungle gyms and swing sets.”
Rep. Mike Burgess, R-Texas, a member of the House Energy and Commerce Committee who will be heavily involved in the repeal-and-replace effort, was equally scornful, calling it a “slush fund” that health and human services secretaries could control with little oversight from Congress because its mandatory funding falls outside the appropriation process.
“This fund, the way it was set up, there were no controls that the legislative branch had over the secretary of HHS,” Burgess said this week. “So it was entirely skewed in whatever direction the administration wanted to go. … If they had allowed us to direct it … maybe we could talk about it. … But I think it was abused so badly that I think it would be a hard sell.”
The fund originally was earmarked for $15 billion over 10 years, and Republicans quickly began calling for the program’s elimination. Heeding calls to cut the federal budget deficit, President Barack Obama called in 2011 for cutting the fund by $3.5 billion over 10 years. In 2012, Obama sought a $4 billion cut.
That same year, Congress did cut it – by $5 billion over 10 years through the Middle Class Tax Relief and Job Creation Act.
More than 300 organizations have written to congressional leaders asking them to save the fund. Fourteen public health organizations have made the same appeal.
In their letter to congressional leaders, the groups said the program’s demise without replacement funding “would equate to a massive reduction in state efforts to respond to food-borne outbreaks, prevent emerging infectious diseases like Ebola and Zika, and jeopardize the health response to natural and man-made disasters.”
The fund’s Preventive Health and Health Services Block Grant provides $160 million a year to help states respond to health emergencies or funding shortfalls in other programs.
The fund supplied nearly 5,000 doses of measles vaccine to county health departments in California during the state’s 2015 outbreak. It also helped Florida’s state laboratory respond quickly to the Zika virus, Kyriacopoulos said.
“Because they had some additional staff in the laboratory through this funding, things went much better for them,” Kyriacopoulos said, adding that test results came back “quicker than they would have, had those additional boots on the ground not been there.”
In the Seattle area, money from the fund is helping health officials respond to a measles outbreak at 32 schools, said Patty Hayes, the director of public health for Seattle and King County.
In Charlotte, N.C., the money helped local health officials react quickly to the 2014 Ebola outbreak, which led to the quarantine of missionaries who had returned from Africa.
“We put quite a bit of person-power into the Ebola” epidemic, said Dr. Marcus Plescia, director of the Mecklenburg County Health Department in Charlotte. “When we’re dealing with diseases that are really high profile, that people are frightened by, it’s very important that we respond quickly so people feel safe and secure.”
North Carolina would lose $20 million a year if the fund were terminated. “It would devastate our public health budget,” said Peg O’Connell, chair of the advocacy committee for the North Carolina Public Health Association.
Texas has received more than $124 million from the fund since 2010, including more than $29 million last year. In 2015, the state got more than $4.8 million for the effort to provide a vaccine safety net for low-income adults and the uninsured.
But the fund has remained on the GOP chopping block, in part because the effectiveness of its prevention programs are difficult to quantify and it often can take years before progress is shown.
Barbara Anderson of The Fresno Bee, John Gravois of the Star-Telegram in Fort Worth, Texas, and Karen Garloch of The Charlotte Observer in North Carolina contributed to this article.