There has been much discussion of the impact of repealing the Affordable Care Act (ACA) on individual health insurance. The Congressional Budget Office estimates that repealing the ACA could translate to roughly 18 million Americans losing their health insurance. Further, the implications for those receiving insurance through their employer could be broad as well, such as loss of coverage of preventive services (screenings, immunizations, annual check-ups), loss of affordable contraception, and elimination of the pre-existing conditions exclusions.
Additionally, the ACA included legislation that provided money to improve other aspects of public health, and contains provisions for community disease prevention, clinical prevention, public health infrastructure and training, and research and surveillance focused on workforce wellness. A large proportion of these programs have been funded through the Prevention and Public Health Fund (PPHF), which by law, must be used to: “provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health case costs.” The PPHF has funded programs across the spectrum of health, including tobacco use prevention programs, obesity prevention and fitness, access to critical wellness and preventive health services, and public health infrastructure and training, just to name a few.
Funding is provided mainly through the Centers for Disease Control and Prevention (CDC) to state and local agencies, businesses, schools, and other educational institutions, unions, professional health organizations, tribal organizations, and community and faith-based organizations. Program funding decisions are based on population size, burden of disease, and the ability to reduce health disparities and/or achieve positive outcomes. In total, the PPHF spends approximately $890 million annually to support programs that directly support the health of the public.
What does this mean for Pennsylvania? A non-partisan, non-profit organization, Trust for America’s Health, summarized some of the data from the PPHF on a state-by-state basis, to determine what the impact of repealing this part of the ACA would be. The results are astounding. In total over the next five years, the commonwealth could stand to lose more than $111 million in funding, the fifth largest loss in funding across the US. This is a lot of money, but what does it mean in terms of the public’s health?
The major focus of Pa.’s use of the PPHF has been directed towards preventing injuries (including sexual assault and rape prevention) and addressing the issues associated with chronic diseases (e.g. cancer prevention, diabetes, heart disease and stroke). Other areas that have been targeted with PPHF funds include oral health, nutrition and physical activity, osteoporosis, and tuberculosis.
Since heart disease, cancer, unintentional injuries and stroke comprise four of the top five leading causes of death in the U.S., these are wise areas to implement public health programs. However, the funding has further reach – almost a million dollars has been spent on trying to reduce the burden of disease in the highest risk, and typically most underserved, populations through the Racial and Ethnic Approaches to Community Health (REACH) program. The REACH program establishes community-based programs and culturally appropriate interventions serving African Americans, Hispanics/Latinos, Asian Americans, Alaska Natives and Pacific Islanders. In addition, PPHF funding has been used to support breast and cervical cancer screening among underinsured and underserved populations, those who are culturally or geographically isolated, and women of racial, ethnic and/or cultural minorities across the state. Health clinics have provided funding to implement immunization programs, and the state has received extensive funding to improve access to vaccines for its citizens.
In Philadelphia, smoke-free public housing has been implemented and evaluated through funds provided by the PPHF. Breast and cervical cancer screenings for underserved women have been funded through the PPHF. The City Health Department received money to improve the quality of their services, and to help enable them to better meet public health goals. The number of citizens of Philadelphia, and Pa. more broadly, whose health has been improved by the PPHF is uncountable.
The loss of the PPHF would mean going backwards for public health. Women around the state would lose access to preventive care and early interventions for treatable cancers. Children would lose access to vaccinations for deadly diseases that are nearly eradicated. Improvements in health disparities would decline, and the work we as a profession have done to reduce the occurrence of chronic diseases and their risk factors could be erased. Public health professionals would be out of jobs, at a time when they are needed most.
The Affordable Care Act isn’t just about health insurance. It is about the public’s health. Our health. We can’t afford to lose it.
Make your voice heard – tell your representatives that you stand for public health.
Leslie McClure, PhD is Professor & Chair of the Deapartment of Epidemiology and Biostatistics at Drexel University’s Dornsife School of Public Health
Read more about The Public's Health.