Prevention Matters

Over at the Senate Finance Committee, Republicans who have expended a lot of energy claiming that the federal government can't do anything right won a vote preserving $50 million a year for "abstinence-only" education programs. 

President Obama’s first budget eliminated federal funding for such programs, instead putting money into “evidence-based” teen pregnancy prevention programs. But now, writes The New Republic's Suzy Khimm, "the Finance Committee vote could mean that Bush’s legacy will continue well past Obama’s first term, funding the so-called Title V block grants to states through 2014."

Sen. Orrin Hatch (R-Utah), the sponsor of the amendment that won by a 12-11 vote, appeared to recognize the dichotomy inherent in his efforts.

"“My first choice would be to not have the federal government involved in any way in these types of education programs,” Hatch said in a press statement. “However, if the federal government is going to spend money on educating people about sexual decisions, the absence of an abstinence only education program has negative health consequences for our nation’s most vulnerable citizens.”

Khimm put it this way: "In other words, if the federal government is going to go there, we might as well pile on."

A 2007 survey of more than 2,000 teenagers carried out by a research company on behalf of Congress found that the half of the sample given abstinence-only education displayed exactly the same predilection for sex as those who had received conventional sex education in which contraception was discussed. Twenty-three states currently have rejected abstinence-only funds, even in the midst of a deep recession that has left states starving for funding.

Immediately after the Hatch amendment vote, the committee also voted 14-9 to approve an amendment sponsored by Finance Committee Chairman Max Baucus (D-Mont.) that supported a more comprehensive approach to sex education passed. The amendment will provide funding to a wide range of teen wellness programs, including those dealing with contraception and HIV/AIDS. Those funds will support abstinence education programs that are deemed “medically accurate and complete.”

Senate Finance Committee Chairman Max Baucus (D-MT) has amended his version of the health reform bill to add a $200 million program to help small businesses establish wellness programs. The funding would allow the Secretary of Health and Human Services to make grants for up to five years to businesses with less 100 than full and/or part-time employees (to provide access to comprehensive, evidence-based workplace wellness programs.

Qualifying programs will include the following components to help employees make healthier choices: health awareness (such as health education, preventive screenings and health risk assessments), employee engagement (such as mechanisms to encourage employee participation), behavioral change (elements proven to help alter unhealthy lifestyles such as counseling, seminars, on-line programs, self help materials) and supportive environment (such as creating on-site policies that encourage health lifestyles, health eating, physical activity and mental health).

Grant money from this amendment would only be available for employers that are not already providing qualified wellness programs.

Earlier this year, Congress had proposed spending between $3 billion and $10 billion on prevention and wellness programs when it initially crafted an economic stimulus bill. But when key senators insisted the overall price tag for the legislation had to fall below $900 billion, prevention's share was zeroed out by Congress before the White House intervened to insist on $1 billion.

Fast-forward to August and remarks made by Senate Finance Committee Chair Max Baucus, D-Mont., as health reform negotiators work to achieve a bipartisan bill.

As the Washington Post explains: "Before leaving for the month-long recess, Baucus had pegged the cost of the negotiators' ideas at less than $900 billion over the next decade. Thursday's discussions focused on driving that cost lower, the sources said."

The House version of the bill contained provisions requiring first-dollar coverage for many clinical preventive services, and establishes a trust fund reserved for prevention and wellness programs. Many observers fear such programs will be deemed "expendable," particuarly in light of Congressional Budget Office statements that prevention programs do not save money for the federal government.

Is it deja vu all over again?

The New York Times' Robert Pear reported over the weekend that Congress is planning to put language in the health reform bill to give employers "sweeping new authority to reward employees for healthy behavior, including better diet, more exercise, weight loss and smoking cessation."

Senate Finance Committee Chairman Max Baucus, D-MT, and Sen. Tom Harkin, D-IA, are taking the lead in devising such incentives. Harkin recently re-introduced his legislation to provide tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. In addition, Pear reports, "lawmakers said they would make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees."

CQ Health Day says the chairman of the Senate Finance Committee is complaining that "health care reform is in jeopardy" unless he can convince the Congressional Budget office to to score savings in the health proposals he’s shown them.

Sen. Max Baucus Baucus, D-MT, said at a hearing Thursday that the legislation would be a tough sell to the public if lawmakers and congressional actuaries can’t deliver on one of President Obama’s key promises — that a health care overhaul would lower spending growth.

“The slight challenge we have is getting numbers and estimates from CBO,” Baucus said. “Otherwise, health care reform is in jeopardy.”

The Philadelphia Inquirer quotes Sen. Max Baucus, chairman of the Senate Finance Committee and one of the most influential voices in Washington on health care, as promising to introduce comprehensive health-care legislation in June, "certainly before the chamber's August recess."

"He said that he planned to introduce a bipartisan bill with Sen. Charles E. Grassley (R., Iowa) that would adopt a mix of public and private solutions and that he hoped 70 senators would approve it."