Healthcare Policy Expert, Robin Scott, is a contributing blogger for Protestants for the Common Good.
America spends more on health than other nations – almost $2.5 trillion in 2009 – and yet scores less than other wealthy nations on life expectancy, infant mortality and other indicators of population health. The bulk of U.S. health expenditures (75 percent) are spent treating chronic diseases, many of which are preventable. (Chronic diseases include obesity, diabetes, high-blood pressure, heart disease, and cancer.) A mere fraction of U.S. health expenditures (3.1 percent) is spent on prevention. An Institute of Medicine report released in 2012 concluded that the federal government’s public health investment ($11.6 billion in 2009) should be doubled to begin to fund public health efforts at a level that would address current needs.
The Affordable Care Act makes public health and the prevention of chronic disease a United States priority for the first time by establishing mandatory funding for the Prevention and Public Health Fund. Fifteen billion dollars over 10 years was set aside for the Fund. The Fund already has provided $1.25 billion for prevention and public health activities: $500 million in FY 2010 and $750 million in FY 2011. Another $1 billion has been allocated in FY 2012 and is in the process of being distributed.
The Fund is anticipated to be used for programs at the local, state, and federal level. Illinois has been awarded more than $31 million in Prevention Fund grants. Funding is intended for community prevention, clinical prevention, public health workforce and infrastructure, and research and tracking. Community prevention includes tobacco prevention and obesity prevention and fitness. Public health workforce and infrastructure includes supporting training of public health providers.
The Prevention and Public Health Fund is intended to supplement not supplant existing federal commitments for public health and prevention. However, the Affordable Care Act allows Congress to use money from the fund to spend on existing prevention or health promotion programs that met the goals of improving health and restraining growth in costs. Also, Congress can still pass laws to reduce the amount of money allocated to the Fund. Congress can even amend the Affordable Care Act to eliminate the Fund. Funding of the Prevention and Public Health Fund has already been cut by $6.25 billion over nine years to help postpone a cut in Medicare physician payments.
The Fund remains at risk. Earlier this year, Congress passed the Sequestration Act which would make across-the-board cuts in defense and nondefense discretionary programs in January 2013 if a deficit reduction plan was not passed and signed into law. So far, a deficit reduction plan has not been enacted. According to an OMB report released mid –September critical programs that protect the public’s health face an 8.2 percent cut. (The Prevention and Public Health Fund would be subject to cuts of 7.6 percent.)
Some useful websites for more information: