April 14, 2011 Liz Borkowski, MPH 6Comment

At her Washington Post blog 2chambers, Felicia Sonmez reports that the House has passed legislation repealing the section of the Affordable Care Act that created the Prevention and Public Health Fund, which gives the Department of Health and Human Services $15 billion over the next 10 years to fund prevention and public health.

The Republican complaint? Sonmez reports, “Republicans have criticized the account as a “slush fund” that gives Health and Human Services Secretary Kathleen Sebelius wide latitude in administering federal money without congressional oversight.” This is an odd critique. Having Congress oversee how every federal dollar is spent would be a poor use of their time, and not at all feasible. Instead, Congress passes legislation telling agencies what the priorities are for spending money, and the agencies set specific criteria and wade through all the grant applications that come in.

Maybe the House Republicans are upset about how Sebelius has decided to dole out the money? I did a quick search at the HHS website for “Prevention and Public Health Fund” and found the following:

June 18, 2010:

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced $250 million in new Affordable Care Act investments to support prevention activities and develop the nation’s public health infrastructure.

…The $250 million investment in prevention and public health will go to:

  • Community and Clinical Prevention: $126 million will support federal, state and community prevention initiatives; the integration of primary care services into publicly funded community-based behavioral health settings; obesity prevention and fitness; and tobacco cessation.
  • Public Health Infrastructure: $70 million will support state, local, and tribal public health infrastructure and build state and local capacity to prevent, detect, and respond to infectious disease outbreaks.
  • Research and Tracking: $31 million for data collection and analysis; to strengthen CDC’s Community Guide by supporting the Task Force on Community Preventive Services; and to improve transparency and public involvement in the Clinical Preventive Services Task Force.
  • Public Health Training: $23 million to expand CDC’s public health workforce programs and public health training centers.

September 27, 2010:

HHS Secretary Kathleen Sebelius has announced $320 million in grants under the Affordable Care Act (ACA) to strengthen the health care workforce. Of those grants, $253 million will go to improve and expand the primary care workforce under the Prevention and Public Health Fund of the Affordable Care Act.

… The $253 million in Prevention and Public Health Fund grants are awarded under six health professions programs administered by HHS’ Health Resources and Services Administration (HRSA). The programs are designed to build the primary care workforce and provide community-based prevention. States will receive funding to support comprehensive workforce planning and implementation strategies that best address local current and projected workforce shortages.

“These grants are the most comprehensive yet in addressing our nation’s shortage of key health professionals,” said Mary K. Wakefield, Ph.D., R.N., administrator of HRSA. “They will provide much-needed support for increasing primary care capacity by expanding training programs for primary care providers, increasing access to patient care clinics, strengthening state-level workforce planning and providing training for personal home health care aides. All are vital to our future healthcare workforce.”

February 9, 2011:

Department of Health and Human Services Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law.

… This year, building on the initial investment, new funds are dedicated to expanding on four critical priorities:

  • Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer.
  • Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law. They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings.
  • Public Health Infrastructure ($137 million): These funds will help state and local health departments meet 21st century challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats.
  • Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges.

HHS has now posted online descriptions of how Fund money is being spent in each state. As an example, DC’s federally-funded community and clinical prevention initiatives include the following:

  • Primary and Behavioral Health Integration ($3,596,000). Assists communities with the integration of primary care services into community-based mental & behavioral health settings.
  • HIV Prevention ($1,276,000). Focuses on HIV prevention in high risk populations and communities by increasing HIV testing opportunities, linking HIV-infected persons with appropriate services, and filling critical gaps in data and understanding of the HIV epidemic.
  • Tobacco Cessation ($53,000). Strengthens Washington, D.C.’s ability to move towards implementing a plan to reduce tobacco use. It also enhances and expands the national network of tobacco cessation quitlines to significantly increase the number of tobacco users who quit each year.

These all sound like worthwhile initiatives to me, so I was glad to see Sonmez reporting that the legislation repealing the Prevention and Public Health Fund is unlikely to pass the Senate and will be vetoed by President Obama if it does.

In the meantime, maybe the 236 House members (including four Democrats) who voted for this bill could stand to learn a little more about the importance of investing in public health.

6 thoughts on “House Votes to Scrap Prevention & Public Health Fund

  1. HIV prevention is taught in churches for FREE. It’s called wait till you get married to have sex. That saves us alot of money.

    Everything list on the list is crap too. Prevention is important but most people already know about diabetes/obesity/heart disease/ cancer prevention.

    Furthermore, i hope the Republicans defund Obamacare into oblivion. It may be the law, but who say it;s the law to fund it? It should have been voted on by the public, not a bunch of whiny arrogant pricks in washington.

  2. Ok, DIMS- I get it, Poe. Otherwise, I’d like to ask you about Dengue Infections, or tracking the spread of the NDM resistance gene. Quick, no googling please. So everyone knows about diseases, eh?

  3. @1: Prevention is usually cheaper than cure. E.g. $174 billion: Total costs of diagnosed diabetes in the United States in 2007 (www.diabetes.org).

    You could even argue that Christianity spreads AIDS as a consequence of its teachings (http://www.martinrothonline.com/MRCC11.htm)

    Why would I go to a church for information? I fail to see how the opinions of bronze-age desert dwellers stands up to the edifice of modern science.

  4. My church teaches to care for the least of our brothers and sisters. To me that means ensuring that pregnant women receive prenatal care, children receive vaccinations, communities provide safe drinking water, sanitation services and control toxic emissions, and the elderly receive assistant with transportation and activities of daily living to help avert injuries. All of these and more are parts of public health prevention and are integral to my idea of a civil and just society.

  5. Doctor IM Smart, the point of public health is to address the world we live in, where not everyone has the knowledge, resources, self-control, or genetic luck to avoid the conditions you name. Public health also addresses the control of viruses, bacteria, and parasites that spread freely through the environment. If you don’t think those are worthwhile aims, then we’ve got a fundamental disagreement.

    The overwhelming popularity of Medicare and Social suggest that people in this country really don’t want to fend for entirely for themselves, especially during a stage in life where they’re likely to be vulnerable.

  6. I’m deleting the comments that are irrelevant to the post and seem to be about people’s own personal hobby horses.

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