ObamaCare Prevention Fund Prevents Good Stewardship of Taxpayer Dollars | Foundation for Government Accountability

ObamaCare Prevention Fund Prevents Good Stewardship of Taxpayer Dollars

We’ve all heard about the egregious revenue raisers in the Patient Protection and Affordable Care Act, otherwise known as ObamaCare…

The individual mandate that forces people to pay federal penalties if they don’t buy federally-approved health coverage they may not want or need.  An employer mandate that drives up the cost of doing business. And, the more than 20 new or increased taxes that ObamaCare imposes on families and businesses.

ObamaCare raises a lot of money for the government to spend, but where is it all going?

Some states will put more people on the broken Old Medicaid program that is failing patients and taxpayers.  Others will funnel billions through health insurance exchanges, which are new federal bureaucracies designed to regulate and subsidize health insurance.  Think of these exchanges as having to buying health insurance at the DMV.

And then there’s the ObamaCare slush fund.

Officially the Prevention and Public Health Fund, this little-known component of ObamaCare directs $10 billion to state and local health promotion programs through 2019—and requires a startling $2 billion in funding each year in 2020 and beyond.

Although the Fund must statutorily “improve health and help restrain the rate of growth in private and public sector health care costs,” the federal government will give billions to health prevention programs before finding out if they even accomplish these goals.

And unlike the typical federal budgeting process, the U.S. Department of Health and Human Services (HHS) and its subagencies unilaterally determine how much of the money is spent.  To date, Florida grantees were awarded more than $118 million in 170 awards from the Fund.  Of these $118 million in grants, $30 million went to the state of Florida, $40 million to Florida non-profits, $30 million to Florida county or city governments, and $11 million to for-profit Florida companies.[1]

When “Public Health” Means the Nanny State

The U.S. spends about $24 billion annually funding “public health,” a term whose definition has changed over time.[2]

Traditionally, “public health” activities meant controlling communicable diseases, like tuberculosis or smallpox.  But as these diseases were brought under control and life expectancy increased, federal public health programs veered away from disease treatment and prevention, and towards regulating lifestyle choices, like eating, drinking, or smoking.

For example, the U.S. Centers for Disease Control and Prevention (CDC) was established during World War II as a unit of the U.S. Public Health Service, and charged with malaria control in war areas.  Today, only two of the CDC’s eight “CIOs” (“centers, institutes, and offices”) are formally charged with the prevention of infectious diseases.[3]

Grants from ObamaCare’s Prevention and Public Health Fund have followed a similar pattern.  Since the Fund began disbursing grants in 2010, a majority of funds have been allocated to influencing lifestyle and behavior choices like nutrition,
physical activity, and tobacco control:

 

Prevention and
Public Health Fund: Major Grants by Year,
2010-2011

Year

Grant

Purpose

2010

$250 million

Train/develop new
primary care providers.

2010

$126 million

Support programs that
address tobacco control, obesity prevention, HIV-related health disparities,
and better nutrition/physical activity; supports primary care services;
supports the First Lady’s “Let’s Move!” initiative and the President’s
Childhood Obesity Task Force.

2010

$70 million

Supports state and
local public health infrastructure to advance health promotion and disease
prevention; builds capacity to prevent, detect, and respond to infectious
disease outbreaks ($20 million).

2010

$31 million

Supports the
Affordable Care Act’s expansion of coverage for preventive services.

2010

$23 million

Supports the training
of public health officials, especially in medically underserved communities.

2011

$29 million

Supports Community
Transformation Grants and other programs to prevent obesity and tobacco use.

2011

$182 million

Increases awareness of
the Affordable Care Act’s preventive benefits; expands behavioral health
screenings.

2011

$137 million

Supports state and
local public health infrastructure to advance health promotion and disease
prevention; builds state and local capacity to prevent, detect, and respond
to infectious disease outbreaks ($52 million).

2011

$133 million

Supports the
Affordable Care Act’s expansion of coverage for preventive services and funds
prevention research.

Source: U.S. Centers for Disease Control and Prevention[4]

When “Education” Means Lobbying

A closer look at the grants reveals an even more disturbing trend—federal dollars used for lobbying.

The watchdog group Citizens Against Government Waste reports that the Fund’s Community Transformation Grants  (CTG) not only support efforts to modify behavior through anti-obesity campaigns, but also fund advocates who call for increased taxes and regulations on soda, cigarettes and even whole milk.[5]  The CDC reports that to date, CTG has awarded $173 million and will “improve the health of more than 4 out of 10 U.S. citizens.”[6]

CTG’s sister initiative, Communities Putting Prevention to Work (CPPW), has faced similar criticism.  This CDC program, which began as part of the 2009 stimulus and continues to receive federal dollars through the Fund, offers grant making to local health promotion programs nationwide.

Miami-Dade County in Florida is one of 44 localities to receive CPPW funding.[7]  In 2010 the County received $14.7 million to launch the “Make Healthy Happen Miami” initiative charged with reducing obesity by, among other things, installing federally-reimbursable, healthy vending machines; supporting policies that encourage breastfeeding; and installing 50 bike racks in North Miami.[8]

Unsurprisingly, the initiative did little to affect overall obesity outcomes.  According to the Robert Wood Johnson Foundation’s County Health Rankings, the adult obesity rate in Miami-Dade was 21% in 2010, the year the CPPW grant was awarded.  In 2012, the adult obesity rate increased to 24%.[9]

Miami-Dade’s CPPW activities might be viewed as ineffectual.  But in other localities, some CPPW activities may actually be illegal. In June, HHS Inspector General Daniel Levinson reported inappropriate lobbying activities by some CPPW grantees, which violates federal laws and regulations prohibiting the use of federal funds to influence federal, state, or local officials.

Specifically, CPPW applicants were asked to provide “a comprehensive plan to reduce tobacco use through legislative, regulatory, and educational arenas” and that some of the strategies encouraged by the CDC included zoning restrictions, labeling initiatives, and changing the prices of healthy and unhealthy items.

Levinson concluded that “some of the CDC information, as well as the non-CDC resource materials posted to the CDC Web site appear to authorize, or even encourage, grantees to use grant funds for impermissible lobbying.”[10]

The Futility of Government Prevention Efforts

Let’s imagine for a moment that it’s the proper role of the federal government to fund “for your own good” programs that regulate lifestyle choices.  Let’s also imagine that all CTG and CPPW funds have been used in an ethical manner.  The question still remains: Do federal health promotion programs really work?

In 2009, Congressional Budget Office (CBO) Director Doug Elmendorf was asked to determine if federal health care costs would be reduced if the government expanded support for preventive care and wellness.  Elmendorf concluded:[11]

 

“Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.

“That result may seem counterintuitive.  For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. … [But] to avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway.”

 

The CBO similarly found that expanded government support for wellness services, like encouraging healthy eating and reducing smoking, have little effect on reducing federal health costs because “designing government policies that are effective at inducing people to be healthier is challenging.”[12]

What’s Next?

Some officials have proposed reducing or eliminating the Fund to relieve federal budgetary pressures.  In February, Congress agreed to cut the Fund’s spending from $15 billion to $10 billion in order to preserve jobless benefits, Medicare payments to doctors, and the temporary payroll tax cut.  And with the “fiscal cliff” looming, the Fund may again be on the chopping block as Congress looks to make further cuts.

Because of federal fiscal uncertainty, states would be wise to avoid soliciting Fund grants to bolster existing health promotion programs.  But more importantly, lawmakers should reject these “for your own good” lifestyle interventions that are
costly, bureaucratic, and simply don’t work.

Click HERE for a PDF of the report.

Tarren Bragdon is chief executive officer of the Foundation for Government Accountability, a Naples-based free market think tank.


Sources


[1] According
to the Tracking Accountability in Government Grants System (TAGGS) for ACA-related grants coded as CFDA code of 93501-93548.  Available at: http://taggs.hhs.gov/AdvancedSearch.cfm?bc=yes and accessed on November 28, 2012.  A spreadsheet of these grants is available at: http://www.floridafga.org/wp-content/uploads/ACA-Grants-Nov-2012.xlsx

[2] Julian Pecquet, “Report Calls for Doubling the Nation’s Health Spending,” The Hill, April 10, 2012.

[3] U.S. Centers for Disease Control and Prevention, “CDC’s Centers, Institutes, and Offices (CIOs),” found at: http://www.cdc.gov/washington/docs/cioandorgchart.pdf.

[4] 2010 Prevention and Public Health Fund grants found at: http://www.healthreform.gov/newsroom/acaprevention.html.  2011 Prevention and Public Health Fund grants found at: http://www.healthcare.gov/news/factsheets/2011/02/prevention02092011b.html.  Grant highlights from the 2012 Prevention and Public Health Fund (found at: http://www.hhs.gov/open/recordsandreports/prevention/index.html) include $6 million to promote “elder justice”; $7.05 million to support breastfeeding; and $20 million to “generate broad awareness of preventive benefits and encourage people to utilize them for better health.”

[5] Erica Gordon, “Government in the Grocery Cart: $15 Billion to Influence Consumer Behavior, Citizens Against Government Waste’s Wastewatcher, October 28, 2011.

[6] U.S. Centers for Disease Control and Prevention, “Community Transformation Grants (CTG) Program Fact Sheet,” October 11, 2012.  Found at: http://www.cdc.gov/communitytransformation/funds/index.htm.

[7] U.S. Centers for Disease Control and Prevention, “American Recovery and Reinvestment Act Prevention and Wellness Initiative: Communities Putting Prevention to Work.”  Found at: http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/communities/profiles/pdf/HHS_CPPW_CommunityFactSheet.pdf.

[8] Miami-Dade County Health Department, “Make Healthy Happen Miami Accomplishments.” Found at: http://www.dadehealth.org/cppw/CPPWresults.asp.

[9] Robert Wood Johnson Foundation, “Miami-Dade County, Florida, County Health Rankings and Roadmaps.”  Found at: http://www.countyhealthrankings.org/#app/florida/2012/miami-dade/county/1/overall.

[10] HHS Inspector General Daniel Levinson, “Communities Putting Prevention to Work – EARLY ALERT,” Letter to CDC Director Thomas R. Freiden, June 29, 2012.  Found at: http://www.scribd.com/doc/99735795/2012-07-09-HHS-IG.

[11] CBO Director Douglas W. Elmendorf, Letter to the Honorable Nathan Deal, August 7, 2009. Found at: http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/104xx/doc10492/08-07-prevention.pdf.

[12] Ibid. See also: Noelia Duchovny and Colin Baker, “How Does Obesity in Adults Affect Spending on Health Care?”, CBO Economic and Budget Issue Brief, September 8, 2010.

About the author

Tarren Bragdon is president and chief executive officer of the Foundation for Government Accountability, a research and advocacy organization committed to making Florida the most economically vibrant state in America.