Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — When Congress passed major health reform legislation earlier this year, it approved billions of dollars in spending over the next several years for public health programs.

Beginning with $500 million this year and ratcheting up to $2 billion by 2015, the Prevention and Public Health Trust Fund was created with the goal of launching a concerted, nationwide effort to improve Americans’ health.

But the funds are now back on the line with a scheduled Sept. 14 vote on a measure introduced by U.S. Sen. Mike Johanns, a Nebraska Republican and former secretary of agriculture under President George W. Bush.

Johanns and others, backed by the farm lobby, want to repeal a provision of the health reform law that would require businesses to file 1099 tax forms for annual purchases of goods or services of $600 or more from a single vendor.

Currently, farmers and other business operators are required to file 1099s only for purchases of services.

Johanns and other critics of the expanded 1099 provision say it adds new paperwork burdens on farmers, ranchers and other small business operators.

“It creates more hoops to jump through, more boxes to check, more papers to file and more regulations to meet,” Johanns wrote in a July 15 column in Roll Call.

The Johanns amendment would put on hold all appropriations for the public health fund until 2018.

The pressure from farm and business groups to have the provision repealed has public health officials concerned that one of the largest federal investments ever made for preventive services will be lost before it really begins.

“It is not a surprise to anyone in the Washington, D.C. public health community that we’re going to have to continue to defend the fund,” said Donna Brown, government affairs counsel for the National Association of County and City Health Officials. “It certainly is a surprise to me that we’re having to do it quite so soon.”

New goals for health

Among other things, the funding would help expand campaigns against smoking and obesity and also pay for research and training of public health workers.

The law also calls for the leaders of federal agencies dealing with health, labor, homeland security, transportation, education and agriculture to jointly develop a report by March 2011 setting goals for how the agencies will work together to help communities improve health.

The council, headed by the surgeon general, will identify policies and programs that help people quit using tobacco and alcohol, eat healthier, exercise, and lose weight. Funding will then be made available for communities to implement the programs. All programs must be supported by scientific research.

Research shows that the same practices – exercise and eating well, for instance – can reduce the risk and severity of multiple chronic diseases, said Dr. Jason Eberhart-Phillips, director of health for the Kansas Department of Health and Environment.

“Physical activity will address your heart problem, your cancer problem, your stroke problem, your arthritis problem, your Alzheimer’s problem,” he said. “You name all the biggest health problems we’ve got and eating right, not smoking, and being active – and finding easy ways for people to do those things as a default option – is 90 percent of the work we need to do.”

Controlling costs

The emphasis on wellness and prevention was designed to complement the other provisions of the health reform law that aim to improve health care quality and access while reducing cost, said Dr. Georges Benjamin, executive director of the American Public Health Association.

The Centers for Medicare and Medicaid Services earlier this year released a report that showed that Americans spend $2.3 trillion on health care each year, more than 16 percent of the Gross Domestic Product.

According to the Centers for Disease Control and Prevention, Kansans spend $657 million each year on health care related to obesity alone. Tobacco use in Kansas costs $930 million.

The health reform council also likely will embrace policies that fall outside the health care sector, Benjamin said.

“If you’re a state secretary of transportation, when you build roads and transportation systems, you should think about health,” he said. “If you have something to do with the tax policy in your state, you need to be thinking ‘how do we incentivize small businesses that offer unhealthy foods to offer healthy foods?’”

Eberhart-Phillips said removing the prevention component from health reform could eliminate the very thing that would reduce its cost.

“Congress, in its wisdom, saw the value of supporting prevention this way in counterbalancing the potential for expanded health care costs when extending the umbrella of health care to millions more Americans,” he said. “If you take away this prevention element from the mix, you lose the cost saving benefit that the health reform bill was intended to have.”

Future uncertain

Public health officials knew from the start that prevention and public health funding could be tenuous, Brown said.

“It’s a tempting target because it’s mandatory spending that’s just sitting out there that’s new, at this time when both parties in Congress are very concerned about cutting spending,” she said. “Any new spending is in jeopardy.”

National public health organizations, including the American Public Health Association, have sent letters to Congress and e-mails to their members, asking for phone calls and e-mails to their senators in opposition to the Johanns’ amendment.

“If (the amendment) comes even close to passing, it will encourage future attempts to use the fund as an offset for other legislation,” Brown said.

U.S. Senate Democrats have also authored an amendment that would modify the 1099 reporting requirements, but keep intact the public health fund.

U.S. Sen. Tom Harkin, an Iowa Democrat, is among those who support the public health fund.

“The Prevention and Public Health fund creates a reliable, dedicated funding stream for public health that is needed to meet the many emerging health threats we must face and the persistent chronic disease rates that we must begin to control,” said Bergen Kenny, a Harkin spokeswoman. “Simply put, it is penny wise and pound foolish to take money away from a fund that will rein in health care costs by investing in proven prevention interventions.”

Kansas: ahead of the curve

The first grants are already being offered from the prevention fund and would not be affected by the Johanns' amendment, Brown said.

Edie Snethen, executive director of the Kansas Association of Local Health Departments, said she provided input on a proposal submitted earlier this month by the Kansas Department of Health and Environment for a $2.7 million grant to encourage local and state governments to work together to provide public health services.

Kansas already has a head start on some of that, Snethen said.

A group of public health organizations have been working with national officials who are drafting standards for accrediting public health departments.

Public health departments currently are not accredited and are funded and organized differently state to state. The majority of funding for public health departments in Kansas, for instance, comes from the county level.

It will be important for communities to assess their residents’ health, Snethen said, in order to better understand the barriers to healthy living and the resources needed to fix the problems found.

Those community assessments will be a crucial part of making sure health departments can become accredited, Snethen said.

“I think it’s important to work together as a community, gather the partners, and look at priorities – all of which are based on data,” she said. “Once all that stuff is laid out clearly on the table, then the group can decide ‘these are the areas we need to address.’

KDHE applied for the maximum funding allowed, said Dr. Jason Eberhart-Phillips, director of health for the KDHE. The actual amount of the grant, or whether Kansas will receive it, won’t be known until later this year.

It’s expected that somewhere between 10 and 27 states will receive grants to improve their public health infrastructures, he said.

Kansas also applied for and will receive a $200,000 grant to create an Office of Performance Management at KDHE to oversee public health infrastructure improvements at the state and local levels, Eberhart-Phillips said.