Investments in disease prevention — a core principle of President Obama’s health-care overhaul legislation — would face a setback under his budget proposal for next year. Obama’s fiscal 2013 budget would scale back the Prevention and Public Health Fund, established as part of the health law, by over $4 billion by fiscal 2022 — leaving that much less money for public-health prevention programs meant to thwart outbreaks or cut down on rates of diabetes, heart disease, and other chronic conditions that account for 75% of U.S. health-care costs. The law originally called for $21 billion between fiscal 2010 and 2022, a substantial boost in public-health funding. Now it calls for about $16.75 billion over that period. That’s still a lot of money. But so far, the prevention fund has been used heavily to compensate for cuts to the regular budget of the Centers for Disease Control and Prevention rather than for its originally intended use — new disease prevention-related programs. A $664 million, or 11%, cut to the CDC’s proposed budget, is the largest proposed for all the government’s health agencies and would amount to a $1.4 billion erosion in the agency’s discretionary budget since fiscal 2010. Cuts would come in immunization and public-health preparedness as well as the elimination of an $80 million pot of money awarded to health departments for preventive services. Of $1.25 billion in prevention fund money proposed for fiscal

2013, the bulk — $903 million — is directed to the CDC to fill in funding gaps and pay for some new activities, such as surveillance for health-care-associated infections and improving the efficiency of overloaded state laboratories. About $107 million of the prevention fund dollars would fund programs related to birth defects and developmental disabilities. Another $261 million would be targeted at a breast and cervical cancer program and $72 million would be used for immunization activities. “If you don’t take full advantage of the prevention fund, it will come back several times over in health-care costs down the road,” Jeff Levi, executive director of the Trust for America’s Health, which advocates for spending on prevention, said in reaction to the budget proposal. “Backfilling wasn’t the intent of the prevention fund.” Such cuts reflect “difficult choices” the administration had to make in a time of budget pressures, Bill Corr, deputy secretary of the Department of Health and Human Services, said at a briefing Monday. “We have to set priorities. We have to make difficult tradeoffs.” Given tight budgets, he said, the administration will focus on the most innovative preventive-health programs. The administration also proposed consolidating funding at the CDC for chronic diseases with common risk factors into one comprehensive program to save money and improve outcomes. Photo: Associated Press

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What Obama’s Budget Proposal Means for Disease Prevention