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US House's health care plan could cut into Alaska public health funding

WASHINGTON — Alaska could lose about $4.4 million per year in public health funding under a proposed U.S. House bill to repeal and replace the Affordable Care Act.

At stake are preventive and public health measures: vaccination programs, efforts to reduce, manage or detect things like heart disease, cancer and new viruses like Zika, and programs meant to help with drug overdoses.

The House GOP's American Health Care Act would eliminate funding for the Prevention and Public Health Fund — the source of those funds — by 2019.

Proponents of the funding, particularly Democrats who supported the ACA, argue preventive care is cost-effective. Republicans who want to repeal it have targeted the fund as wasteful public spending.

Alaska's piece of the pie is small — about $4.4 million annually. About 75 percent of that goes to the state, and the rest to the Alaska Native Tribal Health Consortium, according to Jay Butler, chief medical officer and director of the Alaska Division of Public Health.

He's concerned the funds could be lost in the larger shuffle of the repeal-and-replace effort.

Cuts could also impact the state's preparedness levels for emerging and infectious diseases, Butler said, as well as the Preventive Health and Health Services Block Grant, which began during the Reagan administration and offers states considerable leeway to address public health issues on a state-by-state basis.

"Generally they address chronic diseases and injury control, and part of it is set aside explicitly for sexual assault prevention," Butler said.

"I think a lot of people don't realize with repeal of ACA, funds that have gone to the state literally for decades are at risk of being lost," Butler said.

The Congressional Budget Office estimated the cost of the Prevention and Public Health Fund, under ACA, would be $1 billion annually, rising to $2 billion per year in 2025. Cutting the PPHF would save $9 billion over the 2017-2026 period, according to the CBO report.

That $9 billion in savings isn't a sure thing — there's a fair chance the money would be inserted into a future appropriations bill, according to the American Public Health Association, which opposes cutting the program.

The "CBO assessment fails to take into account that these dollars will have to be replaced through the regular appropriations process," said Georges C. Benjamin, executive director of the association.

Most of the funds in the Prevention and Public Health Fund have been sent to the states through U.S. Centers for Disease Control and Prevention budgets for decades, Butler said.

The bill would gut funding for the "Section 317" vaccine program, which makes sure doctors get the doses of vaccines they need, helps fund vaccines for those that can't afford them, and manages responses to disease outbreaks.

That funding has been in place for nearly 50 years now, Butler said.

Alaska has some of the nation's best rates of pneumococcal and seasonal flu vaccinations for people aged 65 and older, but is ranked among the worst for children under 3 years of age, who don't have all their immunizations, according to CDC data collected by the Trust for America's Health.