GOP health bill would cut nearly $47 million in Arizona public health funds

• Arizona could lose $46.8 million in federal public health funds over the next five years
• The funding was included in the Affordable Care Act, but the GOP's American Health Care Act would cut it

Arizona could lose $46.8 million in federal public health funding over the next five years via a cut included in the House Republican health bill, likely forcing local health departments to reduce or cut public health programs.

While debate over the GOP's American Health Care Act largely focuses on how the bill seeks to remake private-sector insurance and the Medicaid program for low-income and disabled people, a less-publicized provision would eliminate a Centers for Disease Control and Prevention fund of nearly $1 billion that sustains public health programs nationwide.

The Arizona Department of Health Services received $9.3 million this fiscal year from the Prevention and Public Health Fund. The money is included in the Affordable Care Act, but the GOP plan that cleared two House committees last week would discontinue funding next fiscal year.

The fund pays for program such as providing childhood immunizations and counteracting emerging public health threats such as the Zika and Ebola viruses. It also helps pay for efforts to curb childhood lead poisoning, fight heart disease, manage diabetes, promote skin-cancer awareness and smoking cessation.

"This funding is in danger," said Dr. Cara Christ, director of the Arizona Department of Health Services. "There is no guarantee these programs would continue."

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Christ noted that money for many of these public health programs was allotted before the Affordable Care Act became the nation's health law in 2010, so she is hopeful that Congress will restore funding even though the GOP bill, as written, would eliminate it next fiscal year.

The Maricopa County Department of Public Health gets about $8 million a year from the fund. Half of that is used to pay for childhood immunizations. Maricopa County operates clinics in central and west Phoenix and Mesa that provide free immunizations to children and uninsured or underinsured adults.

Dr. Bob England, Maricopa County's director of public health, has provided information to representatives of both Sen. John McCain and Sen. Jeff Flake about the potential cuts.

 'Essential for maintaining public health infrastructure'

Gov. Doug Ducey also has urged Congress to maintain public health funding. In a January letter to U.S. House Majority Leader Kevin McCarthy, Ducey's health policy aides noted that most of the affected programs existed before the Affordable Care Act was passed and should be maintained with the GOP overhaul.

"We're hopeful they (Congress) will realize the funding existed (before the Affordable Care Act) and that it is essential for maintaining public health infrastructure throughout the nation," Christ said.

If the federal funding is not maintained, Arizona could be forced to eliminate or reduce several programs.

Last May, the state health department coordinated a statewide response to the emerging threat of the Zika virus. Zika is a mosquito-borne virus linked to microcephaly in newborns. Microcephaly is a condition that leads to abnormally small heads and a lack of brain development.

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The state health department, along with county health and environmental agencies statewide, have worked in tandem to prevent the spread of Zika and other mosquito-borne illnesses. While some Arizona residents have been infected with Zika after traveling to countries where the virus is widespread, health officials have worked to prevent the spread of Zika to the local mosquito population.

Arizona is at risk because the Aedes aegypti mosquito that carries Zika circulates in Arizona and thrives during the summer months. Public health and environmental service agencies are coordinating efforts to ensure that local mosquitoes don't have contact with a local person who is infected with Zika.

Dr. Daniel Derksen, a University of Arizona professor and director of the Arizona Center for Rural Health, said it is critical to fund public health efforts such as preventing the spread of the Zika virus.

Lack of funding now could lead to higher health and fiscal costs down the road.

"When somebody has a child with microcephaly, the consequences are lifelong," Derksen said. "It is very expensive care and has devastating consequences in terms of brain development and physical disabilities."

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The state health department also has worked to promote recommended vaccinations among school-age children. That can be a challenge in a state that has seen a growing number of parents opt out of the measles, mumps and rubella vaccination under the state's personal-beliefs exemption.

In addition to health costs, a measles outbreak also can cost the state hundreds of thousands of dollars to identify, isolate and treat people with active measles infections.

In February 2008, a measles outbreak in Tucson cost two area hospitals about $800,000 to halt, according to a study in the Journal of Infectious Diseases.

Similarly, Christ said that the public does not always notice the programs and efforts to promote health and prevent the spread of disease.

"Public health is in the background, and you don't understand we are working in the background," Chirst said.  But "you notice when Zika or Ebola hits."