In Support of Senator Tom Harkin (D-Iowa)

April 27, 2013

“The Affordable Care Act, the health care law of 2010, created a Prevention and Public Health Fund.
The fund is an unprecedented investment in promoting wellness, preventing disease, and protecting against public health emergencies.
Much of this work is done in partnership with states and communities, which are already using Prevention Fund dollars to help control the obesity epidemic, fight health disparities, detect and quickly respond to health threats, reduce tobacco use, train the nation's public health workforce, modernize vaccine systems, prevent the spread of HIV/AIDS, increase public health programs’ effectiveness and efficiency, and improve access to behavioral health services.
…..
With this investment, the Affordable Care Act helps states and the nation as a whole focus on fighting disease and illness before they happen.”
HHS.gov

Sounds magnificent, doesn’t it? Section 4002 of the Affordable Care Act (ACA) authorized the appropriation of $15 billion over ten years to be used for public health by the Secretary of Health and Human Services (HHS), and last year a third of that was taken away during budget negotiations to support other unrelated worthy endeavors. During 2010 and 2011, the Fund spent $1.25 billion on various public health activities, including $198 million on additional primary care residencies and physician assistants training. In 2012 the Fund allocated approximately $1 billion to various community efforts ranging from early childhood obesity prevention to Alzheimer’s education and support. For 2013, the Fund is planning on spending half that much on prevention and public health, while diverting $453.8 billion to CMS to assist with enrollment in the new health insurance exchanges. So out of the original $15 billion allocated to public health and prevention, only a fraction will go to its intended purpose, unless of course the Republican sponsored Helping Sick Americans Now Act defunds the entire thing through 2016 to replenish the stopgap Pre-Existing Conditions Insurance Plan which ran out of money earlier this year.

The public health fund from its inception was just an effort to make communities where most Americans live and work more conducive to healthy lifestyles through a variety of small investments in infrastructure improvements, services, education and research. There is quite a bit of health IT in the Fund, but instead of the sexy fly-by-night EHR type of IT that gets all the media attention and all the money we don’t have, the Fund is supporting electronic infrastructure for immunizations, infection prevention and surveillance, data collection and analysis of health indicators for various purposes. The Fund was a long term proposition and it was never clear how businesses profit directly from its moneys, if at all, thus it came under attack almost immediately when in September 2010, Republicans proposed to defund it to pay for things that would save real dollars to the business community in the here and now. In some circles the Fund was referred to as a “slush fund for jungle gyms”, because obviously playgrounds for children are much inferior to proper pharmacotherapy for the next generation of obese diabetics.

But the Fund had many Democrat champions who (almost) consistently, and selflessly, went to bat for the wellbeing of future generations. For example, in April 2012, shortly after shaving off one third of the Fund’s money to pay for the payroll tax cut extension package, Democrats made a stand and refused to allow others to join in the pillaging of the same Fund, this time to pay for a student loan interest reduction program. In a brilliant strategic move, Minority Leader Nancy Pelosi, surrounded by an all-female legislative chorus, called the Republican bill a "continuation of the assault on women's health" and suggested that student loan interest reductions should be paid by taxation of oil companies. This of course, had nothing to do with the Presidential election and the gender issues carefully cultivated to defeat a slew of idiotic Republican candidates taking turns at making the most medieval statements about 50% of the electorate.

In the past, all attempts to take money out of the Fund somehow required Congressional approval, but in a recent development it seems that the administration that created the Fund, and valiantly defended it over the years, can now freely treat public health as a true “slush fund”, and quietly divert as much funding as it deems appropriate to other activities without an up or down vote in Congress. Obviously this does not qualify as an “assault on women’s health” because most women, and men, are not aware that hundreds of millions of dollars are proposed to be diverted from public health to paying “navigators” for the new health insurance exchanges. And as the Secretary of HHS, who is able to do what an elected Congress cannot, pointed out, the money will still indirectly support preventive care because the navigators will help Americans to enroll in health plans that give them preventive benefits.

Until now, most people were able to purchase health insurance without hiring a consultant, but it seems that the new health insurance exchanges, that were meant to simplify the process, require that the government provides us with personal shoppers to expedite the transfer of taxpayer subsidies to big corporations. And since the government is buying us preventive care, such as screening for obesity and diabetes (but not necessarily treatment for either one), we don’t need to actually prevent obesity and diabetes by building sidewalks, playgrounds or gardens in our communities. Makes sense, doesn’t it?

It didn’t make much sense to Senator Tom Harkin, who is not running for any more reelections, so is now free to stand for principles. In a seemingly unrelated move, Mr. Harkin chose to block the nomination of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services (CMS), until the Obama administration is willing to negotiate its private raiding of the Preventive and Public Health Fund. The former champions of the Fund seem a bit irked by Mr. Harkin’s position, particularly because the nomination of Ms. Tavenner was a rare moment of bipartisan support (most likely because she is not seen as an obstacle to privatizing Medicare and Medicaid), and like a typical battered spouse, the Democratic Party is desperate to enjoy this brief moment of validation from its abuser.

You will not win this one, Mr. Harkin, and any “negotiation” on the amounts stolen from public health this year will be more than made up for after you retire, but sometimes making a stand on behalf of the people is more important than winning the battle, something this administration never understood, and watching an elected official represent the interest of the public instead of private or party interests, may very well affect public health infinitely more than the moneys currently at stake.
So stay the course Mr. Harkin, and let Mr. Harry Reid file cloture if he must, and let this be a lesson in integrity for future generations. Godspeed and thank you!

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