Tuesday, August 29, 2017

Safe, For Now

http://www.citylab.com; July 28, 2017

Hello Everyone:

Before we get going today, the flood waters continue to rise in Houston, Texas and more rain is on the way.  In the meantime, Houstonians trapped in the city are in absolute dire need of water, food, medicine, diapers, and most important safe shelter.  If you would like to help, you can text your minimum $10 donation to 90999 or you can go to http://www.gothamist.com for a complete list for places you can send money or material.  Every little bit helps.  Stay safe.  Shall we move on to urban health?

Right before the Congressional August recess, the latest attempt by Republicans to repeal the Affordable Care Act (Obamacare)-i.e. "skinny repeal"-went down in glorious flames. The non-partisan Congressional Budget Office scored the "skinny repeal," finding that it would increase the number of uninsured to 16 million by 2026, decrease the projected federal deficit by $142 billion over the same timeline, and increase premiums in the exchanges by 20 percent. (http://www.theatlantic.com; July 27, 2017; date accessed Aug. 29, 2017)  Blogger, for one, was quite happy about that outcome.  As of writing, the Senate is quietly attempting to find a bipartisan solution to Obamacare.  Yours truly hopes this effort will be reparative not wholesale repeal and replace.  Stay tuned to find out what happens next.

Laura Bliss, in her CityLab article "Urban Health Has Dodged a Bullet" writes, "Unlike previous repeal-and-replace attempts, this bill nothing to directly undo the Affordable Care Act's historic expansion of Medicaid."  However, somewhere between those unable to afford the higher cost ACA exchange plans and the millions left without job-based insurance once the employer-based mandate goes away,  this latest effort dubbed by Republican Senator Lindsey Graham (who voted yes; http://www.nytimes.com; July 28, 2017; date accessed Aug. 29, 2017) a ...policy is a disaster.

Other than leaving millions of people without coverage, the now defeated bill would have stranded ailing urban communities.  ACA established the Prevention and Public Health Fund (http://www.apha.org; date accessed Aug. 29, 2017) which "...appropriated nearly $1 billion last year to stem chronic disease, prevent infectious outbreaks, and promote health equity, largely through research grants, and programs orchestrated by the CDC [Centers for Disease Control]."  The fund, set to double in 2022, would have been repealed in 2019.  "Every corner of the country would have felt some impact, with states losing up to $3 billion over the next five years."

Cities would have been greatly affected, albeit those with concentrated health inequities and dense populations.  Below is a summary of what would have gone away with PPHF had ACA been repealed:

* The CDC spent $13 million on lead prevention programs nationwide in 2016.  Houston, Los Angeles, Washington D.C., Chicago, New York, and Philadelphia have all recently received millions to monitor lead poisoning risks, educate communities, and manage treatments.  [http://www.cdc.gov; date accessed Aug. 29, 2017]

* Another $40 million bolstered the CDC's Epidemiology and Laboratory Capacity program, which distributes money to cities and states for research on infectious diseased like Ebola and Zika... (Ibid)

* The CDC distributed another $160 million of PPHF dollars to Preventive Health and Health Services Block Grants, which support localized solutions to community health challenges.  Think text-based health alert in California, bike paths in Connecticut, farmers markets in rural Kansas. (Ibid)

* The CDC dishes out nearly $51 million per year to a longstanding, remarkable program called Racial and Ethnic Approaches to Community Health [http://www.citylab.com; Marh 15, 2017; date accessed Aug. 29, 2017].  Rooted in neighborhoods from the West Bronx, to suburban Detroit, to South L.A., some 49 REACH non-profits around the country connect minority communities with high health risks to care and prevention services.

Preventative measures, outside the expensive boundaries of doctors's office, go a long way to healing communities and stretch healthcare dollars further.  Laura Bliss reports, "As with so many kinds of federal funding cuts-including those to Planned Parenthood, also proposed by the 'skinny repeal-low-income Americans, who are disproportionately black and brown, stand to lose most. [Ibid]". Although the seven year attempt by the Congressional GOP to repeal and replace ACA seems dead, the prospect of a bipartisan solution offers a tiny glimmer of optimism.  Of course, that may get torpedoed by the hardliners and a petulant president.

The looming debate over the 2018 Federal Budget may also sabotage any bipartisan healthcare effort. Alan Rappeport report in the July 18, 2017 issue of The New York Times, "...the failure of the health care plan complicates Republicans efforts to overhaul the tax code.  It also adds to the urgency Republicans face to secre a signature in President Trump's first year in office..." (http://www.nytimes.com; July 18, 2017; date accessed Aug. 29, 2017).  Laura Bliss writes that the budget debate will be "...guided by the blueprint released by the White House earlier this year."  In addition to cuts to the Federal Drug Administration, the National Institute of Health, Medicaid, and Planned Parenthood, the proposed budget also calls for cuts to the Centers for Disease Control's budget by $1.3 billion, this could include AIDS research, opioid addiction interventions, and programs to combat diabetes, cardiac disease, and obesity.  So much for a commitment to providing a beautiful healthcare plan for every American.