Costs, Including Prevention, Come Under Fire in Health Care Debate

The Senate Committee on Health, Education, Labor and Pension (HELP) held its first meeting yesterday on proposed health care reform legislation. The meeting, led by Senator Chris Dodd (D-CT) in Chairman Edward Kennedy’s (D-MA) absence due to illness, comes amid increasing talk of costs and implications on the federal deficit.

Earlier this week the Congressional Budget Office (CBO) reviewed the HELP bill in response to inquiries from Senators Kent Conrad (D-ND) and Judd Gregg (R-NH). The CBO estimated the plan currently being considered by the Committee would leave 37 million Americans uninsured and cost more than $1 trillion over ten years.

One of the areas addressed in the report is the cost for preventative care and wellness in health care reform. Overall, the report concludes that increasing access to preventative services and wellness could decrease costs by making people healthier but may not materialize savings because long-term empirical evidence is lacking for the broad array of services considered under this category, including programs to decrease obesity. One scenario presented is that while reducing chronic disease through healthy lifestyles would help people live longer, it could cost the government more in Social Security benefits.

In April, IHRSA along with the Partnership to Fight Chronic Disease called on House leadership to update how the CBO produces estimates for health care bills. It made several recommendations for how the CBO can accurately estimate the fiscal impact of prevention legislation, such as including the deteriorating health of the population its estimated impact in the future, scoring beyond ten years to capture the long-term value of prevention, and incorporating broader economic impact, such as worker productivity. "The inability of the CBO to accurately account for savings created by prevention and wellness further demonstrates the lack of historical support for wellness initiatives in Washington," says Helen Durkin, J.D. IHRSA Executive Vice President of Global Public Policy. "With Congress and the White House calling on prevention as a key component of reform, the CBO needs to reevaluate its outdated modeling."

Meanwhile, the Senate Finance Committee and House Democrats are preparing to introduce their own reform bills shortly. Early estimates on the not yet public Finance Committee bill are $1.6 trillion over ten years. It is unclear how many Americans would be covered under the plan. Reportedly Chairman Max Baucus (D-MT) wants the bill under $1 trillion. One thing that does seem apparent is that all options remain on the table. Despite some partisan banter, both sides seem willing to address health care reform. Costs and impact on the deficit will likely remain major points of contention throughout the debate.

- Breanne McGahey