House ACA Repeal and Replace Plan Imperils Public Health

The National Association of County and City Health Officials (NACCHO), representing nearly 3,000 local health departments, is disappointed that the “American Healthcare Act” eliminates funding for core public health programs that keeps communities healthy and safe.”


The Hill |   House passes Obamacare Repeal |  AARP Remains Steadfastly Opposed to Health Bill | Health advocates, doctors, individuals with pre-existing conditions decry “TrumpDon’tCare” |  Tumpcare, Putting Millions of North Carolinians At Risk


Updated 5.4.2017  – Although the first two attempts to repeal and replace the Affordable Care Act (ACA)  have failed this year it is vitally important for communities, especially in rural areas of the state like Robeson County, to carefully consider the grim warnings that have been articulated by diverse voices throughout the evolution of this ongoing debate as the US House passed their version of a repeal bill today and  further repeal and replace strategies are still being considered.   And while it may be tempting to digest this information through a partisan lens, rural  populations regardless of political affiliation or socioeconomic status cannot afford to do so since a series of current public policy decisions that are being rolled out are poised to disproportionately inflict serious injury in rural counties that are already struggling to survive.    Therefore as is the case with all public policy considerations this issue is bigger than politics,   a fact that was highlighted as Robeson County was recently ranked as the most unhealthy county in North Carolina….again.   So regardless of who we voted for, it should give us all pause to read the following excerpt  from this press release by NACCHO:


The “American Healthcare Act” eradicates funding for the Prevention and Public Health Fund (PPHF) in FY2019, which makes up 12% of the Centers for Disease Control and Prevention’s (CDC) funding.   Among the programs at risk at the CDC are the 317 Immunization Program, Epidemiology and Laboratory Capacity, Childhood Lead Poisoning Prevention Program, Heart Disease and Stroke Prevention, and Diabetes Prevention, among others.”

The Prevention and Public Health Fund provides vital resources to governmental public health at the federal, state, and local levels, and its elimination will serve to further erode our public health system. Congress continues to invest the nation’s health resources in a sick care system, while severely scaling back investment in programs that prevent people from getting sick in the first place,” said NACCHO’s Chief of Government Affairs Laura Hanen, MPP.”


The Hill:  We can put America first by preventing public health disasters
HuffPost:  Gates Warns That A Devastating Pandemic Is Right Around The Corner 
CityLab:  If Obamacare Dies, Cities Will Feel It


In Robeson County and other counties across the region that have traditionally scored the lowest health rankings over the years , any manifestation of public policy decisions like these threaten to transform a public health crisis into a public health disaster by systematically inserting premeditated chaos, dysfunction, and multidimensional inputs that facilitate the prevalence of health disparities and health inequality exponentially.   Moreover,  any strategy that eliminates the ability for the unhealthiest counties in the state to shift the paradigm through the scale of research, prevention, immunization,  and health education services that are necessary to save lives creates impermeable barriers and essentially guarantees that our  most vulnerable regions will continue to experience the worst health outcomes and health factors in the future.  This should be particularly troubling to North Carolina counties that are at the bottom of this list when it comes to health since a recent study reveals that Stroke rates appear to be rising steadily in young adults, and another recent study suggests that Diabetes is Even Deadlier than we thought.   But as if that is not enough hysteria,  gently stir into the cauldron the salty twist that as some are entertaining the concept that it’s a  great idea to repeal epidemiology and laboratory capacity in a classic ‘cut off your own nose to spite your face tug of war,’   ironically the CDC and FDA is currently scrambling to address a global vaccination shortage as Yellow Fever is spreading next door  and  while states nervously brace for the end of CDC funding to fight the spread of Zika this summer.   In other words, if we think it’s bad now stay tuned – because our situation may be worse than current health statistics suggest – and due to current policy decisions counties at the bottom of the hill may soon be pushed off an even steeper and deadlier cliff.   And to add insult to serious  injury [quite literally] , NACCHO highlights that:


In addition, the “American Healthcare Act” ends funding in FY2020 for the Medicaid expansion in 32 states, which has provided access to primary and emergency care to millions of Americans.  The bill also caps federal Medicaid funding that will ultimately result in shifting responsibility to the states and counties ― leaving governors, state legislatures, and local governments facing tight budgets with no choice but to reduce coverage for millions of seniors, low-income families, people with disabilities, and children.


But  in the event that the aforementioned warnings are not alarming enough for those who may not rely on Medicaid or the public health department,  the following considerations shared by the CEO of our local hospital in an article released earlier this year by should bring this issue closer to home:


Joann Anderson, CEO of Southeastern Health in Lumberton, served as a national voice for rural health care Tuesday as two U.S. hospital associations made a case against the proposed repeal without prompt replacement of the federal Affordable Care Act.”

When I first heard ‘repeal and replace’ my gut kind of went into a knot,” she told reporters representing outlets from the New York Times to the Huffington Post.”

To think about going through another rapid change … is gut-wrenching. We need to know what the replacement is going to be. I don’t think we are significantly different from other areas across the United States. We cannot take additional cuts.”

Anderson heads the 325-bed Southeastern Regional Medical Center in Lumberton, county seat of Robeson, where the ACA has had a significant impact.  She said repeal of the act would be catastrophic for health care in Robeson County, recently hit hard by Hurricane Matthew, as well as in other rural areas across the country.”

Southeastern Regional already operates a range of services, including rural health clinics, at a low margin of revenue compared to expense, Anderson said.  Further cuts would likely mean the loss of services such as inpatient and outpatient behavioral health care, as well as neonatal intensive care and obstetrics services.

Leaders of the hospital groups made several mentions of Anderson’s projections of what repeal of the ACA would mean for Robeson, whose citizens have among the lowest incomes and worst health indicators in North Carolina.

As is the case in other primarily rural communities, the local hospital, Southeastern Regional, is not only the county’s chief health care provider, but also one of its leading employers.”


NPR:  What An Obamacare Repeal Would Mean For Rural Hospitals

Yale News:  ACA repeal prompts medical student advocacy


So  not only do repeal and replace efforts potentially endanger the public’s health by threatening the lives of babies, pregnant mothers, and those living with behavioral health challenges;   they also can facilitate enormous local job loss that will further imperil an already vulnerable economy in Robeson County and eliminate life-saving programs and services at our regional hospital.   And the plot  thickens if we also consider what recently published about the impact of other proposed policy decisions:


,,,the Trump budget would have direct implications for North Carolina’s success in boosting its health care workforce.  In the 1115 waiver application to reform Medicaid, there is an initiative to address workforce shortages in rural and under-served communities.  Trump’s budget would cut $403 million in health profession and nursing training programs as they “lack evidence” to improve the healthcare workforce. That’s just not true. North Carolina’s waiver states that community-based residency and education programs are critical to strengthening the healthcare workforce. The waiver application even request federal dollars to implement the program. Unfortunately, funding to transform North Carolina’s ability to address the unmet needs in rural and underserved communities may be stunted if there are significant cuts to workforce education, training, and development.”



And for those who may be misguided by the assumption that only those who work in healthcare should be concerned about job loss,  this article by about initial ACA repeal and replace efforts should also be a sobering wake up call:


If the current ACA repeal effort moves forward, Congress and the Trump administration would kill 2.6 million jobs by 2019, rising to a total of 3 million jobs lost by 2021.  Close to a million of these jobs are in the health care arena, with the rest coming from industries like construction, real estate, retail trade, finance, insurance, and the public sector.”

North Carolina would see some of the highest job losses with an estimated total of 76,000 by 2019. A full 97% of these losses would come from the private sector.” 

In addition to losing jobs, between 2019 and 2023, North Carolina could see fewer dollars coming into the state, including a loss of nearly $25 billion in federal funds. This would result in diminished economic activity, including losses of $67.2 billion in business output and $39.4 billion in gross state product.’

What’s more, over this period, repeal of the ACA could force our state to lose out on $1.2 billion in state and local taxes—revenue no longer available for the state to invest in priorities like education,teacher pay, and economic development.’


In other words, many of us who may feel that we are comfortably insulated from the potentially devastating affects associated with these and other interconnected policy decisions , simply because we are currently employed and have health insurance, may soon find ourselves in exactly the same boat as our most vulnerable friends and neighbors at a time when our economic environment would be intensely more difficult.  Moreover, even some insured individuals who may believe that they are safely inoculated inside the beautiful bubble of retirement, may also soon find themselves scrambling in the middle of the night desperately trying to find help as hospitals across the region and throughout the nation are forced to drastically eliminate and reduce vital services that save lives.  And so much for rhetoric and propaganda that promotes the assumption that state, county and local governments will have the means to make up the difference if federal investments are eliminated.   Again, deliberations about this issue should give us all a moment pause since according to the 2017 Economic Snapshot of Robeson County that was recently released by  “There were 3,776 people looking for work in Robeson County compared to 1,757 job openings in December 2016.”  So imagine what it would be like in Robeson County and in other rural areas of the state if a substantially greater number of people are looking for work in a job market with even fewer jobs available, and even fewer options to access the tools that provide health and safety.  That’s why this issue is bigger than politics, it’s a matter of life and death, especially in Robeson County.


imperil – to put at risk of being harmed, injured, or destroyed.

catastrophic – involving or causing sudden great damage or suffering.


US Capitol Photo by:  Architect of the Capitol


Relevant Links:

The Hill | 05.1.17:  Congress increases NIH funding after Trump calls for cuts

WAPO | 05.1.17:   Science funding spared under congressional budget deal, but more battles ahead

Changes To Federal Insurance Plans Could Hurt Families Of Chronically ill Kids

New GOP Health Proposal Could Ditch Protections For People Who Are Sick

GOP Plan To Trim Insurance Benefits Might Not Tame Premiums Trump budget cuts threaten emergency response to Zika and other disease outbreaks