Va. could lose $20 million in public health funds with ACA repeal

“In the zest to repeal ACA, we uncovered, with a lot of our colleagues from around the country, that there were programs subsumed into the ACA that actually existed well back to the Reagan administration that supported this public health infrastructure,” Virginia’s Health Commissioner Dr. Marissa J. Levine told the House Appropriations Health and Human Resources subcommittee during a presentation recently.

“And if not careful,” she continued, “and all of the repeal goes forward, we could pretty rapidly lose about $27 million like that. That means about 133 of our people, mostly in our local health departments, could go away overnight.”

Jeff Ryer, press secretary for the Virginia Senate Republican Caucus, was skeptical of the idea that the federal government would strip Virginia of such a large chunk of public health funds.

“I seriously doubt that Congress is going to eliminate funding that was available prior to the passage of the act simply because the byzantine structure of the act grabbed that funding,” he said.

Levine said in an interview that the amount the state could lose is a “moving target” and is probably in the $20 million range. That is not an annual figure, she said, because some of the grants the department receives — largely from the Centers for Disease Control and Prevention — are multiyear funds.

She said the figure also could change depending on what an ACA replacement plan entails, the nature of which is up in the air as federal lawmakers continue to debate what the future of health care should look like.

There is little hope of Virginia picking up the slack should federal funding disappear, Levine added, considering the state’s current budget shortfall.

“I don’t think there are available funds to replace this, which is why we certainly want our federal legislators to be careful in how they move forward,” said Levine, who was appointed to her position in 2014 by Gov. Terry McAuliffe, a Democrat.

She declined to comment on what the Department of Health would do — or which programs it would prioritize — should an ACA replacement fail to protect the public health funds.

When asked about the possibility of losing a chunk of public health funds, Brian Coy, spokesman for McAuliffe’s office, said the governor predicts that, across the state government, Virginia is poised to lose $200 million should a repeal take place without a proper replacement plan.

Del. John M. O’Bannon III, R-Henrico, said the issue with public health funds involved in the ACA is an example of what’s missing in the discussion over the health law: What will replace it after a repeal takes place.

“I feel very strongly that we need to support public health,” he said. “I’m optimistic and hopeful that what comes from Washington will give us the resources we need and the flexibility that’s been missing to make health care better for Virginians.”

O’Bannon is supporting public health legislation this session, largely through a bill that passed the House on Friday and would allow the Department of Health to set up syringe services programs in parts of the state where the opioid epidemic is strongest so as to prevent injection needle users from contracting and spreading hepatitis C and HIV.

When the ACA was enacted, it created the Prevention and Public Health Fund, which was meant to expand and sustain national investments to improve health outcomes, according to the U.S. Department of Health and Human Services website.

The fund absorbed core public health programs such as immunizations and vaccines for children, tobacco cessation and funds for rural hospitals.

“We also have something called the Epidemiology and Laboratory Capacity for Infectious Diseases grant, which is really critical for supporting the people who work on all those infectious diseases — to control and investigate things related to newborn disease, for example, or health care-associated infections, and vaccine-preventable disease,” Levine said. “It’s the work you don’t hear about because it happens behind the scenes.”

That program was founded in 1995 and was absorbed into the Prevention and Public Health Fund.

Through the epidemiology program, Virginia received just under $100,000 to fight Zika in 2017. Zika is a mosquito-borne virus that can cause birth defects in children should pregnant women become infected.

Other public health programs came into existence because of the ACA, such as Virginia’s home visiting programs and its community health improvement work.

Chas Roades, chief research officer with Advisory Board, a Washington, D.C.-based think tank, said the Prevention and Public Health Fund may get caught up in a broader ACA repeal because it not only absorbed old funding streams but also created new ones, and so could be cut as part of an effort to reduce federal spending.

“But it’s really important,” he said. “People don’t often think of the public health aspects of the Affordable Care Act, but the public health infrastructure in Virginia is a really important part of the broader effort to make sure that Virginians have access to good, quality health care and that we’re improving the health of Virginians.”

In 2016, the Department of Health received just under $10 million from the CDC through the Prevention and Public Health Fund, according to the U.S. Department of Health and Human Resources website.

That money included $2.6 million for a heart disease and stroke prevention program; $3 million to decrease premature deaths and to eliminate health disparities; and $1 million for immunization grants for children.

“We obviously have a huge issue with the burden of chronic disease on the population,” Levine said. “If we don’t do a better job to make sure all our children have a strong start, we’re just going to add to that burden.”

In total, the fund distributed $913 million to fuel numerous public health programs across the country last year.

The home visiting program allows health officials to visit parents and make sure they have the education and services they need.

“For many families, it’s been demonstrated that if you can intervene early with a professional, usually a nurse, then you can significantly improve the health outcomes of the child,” Levine said. “So it’s quite a good investment, in fact.”

She urged lawmakers to consider health whenever creating new policies, because all policy decisions in some way affect health.

“I really think it’s just about making good policy decisions and understanding the health impacts before final decisions are made,” she said. “We certainly encourage folks to ask the question for any policy decision: What impact will this have on health?”