A House Republican says Congress should eliminate Patient Protection and Affordable Care Act (PPACA) provisions that pre-fund some PPACA implementation efforts.
Rep. Joseph Pitts, R-Pa., chairman of the health subcommittee at the House Energy and Commerce Committee, talked about PPACA implementation appropriations today at a health subcommittee hearing on health care funding fiscal priorities.
PPACA is a major component of the federal Affordable Care Act package.
PPACA Section 4002 of PPACA has established a Prevention and Public Health Fund “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs,” Pitts said today at the hearing, according to a written version of his opening statement posted on the committee website.
Annual PPACA appropriations included in PPACA Section 4002 start at $500 million in fiscal year 2010, which started Oct. 1, 2009, and are on track to increase to $2 billion in fiscal year 2015, which will start Oct. 1, 2014, Pitts said.
U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius “has the full authority to use this account to fund any programs or activities under the Public Health Service Act that she chooses, without congressional oversight,” Pitts said.
In February, for example, Sebelius used $750 million from the fund for efforts to prevent conditions such as stroke and heart disease, and to promote immunizations and efforts to prevent tobacco use, Pitts said.
“The goals of these three disbursements from the fund are laudable, and there is no doubt that we must focus on preventing disease,” Pitts said. “But, we must remember that this funding is
over and above the amount that Congress has decided should go to these activities and the amount that Congress has already appropriated for these activities. It is also disbursed at the sole discretion of the secretary… This should concern every member that we have a created a slush fund that the secretary can spend from without any congressional oversight or approval.”
Congress could eliminate the fund without necessarily cutting any specific program or activity, Pitts said.
A hearing witness, Ernest Istook Jr., who has represented Oklahoma in the House as a Republican, testified that PPACA bypasses the normal appropriations process in a fashion that makes defunding implementation difficult.
PPACA appropriated a total of $6 billion immediately and about $105 billion for fiscal years 2011 and later, Istook said.
“The normal process typically involves enacting authorization bills that authorize spending, and then follows those with separate legislation that actually appropriates the money,” Istook said. “This enables those to be balanced with other spending decisions. The PPACA contained large authorizations for future appropriations as well as containing these actual appropriations. That made it quite different from most bills, even major legislation.”