If the U.S. Senate's bill to repeal and replace Obamacare becomes law, the Jefferson County Health Department would lose more than $1 million in funding for programs like stroke prevention and lead poisoning remediation.
And that doesn't take into account the potential reduction in available treatment options if members of Congress succeed in rolling back Kentucky's Medicaid expansion.
Senate Majority Leader Mitch McConnell of Kentucky unveiled the bill — drafted by 13 senators behind closed doors — earlier this week. It would make fundamental changes to the health care delivery system, including a rollback of consumer protections that prevent insurance companies from denying coverage based on pre-existing conditions. It would also eliminate the Affordable Care Act's mandate that everyone have health insurance.
The reductions to public health efforts in the legislation have received less public attention.
Jefferson County Health Department Medical Director Sarah Moyer said Congress needs to slow down.
“Let public health experts have the opportunity to weigh in before they move forward so quickly,” Moyer said.
The Senate bill would cut 12 percent of funding for the Centers for Disease Control and Prevention. This money funds programs across the country designed to help prevent conditions like heart disease and diabetes, and to provide immunizations.
That funding also pays for lead testing. Every child 1-2 years old is tested for lead in their blood. And if levels come back elevated, the funding helps the Jefferson County Health Department to go to their home to find the source and replace it.
Moyer said the program is essential to identifying a simple problem that can have significant consequences later in life, including developmental delays.
“I would hope we’d find some way to keep it going," she said. "We know that high lead levels leads to a greater chance of being incarcerated and not graduating high school."
Medicaid Expansion Eliminated
The Senate bill would also roll back the ACA-driven Medicaid expansion by 2024.
More than 400,000 Kentuckians have gained coverage since the income threshold for Medicaid was raised to around $15,000 a year. And that means more people are able to access treatment for conditions like drug addiction.
Moyer said the health department has come into contact with a lot of those Medicaid recipients through the county's syringe exchange, which has served 10,000 people in the past two years. The health department runs the program, and besides serving as a place to get clean drug syringes, it connects users to drug treatment.
Although the exchange itself isn't on the chopping block, Moyer said without the Medicaid expansion, her staff won't have many places to send people who want to get help.
“If Medicaid coverage is decreased, it’d be hard for us to refer them to treatment and it’d be more out-of-pocket costs for them," she said. "And any stressor is a barrier for treatment."
The bill also would let states eliminate requirements that insurance cover 10 essential health benefits under the ACA. Those include mental health and substance abuse treatment.
