State could lose $80M in public health funds under AHCA

March 13--Minnesota stands to lose $80 million in public health funding over the next five years under the new congressional GOP health care bill, a fact obscured in the larger debate that the measure has sparked over private insurance coverage and government health care programs for the poor.

The American Health Care Act, which passed two U.S. House committees since its introduction last Monday, would cut $1 billion annually from the nation's public health system, money that is the core source of funding for childhood immunization programs, lead poisoning prevention and infectious disease monitoring.

"This would be a huge hit for us at the state level," said Minnesota Health Commissioner Dr. Ed Ehlinger. "This would be just one further stress on an already weakened system."

Other programs that would be affected in Minnesota, which gets an average of $15 million each year under the program, include diabetes, obesity and heart disease prevention, nutrition and physical education, tobacco cessation and refugee disease surveillance.

The effects would be felt throughout public health agencies, starting at the federal Centers for Disease Control and Prevention (CDC), the country's lead agency for prevention and outbreak control. The agency gets 12 percent of its budget, about $1 billion, from the Prevention and Public Health Fund, the program authorized under the Affordable Care Act (ACA) in 2010 that is now slated for elimination.

That money is distributed throughout the system, including local public health agencies, which in Minnesota are operated by counties and some of the larger cities in the metro area.

"This funding is like bread and butter," said Minneapolis Health Commissioner Gretchen Musicant. "This is for basic protective activities of public health."

Ehlinger, who met with congressional and federal officials last week, said the importance of public health funding has gotten lost in the efforts to remake federal health policy, especially the push to repeal the health insurance mandate and the replacement of health insurance premium subsidies with tax credits.

As part of a delegation of public health officials, Ehlinger stressed that the federal government had funded many of these public health activities long before the ACA took effect and that the cuts would undermine a system that relies on federal, state and local agencies that work closely together.

Ehlinger said that U.S. Health and Human Services Secretary Tom Price told the delegation that he would work to mitigate at least some of the cuts.

"He didn't say that there wouldn't be any losses," said Ehlinger. "I think he recognizes that there are public health issues here."

This comes at a time when the Trump administration has signaled that it will seek cuts in domestic programs, partly to pay for a buildup in military spending. Some in public health are worried that the CDC could take another hit on top of the loss of the prevention fund.

"Public health is fighting for a piece of that shrinking pie," said Brian Awsumb, budget director at the Minnesota Department of Health. "Every corner of the state would have something to lose if the prevention fund were eliminated."

One core program likely to be affected offers free vaccines for low-income families and children. The prevention fund pays for nearly half the cost of the nation's immunization assistance programs. Local health agencies also use the funds to educate the public, including immigrant communities, about the disease protection that vaccines provide.

"Our immunization rates were lower in some communities; we specifically targeted some money to see how can we increase those rates," said Anne Barry, St. Paul-Ramsey Public Health director.

Minneapolis has a $1.5 million grant from the prevention fund that uses community health workers to help residents in public housing manage chronic conditions. Community pharmacists also help them manage medications safely and effectively. It also receives money for a program that targets high-risk people to help them avoid becoming diabetic, among other things.

Loss of the funds would mean that some healthy living efforts and staff would need to be cut in half, Musicant said.

State officials said the state's ability to respond to outbreaks, including infectious diseases like the Zika virus, would be diminished. Food-borne illness investigations would also be affected.

That, in turn, would affect local health departments because they rely on the state, with its nationally recognized laboratory, for expertise.

"It is not like we are stand-alone systems," said Bloomington public health administrator Bonnie Paulsen. "We are basically intertwined to make sure that we do cover and keep people healthy."

Public health administrators also predicted that the loss of prevention money will end up costing the health care system more due to rising disease rates, particularly the growing problem of chronic diseases.

"If we don't have the prevention fund there's going to be bigger costs down the road for any number of things," said Susan Palchick, Hennepin County Public Health director.

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