For the nation’s public health agency, Obamacare repeal means a big funding cut, although it was never supposed to be that way.
Time and time again over the last few years, Congress dipped into a special public health fund set up under the Affordable Care Act to patch over cuts to the Centers for Disease Control and Prevention, instead of using the account for new projects as intended.
The CDC has become so reliant on the healthcare law’s Prevention and Public Health Fund that the agency now uses the fund to finance 12 percent of its programs. That money could be erased if Republicans follow through on their promises to repeal much of the law.
Rep. Nita Lowey, the top Democrat on the House Appropriations Committee, said killing the prevention fund would “blow a massive hole” in the CDC’s budget.
“It would mean less research, worse health outcomes and more death and suffering from preventable disease,” Lowey said. “It is just one of many terrible consequences that would result from this unconscionable idea.”
The prevention fund comprises just a small piece of the sweeping health reform law, providing about $1 billion a year of mandatory funding, compared to hundreds of billions of dollars spent on insurance subsidies and Medicaid.
But it’s a reliable chunk of change for congressional appropriators, under pressure to provide more funding to the CDC even amid sequestration cuts and spending caps. Every year since 2011, Congress has transferred between $600 million-$900 million out of the prevention fund to the CDC to soften the blow of cuts.
“At a practical level, money is fungible. Green is green,” said Emily Holubowich, executive director at the Coalition for Health Funding.
The healthcare law set up few perimeters for how the money must be used, specifying only that it’s for “prevention, wellness and public health activities, including prevention research, health screenings and initiatives and immunization programs.”
Lawmakers haven’t just dipped into the fund to help out the CDC. They also used it in 2015 to help fund a long-term fix to a faulty Medicare formula for paying doctors, and again late last year to help pay for a medical cures bill.
Before that, Congress used it to help keep doctor payments stable, and the Center for Medicare and Medicaid Services used it to help build the federal healthcare.gov insurance marketplace.
Some Democrats have long been frustrated by the seemingly cavalier use of the fund for other purposes. Former Sen. Tom Harkin of Iowa once put a hold on the confirmation of Marilyn Tavenner as CMS administrator to register his disapproval.
“It’s not really been utilized for the intent it was meant for,” said Jeff Todd, chief operating officer at Prevent Blindness.
It’s not clear exactly what parts of the Affordable Care Act Republicans will repeal. But if the bill they passed last year to repeal Obamacare — which was vetoed by former President Barack Obama — is any clue, the prevention fund would be eliminated, requiring CDC officials to make hard decisions about where to trim.
The issue has mostly flown under the radar as congressional Republicans have focused on figuring out what to do with the biggest pieces of the law, such as its subsidies and Medicaid expansion.
But healthcare advocates say they’re ramping up their lobbying game over the next few weeks, as newly confirmed Health and Human Services Secretary Tom Price sets up shop and helps guide the direction of the repeal-and-replace effort.
“I think Republicans would probably be fine getting rid of it, but it’s making sure they understand that is 12 percent of CDC’s programmatic budget right now,” said Jeremy Scott, a lobbyist at Drinker Biddle and Reath’s District Policy Group.
Advocates for illnesses that receive smaller portions of CDC funding are fearful they will be cut first if the prevention fund goes by the wayside. For example, about $13 million goes to efforts aimed at ovarian cancer, said Chad Ramsey, who oversees public policy for the Ovarian Cancer Research Fund Alliance.
“We think it’s incredibly important, but it’s the smaller programs like this that could face the chopping block,” Ramsey said.
A tiny amount of CDC funding, about $3 million, is focused on vision problems, Jeff Todd said.
“If this prevention fund should go away, it could very easily result in the complete elimination of funding for vision problems altogether at the CDC,” Todd said.
Health advocates are realistic that if Congress votes on repealing the healthcare law, it’s unlikely to preserve the prevention fund, even though it costs even less money than when it was set up. While it was supposed to receive $2 billion every year starting in 2015, it has only been funded at $1 billion annually since Congress pulled back on future funding to pay for other pieces of legislation — a common funding gimmick.
Holubowich said she wouldn’t be surprised if the prevention fund gets scrapped. “We have no reason to believe it won’t be,” she said.
