The American Health Care Act now being considered by a Senate committee would result in many disturbing consequences, including an estimated 23 million people losing their health insurance coverage by 2026 and increased premiums and other out-of-pocket costs.
An estimated more than 2.5 million Texas would lose insurance coverage, adding to our already high rates of those uninsured. The AHCA would cut more than $830 billion from the federal contribution to the Medicaid program over the next decade. The bill would also allow states to opt out of protections that restrict insurance companies from charging higher premiums for people with pre-existing conditions and from the requirement that insurers cover 10 essential health benefits, including maternity care, prescription drugs and services for mental health and substance use disorder.
Texas is likely to be one of these states cutting benefits — but not costs — as a lack of insurance forces people to use emergency departments as their health care provider, which is the most-expensive and least-effective way to provide medical care for chronic, nonacute conditions.
There’s another disturbing aspect of the AHCA: It would repeal the Prevention and Public Health Fund meant to expand and sustain national investment in prevention and public health programs. The fund represents 12 percent, or $1 billion, of the Center for Disease Control and Prevention’s budget — and this is on top of the cuts proposed in the president’s budget.
Texas faces significant health and fiscal challenges that could be mitigated by a better and more reliably funded public health system. The Prevention Fund is a vital part of the effort to create such a system. Since 2010, the Prevention Fund has provided Texas with more than $150 million — $29 million in 2016 alone — to support a variety of public health activities. Repealing the Prevention Fund would result in a major loss of funding for core public health programs in Texas.
The Prevention Fund supports programs to reduce tobacco use, such as the 1-800-QUIT NOW telephone line with tips on quitting. A recent study found that the campaign led to over 1.5 million smokers attempting to quit and prevented over 17,000 premature deaths. It’s worth noting here that tobacco use is the No. 1 cause of preventable deaths.
The Prevention Fund also provides helps Texans prevent diabetes, obesity and heart disease through programs promoting nutrition and exercise. Texas receives money to immunize children and low-income adults, helping all of us as a well-immunized population stops spread of infectious diseases.
The Texas Department of State Health Services received almost $1 million to upgrade the laboratories that detect outbreaks of disease and food borne illnesses and bioterrorism events. Texas also received money to prevent health care associated infections, a major problem within health care facilities and one that could affect anyone entering a hospital or nursing home.
Another program that the Prevention Fund supports in Texas is called the Preventive Health and Health Services Block Grant, which funneled over $6 million to Texas in 2016 alone. These are funds that gives Texas the flexibility to respond rapidly to emerging health issues — like Zika — and to fill funding gaps that are leading causes of death and disability in Texas.
While personal responsibility for health is certainly part of the equation, the Prevention Fund is intended to ensure a coordinated, comprehensive, sustainable and accountable approach to improving our country’s health outcomes through the most effective, evidence-based programs.
All Texans — businesses, schools, nonprofits, hospitals and insurers, as well as individuals — should come together to support the Prevention Fund and the health of all in our state. U.S. Sens. John Cornyn and Ted Cruz of Texas serve on the Senate committee considering the AHCA. Let them know your thoughts.
Troisi is a member of the American Public Health Association executive board.