An article in Health Affairs looks at how the Trump administration could push disease-prevention efforts while it also kills much of the Affordable Care Act.

The authors note:

“Using the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, legislation put forward by the new Secretary of Health and Human Services Dr. Tom Price, as a template, it is likely that the Prevention and Public Health Fund could be repealed given its budgetary impact. If full repeal of the ACA happens, the authority for some prevention-focused rules created through the ACA, such as rules on nutrition labeling of standard menu items at chain restaurants, would also disappear.

“Beyond the ACA, however, there is reason to believe that prevention can and may play a role in the Trump Administration and Republican Congress, given the core Republican philosophical objective of reducing federal entitlement spending. While Medicare premium support and Medicaid block grants may be strategies pursued by Republican leadership to reduce government spending on health care, overall health care expenditures continue to rise as evidenced by the latest national health spending data from the Centers for Medicare and Medicaid Services. Recent data on U.S. spending on personal healthcare and public health demonstrate that preventable chronic conditions such as diabetes, ischemic heart disease, and hypertension account for the highest amounts of health care spending. Without reducing the prevalence of chronic diseases, it will be difficult to achieve a sustained moderation of health care costs.

“To promote chronic disease prevention, any strategy will likely adhere to two fundamental Republican principles – 1) personal responsibility and 2) locally driven solutions. There are several possible ways the Trump administration could advance prevention consistent with these principles”