By Kim Krisberg
Friday wasn't a great day for public health.
That day, Congress voted to raid the Affordable Care Act's Prevention and Public Health Fund to the tune of $5 billion. The move comes as part of a deal to delay scheduled cuts to Medicare physician payment rates and was part of a legislative package to extend the payroll tax cut and unemployment benefits. Both the Senate and House voted by wide margins to pass the bill, and President Obama is expected to sign it.
Of course, this was hardly the intent of the Prevention and Public Health Fund, which was created via the Affordable Care Act and represented a historic national investment in wellness and prevention. The money was intended to help reduce the growing burden of preventable and chronic disease; support proven, evidence-based public health interventions; and put the country on a path toward lowered health care spending.
Now, because of the Medicare payment fix, the flow of prevention fund dollars will slow significantly. According to Kaiser Health News, "the fund was to receive $1.25 billion in fiscal 2013, $1.5 billion in fiscal 2014 and $2 billion in fiscal years 2015 and beyond. If the proposed cuts in the conference package become law, the fund won't hit the $2 billion mark until fiscal 2022."
Here's what public health advocates are saying about the unfortunate vote:
Georges Benjamin, executive director of the American Public Health Association (APHA), said :
APHA is deeply disappointed by a measure today to eliminate designated funding from the Prevention and Public Health Fund to offset cuts to Medicare physician payments. This misguided decision flies in the face of years of dedicated work by the public health community - and Congress - to transform our once 'sick care' system to one focused on health and wellness.
Eliminating prevention funding is not without dangerous risk. It could seriously weaken efforts to respond to public health threats and outbreaks and could cost billions of dollars in health expenses along the way.
Richard Hamburg, deputy director of the Trust for America's Health, said:
Cutting prevention to pay for doctors' visits is illogical - prevention is the best way we have to actually improve the health of Americans and reduce their need to go to the doctor in the first place.
With this reported Congressional agreement, we're resigning the country to a future of higher rates of diseases such as type 2 diabetes, heart disease and cancer, and higher health care costs. If we continue to have a sick care system, we will never get health care spending under control, our children will continue to be at risk of living shorter and less healthy lives than their parents, and the economy will suffer.
And Robert Pestronk, executive director over at the National Association of County and City Health Officials, said:
We know there are difficult decisions to be made on the budget. But it's counterintuitive to cut the singular major investment to prevent the diseases that kill Americans and reduce their quality of life, and increase health care costs. This critical work has already been undercut by several previous rounds of federal, state and local budget cuts. Local health departments have the tools to bend the cost curve, but without sufficient investment, activities cannot be put into practice in a way that will have the greatest impact on health spending in programs like Medicare.
Friday's vote came less than a week after Obama unveiled his budget proposal for fiscal year 2013. That proposal (brace for more bad news) calls for cutting the Centers for Disease Control and Prevention's budget by $664 million as well as diverting monies from the Prevention and Public Health Fund to fill in for budget shortfalls at CDC and other public health agencies. In other words, public health advocates' fear that the fund would be used to supplant -- instead of enhance -- public health funding streams are becoming reality.
APHA has set up a web page that lets visitors send ready-made letters to their congressional representatives about cuts to the Prevention and Public Health Fund.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for almost a decade.
This just seems like such bad math. Outbreaks cost tons of money, to the point that preventing outbreaks is cheaper than responding to them. So we... cut funds to prevention? And thus pay more later, in response? I guess so the number looks smaller on paper?
It's bad math if you're looking at all expenditures over a long time frame. If your primary goal is to create a budget for the next fiscal year that appears to be balanced, then these kinds of cuts are rational. The question is, how do we get people into office who will create budgets that are good for the long term?