The Bombast of Health Care Funding and Student Loan Interest Support

The Disease Management Care Blog was shocked, shocked when it learned that Representative Pelosi's political opponents have conspired to fund federal student loan subsidies by "tak[ing] it from their favorite target: women's health" (italics DMCB). The White House has chimed in about this political evildoing, noting defunding women's health could result in "hundreds of thousands of women" losing access to cancer screenings.

Alarmed by this unfair disenfranchisement of half of the U.S. population, the DMCB spouse and a number of future Secret Service agents, the DMCB decided to investigate.

As the DMCB understands it, the House Republicans propose to pay for the loan subsidies by defunding all or some the Sec 4002 of Affordable Care Act's Prevention and Public Health Fund (PPHF). 

Here's the key wording from the ACA:

SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND ....to be administered through HHS, to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. FUNDING.—There are hereby authorized to be appropriated, and appropriated, to the Fund, out of any monies in the Treasury not otherwise appropriated—
(1) for fiscal year 2010, $500,000,000;
(2) for fiscal year 2011, $750,000,000;
(3) for fiscal year 2012, $1,000,000,000;
(4) for fiscal year 2013, $1,250,000,000;
(5) for fiscal year 2014, $1,500,000,000; and
(6) for fiscal year 2015, and each fiscal year thereafter, $2,000,000,000.
(c) USE OF FUND....for prevention, wellness, and public health activities including prevention research and health screenings, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs.

Unable to find the words "women's health" in Sec. 4002 of the ACA, the DMCB next looked up the Community Transformation grant program and the Education and Outreach Campaign.  There is practically no mention of "women's health" there either.

With further research, the DMCB did find this insight on the mechanics of federal health grant funding in the unbiased and refereed policy journal Health Affairs.  According to Boston academic authors Mariana Arcaya and Xavier Briggs, the institutional complexity of overlapping committee and agency jurisdictions and budgets make it extremely difficult - absent innovation, reorganization and new support mechanisms - to coordinate grant programs like the PPHF and give the taxpayers their money's worth.

The DMCB's conclusions?

1. Given the size of the U.S. government's deficit, it's Congress' job to make tough choices. Cancelling one program to fund another is one of them. The DMCB wishes that happened more often.

2. Trading a costly and questionably effective PPHF for a national investment in college education doesn't sound like a bad idea to the DMCB.

3. This is only the beginning. Those of us in the health care industry can look forward to the threat of funding cuts in other federally supported programs.

4. Even in this time of political discontent, Speaker Boehner has a point. Shame on Ms. Pelosi and her allies for their bombast and for the mainstream news media for failing to recognize it.

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