GOP renews pressure to drop $15 billion HHS prevention fund

Washington -- A top Dept. of Health and Human Services official defended a $15 billion fund that is used for prevention programs and that has been under attack from Republicans since its inception. The fund could be vulnerable in the next round of budget cuts.

The Prevention and Public Health Fund, created by last year's health system reform law, has become a repeal target for conservative lawmakers. Sen. Tom Coburn, MD (R, Okla.), articulated the case against what he calls the "slush fund" during a Nov. 9 forum sponsored by the Washington newspaper Politico and CVS Caremark.

Sen. Tom Coburn, MD (R, Okla.)

HHS Assistant Secretary for Health Howard K. Koh, MD, rebutted the notion that it's a slush fund, saying it would be penny-wise and pound-foolish to eliminate the program. "The fund is a major transformative event," he said.

The prevention fund was created to "assist state and community efforts to prevent illness and promote health," according to a description on the HHS website. The $15 billion over 10 years is earmarked for various public health initiatives, such as smoking cessation efforts, alcohol abuse programs and healthy diet initiatives.

For instance, on Aug. 25, HHS awarded $5 million to help states enhance the national network of tobacco cessation toll-free "quitlines," $42 million to make improvements to immunization information system registries and $75 million to fund substance abuse treatment programs. On Feb. 9, HHS announced $750 million in community and clinical prevention efforts across the country.

In April, the Republican-controlled House voted to eliminate the fund. Democrats control the Senate and support the money being used for public health projects, but the funding still could be vulnerable to cuts as lawmakers search for ways to trim federal budget deficits.

The Joint Select Committee on Deficit Reduction has been directed to approve at least $1.2 trillion in budget savings by Nov. 23. If the committee fails to agree on the cuts or if Congress votes down the recommendations, an automatic budget trigger would require cuts largely across the board.

Republicans have called for the prevention fund to be on the chopping block because the fund is inefficient and the country can't afford to spend the money right now, Dr. Coburn said. Instead, he advocated for Medicare to cover preventive exams.

"Prevention is about focusing on an individual patient," he said. "All this talk we do in Washington somehow gets away from the doctor-patient relationship. What's key to someone's health is if that the relationship is good."

Drs. Coburn and Koh agreed on the need to provide incentives for prevention but differed on how best to accomplish that. Dr. Koh said the government is the only part of society that has to care for all citizens, all the time. One's health is not something to be taken for granted, and the government must support projects that keep Americans healthy, he said.

Health "has to be protected, and that means a strong system of public health and an aggressive approach on prevention," Dr. Koh said.