Robbing Peter to pay Paul…

April 13, 2013

peterpaulOkay Network faithful, another important component of the Affordable Care Act you need to commit to memory because it will increasingly come into play is the Prevention and Public Health Fund. You may be wondering what has gotten under Senator Tom Harkin’s (D-Iowa) skin about this if you have been watching the news the past few days. In the President’s budget, payment for the Marketplace Navigator Grants is coming from the Prevention and Public Health Fund. As Senator Harkin stated the other day, “It’s like robbing Peter to pay Paul.”

For the Children’s Mental Health Network, understanding the global context of how health care reform is unveiling itself is critical as we expect mental health to be integrated into public health in the near future. Given that health care reform is fully embracing a public health model, what looks good on paper in Washington needs to be good for youth and families with mental health challenges at the local level. And if we continue to chip away at the Prevention and Public Health fund to pay for other good ideas, and the health fund is designed to shore up existing public health operations (including mental health) that will be weakened if we keep digging into the fund to pay for things like Navigators, who are so important to ensuring individuals and families get what they need from a health system that… oh wait a minute… may be crumbling because we are robbing the fund set up to support it… Dang, no wonder people throw up their hands when they try to decipher all of this. Yes, an English teacher’s worst nightmare run-on sentence was intentional.

So take a bromo and consider it this way:

  • Prevention and Public Health Fund
    The Affordable Care Act of 2010 created the Prevention and Public Health Fund to invest in public health and disease prevention. The health care reform legislation allocated the prevention fund with $15 billion over its first 10 years. But President Barack Obama signed legislation on February 22, 2012 that cuts the fund by $5 billion over 10 years to help pay for other initiatives, including a continuation of payroll tax breaks. Earlier, congressional Republicans had targeted the fund for cuts or complete elimination, arguing either that it was unnecessary and wasteful or that it would accomplish little on top of existing federally funded efforts for disease prevention and health promotion. Read a great analysis of the back and forth with the Prevention and Public Health Fund here.
  • Navigator Program
    Navigators are individuals and entities that will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

    The new funding opportunity provides up to $54 million in total funding and applications are due by June 7, 2013. The funding opportunity announcement is open to eligible self-employed individuals and private and public entities applying to serve as Navigators in states with a Federally-facilitated or State Partnership Marketplace. Read the details here.

  • Chipping away – How the two are related
    On Tuesday, the administration announced that $54 million would be made available for Navigator grants to help people sign up for insurance in the new online marketplaces that open for enrollment Oct. 1.  As it turned out, that money came from the ACA’s prevention fund.

    The Prevention and Public Health Fund has been chipped away at by both Republicans and Democrats. President Barack Obama has repeatedly endorsed cutting the Fund budget as a means to reduce the deficit, while Republicans have voted to repeal it or failing that, use the money for other purposes.

  • What it all means?
    The Obama administration requested $1.5 billion to set up and run the marketplaces (which includes Navigators) as part of its 2014 budget blueprint. It’s going to be a tough road to find the money to do this and we as advocates need to be focused on the bottom line – quality services for youth and families in communities across America – not in the offices of policy wonks in Washington DC.

Here is what Senator Harkin had to say about all of this the other day:

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