By Jane Norman, CQ Healthbeat Associate Editor
May 4, 2012 -- House Republicans so detest the health care law's prevention fund that they recently moved to kill it twice in two days, voting in one measure to use the money to maintain a reduced interest rate for student loans.
It was one more sign of the way a fund designed for the seemingly benign purpose of keeping Americans from getting sick has become one of the most hotly debated pieces of the health care law. Senators could try to tap all or part of the fund when they take up the student loan bill this week. In the meantime, localities across the nation have received millions of federal dollars from the fund for everything from quit-smoking phone lines to children's immunizations.
The fund, however, has its protectors. The Obama administration threatened to veto a bill—(HR 4628), which the House approved, 215-195, on April 27—that would use $6 billion from the Prevention and Public Health Fund to pay to extend a break on student loan rates. In the Senate, Democratic Sen. Tom Harkin of Iowa, one of the health fund's authors and fiercest defenders, will oppose the measure. Majority Leader Harry Reid, D-Nev., has filed for cloture on a bill (S 2343) that would finance the student loan rate extension by ending a corporate tax break.
Advocates of prevention and public health efforts have now fought off more than a half-dozen attempts at repeal or cuts. They suffered a defeat when earlier this year $5 billion was taken from the fund to pay for Medicare physician reimbursements. Both Republicans and the Obama administration agreed to that deal.
Hundreds of public health groups have signed on to letters to Congress in support of the fund and its goal of keeping Americans from contracting chronic illnesses that rack up health care costs. "I think there's been more than a pound of flesh taken out of the fund," says Richard Hamburg, deputy director of the Trust for America's Health, a health prevention advocacy group.
Investment or 'Slush'?
The fund was designed as a consistent, mandatory and long-term mechanism to send federal money to states and communities with hard-hit public health budgets. "For the first time in history, we have decided not just to pay lip service to prevention and wellness, but actually invest in wellness and prevention in a very robust way," Harkin said in 2010. "By dedicating resources to preventing obesity, preventing diabetes, preventing heart disease, and other very costly conditions and diseases, we have a tremendous opportunity both to improve the health of the American people and to restrain health care spending."
But Republicans call it a "slush fund" because the Health and Human Services secretary controls how the money is spent. Congress could influence fund allocations through HHS appropriations bills, but that has not happened under the Republican-controlled House.
The health care law (PL 111-148, PL 111-152) provided for $15 billion over 10 years for the fund to pay for preventive care programs, with funding eventually rising $2 billion a year. However, to pay for the physician fix, Congress reduced the fund's automatic spending levels and delayed until fiscal 2022 the time when it would get $2 billion a year. In fiscal years 2012 through 2017, the fund will receive $1 billion a year.
Democrats have said that attempts to kill the fund amount to an attack on women's health because the administration proposes to use it to pay for breast cancer screenings in fiscal 2013. Other initiatives in the 2012 fiscal year budget include money for anti-smoking media campaigns, community projects to reduce cancer, stroke and diabetes, public awareness of Alzheimer's and promotion of healthful eating and physical activity. Hamburg says media campaigns to promote "quit lines" to help people stop smoking are particularly successful.
But Republicans say initiatives can go too far. The top Republican on the Senate Homeland Security and Governmental Affairs Committee on May 2 questioned whether Centers for Disease Control and Prevention grant guidelines require recipients to lobby states and localities for policy changes on food or tobacco. Sen. Susan Collins of Maine said she is worried about the "appearance of impropriety" in such actions. HHS officials say they're committed to the "proper use of appropriated funds."
Other Republicans say that they are concerned that previous CDC-funded prevention programs, such as urban gardens in Boston and bike trail signs in Pitt County, N.C., that they regard as wasteful will also be included in future prevention fund grants. That's why they want to kill the prevention fund now.
House Republicans also say the HHS Office of Inspector General is probing the prevention fund. The OIG's 2012 work plan, which covers many HHS programs, says that at least three audits will include the fund, a spokeswoman confirmed.
As the Senate wades in and Republicans possibly push for cuts in the fund, look to Harkin to try to ride to the rescue from his perch as chairman of the Senate Health, Education, Labor and Pensions Committee. "I don't know when we're going to learn that our mothers were right: An ounce of prevention's worth a pound of cure, and that's true in health care," Harkin said.