The Senate's passage of the 21st Century Cures Act Wednesday reflects a mixed bag for public health advocates.
Much of the focus around the bill revolved around whether the quicker regulatory approval process of new drugs and medical devices would come at the expense of patient safety. Provisions added on the final version of the Cures Act provide much-needed resources for behavioral health and drug-abuse treatment, and were seen as a major win by advocates.
The bill provides $1 billion in funding over two years to address the opioid crisis, and it creates the new position of assistant secretary for mental health. The bill also reauthorizes funding for a number of mental health and suicide prevention programs.
But the wins come at the expense of funding for public health prevention programs. The bill cuts $3.5 billion over 10 years from President Barack Obama's Prevention and Public Health Fund, which was established under the Affordable Care Act and sets aside money for prevention programs that help battle Alzheimer's disease, smoking, lead poisoning, heart disease, diabetes, stroke and falls among elderly adults.
The fund also serves as a resource for programs that promote breastfeeding, enable self-management among those living with chronic disease, improve tracking of hospital-acquired infections, address racial health disparities and increase immunization.
"Obviously, we weren't against the bill itself we were against the prevention dollars being used as a pay-for,” said Dr. Georges Benjamin, executive director for the American Public Health Association. “It fundamentally means that we will not have the growth in dollars for prevention that we thought that we were going to have--a lot of the more innovative things that we had hoped to do that really went to offsetting the leading causes of death aren't going to be there.”
The program has been the target of cuts by lawmakers in the past. In 2012, Congress cut the prevention fund by more than $6 billion over nine years to avoid Medicare physician payment reductions.
“Time and again, research shows that the vast majority of these chronic diseases can be prevented by investing in addressing the root causes. Yet, the country has repeatedly failed to do so,” said Rich Hamburg, interim president and CEO of Trust for America's Health, in a statement. “The nation cannot afford to trade away our single best investment in preventing disease, preparing for and responding to infectious disease outbreaks, reducing rates of chronic illness, and saving lives and money.”
More than $930 million was distributed to programs under the ACA's prevention fund in 2016, most of which are run by the Centers for Disease Control and Prevention. More than 12% of the CDC's total budget for 2016 comes from the fund, which also provided $160 million to support a block-grant program to increase preparedness for public health emergencies.
Mary Woolley, president of CEO of Research America, said in a written statement Wednesday that she recognized the Cures Act comes at a loss for such programs, but remained a supporter of the legislation for the public health issues it addresses.
“Regretfully, the Prevention and Public Health Fund will be reduced to offset the costs of the Cures Act, which will inevitably impact efforts to address health threats,” Woolley said. “But we should be reminded that the Cures Act will incorporate the patient voice in the regulatory decision-making process, among other important provisions, and provide resources to help those impacted by mental illness and the opioid epidemic.”
Benjamin said he was excited about the prospect of more funding for mental health and treatment for opioid abuse, but was afraid the neglect of preventive health concerns would prove to be costly in the long term.
“It's always cheaper to prevent these things from happening in the first place,” Benjamin said. “The problems are not going to go away.”
This story was updated at 5:29 p.m.