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White House spins women's health

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Republicans are right: The White House is greatly exaggerating when it says that "women, in particular," benefit from a prevention fund that the House GOP proposes to repeal. The truth is that the fund in question wasn't set up specifically for women's health programs, and we could find no concrete evidence that it has paid anything to gender-specific health programs so far.

For example, the fund has paid for programs to discourage tobacco use, encourage physical fitness, and prevent heart disease and cancer — for both sexes. And House Speaker John Boehner is correct when he says the White House itself has proposed cutting this very same fund. The president's fiscal 2013 budget proposes to slash $4 billion from the fund over 10 years. Furthermore, in February, Democrats agreed to a $5 billion cut in the fund to help pay for extending a payroll tax cut and delaying a reduction in Medicare payment to physicians. That bill passed with bipartisan support.

It's true that the fund could specifically pay for women's health programs — in the future. The Centers for Disease Control and Prevention's 2013 budget request proposes using money from the fund for its National Breast and Cervical Cancer Early Detection Program, which started providing such screenings to low-income women more than 20 years ago. The fund is also slated to be tapped in 2012 for a community-based program to encourage breastfeeding, according to the Department of Health and Human Services, which administers the fund.

The flap is yet another front in a political battle over which party is waging a "war on women." Republican presidential candidate Mitt Romney and his campaign have charged President Obama with doing just that — but they've used misleading statistics to do so, as we've pointed out. This time, it's the White House accusing House Republicans of sacrificing women's health in order to pay for a continued reduction in student loan rates.

Students over women's health?

On April 27, the House narrowly approved the Interest Rate Reduction Act, which would extend the 3.4 percent interest rate on subsidized Stafford loans for one year. The rate is set to jump up to 6.8 percent in July. To pay for the rate cut — a cost of about $6 billion — the bill would eliminate the Prevention and Public Health Fund, a fund set up by the Patient Protection and Affordable Care Act (the federal health care law). The law said that HHS was to use money in the fund "for prevention, wellness, and public health activities including prevention research, health screenings, and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign Regarding Preventive Benefits, and immunization programs."

Eliminating the fund would save $12 billion over 10 years, twice the cost of the student loan rate extension, according to the Congressional Budget Office. Only 13 Democrats voted for the House bill.

The White House has threatened a veto if the bill makes it to the president's desk, saying in a statement that women would be hurt by the measure:

White House statement: Women, in particular, will benefit from this Prevention Fund, which would provide for hundreds of thousands of screenings for breast and cervical cancer. This is a politically-motivated proposal and not the serious response that the problem facing America's college students deserves. If the President is presented with H.R. 4628, his senior advisors would recommend that he veto the bill.

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A White House blog post by Deputy Press Secretary Amy Brundage on April 27 said that eliminating the fund "would have a devastating effect on women's health and our work to prevent disease and illness." It went on to claim that "[h]undreds of thousands of women could lose access" to breast and cervical cancer screenings.

A year ago, however, when another Republican bill proposed eliminating the fund, the White House stated its opposition to the measure but didn't mention women's health as a focus of the fund.

House Speaker Boehner was asked about the women's health dustup by CNN "State of the Union" host Candy Crowley. He countered: "I'll guarantee you that they've not spent a dime out of this fund dealing with anything to do with women's health."

Boehner said, "There's no women's health issue here." And he noted, correctly, that "[t]he president's own budget called for reductions in spending in this fund, in this prevention fund."

The president's fiscal 2013 budget proposes cutting $4 billion from the fund over 10 years. But Boehner's bill would eliminate the fund altogether.

We are unable to determine definitively whether Boehner is correct when he says that "they've not spent a dime out of this fund dealing with anything to do with women's health." It's hard to prove a negative, and the prevention initiatives backed with money from the fund have been so broad in many cases that it's certainly possible specific women's health issues have been funded, particularly at the state or community level, so far. But the White House is overselling — by a long shot — the idea that the fund specifically helps women.

HHS says on its website that much of the money has gone to state and community projects that "are already using Prevention Fund dollars to help control the obesity epidemic, fight health disparities, detect and quickly respond to health threats, reduce tobacco use, train the nation's public health workforce, modernize vaccine systems, prevent the spread of HIV/AIDS, increase public health programs' effectiveness and efficiency, and improve access to behavioral health services." There's no specific mention of women's health projects.

The list of programs funded in 2011 included: state and community programs to prevent tobacco use and obesity and to reduce disparities in health; behavioral health screenings; programs promoting awareness of preventive care provided by the federal health care law; public health training and the use of information technology; research on prevention; and other initiatives such as first lady Michelle Obama's Let's Move program.

Women's health isn't specifically mentioned in that list, either. For 2012, the program to promote breastfeeding is one in a long list of prevention programs. None of the others specifically mentions women.

When we contacted Health and Human Services about this, an official told us the fund supported the National Breast and Cervical Cancer Early Detection Program and pointed us to the CDC's 2013 budget request. The CDC requested $511.7 million from the Prevention and Public Health Fund to pay for various programs, and about half of that amount is slated for "Cancer Prevention and Control." (See page 138.) The cancer prevention program includes screenings for breast, cervical and colorectal cancers, and cancer registries. While federal appropriations have funded the Cancer Prevention and Control program in the past, for 2013, most of the total funding ($323.7 million) would come from the Prevention and Public Health Fund ($260.9 million). The total 2013 funding for the Prevention and Public Health Fund is set at $938 million, as stipulated in the president's budget (page 181). That means the money requested by CDC for Cancer Prevention and Control would make up 28 percent of the fund's 2013 resources.

So, most of the funding for the CDC's cancer prevention programs, which includes the breast and cervical screening program, would come from the Prevention and Public Health Fund in 2013 for the first time. But as we said previously, the breast and cervical cancer program was set up more than 20 years ago.

The White House blog posting says that without the prevention fund "[h]undreds of thousands of women could lose access to vital cancer screenings. Prevention Fund resources are expected to help more than 300,000 women be screened for breast cancer in 2013 and more than 280,000 be screened for cervical cancer."

Those are the total expected screenings to be done under the CDC's program. For calendar year 2010, the breast and cervical cancer program provided screenings for 326,136 women for breast cancer and 283,997 women for cervical cancer, according to the CDC. That was before it requested Prevention and Public Health Fund money to do so.

Health and Human Services also sent us a a one-page document that says it is supported by various medical groups, including the American Congress of Obstetricians and Gynecologists, Association of Maternal and Child Health Programs, and March of Dimes. It says that reducing or eliminating the prevention fund "will have a significant impact on community efforts to prevent chronic disease and promote and protect the health and safety of all Americans, including women and their families." It says women benefit from several of the programs slated for funding in 2012, beyond the breastfeeding initiative, such as tobacco cessation programs that can help pregnant women or women of childbearing age quit smoking. "States are already using the Prevention and Public Health funds to help control obesity, reduce tobacco use, and improve nutrition – risk factors known to impact pregnancy outcomes," the document says.

We don't argue with the fact that tobacco, obesity, nutrition and other prevention programs can help women, pregnant or otherwise. But those programs also help men, and they show that prevention fund dollars go to many initiatives that aren't women-specific.

We'll chalk this up as another distortion in the political "war on women."

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House Speaker John Boehner is correct when he says the White House itself has proposed cutting the same prevention fund that the House GOP proposes to repeal.

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