After much anticipation, Senate Republican Leader Mitch McConnell unveiled the Better Care Reconciliation Act (BCRA) late last week – the upper chamber’s version of Affordable Care Act (ACA) repeal legislation – following the House’s passage of the American Health Care Act (AHCA) almost two months prior.
Just when you thought it couldn’t get worse, it did.
To review, Section 101 of the House’s AHCA would repeal the ACA’s Prevention and Public Health Fund (PPHF) beginning in fiscal year (FY) 2019, the loss of which would result in a 12 percent reduction in the Centers for Disease Control and Prevention (CDC) budget. More specifically, the loss of the Prevention Fund would leave Epidemiology and Capacity (ELC) grants with one-fifth less funding, immunizations with one-third less funding, and would completely eliminate all funding for core public health capacity supported by the Preventive Health and Health Services Block Grant. Former CDC Director Dr. Tom Frieden spoke on CNN this week about the impact of the Prevention Fund loss HERE.
Facing such cuts in more than a year from now is bad enough, but the Senate’s BCRA would repeal the Prevention Fund beginning in FY 2018 – just three short months from now.
Why does timing matter?
The FY 2018 appropriations process is behind schedule, and it is certain that lawmakers will not complete their work before the end of the fiscal year on September 30. That means Congress will have to pass – and the president will need to sign – a continuing resolution to keep the government running for a specified period of time while lawmakers work out their differences. By definition, a continuing resolution continues programs at the previous year’s funding levels. If the funding doesn’t exist – because it is repealed, for example – the funding can’t be continued. In the case of the Prevention Fund, this would mean that several core CDC programs – ELC, immunizations, chronic disease, Prevent Block among them – would be operating at significantly reduced capacity for a specified period of time. If Congress ultimately can’t complete its budgetary work and then passes a year-long continuing resolution, lawmakers will not have the opportunity to backfill the CDC losses created by the Prevention Fund cut through spending legislation repeal for another year.
In sum, enactment of the BCRA would pull the rug out from under CDC and core governmental functions that are essential to our nation’s health security.
Despite all of this, the future of the BCRA is tenuous at best. This week, leader McConnell delayed a vote on the bill before lawmakers leave for the July 4th recess after failing to secure the requisite 50 Republican votes to pass it – several conservative and moderate Senators have come out in opposition and/or expressed skepticism about the legislation as written. Several notable polls this week, including an NPR/PBS poll and a USA Today poll, show dwindling support for repeal/replace legislation in its current form. However, it is certainly possible that Senators will take up a revised version of the bill when they return after Independence Day; in fact, some are saying a vote could be scheduled for July 11th.
For background information, including a detailed analysis on the impact the loss of this fund will have on state public health departments, please view the Trust for America’s Health factsheets and analysis.