Vaccination funding may be cut if Obamacare ends, public health experts warn

Feb. 03--Many worry that up to 1 million Illinois consumers could lose their health insurance if Obamacare is repealed.

But Chicago Department of Public Health leaders aren't just worried about that part of the Affordable Care Act being repealed. They're also concerned about the possible loss of funds used to vaccinate Chicagoans and deal with disease outbreaks.

The Prevention and Public Health Fund created under the health care law has distributed about $12.8 million to the city's Department of Public Health since 2012 for programs to vaccinate thousands of Chicagoans and educate consumers on diseases, among other things.

Statewide, Illinois health departments and organizations got $18.6 million last year, according to the Association of State and Territorial Health Officials.

"It really allowed public health systems throughout this nation to be stronger," said Dr. Julie Morita, Chicago public health commissioner. "It's a critical piece of the Affordable Care Act that really needs to be sustained."

It's unclear whether congressional Republicans will try to erase the fund as part of a broader effort to repeal and replace the Affordable Care Act -- but they've already tried to get rid of it multiple times in the past, said Jeffrey Levi, a professor of health policy and management at George Washington University. Levi said the fund "clearly is at risk."

Representatives of House Speaker Paul Ryan and the U.S. Department of Health and Human Services did not immediately respond to requests for comment Thursday.

Chicago health leaders are watching the issue closely. In recent instances, the city used the funds to:

--Deal with an outbreak of bacterial meningitis in 2015 and 2016. The department partnered with other agencies to vaccinate 20,000 at-risk Chicagoans, Morita said.

--Undertake a media campaign in 2013 and 2014 to encourage use of a vaccine that protects against the human papillomavirus, which currently infects about one out of every four people in the U.S. and can lead to cancer, according to the federal Centers for Disease Control and Prevention. The city department spread the message through radio ads, posters and billboards, and worked with doctors. In 2013, only about 50 percent of the city's teenage girls had gotten the first dose of the vaccine. In 2014, after the campaign began, that figure rose to 80 percent, Morita said.

--Improve its system for identifying foodborne outbreaks of disease, such as at a restaurant or event, "so fewer people go on to get sick," Morita said. In 2015, the department identified and responded to 16 such outbreaks -- nearly triple its typical annual amount, she said.

"We've made huge strides, but there's still more work that needs to be done," Morita said.

It's not just a Chicago or Illinois issue.

Last fiscal year alone, the entire fund totaled $932 million -- more than 10 percent of the CDC's budget. Most of that money went to state and local health departments and organizations, Levi said.

"It would be a huge problem, ranging city-by-city and community-by-community," said Chrissie Juliano, director of the Big Cities Health Coalition, which includes as members officials from 28 city health departments across the U.S. "In a field that does not get a lot of money and has seen continual cuts, losing these dollars really makes it hard for them to do their jobs, which is keeping communities healthy and safe."

Levi also noted that a loss of the money might hit poor people especially hard. Public health departments can sometimes be a "provider of last resort" for people who don't have insurance or money for things like vaccines.

"The last time I looked, Chicago didn't exactly have a lot of extra cash floating around to close those gaps," Levi said. "When you're losing literally millions of dollars toward a program, it's going to be very hard for local revenues to close that gap."

lschencker@chicagotribune.com

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