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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Prevention and Public Health Fund

The Affordable Care Act (P.L. 111-148 and P.L. 111-152) established the Prevention and Public Health Fund (PPHF) to increase funding for prevention and public health activities under the Public Health Service Act. The law provides a mandatory appropriation for the Fund beginning in FY 2010 and designed to increase up to $2 billion.

Extenders Legislation Slows Growth of Prevention Fund: On February 22, 2012, the president signed legislation (P.L. 112-96) to extend the current sustainable growth rate (SGR) formula patch, payroll tax holiday, and unemployment benefits; the legislation partially offsets its costs through $20 billion in health care savings over 10 years, including a provision to slow the growth of the Prevention and Public Health Fund. The legislation amends the fund - originally scheduled to increase incrementally until FY 2015 when it would reach $2 billion - so that each year:

• between FYs 2012 and 2017, $1 billion becomes available;
• between FYs 2018 and 2019, $1.25 billion becomes available;
• between FYs 2020 and 2021, $1.5 billion becomes available; and,
• from FY 2022 onward, $2 billion becomes available.

FY 2013: The president’s FY 2013 budget request proposes $1.25 billion from the PPHF to supplement the budgets of the Centers for Disease Control and Prevention ($903 million), Substance Abuse and Mental Health Services Administration ($105 million), and the Agency for Healthcare Research and Quality ($12 million), among other agencies. The request also proposes $100 million from the fund to support Alzheimer’s research and related initiatives, as announced February 7, 2012. However, the "extenders bill" (P.L. 112-96), enacted after the president released his budget request, amends the fund to allow $1 billion in FY 2013, rather than the original $1.25 billion. It is unclear whether the White House plans to revise its budget proposal to reflect the lower funding level.

Primary Care Residency Expansion Program: The ACA provided a total of $500 million for the Fund in FY 2010. On June 16, 2010, Secretary Sebelius announced that $250 million of that total would be available to develop and strengthen the primary care workforce over the next five years, including $168 for a “Primary Care Residency Expansion” initiative through Title VII of the Public Health Service Act. The initiative focused on increasing enrollment in accredited primary care residency programs (i.e., family medicine, general internal medicine, and general pediatric medicine). The secretary also announced support for other HRSA workforce programs for physician assistants and nursing education, establishing nurse practitioner-led health clinics, and state health workforce planning. In a June 17, 2010 statement, the AAMC praised the initiative as “the first of many necessary steps to improve America’s health by expanding access to preventive, primary, and specialty medical care” and encouraged Congress and the Obama administration to “take the next step and lift the freeze on Medicare-supported residency training.”

Proposals to Eliminate the Fund: On April 13, 2011, the House approved, 236-183, legislation (H.R. 1217) to eliminate the Prevention and Public Health Fund (PPHF) established in the Affordable Care Act. Four Democrats —Reps. Jason Altmire (Pa.), Dan Boren (Okla.), Mike McIntyre (N.C.), and Collin Peterson (Minn.) —joined all voting Republicans in supporting the measure, after party-line votes in the Energy and Commerce subcommittee and full committee markups. The White House issued an April 13, 2011, Statement of Administration Policy indicating that if H.R. 1217 reached the president’s desk, “his senior advisors would recommend that he veto it.” On March 9, 2011, the House Energy and Commerce Subcommittee on Health held a hearing focused on the Prevention and Public Health Fund, as well as four other mandatory spending programs established in the Affordable Care Act. A background memo prepared by the committee's majority staff proposed eliminating the PPHF.

On September 14, 2010, the Senate rejected an amendment offered by Senator Mike Johanns (R-Neb.) to the Small Business Jobs and Credit Act of 2010 (H.R. 5297) that would have rescinded funding provided for the PPHF as an offset for repealing an ACA tax reporting provision for businesses. The AAMC sent a September 10, 2010 letter urging senators to oppose the Johanns amendment. The letter states that “using the Fund as an offset would undermine programs designed to reduce the burden of disease, improve the quality of life, and bend the health care cost curve."

Contact

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525
Email: trasouli@aamc.org