The ACA Prevention and Public Health Fund: In Brief (CRS Report for Congress)
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| Release Date |
Revised June 9, 2017 |
| Report Number |
R44796 |
| Report Type |
Report |
| Authors |
Sarah A. Lister |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Summary:
SUPPRESS: Section 4002 of the Affordable Care Act (ACA, P.L. 111-148, as amended), Prevention and Public Health Fund (PPHF) a permanent annual appropriation to be administered by the Secretary of Health and Human Services (HHS). PPHF was intended to support an "expanded and sustained national investment in prevention and public health programs." (42 U.S.C. 300u-11)
PPHF amounts for each fiscal year are available to the Secretary of HHS beginning October 1, the start of the respective fiscal year. Congress may explicitly direct the distribution of PPHF funds, and did so for FY2014 through FY2017.
Under the ACA, the PPHF's annual appropriation would have increased from $500 million for FY2010 to $2 billion for FY2015 and each subsequent fiscal year. Congress has amended the provision two times, using a portion of PPHF funds as an offset for the costs of other activities. 21st Century Cures Act P.L. 114-255.
As with ACA in general, the PPHF has sparked some controversy. Since it was enacted in 2010, Congress has considered several proposals to repeal it and rescind any unobligated funds. One of these measures, the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 (H.R. 3762 in the 114th Congress) was passed in both chambers. It was vetoed by President Obama, and the House failed to override the veto. The American Health Care Act (115th Congress) also would repeal and rescind. American Health Care Act (H.R. 1628)
The PPHF authority directs the HHS Secretary to transfer amounts from the Fund to HHS agencies for prevention, wellness, and public health activities. Since the PPHF is already appropriated, the Administration's annual budget sets out its intended distribution and use of PPHF funds for that fiscal year, rather than requesting the funds. For FY2010 through FY2013, the Secretary determined the distribution of PPHF funds. For FY2013 the Secretary used almost half of the available PPHF appropriation to implement ACA insurance exchanges, a funding allocation that spurred objections both from opponents of the ACA and the Fund, and supporters of the Fund and the public health programs it has bolstered.
Congress has explicitly directed annual PPHF transfers since FY2014, providing most of each annual appropriation to the Centers for Disease Control and Prevention (CDC). Although the Secretary used the PPHF to fund a mix of pre-existing activities, as well as activities newly authorized under the ACA, Congress has favored funding pre-existing activities.
For some activities the PPHF contribution for FY2016 made up more than half of its total funding. Examples include CDC immunization grants to states (54%) and tobacco prevention activities (60%). The CDC Preventive Health and Health Services Block Grant and the lead poisoning prevention program received 100% of their FY2016 funding from the PPHF. In addition, PPHF transfers accounted for about one-third of the funds for the Garrett Lee Smith suicide prevention grants to states, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).
As part of a continuing resolution for FY2017 Congress directed the distribution of FY2017 PPHF funds. Division A of P.L. 114-254.
FY2018 budget.
