GOP health bill could shred safety net for millions
© Greg Nash

The Affordable Care Act (ACA) historically expanded coverage of a range of effective, targeted preventive services to make them accessible to millions of Americans. In fact, about 137 million private insured Americans received guaranteed preventive services without cost sharing, increasing access to blood pressure screenings and well care visits.

In addition, the 14 million Americans who gained coverage through Medicaid expansion now qualify for no-cost coverage of Essential Health Benefits, other top rated preventive services and tobacco cessation services. 


To date, expanding access to preventive services has resulted in improved birth outcomes and child health and increased the use of services, which “translates into … earlier detection of health and developmental problems in children, and earlier diagnosis of cancer, diabetes, mental illness, and other chronic conditions,” according to the Kaiser Family Foundation.


Yet, much of this progress could go away. 

According to the latest score from the Congressional Budget Office, 23 million more people would be uninsured under the latest version of the Republican American Health Care Act (AHCA), effectively sending the nation back a decade. With the ACA, the nation took our first legitimate step toward investing in preventive services and working to prevent illness and costs before they occur.

Research has shown that, without health insurance, people are far less likely to access the preventive treatments that would keep them from developing chronic, debilitating and costly conditions.

For example, young adults with health coverage are more likely to receive preventive services like routine examinations, screenings for blood pressure and cholesterol, and annual dental visits. And, Medicaid beneficiaries with coverage for preventive services are more likely to get screened for diabetes, which costs the nation $825 billion each year and is preventable. The Diabetes Prevention Program reduces the risk for developing type-2 diabetes by 58 percent.

Going another harmful step further, the AHCA would also eliminate the Prevention and Public Health Fund, which provides 12 percent of the Centers for Disease Control and Prevention (CDC) budget — of which $625 million goes to states.

One Prevention Fund program, Tips from Former Smokers, has led to 5 million smokers attempting to quit. Smoking causes lifelong, expensive chronic illness and remains the nation’s leading cause of preventable death, killing nearly 500,000 people a year.

Just at the moment we’re beginning to see real results, the AHCA would decimate that progress and put our nation’s most vulnerable in a precarious position.

If you can remember, nearly a decade ago, low- and middle-income uninsured Americans had no choice but to turn to local public health departments to receive care, including blood pressure, heart disease, diabetes, cancer and STD screenings, well child visits and vital prenatal care.

In essence, public health departments served as a safety net to keep as many disadvantaged people as possible healthy and secure. These clinics were most important in southern and other rural states, where there is less access to care and people tend to be lower income.

After the ACA passed, many of these former public health patients gained access to community health centers and private practices, resulting in countless public health clinics closing or scaling back services. 

The states cannot and will not fill the gaps — 24 states recently reduced their public health funding and, overall, state public health funding is still below where it was prior to the recession.

Quite simply, if tens of millions of people lose insurance, the nation is unprepared to help them when they need help the most and we’ll go back to waiting until they get sick and paying an exorbitant price to get them healthy.

This scenario isn’t just likely, it’s a sure thing with the AHCA.

Without the ACA’s expanded coverage and protections, if someone gets sick, there will be no safety net to catch them when they fall ill.  

John Auerbach is President and CEO of Trust for America’s Health, an organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. He served as 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.

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