When the Affordable Care Act (ACA) was passed a little over six years ago, it brought with it the promise of health insurance for all Americans. It also sought to begin to shift the paradigm for health care in this country, emphasizing value over volume, and recognizing the importance of prevention coupled with appropriate access to care.
By now, it is well known that repealing the ACA could leave nearly 20 million Americans uninsured and simultaneously result in millions of job losses across the country. An associated cost that has been less discussed, but no less relevant, is what repeal could mean for the nation’s already-fragile governmental public health system. As the director of the Big Cities Health Coalition (BCHC), a membership organization of 28 governmental public health departments in the largest, most urban areas of the country, I cannot underscore the importance of these funds enough.
Without a comparable replacement, or appropriation of additional funds, at least $3 billion will be cut from state and local public health departments alone over the next five years through funds allocated by the U.S. Centers for Disease Control and Prevention (CDC). An additional $2 billion in federal resources would be lost to a number of other prevention-oriented activities across the entire public health enterprise. This $5 billion is essential to core public health programs that keep Americans healthy and safe every day and makes up 12 percent of CDC’s annual budget, supporting disease tracking, access to immunizations for those most in need, and preventing and addressing lead poisoning, among other priorities.
The Prevention and Public Health Fund was designed to provide additional dollars to support the programs that prevent disease in communities across the country, including addressing many of the leading causes of death. These are the same conditions that drive our rising health care costs, including cancer, heart disease and stroke, diabetes, and asthma. These conditions are so prevalent that they now touch almost every family in every community across the country.
To highlight what this means to communities, let’s consider a few examples of how repealing the ACA would lead to deep cuts in public health initiatives at the state and local level.
- According to an analysis by the Trust for America’s Health, the state of North Carolina, home to public health champion Senator Richard Burr (R-NC), would lose more than $85 million in grants from the CDC over the next five years if the fund were repealed. Approximately five million dollars each year in funding to prevent diabetes, heart disease, and stroke prevention—leading causes of death and health care costs—would be gone.
- The state of Texas, home to four BCHC member cities, would lose more than $147 million in grants from the CDC over the next five years. This loss could include $4 million a year in vaccine funding that ensures access to necessary immunizations for those most vulnerable.
- Finally, the state of California, home to five of BCHC member cities, would lose more than $300 million in grants from CDC over the next five years. More than $7 million in vaccine funding and approximately $13 million in chronic disease funding would be at stake.
At the macro level, the Prevention and Public Health Fund supports and fights a multitude of health threats that do not respect state or national borders. Immunization programs supported by the fund ensure access to vaccines that protect the most vulnerable among us from routine diseases like the flu, and recently re-occurring ones like mumps or measles. The fund also supports the ability to track outbreaks of recently emerged diseases like Zika or Ebola, but also routine foodborne illnesses, like Salmonella. Without these dollars provided by the Affordable Care Act, CDC’s ability to protect the health and safety of Americans will be dramatically reduced. And our collective ability to address the next big public health threat will put us at risk.
Eliminating the fund would directly affect everyday Americans and their families in a number of ways:
- Perhaps the most damage would be done to one of the nation’s leading vaccine programs, which would be nearly dismantled, shrinking by more than 50 percent, according to an analysis by the National Association of County and City Health Officials. According to the CDC, the 317 Immunization Program plays a critical role in achieving national immunization coverage targets and reductions in disease. Dollars from this program support vaccinations across the life course, from newborns to the elderly. Every parent knows how essential vaccines are to protecting kids and their grandparents, allowing them to take part in daily life with fewer worries of contracting vaccine-preventable diseases. From an economic point of view, immunizations continue to be one of the most cost-effective public health interventions. Over the past 20 years, childhood immunizations have prevented 322 million illnesses, 732,000 deaths, and nearly $1.4 trillion in societal costs.
- Another key capability that would suffer greatly is our scientists’ ability to identify and track disease outbreaks, as well as respond. Public health threats like Zika and foodborne illnesses like salmonella can only be addressed if experts have the resources they need to identify where the threats begin, where they will travel next, and how to stop them in their tracks. About one third of disease tracking is supported by the fund and its loss would severely hamper efforts to combat and contain these threats.
- Finally, our ability to prevent and identify lead poisoning in our children, a function largely financed by the fund, would be deeply cut. America witnessed the damaging toll that lead can take in the brains and bodies of our kids when it saw the tragedy unfold last year in Flint, Michigan. Each dollar invested in lead poisoning prevention yields in a return on investment of $17–$221 or a net savings of $181–269 billion. Even without considering the human cost, this investment makes good fiscal sense.
Protecting the Prevention and Public Health Fund is about defending the very core of our nation’s public health system, which has been chipped away year after year. Without a doubt, just as every American has the right to access care when they become sick, every community has the right to be healthy and safe and to know that their government is protecting them from the dangers of disease outbreaks and natural disasters. Every child should be able to attend school without their parents worrying that they could contract a previously eradicated, life threatening disease.
The repeal of the Affordable Care Act would create a serious threat to our nation’s health system and would wreak havoc on the 20 million Americans who have gained coverage through the ACA. But repealing the Prevention and Public Health Fund without a clear plan for replacement goes beyond cancelling coverage to eroding the foundation on which our public health system sits. It’s a cost we simply cannot afford.