One issue related to the success of the Affordable Care Act that has not received a lot of attention, but is key to the law's sustainability, is the need to focus on prevention of major chronic diseases that drive the majority of the costs. Federal prevention funding has been cut successively since control of Congress began to change after the ACA's passage, almost as if it were a scheme by the law's opponents to unravel it. Without increased prevention, no matter how many are covered under the ACA, premiums will continue to escalate eventually turning even those who support and rely on the law's services to turn against it because of growing affordability issues. The latest federal budget proposal includes sizable cuts to CDC state prevention funding which could impact prevention program staffing at Hawaii's Dept. of Health. Should that occur, Hawaii legislators should consider tobacco and sugary beverage taxes to replace federal funding as those products fuel chronic diseases.