A new analysis by the Trust for America’s Health (TFAH) found the Centers for Disease Control and Prevention (CDC) would lose 12 percent of its annual budget if the Prevention and Public Health Fund, part of the Affordable Care Act (ACA), were repealed. The study said, “States would end up losing more than $3 billion over the next five years – from grants and programs supported by the Prevention Fund.”
A TFAH report in April 2016, Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts, had already gloomily forewarned, “federal funding for public health has remained at a relatively flat level for years,” noting that, “The budget for the CDC has decreased from a high of $7.07 billion in Fiscal Year 2005 to $6.93 billion in FY 2015. Spending through CDC averaged to only $20.01 per person in FY 2015. And the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $15.14 in Indiana to a high of $50.09 in Alaska.”
Finally, the report said, “The Hospital Preparedness Program (HPP) — which seeks to improve medical surge capacity and enhance community and hospital preparedness for health emergencies — has been cut from a high of $515 million in fiscal year 2004 to just $255 million in FY 2015, a cut of more than 50 percent, including a more than $100 million cut in FY 2014.”
In addition, the report said, “public health emergency preparedness cuts in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding program — which provides support for states and localities to prepare for and respond to all types of disasters — has dropped from a high of $919 million in FY 2005 to $643 million in FY 2015."
At the state and local levels, the problem is even worse, the report found.
TFAH’s latest survey isn’t any rosier.
The group’s report stated that Health Security Funds for Disease Outbreaks, Disasters and Bioterrorism, “With the exception of the one-time-only funding for Ebola and Zika, the core funding for preparedness and response to health emergencies has been cut by more than one-third in the past decade. CDC has responded to more than 750 health emergencies in the past two years. Infectious diseases cost the country more than $120 billion per year, and that cost grows exponentially when major new diseases strike.”
“CDC is the world’s leading public health authority and the front line against major threats to the health and well-being of the American people—such as disease outbreaks, prescription drug misuse and diabetes,” said TFAH President and CEO John Auerbach. “Losing the Prevention Fund would result in diminished support for public health in every state, undermining their ability to fight epidemics and keep people safe. The costs of these vital public health efforts will either be passed along to states or the efforts will be eliminated—resulting in more people becoming sick and higher healthcare costs.”
TFAH said the “$890 million gap in CDC’s annual funding created by eliminating the Prevention Fund could not be filled under current laws without drawingfunds away from other Department of Labor, Education and Health and Human Services programs. Among activities supported directly by the Prevention Fund are grants to states for infectious disease control, resources through the Preventive Health and Health Services Block Grant and other core public health programs which, if cut, would increase illness, injuries and preventable deaths.”
“If the Prevention Fund is eliminated,” TFAH warned, “the impact will be felt at the local, state and federal levels as public health organizations respond to several major health crises that are on the rise."
On February 9, 333 health entities wrote to House and Senate leaders "warn[in] of the dire consequences of repealing the Prevention and Public Health Fund authorized under the Affordable Care Act. Repealing the Prevention Fund without a corresponding increase in the allocation for the Labor-Health and Human Services-Education appropriations bill would leave a funding gap for essential public health programs, and could also foretell deep cuts for other critical programs funded in the bill."
"Today, more than 12 percent of the CDC’s budget is supplied through Prevention Fund investments," the signatories. This includes core public health programs that
provide essential funds to help states keep communities healthy and safe, such as the 317 immunization program, epidemiology and laboratory capacity grants, the entire Preventive Health and Health Services (Prevent) Block Grant program … chronic disease prevention and other critically important programs."
TFAH’s new survey comes on the heels of Homeland Security Today’s report, Cuts in Federal, Public Health Reduces Capabilities to Address Mass Casualty Events, on the group’s April 2016 report which found combined federal, state and local public health spending has fallen below pre-recession levels at $75.4 billion in 2013 — or $239 per person ($218 adjusted for inflation) compared to $241 per person in 2009. Adjusting for inflation, TFAH said, “public health spending was 10 percent lower in 2013 than in 2009."
These federal, state and local public health preparedness funding shortfalls – and potential further cuts in funding such as at CDC – come at a time when Western counterterrorism and intelligence officials worry about the increasing potential for an Islamist jihadist group or inspired individual to carry out a chemical, biological or radiological mass casualty attack in the United States.