Legislative Alerts


Senate Releases the Better Care Reconciliation Act of 2017, Eliminates Prevention and Public Health Fund

June 22, 2017

Today, the U.S. Senate released a discussion draft healthcare legislation entitled the “Better Care Reconciliation Act of 2017.” This legislation eliminates the Prevention and Public Health Fund (PPHF) in FY18, which is used by every state and territory to support vital public health programs that promote health, prevent disease, and allow for rapid response to emerging public health threats.

ASTHO released a statement expressing our disappointment about the repeal of the PPHF. Specifically stating, “We are deeply disappointed the Senate discussion draft legislation includes a repeal of the Prevention and Public Health Fund in FY18. Repealing this fund, coupled with sequestration this year, would result in more than 12 percent cut to CDC programs in just a few months and this will affect other federal programs that keep our nation healthy.” This bill is very complex and ASTHO will provide additional information as we learn more. However, according to our preliminary analysis other provisions in the bill include the following:

  • $2 billion in FY18 for the secretary of HHS to provide grants to states to support substance use disorder treatment and recovery support services for individuals with mental health or substance use disorders. Importantly, this new $2 billion is one time funding, whereas the PPHF supported core public health programs and provided approximately $1 billion per year for many public health activities.
  • Creates a state innovation fund for non-expansion states.
  • Rolls back the Medicaid expansion, but more slowly than the House version.
  • Proposes giving states either a per capita cap on Medicaid or a block grant of funds beginning in 2020. According to NPR, the inflation rate on the Senate would be lower than the inflation rate on the House which would result in less Medicaid spending in 2025.
  • Eliminates the individual and employer mandate.
  • Insurance companies are not allowed to increase premiums or deny coverage based on preexisting conditions.
  • States would be allowed to change what qualifies as an essential health benefit.
  • The non-partisan Congressional Budget Office has not yet scored the entire bill. Since this is a discussion draft, it is very possible the text of the bill could change before it reaches the floor of the Senate. The Senate is expected to vote on the legislation next week and at this time it is unclear if this discussion draft will garner over 50 votes for approval.

ASTHO will continue to monitor these developments, conduct a more thorough analysis, urge Congress to oppose the repeal of the PPHF, and update our members accordingly.

If you have any questions, please contact ASTHO government relations staff Carolyn Mullen.