The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.
But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.
This part of the law, which benefits every American, helps to keep all healthy and safe; it will essentially be undone with the repeal of the ACA. If there is no comparable replacement, communities across the nation are poised to lose $3 billion in federal funds over the next five years through a mechanism called the Prevention and Public Health Fund, which is currently a component of the ACA.
The Prevention and Public Health Fund was designed as an important, complementary component to the promise of insurance coverage for most Americans. It was meant to help us prevent disease instead of just treating it when it strikes, and to address many of the other factors that make us ill and cause our health care costs to keep rising.
Researchers have found that our ZIP code is actually a greater predictor of our health than our genetic code. Strategies supported by the fund are aimed at addressing our nation’s sky-high rate of chronic disease, in particular diabetes, obesity, cancer, asthma, and heart disease. These health problems now touch almost every family in every community.
The resources that flow from the ACA are now being used to backfill funding cuts to support core public health programs by funding a large portion of the Centers for Disease Control and Prevention (CDC), the part of the federal government that works 24/7 to protect America from health, safety and security threats. It is responsible for ensuring access to vaccines to protect against flu and other diseases; supporting local and state first responders in mitigating the effects of outbreaks like Zika or Ebola; and preparing for and responding to natural disasters like hurricanes and earthquakes. The CDC works to protect every American, every single day. Without the funding provided by the Affordable Care Act, its reach will be dramatically reduced.
What would eliminating this funding mean for everyday Americans and their families? Perhaps the most damage would be done to the nation’s largest vaccine program, which would shrink by a whopping 53 percent. Immunizations continue to be one of the most cost-effective public health interventions. Over the past 20 years, childhood immunization has prevented 322 million illnesses, 732,000 deaths, and nearly $1.4 trillion in societal costs.
Another key capability that would suffer is our ability to identify, track and respond to disease outbreaks. Public health threats like Zika and foodborne illnesses like salmonella can only be addressed if experts have the resources they need to identify where the threats began, where they will travel next and how to stop them in their tracks. About one-third of disease tracking is supported by the fund and its loss would severely hamper efforts to combat and contain these threats.
Another part of the public health network that would be diminished is our ability to prevent and identify lead poisoning in our children, a function largely financed by the fund. Recently, America witnessed the often-permanent damage that lead can cause in the brains and bodies of our kids, when the tragedy in Flint, Mich., unfolded.
Lead poisoning can lead to difficulties in school and social development and affect the probability of being involved in the criminal justice system. Each dollar invested in lead poisoning prevention yields a return on investment of $17.
The economic impact of the fund goes far beyond its ability to fight disease, however. If these dollars are eliminated, states will immediately lose billions in funding for core public health programs. In Minnesota, losing the fund would cut more than $80 million over the next five years and eliminate an estimated 451 jobs.
Every American has the right to be safe and healthy, and to know that their government is protecting them from the dangers of terrorist attacks, disease outbreaks, and natural disasters. Every child should be able to attend school with the vaccinations they need so that their parents need not be concerned about them contracting a life-threatening disease. The repeal of the ACA would create a serious threat to our nation’s health system and to the 20 million Americans who rely on its insurance exchanges.
But perhaps more troubling, repealing the Prevention and Public Health Fund without a clear plan for replacement goes beyond canceling coverage to potentially undermining the entirety of our public health system. The consequences will damage not only the health of our nation, but our economy as well.
Gretchen Musicant is city health commissioner in Minneapolis, chair of the Big Cities Health Coalition, and a National Association of City and County Health Officials board member.