Health Reform's Big Bucks for Prevention: Is Your Community Getting Its Share?

The Prevention and Public Health Fund created by the Affordable Care Act is expected to route about $15 billion over the next decade to states for community health programs. That is, if it survives; House Republicans voted to eliminate the fund entirely in April, calling it a slush fund and "taxpayer-funded social-engineering effort." The President threatened a veto and the bill, H.R. 1217, hasn't yet been voted on in the Senate, where it's stuck in committee.

In the meantime, how much money is your state or community getting and how will officials use the money? These grants really are worth paying attention to because they're a fresh source of funds at a time when recession-strapped states and communities are slashing their public health budgets.

For example, Massachusetts recently cut in half the number of free flu shots it has previously provided to the poor.  Ironically, the state recently received about a half million dollars to prevent hospital-acquired infections, so when people who couldn't get flu shots this winter are hospitalized for flu-related symptoms, perhaps fewer of them will be infected with MRSA.

Here are five tips to help you track how this important feature of health reform is playing out in your community. New grants are announced frequently, with the most recent group of grants totaling $40 million announced earlier this week.

1. What is this money paying for? It's designated for treatment, education and other programs aimed at preventing the spread of disease or the development of chronic diseases such as asthma, diabetes and heart disease. It also can be used to build or update public health infrastructure like laboratories. States can use the money for programs that increase physical activity, improve nutrition, and prevent smoking, just for starters.

2. How do states and communities get the money? They compete for funds by submitting grant applications. Did your state apply for money and not get it? Why not? Has your state's public health department been instructed not to apply for grants because the state's governor opposes the Affordable Care Act?

3. Does this money simply replace funds cut by states and communities? Or does it add to what states were already doing? (To put it another way, does the money allow states and communities to provide more services than before, or does it just maintain services or programs that were in danger of being eliminated?)

4. How can I follow the money in my community or state? Check out the federal government's state-by-state list of prevention grants from February 2011 for an overview, then check out this updated list of grants from August 2011. Then check in with your local and state health departments. Who is responsible for doling out the money locally? Who will benefit from the programs? When will the programs start?

5. Follow up at regular intervals. Ask for local and statewide progress reports on the programs funded by the Prevention and Public Health Fund money. Check with the feds, too: these application instructions for just one type of public health grant under the fund will give you a sense of the kind of reports that states and communities are required to submit to justify their grants. Did the programs serve as many people as originally planned? Did the programs actually work to prevent new HIV cases, help smokers quit, reduce the weight of people who participated? Could these programs be linked to fewer emergency room visits for asthma or a reduction in state Medicaid spending?

Think like a program auditor or evaluator. This is public money, remember, so documents relating to how it's spent are public. You can (and should, if officials balk) file federal or state public records requests for these documents.

Reporting Resources:

The Affordable Care Act's Prevention and Public Health Fund in Your State: This is the federal government's state-by-state list of grants, but it hasn't been updated. Check this August 2011 press release for additional grants to states.

The New Prevention Fund: An Investment in the Future Health of America: This report from the Trust for America's Health, last updated July 2011, outlines the grants each state is receiving in 2011.

Freedom of Information (Open Records) Letter Generator: This useful resource is from the Reporters Committee for Freedom of the Press.