Public health funding slashed in Senate's proposed ACA repeal bill

Senate Republicans' bill to repeal and replace the Affordable Care Act deals a heavy blow to public health efforts by eliminating key funding created by the landmark healthcare reform bill.

The Better Care Reconciliation Act revealed Thursday proposed eliminating the ACA's Prevention and Public Health Fund in 2018, which makes up 12%, or nearly $900 million, of the Centers for Disease Control and Prevention's budget.

"If the Better Care Reconciliation Act becomes law, the American people will be sicker and poorer," said John Auerbach, president and CEO of Trust for America's Health, in a statement. "We will likely see more overdoses and untreated STDs, rises in infant mortality and increases in innumerable other preventable health issues, all of which add up to ever-increasing healthcare costs."

State and local health departments receive more than $620 million a year from the fund to support various programs, including infectious disease outbreak responses, chronic disease prevention and management, and emergency preparedness efforts.

Under the bill, states could apply for waivers that would allow them to remove the essential health benefits requirement from health plans. Health plans sold without those requirements could stop covering treatment for mental health and substance use disorders, and could end coverage for preventive care services such as cancer screenings, vaccines and prenatal care.

The bill also would prohibit states from allowing healthcare providers that provide abortion services from receiving federal Medicaid funding for one year. It's a move that could hinder reproductive health service providers such as Planned Parenthood from delivering preventive health services to people in medically vulnerable areas.

Several of the country's leading public health advocates spoke out after the bill's unveiling, expressing concerns that the Senate bill was either as harmful, or more harmful, than the House's American Health Care Act, which passed in that chamber in May.

"The Senate is supposed to be our great deliberative body — instead, Senate leaders created a plan in secret with no hearings, no debate and no public input," said Dr. Georges Benjamin, executive director for the American Public Health Association in a statement.

Dr. Carlos Del Rio, professor of medicine at Emory University's School of Medicine and immediate past chair of the HIV Medicine Association, said he feared the Medicaid cuts proposed in both the House and Senate versions of the ACA repeal bill could severely limit access to HIV care. Medicaid is the largest single payer for HIV care and provides coverage for more than 40% of the roughly 500,000 Americans currently receiving treatment.

"It's a little bit like saying what do you think is better: to have someone cut off your arm or cut your leg," Del Rio said.

Cutting HIV care access could affect progress made in recent years, as cases of new HIV infections declined by 17% between 2008 and 2014, according to the Centers for Disease Control and Prevention.

"At the end of the day, when we compare it to what we currently have, it's definitely a step backward," Del Rio said.