One of ACA’s most farsighted features was to set up a dedicated pot of money, the Public Health and Prevention Fund, to invest in proven prevention measures across the country. The idea is rooted in a rather old-school strain of, well, conservatism—remember that old notion about an ounce of prevention being worth a pound of cure? (Of course, that aphorism was coined by Benjamin Franklin, who believed in the scientific method and the germ theory of disease, advocated for public investment in sanitation, and served as the first postmaster of the government-funded postal service.)
Yet the prevention fund, which supports the most sensible kind of investment a nation can make in its own health, sits firmly in Republican crosshairs.
Here’s the background: One of the big, hairy failings of U.S. healthcare can be summed in a few simple numbers: At an annual cost of $2.7 trillion, our health system is the most expensive in the world, and one of the least effective. About 40 percent of premature deaths are linked to smoking, poor diet, lack of physical activity and other unhealthy behavior, according to research from the Institute of Medicine. Seven of ten deaths among Americans are caused by chronic, often preventable conditions such as heart disease, stroke, diabetes, avoidable injuries and some kinds of cancer, according to the Centers for Disease Control and Prevention (CDC). These account for roughly three-fourths of the national healthcare tab.
A poll by the Gallup organization released in July showed that 81 percent of Americans thought obesity in the U.S. was an extremely or very serious problem and that 67 percent thought the same about smoking. Solid majorities also thought the government should do something about these two issues, with at least 55 percent saying it was extremely or very important to have “federal government programs that address health risks associated with” each.
Mitt Romney, as the candidates like to say, has a different view. He says the availability of emergency rooms proves that that the healthcare system works just fine without universal health insurance and prevention efforts, thank you very much. Fortunately, Obama and Congressional Democrats understood that a medical model focused on treating people after they are sick or injured leaves people unhealthy and leaves spending in the stratosphere. They realized that in addition to covering the millions of Americans who lack medical insurance, one of the best ways to improve health and reduce unnecessary spending is to make prevention and preventive services widely available.
So the Affordable Care Act set aside $15 billion over 10 years to support prevention and preventive services through the Prevention and Public Health Fund—the largest commitment ever made by the U.S. government to prevent illness and injury before it occurs and keep people healthy in the first place.
Attacks on the prevention fund began almost as soon as it was passed. Some Republicans called it a “slush fund,” tried to kill it entirely and then to reduce its funding. Early this year, the fund was slashed to maintain unemployment benefits and avoid cutting pay to doctors in the Medicare program (the so-called “doc fix”).
Despite the hostility, in 2011, the CDC awarded nearly $300 million in Community Transformation Grants to states, cities and tribes across the country to create safe, walkable streets, promote healthy food environments, support worksite wellness, help children get after-school exercise and reduce people’s exposure to tobacco. One grant went to Oklahoma City, where Republican Mayor Mick Cornett has used the money to boost his efforts to make the city a healthier place.
In 2007, Oklahoma City was dubbed one of the fattest cities in America by Men’s Fitness magazine. Cornett responded to the challenge by creating bicycle lanes and walking paths. He also led by example. He started exercising, went on a diet himself and launched a website, www.thiscityisgoingonadiet.com, to encourage residents to exercise and eat healthy. The $700,000 CDC grant helped support these efforts, by, for example, funding health workers to work with people in the city’s least healthy zip code to help them eat healthier and exercise. This multipronged approach has paid off. The mayor shed almost 40 pounds, city residents lost one million pounds, according to the mayor, and the city moved onto Men’s Fitness 2012 list of the fittest cities in the U.S.
The effort used federal and local funds to improve the physical environment and also appealed to people’s sense of individual and collective responsibility. “We don’t believe in individual freedom to the extent of letting people make poor health decisions and just wither away without help,” Cornett told Sabrina Tavernise of the New York Times.
Federal support for these efforts is now in peril. Further attempts to repeal, weaken or raid the prevention fund are likely to emerge after the November election as the lame-duck Congress grapples with ways of averting the “fiscal cliff” coming at the beginning of January. That’s when automatic spending cuts amounting to $110 billion a year will be imposed under the provisions of a short-term budget deal reached last year between Obama and Congressional Republicans—a deal that was needed to keep the U.S. from going into default.
If Congress doesn’t come up with its own plan to avert the cuts, defense and non-defense funding will be slashed across the board. Healthcare research and prevention services will be cut by $3.6 billion next year alone, according to Research America. That includes a $2.4 billion cut to the National Institutes of Health and a $445 million cut to the Centers for Disease Control and Prevention. The Public Health and Prevention Fund would lose $76 million.
That’s what happens if no deal is struck. Even more draconian cuts to health and prevention funding have been proposed to help avoid the automatic reductions. Republicans may push again for the entire prevention fund to be eliminated.
So here’s the bottom line: If the president is reelected, Obamacare will survive but the threats to health reform and the prevention fund won’t go away. Instead of an outright repeal, they could suffer death by a thousand cuts. That would be a tragic mistake and a huge missed opportunity.
Rob Waters is chief communications officer of the Prevention Institute. The opinions expressed in this column are his own and don’t necessarily reflect the views of the Institute or of Forbes.
