Report: Cuts To Public Health Will Increase Illness And Raise Costs
Optometry students administer vision tests to patients at a Remote Area Medical (RAM) mobile dental ... More and medical clinic on October 07, 2023 in Grundy, Virginia. Programs like these will be hard hit by Medicaid cuts (Photo by)
Yesterday, the Common Health Coalition issued a major report that 'analyzes how cuts to public health infrastructure will ripple through the U.S. health care system – leading to sicker patients, higher costs of care, and added operational burden.' Cognizant of current events, the Coalition noted that 'the proposed disinvestment in Medicaid and the Affordable Care Act (ACA) now under debate in Congress would compound these effects.' In my opinion, every American and their members of Congress should take note.
A Long-Needed Alliance
For most of our nation's history, public health and health care worked in parallel. There was little conflict between the fields, but limited cooperation as well. It took the hard lessons of the COVID-19 pandemic to convince both groups to strengthen teamwork and collaboration. In the spring of 2024, five major health-related organizations: AHIP, the Alliance of Community Health Plans, the American Hospital Association, the American Medical Association, and Kaiser Permanente, founded the Common Health Coalition to 'convince and equip U.S. health care organizations to partner with public health systems.' In 18 months, it has grown to more than 250 national and regional organizations.
The Coalition is chairedby Dave A. Chokshi, MD, MSc, FACP, a primary care internist who previously held leadership roles at NYC Health + Hospitals and served as Commissioner of the New York City Department of Health and Mental Hygiene during the pandemic. 'People have been talking about unifying medicine and public health for decades and frankly, have failed. I've inhabited both sides. I've been a leader in health care and had the privilege to lead in public health as well. This [role]Dr. Dave A. Chokshi, Chair of The Common Health Coalition being interviewed about the fifth ... More anniversary of the COVID-19 pandemic on NY1
Common Health's Priorities
The Coalition is committed to action in four priority areas: 1) Coordination between health care and public health; 2) Always-on emergency preparedness; 3) Real-time disease detection; 4) Exchange of actionable data, particularly to advance health equity.
J. Nadine Gracia, M.D., MSCE, president and CEO of Trust for America's Health and co-chair of the Coalition's advisory council, explained why these priorities were selected. 'As the nation's health risks – from infectious disease outbreaks to rising rates of chronic diseases to extreme weather – increase, now is the time to strengthen partnerships between the healthcare and public health systems. A healthy community is a more resilient community. Through strengthened collaboration, healthcare and public health practitioners can bring each sector's experience and expertise to bear to protect health during future emergencies.'
Initial Success
In its first 3 months, the Coalition grew from 5 members to 50, adding organizations as diverse as the Association of State and Territorial Health Officials, Trust for America's Health and the Yale School of Public Health to Geisinger Health Plan, Ochsner Health and Parkland Health. Its leaders laid out the organization's vision in an editorial published in NEJM Catalyst and took active steps in a range of public forums to promote collaboration between members and engage in outreach to the public. In December, the Coalition launched its inaugural Common Health Challenge – 'Community Health Workers: Catalysts for a Reimagined Health System.' Two months ago, it awarded eleven $40,000 grants to organizations to fund work that demonstrates the integration of CHWs in ways that strengthen partnerships between health care and public health.
An Unexpected Challenge
When President Trump returned to the Oval Office on Jan. 20, the federal government's approach to public health and healthcare abruptly turned. Two weeks later, Elon Musk tweeted that his Department of Government Efficiency (DOGE) 'spent the weekend feeding USAID into the wood chipper.' DOGE followed this with draconian budget and manpower cuts to the CDC, the NIH and several other HHS agencies. Since much of these agencies' funding flows to state health departments and universities, the cuts sent shockwaves throughout the country. Newly appointed HHS Secretary, RFK Jr., closed entire divisions, shifted the department's priorities, and pushed world-renowned experts out the door. If narrow majorities of the House and Senate enact Trump's 'Big Beautiful Bill,' funding for Medicaidand several other health-related programs will be slashed. Collectively, these actions represent a 'perfect storm' for America's health system and all who depend on it.
The Coalition's Warning
Yesterday, the Common Health Coalition released a major report that shows these and other cuts to public health infrastructure will ripple through the U.S. health care system, leading to sicker patients, higher costs and operational burdens that will affect everyone's access to care.
Impact of public health cuts on community health and access to health care
The report, 'More Illness, Greater Cost: the consequences of public health cuts for the health care system,' outlines three primary categories of impact:
'We are trying to shine a spotlight on the ways in which cuts to public health affect us all, because they affect the healthcare systems that we all rely on,' Dr. Choski explained. 'And I want to be clear, public health cuts have very direct impacts on people and communities. We've seen some dialogue around that, but what is less appreciated are the downstream implications these cuts will have for emergency room care, hospitals, and clinics, as well as the doctors and nurses all of us depend upon, regardless of our insurance coverage or ability to pay.'
Although everyone's access to care will be affected, the burden of increasing illness and higher costs will fall heavily on rural areas and underserved communities. As grim as this sounds, Choski warns that it will be even worse if Congress enacts big cuts to Medicaid and the ACA. Millions of Americans will lose coverage, many rural and inner-city hospitals and clinics will be forced to close or cut services, and tens of thousands of scarce health care providers could be laid off or forced to retire.
The Coalition's report concludes with a plea: 'Now is the time to align around shared priorities, act quickly to close urgent gaps, and invest in bold, collaborative solutions to improve and save lives.'
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