Repeal and replace vs. the public’s health
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As efforts to repeal and replace the Affordable Care Act (ACA) begin, the debate continues on what will happen to the millions of Americans who are currently receiving coverage and what it will mean for their health. But that’s only half the debate.

Few are talking about another extremely important part of the ACA, the Prevention and Public Health Fund, which provides major investments in prevention and public health programs that significantly contribute to better health outcomes and reduce healthcare costs.


The Prevention and Public Health Fund, established by the ACA, was designed as a resource for disease prevention and health promotion efforts. Its goal is to support public health programs that prevent illness and disease. Most deaths (nearly 70%) are caused by chronic diseases, such as cancer, stroke, heart disease, diabetes, and chronic lower respiratory illness, and unintentional injuries.

Modifiable behavioral risk factors, such as tobacco use, poor diet, physical inactivity, excessive alcohol consumption, and drug misuse, remain top contributors to the U.S. mortality rate. These risk factors can be mitigated with evidence-based prevention efforts at the local, state, and national levels. The ACA supports programs for all Americans that address the causes of poor health, in addition to guaranteeing access to healthcare for millions.

In the rush to repeal the ACA, many in Congress have overlooked the fact that regardless of how you pay for healthcare coverage and who should have access to it, the bottom line is that preventing disease and promoting health is the most commonsense approach to controlling healthcare costs and improving health outcomes.

Over the past six years, core state and territorial public health prevention programs have been moved into the Prevention and Public Health Fund. They are now at risk of being eliminated with repeal of the ACA, and there is no plan to replace them. While millions may lose insurance coverage in the ACA repeal, all Americans will lose with the repeal of the Prevention and Public Health Fund, which is used by every state and territorial health agency to address state and community health needs and priorities.

If Congress is truly concerned with improving health and lowering costs, now is the time to delay repealing the core investments in disease prevention and health promotion and identify a viable plan to replace them.

Sustained investments in disease prevention and public health will bend the cost curve of sick care spending. These investments will also build the capacity needed by states and territories to protect all Americans from the health threats of new and emerging infectious diseases, natural and manmade disasters, and the ever broadening spectrum of addictive substances and technologies being distributed and used. In the rush to repeal, let’s make sure we replace the Prevention and Public Health Fund with equivalent investments in public health programs that will truly lead to better health for all.

Michael Fraser executive director of the Association of State and Territorial Health Officials, the national nonprofit organization representing the public health agencies of the United States, the U.S. territories, and the District of Columbia.

The views expressed by authors are their own and not the views of The Hill.