A multibillion dollar federal fund that helps prevent disease outbreaks and fights chronic conditions may disappear with a Republican plan to revamp the Affordable Care Act, worrying local physicians and county officials who say they rely on the money to sustain community health.
The GOP legislation, as it was released Monday, proposes cutting a piece of the Affordable Care Act called the Prevention and Public Health Fund – a store of federal money created to bolster immunization rates, disease surveillance, workforce training and community health education, among other programs. If the replacement legislation passes, county and state agencies throughout California will lose millions of dollars they relied on for public health efforts. Those governments also used the grants to prepare for emergencies such as Ebola and Zika virus outbreaks, health officials said.
The Prevention and Public Health Fund has provided more than $4 billion nationally and about $290 million to California since its launch, including $4 million directly to groups in the Sacramento area. That money goes to government agencies such as the U.S. Centers for Disease Control and Prevention and the Administration for Community Living, who then distribute it to state and local health departments as well as hospitals, universities and nonprofit groups.
In the Sacramento area, the fund has supported major public health projects including:
▪ A $98,950 UC Davis effort to prevent the spread of viral hepatitis through early identification.
▪ A $101,999 project at Sierra College in Rocklin to fight suicide among college students.
▪ A $484,389 initiative from the California Center for Public Health Advocacy in Davis to reduce chronic disease in diverse communities.
▪ A $2,661,141 effort by the California Rural Indian Health Board in Sacramento to prevent diabetes among American Indians. In 2017, the fund will award more than $900 million to programs throughout the U.S. addressing Alzheimer’s disease, immunization, breastfeeding, lead poisoning, youth suicide and more.
The Republican plan proposes discontinuing the fund starting in fiscal year 2019. The Affordable Care Act, which went into effect in 2010, not only expanded insurance coverage but also started initiatives to address a range of health issues, such as high hospital readmission rates, electronic medical record adoption and rising drug prices for Medicare enrollees.
The Prevention and Public Health Fund “is one of those very, very small and very, very unknown pieces of the Affordable Care Act,” said Dr. Ronald Chapman, public health officer for Yolo County and former state health officer at the California Department of Public Health. “In the scheme of the ACA, $1 billion is actually not much at all. But for public health at the CDC, it’s really vital.”
Opponents of the Affordable Care Act have called the Prevention and Public Health Fund an “Obamacare slush fund” and criticized it for supporting causes such as soda taxes, fast food bans and health care enrollment efforts. Republican legislators began calling for the fund to be slashed shortly after its creation. In 2012, Barack Obama cut the fund by 33 percent through the Middle Class Tax Relief and Job Creation Act.
State Sen. John Moorlach, R-Costa Mesa, said he has historically supported efforts to trim health education spending.
“I felt the federal government was getting into so much debt that this was more fluff than really useful tax dollars,” he said of health education programs. “It shouldn’t take much to educate someone to be preventative. … You could have saved more money by just giving everybody a gym membership. It makes sense to pare that down a bit.”
Chapman said county health departments use the fund for much more than education. The fund has provided more than $28 million in vaccine supplies to the California Department of Public Health, which county health departments rely on to immunize children and adults, Chapman said. Without free vaccines available, low-income families may vaccinate at lower rates, increasing the likelihood that once-common diseases such as measles and polio will return.
The fund also supports laboratory capacity at the state and local levels so health departments can more rapidly diagnose infectious diseases and quarantine people to prevent their spread. Testing capacity was an issue during both the Ebola outbreak in 2014 and the Zika virus outbreak last summer.
The proposed cut to the fund alarmed state Sen. Richard Pan, D-Sacramento, a pediatrician who called it a short-sighted move that could harm state and local efforts to respond to potential outbreaks.
“When you erode our public health infrastructure, it’s going to curb our ability to respond effectively and quickly to health and safety,” he said. “It’s all about prevention. We need the capacity to track down and fight contagious diseases. When we don’t, people get sick and die.”
Dr. Sara Cody, health officer for Santa Clara County, said the fund was key during a bacterial meningitis outbreak at Santa Clara University in February 2016.
A few months before the outbreak, the county had already hired employees to create emergency preparedness protocols and work in the infectious disease lab. So when the outbreak occurred, Cody and other staff members were able to act quickly to diagnose students and request free vaccines from the state to stem the disease’s spread before tourists flocked to the area for Super Bowl 50, Cody said.
“We needed to mount a rapid and sure public health response to protect the students and to communicate very broadly what we were doing and that everyone was safe,” Cody said. “Right now we have enough of an infrastructure in place that we can turn on a dime and serve the people of Santa Clara County. Prior to this, it was much more of a nail biter.”
In Sacramento, the fund helped launch the Healthy Sacramento Coalition, which has worked with the county public health department to track chronic disease trends in minority and low-income communities, said Diane Littlefield, vice president of programs and partnerships for the Sierra Health Foundation. In 2011, the foundation received a three-year, $500,000 grant from the fund, via the CDC.
Though federal funding for the coalition ended in 2013, it continues to educate people about health in 15 disadvantaged Sacramento ZIP codes and promote healthy eating, tobacco-free living, access to clinical services, social and emotional wellness and safe physical environments, Littlefield said.
County health departments and nonprofit groups say they’ve been working with budgets already shrunk during the recession. Many doubt the state can backfill federal public health funding if the replacement plan cuts the fund.
“Prevention isn’t very sexy – we don’t talk about it a lot until we have a problem,” Littlefield said. “If we dismantle the infrastructure that’s in place, we won’t be able to respond to crisis immediately.”
Claudia Buck contributed to this report.