Missing in the ACA debate: Funding to prevent disease in the first place
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The current drama over the repeal of the Affordable Care Act (ACA) without a clear replacement leaves out a crucial component: funding for public health – the people and departments on the front lines when it comes to preventing illness and keeping Americans safe from things like Zika, Ebola, the flu, and a myriad of other diseases and dangers. 

For the first time in the country’s history, the ACA included intentional funding for effective and innovative public health programs that keep people healthy, with almost $1 billion a year going to the Centers for Disease Control and Prevention (CDC) in the Prevention and Public Health Fund.

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This vital work includes diabetes prevention services at your local YMCA, flu vaccine clinics for the elderly, and anti-tobacco education. All these services, and more that the Prevention Fund covers, have saved countless lives. 

If the ACA is repealed, the Prevention fund disappears and the CDC will lose 12 percent of its budget, most of which goes directly to states, cities and community organizations. Americans will quickly discover that many of the routine public health services they take for granted will be eliminated, resulting in increased illnesses, injuries and premature deaths.

This will undeniably be felt at the state and local level. State health departments will lose their Prevention Fund dollars (to the tune of $3 billion over five years), leaving a massive vacuum in services and workforce. A quick look around the country finds Mississippi will lose $6 million per year, West Virginia $5 millionGeorgia $20 million and Pennsylvania $22 million.        

The work of public health at all levels will be threatened. With the loss of workforce and expertise, emergency response capabilities will be hampered dramatically. With the exception of the one-time only funding for Ebola and Zika, preparedness funding for CDC and states was cut by more than one-third over the past decade. At the same time, CDC was called to respond to more than 750 health emergencies over the past two years—and infectious diseases take a tremendous toll, costing the country more than $120 billion per year. 

Concurrently, deaths from opioids have more than quadrupled in the past 15 years. CDC provides critical support to states and communities to help monitor and control the inappropriate prescribing of opioids—it’s likely these efforts will be hindered if the agency loses 12 percent of its funding.

Add all that up, and, for the first time in two decades, life expectancy in the United States declined. While death rates are higher among blacks and other people of color, death rates have increased the fastest among middle-aged White men and women (ages 45 to 54), increasing the quickest in West Virginia, Mississippi, Oklahoma, Tennessee, Kentucky, Alabama and Arkansas.

The Prevention Fund was designed to begin to solve the root problem of these health issues—and stop people from getting sick. Without it, we’re back to square one.

It’s urgent to protect the Prevention Fund. More than 1,000 groups already support it. And, recently, more than 300 groups signed a letter to Congress warning of dire consequences if it disappears. 

Public health leaders across the nation are also speaking out. The health commissioner from Pennsylvania recently told her state’s legislators that the Prevention Fund “is vital to help protect the health of the nearly 13 million people who call Pennsylvania home.” 

And, a spokesperson for the Georgia Department of Public Health said the Prevention Fund “remains central to basic public health services such as lead screening, immunization and infectious disease prevention. It is critical that this funding continues to exist regardless of changes made in Washington to overall health care policy.”

Voters agree as well: 73 percent support increasing—not decreasing—investments to improve the health of communities.

Citizens and experts have spoken: keeping people from getting sick is just as important as paying for services to make them better.

Now is the time to increase support for our local, state and national health departments as they work tirelessly to perform one of the nation’s most important, yet least heralded, jobs: keeping people healthy, happy and productive in the first place.

John Auerbach is President and CEO of Trust for America’s Health, a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. Previously, John was the associate director for policy at the Centers for Disease Control and Prevention and, before that, served as commissioner of public health for the Commonwealth of Massachusetts.


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