Issue Category: Prevention and Public Health Policy

Trust for America’s Health Applauds COVID-19 Health Equity Task Force Report

Addressing health inequities is critical to protecting everyone’s health and being prepared for future health public emergencies

(Washington, DC – November 10, 2021) – Trust for America’s Health (TFAH) applauds the report of the COVID-19 Health Equity Task Force, including its recommendations to President Biden for mitigating the health inequities caused or exacerbated by the COVID-19 pandemic and for preventing such inequities in the future. We furthermore commend the Biden Administration  for responding to the report’s call to action with new investments in initiatives to improve community and public health in traditionally under-resourced communities, including communities of color and among underserved populations.

In January of 2021, the Biden Administration created the Task Force, a multisector group of individuals with expertise and lived experience relevant to groups suffering disproportionate rates of illness and death from COVID-19, experts in fields such as public health, healthcare, behavioral health, and community-based services, as well as government officials. The Task Force represents diverse perspectives on how to address COVID-19 related health and social inequities and strengthen the nation’s public health response.

“The COVID-19 pandemic has exposed and exacerbated longstanding systemic inequities in our nation,” said J. Nadine Gracia, MD, MSCE, President and CEO of Trust for America’s Health.  “The COVID-19 Health Equity Task Force has laid out a road map for reducing inequities during this pandemic and before the next public health emergency.  As the report acknowledges, we must engage in a multisector effort to address the upstream factors that contribute to underlying health inequities in order to promote optimal health and build resilience in all communities. TFAH looks forward to working with the administration on our shared goals.”

The Task Force’s report echoes many of TFAH’s policy recommendations. The following are policy priorities shared by the Task Force report and TFAH:

  • Fund the public health workforce and emergency response. The federal government should increase and sustain funding for equity-centered pandemic and public health emergency activities and infrastructure at the federal, state, local, Tribal, and territorial levels. This should include building a workforce dedicated to public health emergency preparedness, response, recovery, and disaster-related behavioral health services and supporting communities with the greatest healthcare inequities.
  • Support equity-centered data collection. The federal government should fund an equity-centered approach to data collection, including ensuring sufficient funding to collect data for groups that are experiencing disproportionate impact during the pandemic and to understand the specific needs of currently underserved populations.
  • Fund data modernization for health settings. The federal government should provide funding for healthcare and public health to update data systems centered on equity and to ensure interoperability and automatic electronic lab reporting of a robust set of disaggregated, standardized socioeconomic and demographic data elements.
  • Strengthen multi-sector collaboration. The federal government should strengthen collaboration with a diverse array of community-based organizations and public health providers by providing robust and sustained funding to build capacity, provide technical assistance and establish partnerships with communities of color and other underserved populations.
  • Prioritize vaccine, testing, treatment, and personal protective equipment (PPE) access for underserved communities. Federal, state, local, Tribal, and territorial governments should prioritize vaccine distribution, testing, treatment, and PPE access to communities of color and other underserved populations, including those who face mobility, geographic, or other barriers to access.
  • Address the social determinants of health. The federal government should lead efforts to advance the social determinants of health including nutrition safety net programs for individuals and families who are food insecure and for those that have limited access to healthy food options.
  • Increase access to behavioral healthcare. Federal, state, local, Tribal, and territorial governments should increase investment in and access to comprehensive, equity-centered behavioral health services, including a focus on prevention.
  • Lead and coordinate implementation of the COVID-19 Health Equity Task Force’s recommendations from a permanent health equity infrastructure in the White House.

TFAH reports on emergency preparedness, public health funding, leveraging policy to improve Americans’ health and create health equity, and a legislative blueprint to transform the nation’s public health system, include additional recommendations that support the Task Force’s health equity goals.

TFAH Applauds Court’s Decision Preserving the Affordable Care Act

Decision strengthens the nation’s healthcare system, protects healthcare access for 31 million Americans and will help address health disparities

(Washington, DC — June 17, 2021) – Trust for America’s Health applauds today’s Supreme Court’s decision in California v. Texas for the ways in which it protects healthcare access for 31 million Americans and will help address the nation’s health disparities.

“Access to affordable healthcare is fundamental to individual health. It is also fundamental to achieving health equity. While as a nation we still have a lot of work to do to achieve good health for every individual, today’s court decision keeps us moving in the right direction – it will save lives,” says John Auerbach, President and CEO of Trust for America’s Health.

According to the U.S. Department of Health and Human Services, 31 million people have gained health insurance through the Affordable Care Act (ACA) including many who lost employment and health coverage during the COVID-19 pandemic.[i]  Since the ACA, rates of people without health insurance have decreased in every state, with states that expanded Medicaid experiencing the largest reductions.[ii]

The ACA is transformative legislation in at least three ways: the number of Americans who can now access medical care when they are ill or to deal with chronic conditions (78 percent of U.S. adults 55 and older have at least one chronic condition);[iii] the illness it prevented as millions of Americans gained access to preventive care and screenings and other life-saving services previously inaccessible to them;[iv] and the ways in which it resulted in improved access to healthcare for people of color, reducing – although not eliminating – longstanding healthcare access disparities.

Prior to the ACA, non-Hispanic Black Americans were 70 percent more likely to be uninsured than were whites and the uninsured rate for Hispanics was nearly three times the uninsured rate for whites.[v] Once the ACA was in place, Hispanics had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell for Asian and Black Americans by 8 percent during the same period.[vi]

Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among the low-income population broadly and within specific vulnerable populations.[vii] According to the Center on Budget and Policy Priorities, expanding Medicaid coverage to low-income adults led to significant benefits to those individuals and families including improved access to care, improved health outcomes and increased financial stability – including a reduction in medical debt per person gaining coverage via the expansion.[viii] A study by the National Bureau of Economic Research found states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[ix]

The decision also has major implications for public health by protecting over $16 billion in funding over the next 10 years (FY 2022-FY 2031) for the Centers for Disease Control and Prevention (CDC) and other public health agencies. The Prevention and Public Health Fund, a dedicated funding stream created by the ACA and specifically designated for public health and prevention, funds approximately 11 percent of the CDC’s budget. These funds are put to work in every state to expand immunizations, prevent suicide, modernize laboratory and epidemiology services to detect and contain disease outbreaks, prevent childhood lead poisoning, and help smokers quit.

Also preserved are the requirement that insurers not refuse coverage due to preexisting conditions, the provision disallowing annual or lifetime limits on essential care, and the requirement that insurers cover recommended clinical preventive services without cost-sharing: all essential to Americans’ health.

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[i] HHS, HHS Press Office. New HHS Data Show More Americans Than Ever Have Health Coverage Through the Affordable Care Act. June 5, 2021. New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act | HHS.gov

[ii] ibid

[iii] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm

[iv] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[v] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21

[vi] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[vii] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

[viii] Center on Budget and Policy Priorities. The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion. October 21, 2020. The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion | Center on Budget and Policy Priorities (cbpp.org)

[ix] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

COVID-19 Pandemic Proved that Underinvesting in Public Health Puts Lives and Livelihoods at Risk

Chronic underfunding of public health system weakened the country’s COVID-19 response

(Washington, DC – May 7, 2021) – Chronic underfunding of the public health system was a key contributing factor in the nation’s flatfooted response to the COVID-19 pandemic, according to a new report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021, released today by Trust for America’s Health.

The report discusses how the underfunding of core public health programs impeded the pandemic response and exacerbated its impacts.  According to the report’s authors, the missteps of the 2020 COVID-19 response were rooted in a public health system weakened by years of underfunding, the federal government’s failure to communicate and follow the best available science, and, health inequities that put communities of color and Tribal Nations at particular risk.

This annual report examines federal, state and local public health funding trends and recommends investments and policy actions to build a stronger public health system, prioritize prevention, and address the ways in which social and economic inequities create barriers to good health. Also highlighted is the need for the public health system to be ready to prevent and respond to a spectrum of risks, from weather-related emergencies to the rising numbers of drug overdoses, to increasing rates of obesity and resulting chronic diseases.

Response funding critical but not a long-term solution

Congress passed numerous COVID relief bills since March 2020, funding that has been critical to managing the immediate crisis.  But this one-time funding is not a solution to years of underfunding which hollowed out the system, thereby making it less able to spend emergency funds quickly and efficiently.

“What the system urgently needs is sustained, predictable funding that allows it to grow and maintain its workforce and invest in modern data systems and all-hazards preparedness planning on a year-in, year-out basis,” said John Auerbach, President and CEO of Trust for America’s Health.

CDC funding down for the year and decade

The Centers for Disease Control and Prevention (CDC) is the primary federal provider of public health funding to states. For FY 2021, CDC’s budget (aside from supplemental COVID response funding) was $7.8 billion, down 1 percent from the previous year, and continues to be insufficient to meet the country’s public health needs.  Over the last decade (FY 2012 – 21) the CDC’s core budget fell by 2 percent when adjusted for inflation. That decrease in spending happened over a 10-year period in which the U.S. population grew, the number and severity of weather-related emergencies increased, and the number of Americans grappling with substance abuse, suicide and chronic diseases also grew.  Anemic funding for CDC has meant that effective programs fail to reach all 50 states, and there has been little investment in cross-cutting infrastructure and capabilities.

CDC’s annual funding for Public Health Emergency Preparedness (PHEP) cooperative agreements, which support core emergency readiness capacity in states, territories and local areas, increased by $20 million in FY 2021.  But funding for PHEP shrank by approximating one-quarter (about half when adjusting for inflation) over the last two decades from $939 million in FY 2003 to $695 million in FY 2021.

In addition, the Hospital Preparedness Program, the main source of federal funding to help healthcare systems prepare for emergencies, has experienced a nearly 50 percent funding cut (nearly two-thirds when adjusted for inflation) over the last two decades – from $515 million in FY 2003 to $280 million in FY 2021.

At the state level, 43 states and the District of Columbia maintained or increased their public health funding in FY 2020.  In some instances, state-supported COVID response funding increased the state’s public health funding for the year but this emergency response funding is unlikely to translate into sustained funding growth.

Public health workforce is smaller than it was a decade ago

The state and local public health workforce is a critical part of the nation’ public health infrastructure.  From 2008 to 2019 the estimated number of full-time local public health agency staff decreased by 16 percent, while state health agencies lost almost 10 percent of their collective workforce between 2012 and 2019. These personnel cuts translated into fewer trained professionals available to do critical work as the COVID-19 pandemic was spreading across the country.

“For decades, public health leaders have sounded the alarm about the ways in which underfunding the public health system makes us less prepared and puts lives at risk. The COVID-19 pandemic is a stark illustration of how serious those risks are as public health departments were forced to fight the virus with antiquated tools and a depleted workforce,” said John Auerbach. “We must learn from the COVID tragedy and dramatically increase annual support of the public health workforce, programs and infrastructure.  If we fail to learn the lessons from the pandemic, we will be doomed to repeat them.”

The report calls for a $4.5 billion annual investment in the nation’s core public health capabilities.  Other recommendations speak to the need to:

  • Substantially increase core funding to strengthen the public health system, including by building and supporting the workforce, modernizing the system’s data tools and increasing its surveillance capacities.
  • Strengthen public health emergency preparedness, including within the healthcare system.
  • Safeguard and improve Americans’ health by investing in chronic disease prevention and the prevention of substance misuse and suicide.
  • Take steps to advance health equity by combating the impacts of racism and addressing the social determinants that lead to poor health.

Trust for America’s Health Applauds Public Health Investments Included in President’s FY2022 Budget

(Washington, DC – April 10, 2021) — The President’s FY2022 budget request for the U.S. Department of Health and Human Services (HHS) and other federal agencies, includes a proposed 23 percent increase to HHS and an 18 percent increase to the Centers for Disease Control and Prevention (CDC).

In response, the President and CEO of Trust for America’s Health (TFAH), John Auerbach, released the following statement:

“Trust for America’s Health is encouraged to see proposed increases for public health funding in the President’s FY2022 budget request, including a $1.6 billion increase for the Centers for Disease Control and Prevention (CDC). The unprecedented events of the past year demonstrate the need for increased and sustained investments in core public health. The pandemic exposed gaps in the public health system and major underlying health inequities in our communities – deficits that made the nation particularly vulnerable.

We were pleased to see proposed increases for long-neglected public health issues, including addressing racial inequities and the social determinants of health, the impact of climate change on health, and the substance misuse epidemic. We hope that Congress follows the Administration’s lead and commits the resources that public health needs to carry out its mission. The increases proposed in the budget request are an important step forward, future budgets will also need to invest in public health and address disparities that continue to place some communities at higher risk.”