Congress Dips Into Prevention Health Fund, Putting CDC Programs at Risk

To offset the costs of other health care programs, lawmakers have again cut from an Obamacare funding stream meant for prevention and public health initiatives.

AP Photo/David Goldman, File
Feb. 12, 2018, 3:48 p.m.

Even as the U.S. is in the midst of the worst flu season in nearly a decade, Congress moved last week to slash a pot of money that supports the country’s immunization program.

The cut was part of the deal reached in the Senate last week to raise budget caps and avert a government shutdown. The legislation contained some health care victories, including funding extensions for community health centers and a bump in resources for the opioid-epidemic response.

But the deal came at the expense of the Prevention and Public Health Fund, which is set to lose approximately $1.35 billion over the next 10 years. In the short term, the legislation does resolve an immediate budget cliff, but it slows the growth in funding in later years.

Advocates and experts say the fund—which was established in the Affordable Care Act and has been branded as a “slush fund” by Republicans—now supplants resources that have been cut from the Centers for Disease Control and Prevention. The money pot makes up 12 percent of CDC’s budget and provides most of the funding for the agency’s immunization program, according to the National Association of County and City Health Officials.

But lawmakers have historically turned to the fund as an offset for other initiatives. This latest cut also comes as the CDC is trying to handle turmoil at the top following former director Brenda Fitzgerald’s resignation last month.

“The Prevention and Public Health Fund has been used to support core public health funding, and it continues to get raided to pay for health care, whether that is the Children’s Health Insurance Program, whether that has been community-health-centers extension funding,” said Laura Hanen, interim executive director of the National Association of County and City Health Officials. “Again, it’s robbing Peter to pay Paul. You’re robbing the prevention side of the house to pay for the care side of the house.”

The immunization program, which uses the largest portion of the fund, supports 50 state health departments’ vaccine purchases for in-need populations, and other operations such as implementing billing systems for immunization services at public health clinics, the NACCHO says.

“When you’re looking at a flu outbreak, you’re going to want to make sure on an annual basis as large of a percentage of the population as possible are immunized. We’re nowhere near where we want to be there,” said Richard Hamburg, executive vice president for strategy and policy at Trust for America’s Health.

The fund also entirely supports a program to address childhood lead-poisoning, assisting states in identifying families with harmful exposure to lead, and a preventive-health block grant, which gives states flexibility to solve specific problems. Ohio, for example, has used this funding to address risks associated with poor nutrition, tobacco use, and chronic disease.

“Some of the growth money that would have gone into public health, of course, has not occurred because those dollars have been used for other things,” said Georges Benjamin, executive director of the American Public Health Association. “There’s an opportunity cost, because the money was supposed to go for innovative things to in effect reduce health care cost through prevention. A lot of that has not happened.”

While Democrats have been critical of Republicans for using the funding stream as an offset, this did not dissuade them from supporting the deal overnight on Thursday.

Sen. Ben Cardin told National Journal Thursday that this was a part of the deal he did not favor. “It’s an important fund, one that we fought very hard for, and it’s so disappointing to see Republican leadership look at that as part of Obamacare that they want to get rid of,” he said.

But he added that ultimately the entire package had to be put “on the scale” to “determine whether the collective product should be supported or not.”

Sen. Sherrod Brown described the cut as one of the “losses” during the budget negotiations. “We got a lot of good things; we lost on some things,” Brown said when asked whether the trade-off between the cut and the extension for community health centers was worth it.

Advocates argue that both the prevention fund and other services like community health centers should be fully funded.

The American Cancer Society Cancer Action Network on Thursday morning praised the investment in cancer research, but criticized Congress’s decision to dip into the fund.

“While this deal addresses a number of critical federal programs that are instrumental in making progress against cancer, ACS CAN is disappointed that the legislation cuts the Prevention and Public Health Fund by $1.35 billion as an offset for spending,” ACS CAN President Chris Hansen said in a statement. “Funding for effective prevention programs is critical to reducing death and suffering from cancer, a disease that continues to kill 1,650 people a day in this country.”

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