Background

Unlike the health care system’s primary focus on caring for people after they have become sick or harmed, prevention and public health programs aim to stop illness or harm before they occur.^[1] Examples of such programs include those that focus on smoking cessation, improved nutrition and physical activity, and increasing access to cancer screenings. In addition, public health programs include initiatives such as preventing, monitoring, and responding to outbreaks of infectious disease and foodborne illness, health emergencies and bioterrorism, and environmental threats.^[2]

Historically, prevention and public health initiatives have been subject to unpredictable and unstable funding.^[3] Of the more than $1.7 trillion in health care spent nationally every year, less than four cents out of every dollar is spent on prevention and public health.^[4] As a result, these initiatives often go unfunded from one year to the next.^[5]

Changes Made by the Health Reform Law
P.L. 111-148, § 4002

The law establishes a dedicated “Prevention and Public Health Fund” to provide for “expanded and sustained national investment in prevention and public health programs.” The purpose of the Fund is to “improve health and help restrain the rate of growth in private and public sector health care costs.”^[6]

Funds will be used to support programs “authorized by the Public Health Service Act [PHSA], for prevention, wellness and public health activities including prevention research, health screenings, and initiatives, such as the Community Transformation Grant program,^[7] the Education and Outreach Campaign Regarding Preventive Benefits,^[8] and immunization programs.”^[9]

Implementation

Agency and Timeline

The Department of Health and Human Services, Office of the Secretary, will administer the Fund. Funding will begin in 2010 and extends indefinitely.^[10]

Process

The Secretary is responsible for allocating appropriated funds across eligible programs and activities (see “Changes Made by the Health Reform Law,” above, for eligible programs and activities).^[11] The Committee on Appropriations of the Senate and the Committee on Appropriations of the House of Representatives may also “provide for the transfer of funds in the Fund to eligible activities under this section.”^[12]

The law provides no additional direction to HHS regarding how the law should be implemented. The agency therefore has the discretion to use a range of tools to implement the statute, such as announcing the transfer of funds to new and existing programs, announcing funding availability in the Federal Register for programs to which funds have been transferred, and providing information through the release of the President’s budget. The Federal Register and agency websites can be regularly checked for updates.

Authorized Funding Levels

FY 2010 — $500 million
FY 2011 — $750 million
FY 2012 — $1 billion
FY 2013 — $1.25 billion
FY 2014 — $1.5 billion
FY 2015 and each fiscal year thereafter — $2 billion^[13]

Key Implementation Issues

• Allocation of Funds: What criteria will the Secretary use to determine how funding is allocated across PHSA programs and activities? What conditions, if any, will be attached to the recipients of funding?
• Program Eligibility: How will the Secretary determine which programs fall within the scope of eligibility under the law? What preference might be given to eligible programs established in the PPACA?
• Public Health Programs: Will funding favor disease prevention and wellness initiatives, or will it vary and also include public health activities such as food safety and emergency preparedness or also funding to build the core capacity of state and local health departments?
• Coordination: How will the Fund’s activities be coordinated with the National Prevention, Health Promotion and Public Health Strategy to be released by the National Prevention, Health Promotion and Public Health Council in 2011?
• Funding Recipients: Will funding focus on state and local government entities? Community organizations? Will private entities be eligible for funding?
• Transfer of Funds: What if Congress and the Secretary, under their separate transfer authorities, disagree as to a transfer of funds?
• Evaluation: Will the Secretary measure the success of funded projects and programs to determine whether they “improve health and help restrain the rate of growth in private and public sector health care costs”? If so, using what methods?

Recent Agency Action

On June 16th, 2010 Secretary Sebelius announced the first allocation from the Fund, with $250 million of the 2010 allotment targeted at increasing the number of health care providers and strengthening the primary care workforce. Read the press release and the fact sheet.

[1] Trust for America’s Health, A Healthier America: 10 Top Priorities for Prevention (March 2008), available at: http://healthyamericans.org/assets/files/10ThingsBook.pdf.
[2] Trust for America’s Health, A Healthier America: 10 Top Priorities for Prevention (March 2008), available at: http://healthyamericans.org/assets/files/10ThingsBook.pdf.
[3] Senator Tom Harkin (IA). Service Members Home Ownership Tax Act of 2009. Congressional Record 155:197 (December 21, 2009) pp. S13661.
[4] Trust for America’s Health, A Healthier America: 10 Top Priorities for Prevention (March 2008), available at: http://healthyamericans.org/assets/files/10ThingsBook.pdf.
[5] Senator Tom Harkin (IA). Service Members Home Ownership Tax Act of 2009. Congressional Record 155:197 (December 21, 2009) pp. S13661.
[6] § 4002(a).
[7] § 4201.
[8] § 4204.
[9] § 4002(c); § 10401(b).
[10] § 4002(b).
[11] § 4002(c).
[12] § 4002(d).
[13] § 4002(b).