Issue Category: Public Health Funding

The Senate’s Latest Obamacare Replacement Effort will not improve the Nation’s Health, Affordable Care Act

Washington, D.C., July 25, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the Senate’s motion to proceed.

“Each new iteration of Obamacare repeal legislation has failed to do what a health bill should: improve the nation’s health.

We know—according to the Congressional Budget Office’s scores on any number of the attempted bills—that tens of millions of people will quickly lose access to health insurance and the preventive services and programs which keep them from developing debilitating and costly chronic diseases.

That is, simply, the opposite of what a bill—intended to improve the nation’s health—should do.

Continued attempts to eliminate the Prevention and Public Health Fund would irreparably harm the nation’s health. States and communities rely on the hundreds of millions of dollars they receive annually to work on the critical health issues—including the opioid epidemic, lead poisoning, obesity, tobacco use and vaccine-preventable illnesses—facing their citizens.

To date, any funding included in repeal legislation for the opioid crisis has been nowhere near enough to solve the problem and will not make up for the substantially larger cuts to Medicaid and the Prevention Fund.

Estimates have found that the total coverage cost for people receiving treatment for substance misuse disorders could reach $220 billion over the next decade. And, people with substance misuse disorders often suffer from additional health problems – for example, mental illness and chronic conditions such as heart disease or diabetes – and need the routine access to care and services provided by Medicaid. As such, substance misuse treatment must remain part of the Medicaid integrated care system.

TFAH encourages the Administration and Congress to start over and create a true healthcare bill that will improve upon Obamacare, keep people covered and safeguard the nation’s health.”

Trust for America’s Health is 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.

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The Senate’s Better Care Reconciliation Act is Irredeemable, would eliminate 12 Percent of CDC’s Budget for Fiscal Year 2018

Washington, D.C., June 22, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the Senate’s Better Care Reconciliation Act.

“The Senate version is no better than what the House proposed and in no way improves upon the Affordable Care Act (ACA). In reality, this Act is irredeemable.

If the Better Care Reconciliation Act becomes law, tens of millions will lose insurance. A critical part of what they’ll lose is access to the care they need to prevent or manage chronic conditions in a life- and cost-saving way. More than 80 percent of the $3 trillion dollars we spend every year on healthcare goes to individuals with one or more chronic conditions—with better preventive care and well managed chronic disease clinical services we can reduce costs and improve health outcomes.

A better way for Congress to cut healthcare costs and keep Americans healthy would be to create legislation that increases investments in preventive services and programs and ensures people have access to clinical care before they develop costly conditions.

This bill does the absolute opposite.

In addition to millions losing insurance, the Senate bill would eliminate the Prevention and Public Health Fund beginning next fiscal year, which supplies 12 percent of the budget (or close to $900 million) for the Centers for Disease Control and Prevention (CDC). And, $625 million of that goes directly to states and communities to address their most pressing health needs, including drug misuse, infectious diseases, lead poisoning, obesity, diabetes, hypertension, cancer and tobacco use.

In addition, with the phasing out of Medicaid expansion and possible loss of guaranteed essential health benefits, effective preventive services—including vaccines and screenings for cancer—will no longer be required of insurers.

If the Better Care Reconciliation Act becomes law, the American people will be sicker and poorer. We will likely see more overdoses and untreated STDs, rises in infant mortality and increases in innumerable other preventable health issues, all of which add up to ever-increasing healthcare costs.

We strongly urge the United States Congress to start over and create a true healthcare bill that will actually improve the ACA and the nation’s health.”

Trust for America’s Health is 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.

Public Health Leaders Make Urgent Joint Call to Protect Prevention and Healthcare

Joint Statement from American Public Health Association, Prevention Institute, Public Health Institute and Trust for America’s Health

June 20, 2017

The fight to protect public health is more important than ever.

The Senate is moving quickly—and secretively—on their version of legislation to repeal the Affordable Care Act (ACA). While we don’t know the content of the bill, we do know that the House-passed repeal bill—the American Health Care Act—would cause over 23 million people to lose their healthcare, restructure Medicaid, pare down essential benefits like maternity and newborn care, result in the loss of over a million American jobs, and zero out the Prevention and Public Health Fund. As leaders of organizations dedicated to protecting and advancing the public’s health, we call on Congress now to protect federal investments in public health funding, the Prevention and Public Health Fund, and affordable, high-quality healthcare.

Public health is at the very core of keeping our country safe, healthy, resilient, and secure. It works behind the scenes to ensure we have clean water to drink, safe food to eat, and healthy air to breathe. It works to safeguard us from infectious diseases like measles or Ebola by preventing the onset or spread of disease. It builds on time tested strategies to reduce the toll of chronic diseases and injuries. Public health works to redress long-standing inequities in health and safety, by investing in communities of greatest need. Through prevention, evidence-based treatment of substance use, prescription drug monitoring, and improved opioid prescribing, public health can solve the opioid epidemic, which kills ninety-one Americans a day. From opioid overdoses to rising infant and maternal mortality rates, Americans are seeing both the length and quality of their lives decline—and we need more, not fewer, investments in public health to turn the tide.

Repealing the ACA and its investments in public health and prevention dismantles the capacity of public health to do its work. The pain will be felt in every state, every congressional district, and every neighborhood, and those who are most vulnerable will suffer the most. If the Prevention Fund is eliminated, over the next five years states stand to lose over $3 billion they rely on to prevent chronic disease, halt the spread of infections, and invest in the community resources that support health and safety. Repealing the ACA and the Prevention Fund ensures there is no progress to reduce healthcare spending or improve the health of our workforce. Repealing the ACA will result in an America where preventable suffering and death are more widespread, and an America where the poorest and sickest communities fall even farther behind.

A strong public health infrastructure is at the very core of making our country safe, healthy, and secure. We need to act now to protect it.

The President’s FY 2018 Budget Proposal Would be Perilous for the Nation’s Health

Washington, D.C., May 23, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH) on the President’s Fiscal Year (FY) 2018 proposed budget announcement.

“The proposed $1.2 billion cut to the Centers for Disease Control and Prevention (CDC) would be perilous for the health of the American people.

From Ebola to Zika to opioid misuse to diabetes to heart disease, the CDC is on the frontlines keeping Americans healthy. Cutting nearly 20 percent of the CDC’s Chronic Disease Prevention and Health Promotion center’s budget would be disastrous.

Enormous cuts are also proposed throughout the rest of the agency including to programs that protect the American people from infectious diseases, environmental contaminants, exposure to tobacco and much more. If these budget cuts were to occur, they would cripple CDC’s operations and result in increased illnesses, injuries and preventable deaths.

CDC has already lost more than $580 million in funding since 2010 – and the proposed American Healthcare Act would, in FY 2019, repeal the Prevention and Public Health Fund, which supplies 12 percent of CDC’s budget—of which more than $620 million goes yearly to states.

Even now, with a relatively stable FY 2017 budget, CDC is operating with nearly 700 vacancies and will function with diminished resources once the Zika emergency supplemental funding runs out.

As such, this unprecedented and dramatic cut would have unparalleled and drastic consequences for our nation’s health and would likely lead to staggering increases in our healthcare service costs. It would also create massive holes in state public health funding, as states and local communities rely on the hundreds of millions they receive from CDC every year.

In essence, the proposed budget would force CDC to fight epidemics and health threats with both hands tied behind their back while wearing a blindfold.

We urge the Administration and Congress to work together to ensure CDC is able to protect the American people and help Americans be healthy and thrive.”

 

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Trust for America’s Health is 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.

House ACA Replacement will Cripple the Nation’s Health, Trust for America’s Health Statement

Washington, D.C., May 4, 2017 – The below is a statement from John Auerbach, president and CEO, of Trust for America’s Health (TFAH).

“As historic as the passage of the Affordable Care Act was, any passage of the American Health Care Act will be just as infamous.

Tens of millions of American citizens will lose coverage. And millions of people on private insurance and Medicaid may lose access to life- and cost-saving clinical preventive services.

In particular, the Meadows-MacArthur Amendment would permit states to eliminate the requirement around essential health benefits (EHBs) and allow for the discrimination of people with pre-existing conditions.

Research tells us time and again two truths: Americans with coverage of preventive services are more likely to access these services and investing in preventive services improves health and reduces costs, yielding massive returns on investment.

Additionally, the agencies responsible for keeping us safe daily from ever-increasing public health threats will have their budgets slashed.

If the bill eventually becomes law, the Centers for Disease Control and Prevention (CDC) will lose 12 percent of its budget, of which a significant portion—$625 million a year—goes directly to state and local health departments.

This is a double whammy to the nation’s health.

Every day, the CDC and local public health departments are on the front lines in preventing disease outbreaks like Zika and Ebola, in protecting our children from lead poisoning, in lowering rates of heart disease, in stopping epidemics like prescription drug misuse and in helping people quit tobacco.

If the bill eventually passes, the results won’t be celebrated—they’ll be infamous.

We will likely see more overdoses and untreated STDs, rises in infant mortality and increases in innumerable other preventable health issues—not to mention mounting healthcare costs. All the while, our most vulnerable—the elderly, children, sick and less advantaged—will be at most risk.

That should not be the result of a health law.

We hope the United States Senate sees the many problems in the legislation.”

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Trust for America’s Health is 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.

Federal Funding for Public Health Has Declined by $580 Million Since 2010, According to New Analysis

Washington, D.C., April 13, 2017 – Today, Trust for America’s Health (TFAH) issued A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts, 2017, which found that core funding for disease prevention and health promotion programs has declined by around $580 million federally and has remained flat in states since 2010 (adjusting for inflation).

The annual review demonstrates that cuts to federal funds have not been offset by increases to state and local funding.  Adjusting for inflation:

  • The Centers for Disease Control and Prevention’s (CDC) core budget has decreased by more than $580 million since 2010.  In fiscal year 2016, the agency’s budget was $7.17 billion ($22.26 per person).
  • State public health spending has remained relatively level since 2010 ($11.5 billion total in 2015-2016, median spending $31.62 per capita). 

The President’s proposed FY 2018 budget blueprint would include a nearly 18 percent cut to the U.S. Department of Health and Human Services (HHS).  The full budget detail is expected to be released later this Spring. Budget sequestration – which requires reductions in the rate of increase in federal spending – is scheduled to go back into effect in FY 2018 and would lead non-defense spending, including at CDC, to fall 16 percent below 2010 spending rates (adjusting for inflation).

“Major budgetary cuts have hampered the ability of public health agencies to protect and improve the nation’s health – impeding the response to pressing health concerns and the rising costs of treating preventable illnesses and injuries,” said John Auerbach, president and CEO, of TFAH.  “It is painfully clear that the decrease in federal spending has not led to higher state spending for public health. Rather, the nation has doubled down on cuts at both levels, leaving us vulnerable to the next public health crisis. Cutting public health programs is shortsighted – and we will all pay the price over time.”

The Funding Crisis brief also found that:

  • Around 75 percent of CDC’s funds go to support state and local programs – but this support ranges from a low of $15.39 per person in Virginia to a high of $49.67 per person in Alaska – with differences due to competitive grant awards and some targeted-need programs;
  • Public Health Emergency Preparedness (PHEP) core funding for states and local communities – with the exception of the one-time, short-term funding for Ebola and Zika response needs – has been cut by more than one-third (from $940 million to $651 million) per year since the program was established in the wake of the 9/11 and anthrax attacks.  CDC has responded to more than 750 emergencies in the past two years; and
  • Only $4 per person per year is spent on chronic disease prevention activities at CDC ($1.2 billion total).  Nearly half of all Americans have one or more chronic disease – a majority of which are preventable – and more than 80 percent of healthcare spending is for chronic conditions. 

TFAH also highlights how investing in proven public health strategies can improve health and yield positive returns.  For instance:

  • Investing $1 in substance use prevention to realize as much as $34 in return.  Deaths from prescription painkiller use have more than quadrupled in the past 15 years and deaths from heroin have tripled since 2010, contributing to higher death rates among middle-aged Whites.  Five of the strongest school-based substance use prevention strategies have returns on investment ranging from $3.8:1 to $34:1.
  • Saving more than $16 billion through a more active and healthy population. One in three children will develop type 2 diabetes in their lifetime and one in four young adults are not healthy enough to join the military.  An investment of $10 per person in proven, evidence-based community prevention programs to increase physical activity, improve nutrition and reduce tobacco use could save the country more than $16 billion annually – a $5.60:1 return.
  • Connecting health and social services to cut billions in costs.  Health and social service coordinating systems that address gaps between medical care and effective social service programs – by connecting patients in need with programs ranging from supportive housing to food assistance – could yield between $15 billion and $72 billion in annual healthcare savings within 10 years, according to an analysis by TFAH and Healthsperien.
  • Reducing the $120 billion spent annually on preventable infectious diseases.  Fifteen years after 9/11 and 11 years after Hurricane Katrina, when health crises such as new infectious diseases arise, the country often lacks sufficient funding and capabilities in place to effectively respond.  Preventable infectious diseases cost the country more than $120 billion annually – and that cost is exponentially compounded when new diseases emerge.

Key recommendations for achieving a modern public health system highlighted in the paper include:

  • Increasing funding for public health – at the federal, state and local levels – to support basic capabilities to turn the tide on health epidemics and prevent disease;
  • Modernizing the public health system to address gaps in critical infrastructure and update outdated systems and technologies;
  • Creating a standing Public Health Emergency Fund for immediate use when new threats emerge – while still making sure to maintain ongoing preparedness and response funding.  To be effective, this fund must provide a complimentary surge of resources for response to new crises and cannot replace the need to provide ongoing support for standing health security capabilities that must always be in place to deal with the regular cycle of emergencies and threats the country faces;
  • Supporting better health – and top local priorities –  by providing communities with the flexibility to focus on their highest concerns, develop private-public partnerships to leverage resources and ensure accountability; and
  • Expanding the use of evidence-based, high-impact strategies to improve health in every community.

 

State

Total CDC Funding for State, Per Capita, FY 2016

Alaska

$49.67

Vermont

$41.57

Rhode Island

$39.59

South Dakota

$33.98

New Mexico

$32.66

Maryland

$31.93

Montana

$31.77

Hawaii

$31.76

Delaware

$30.15

North Dakota

$29.88

Wyoming

$29.69

Maine

$27.98

Louisiana

$27.59

New Hampshire

$27.53

Nebraska

$26.64

Georgia

$26.50

Mississippi

$25.48

Idaho

$24.57

Arkansas

$23.97

Massachusetts

$23.43

Oklahoma

$23.18

West Virginia

$22.96

South Carolina

$22.62

Utah

$22.19

Iowa

$21.70

Alabama

$21.60

Nevada

$21.55

Minnesota

$21.54

Oregon

$21.43

Texas

$21.28

Kentucky

$21.17

Colorado

$21.13

Arizona

$21.07

Tennessee

$20.87

Connecticut

$20.29

Kansas

$20.26

Washington

$20.06

California

$19.61

New York

$19.41

Florida

$19.09

Missouri

$18.98

North Carolina

$18.81

Michigan

$18.80

Ohio

$17.90

Indiana

$17.11

Wisconsin

$16.89

Illinois

$16.76

New Jersey

$16.59

Pennsylvania

$15.48

Virginia

$15.39

Includes CDC funds for organizations within the state.
The brief was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Trust for America’s Health is 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.

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Trust for America’s Health Releases Issue Brief on Preventive Services

Washington, D.C., March 30, 2017 –Impact of the 2017 Health Reform Proposals on Clinical Preventive Services, released today by Trust for America’s Health (TFAH), reviews the current status of public and private insurance coverage of preventive services, and what would be at stake if they were eliminated or reduced, either through legislation or administrative actions.

The Affordable Care Act (ACA) expanded coverage of a range of effective, targeted preventive services to make them accessible to millions of Americans.

  • As of 2015, around 137 million private insured Americans received guaranteed preventive services without cost sharing.  Small and individual insurances plans are required to cover 10 Essential Health Benefits, such as blood pressure screenings and well care visits, and non-grandfathered individual, small and large plans are required to cover evidence-based services with top effectiveness ratings, recommended vaccines and preventive maternal and child health coverage (Section 2713 Preventive Services).
  • The 14 million Americans covered via Medicaid expansion qualify for no-cost coverage of Essential Health Benefits, other top rated preventive services and tobacco cessation services.  States determine coverage of preventive services for enrollees in traditional Medicaid plans.

“For too long, America has propped up a sick care system. Instead of prioritizing keeping people healthy in the first place, we’ve waited until they get sick—often with chronic, debilitating and expensive conditions—and then paid the price,” said John Auerbach, president and CEO, TFAH. “Research tells us time and again two truths: Americans with coverage of preventive services are more likely to access these services and investing in preventive services improves health and reduces costs, yielding massive returns on investment.”

According to the brief, a range of proposals could potentially lead to millions of Americans losing access to preventive services – either through reductions or changes in requirements or as part of losing health insurance coverage.  Studies have shown that expanding coverage for preventive services contributes to an uptick in routine exams; screenings for blood pressure, cholesterol and diabetes; use of flu shots; and annual dental exams.  Examples of some outcomes of preventive services include:

  • Among the Medicaid population in Massachusetts, an evidence-based, Medicaid tobacco-cessation benefit was associated with a reduction in smoking rates and an estimated $3.12 in medical savings from averted cardiovascular hospitalizations alone for each dollar spent.
  • The Diabetes Prevention Program reduced risk for developing type-2 diabetes by 58 percent. Even after 10 years, people who completed the program were one-third less likely to develop type 2 diabetes.
  • Comprehensive prenatal maternal care helps reduce premature birth and infant mortality rates.
  • Vaccines prevented an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths among children born in the U.S. between 1994 and 2013 – and yield a net savings of $295 billion in direct costs and $1.38 trillion in societal costs.

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Trust for America’s Health is 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.