02.05.17

By:  Karen Garloch
Source: Charlotte Observer

ACA repeal could cost Mecklenburg and NC millions in health funding

North Carolina public health officials fear a repeal of the Affordable Care Act could mean the loss of about $20 million a year to support programs such as administering vaccines and investigating communicable diseases.

“Losing these funds would be devastating to public health across the county,” said Dr. Marcus Plescia, director of the Mecklenburg County Health Department in Charlotte. “I find it very, very discouraging.”

Nationally, repeal of the ACA could eliminate $3 billion in state and local public health funding over the next five years and cost the U.S. Centers for Disease Control and Prevention nearly $1 billion a year, or about 12 percent of its annual budget, according to the Trust for America’s Health, a Washington-based nonprofit, nonpartisan group focused on disease prevention.

The ACA’s Prevention and Public Health Fund was created to give state and local health departments support for disease prevention programs that operate outside traditional health care settings. A study by the Trust for America’s Health found that every $10 per person per year invested in community programs to increase physical activity, improve nutrition and prevent smoking could save the nation more than $16 billion a year within five years – a return of $5.60 for every $1.

The CDC gets more than $891 million from the fund each year, most of which goes back to states to fund programs targeting obesity, suicide, stroke, diabetes, heart disease, maternal health and even prevention of falls among the elderly. The money also funded the CDC’s “Tips from Former Smokers” ad campaign, which helped an estimated 104,000 Americans kick the smoking habit.

As budget tightening forced cuts in federal and state support for basic public health programs such as child vaccinations, lead poison testing and disease tracking, “dollars were taken from the prevention fund to support this work that is really core to public health,” said Chrissie Juliano, director of the Big Cities Health Coalition, which represents health departments in the nation’s 28 largest cities.

“It was an influx of money to support these programs that had not really been supported in a significant way,” Juliano said.

Now the fund helps pay for infectious disease control and immunization programs, efforts to cut healthcare-acquired infections and other initiatives.

Mecklenburg’s Plescia said loss of the prevention money could inhibit the county’s ability to deal with communicable disease crises such as the 2014 Ebola outbreak in Africa that led to the quarantine of missionaries who returned to Charlotte from Liberia. “We put quite a bit of person-power into the Ebola crisis,” he said.

Also, last summer, Plescia’s department deployed people to reassure the public and eliminate danger at the U.S. National Whitewater Center in Charlotte after a teenage rafter died from a brain-eating amoeba.

“When we’re dealing with diseases that are really high profile, that people are frightened by, it’s very important that we respond quickly so people feel safe and secure,” Plescia said.

Before the ACA, money for public health programs flowed to the states directly from the federal Department of Health and Human Services budget. But when the health reform law was enacted, policymakers decided to “bring together all the pieces of health funding,” said Peg O’Connell, chair of the advocacy committee for the North Carolina Public Health Association.

Because most of the focus has been on other parts of the ACA – online marketplaces, premium subsidies and penalties for not buying – many policymakers don’t even realize that repealing the ACA could also strip public health money from states and counties, O’Connell said.

“It would devastate our public health budget,” O’Connell said. “It could be $85 million over five years” for North Carolina.

O’Connell said the state public health association has written a letter to lawmakers to encourage them not to eliminate this funding. Plescia said Mecklenburg’s health department is preparing a similar letter.

But public health officials are bracing for the worst.

“In meetings that we’ve had with folks on Capitol Hill, the sense that we have gotten is that repeal of the Affordable Care Act will not continue the Prevention in Public Health Fund,” said Peter Kyriacopoulos, senior director of public policy at the Association of Public Health Laboratories.