Prevention Matters

The chairman of the Senate Health Committee tells The Hill that negotiators from the White House, Senate and House reached a final deal on healthcare reform days before Scott Brown’s victory in Massachusetts. Sen. Tom Harkin, D-Iowa said negotiators had an agreement in hand on Friday, Jan. 15 - four days before Scott Brown's surprise Senate win in Massachusetts turned the debate on its head.

“We had an agreement, with the House, the White House and the Senate," Harkin said. "We sent it to [the Congressional Budget Office] to get scored and then Tuesday happened and we didn’t get it back.”

Brown’s Jan. 19 victory gave Republicans control of 41 seats in the Senate, enough to sustain a GOP filibuster of the healthcare bill. But Harkin told reporters in a Monday telephone conference that health reform legislation is still "very much alive."

He said he has been advocating in recent days for the House to pass the Senate version of the health care bill along with a package of revisions that would be passed through the reconciliation process, which would only require a simple majority in the Senate. Harkin predicted that Democrats would pursue that course in the coming weeks and most likely finish by early March.

That differs from the assessment of White House Chief of Staff Rahm Emmanuel, who Thursday told the New York Times that Democrats would try to act first on job creation, reducing the deficit and imposing tighter regulation on banks before returning to the health measure.

Sen. Tom Harkin, D-Iowa, wrote a column for Yahoo.com in which he made a strong call for the inclusion of prevention and wellness services as part of health reform.

"It’s not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are," Harkin said. "It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.

"We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more."

Anyone who doubted Senator Kennedy’s ability to introduce a comprehensive health reform bill this Congress, looked on with embarrassment Tuesday as the majority members of Kennedy’s Senate Health, Education, Labor, and Pensions Committee introduced a 615-page bill detailing the Committee’s plan to reform America’s health system.

The Affordable Health Choices Act details the ins-and-outs of the Committee’s plan and includes mechanisms to ensure quality, affordable health care for all Americans by improving the quality and efficiency of health care and preventing fraud and abuse, bettering the health care workforce, improving access to innovative medical therapies, and last but certainly not least, provisions to increase our emphasis on prevention.

Last year, Kennedy asked Senator Tom Harkin to help lead the prevention and public health aspects of health reform and there is no doubt that Title III of the bill, “Improving the Health of the American People,” is an answer to that charge.

This Title includes several provisions that, if enacted, would greatly increase our health system’s emphasis on health promotion and disease prevention. A number of the policies closely resemble those found in “Real Health Reform Starts with Prevention” (the song book Partnership for Prevention has been singing from for the past two years.)

The wellness and prevention policies include:

• Creating the National Prevention, Health Promotion and Public Health Council – The interagency council would provide coordinating and leadership at the Federal level with respect to prevention, wellness, and health promotion practices, the public health system, and integrative health care in the United States.*
• Establishing a Prevention and Public Health Investment Fund – The fund would provide an expanded and sustained national investment in prevention and public health programs for no less than $10 billion for each fiscal year*
• Expanding the charge of the U.S. Preventive Services Task Force – Under the bill, the Task Force would be responsible for developing additional top areas of new recommendations and interventions including those for specific sub-populations, updating all recommendations every 5 years if not sooner, improving integration with the Federal Government, increasing the dissemination of their recommendations, and submitting annual reports to Congress. The bill also calls for increased coordinating with the Community Preventive Services Task Force and the Advisory Committee on Immunization Practices.*
• Authorizing and expanding the Community Preventive Services Task Force – Authorize the Task Force and expand it’s scope similar to the U.S. Preventive Services Task Force.*
• Establishing an education and outreach campaign regarding preventive benefits.*
• Enacting the “Right Choices Program” – This Program was first introduced in the Senate Finance Committee’s, “Reforming America’s Health Care System: A Call to Action.” The Program would provide low-income, uninsured Americans with a risk-stratified care plan and referral for treatment for any diagnosed illnesses.
• Awarding community transformation grants – Secretary would award competitive grants to promote individual and community health and prevent the incidence of chronic disease.
• Promoting healthy aging, living well for the pre-Medicare population (55-64 years of age)
• The Centers for Disease Control and Prevention would award grants for 5-year pilot programs to provide public health community interventions, screenings, and clinical referrals where necessary.
• Increasing the use of immunizations – States would have the authority to purchase recommended vaccines for adults through government contracts and CDC would establish a demonstration project to improve immunization coverage by implementing evidence-based interventions*
• Requiring nutrition labeling of standard menu items at Chain Restaurants and of articles of food sold from vending machines*
• Increasing research on optimizing the delivery of public health services and providing an annual report to Congress on the research findings *
• Support health impact assessments - Establishing a program at CDC to support the development and of health impact assessments and dissemination of best practices related to health impact assessments.*
• Promoting employer-based wellness programs – CDC will study and evaluate best employer-based wellness practices and educate and provide technical assistance to employers.*
  

* Denotes policy options promoted in Partnership for Prevention’s “Real Health Reform Starts with Prevention” campaign, which includes policy recommendations, policy papers, and model legislative language.

While health reform is far from being complete, the Affordable Health Choices Act is an encouraging starting point for prevention and public health advocates.

A public hearing is scheduled for Thursday, June 11 at 3 p.m. in 430 Dirksen Senate Office Building. The HELP Committee will begin mark-up on Tuesday, June 16 at 2:30 p.m. in 325 Russell Senate Office Building.

For more information on the bill see the Committee’s press release on the bill. Click here for section by section narrative of the bill and click here for a copy of the bill http://help.senate.gov/BAI09A84_xml.pdf.


Tracie Bryant
Congressional Liaison
Partnership for Prevention

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."

Sen. Tom Harkin, D-Iowa, said in an interview with CQ HealthBeat that he is “well down the road” toward drafting a bill that would require private health insurers as well as Medicare and Medicaid provide better coverage and reimbursements for effective preventive health measures. That would include annual physicals, mammograms and colonoscopies.

“Prevention has to be incorporated in how we extend coverage, how we reform the payment system,” Harkin said

Among the elements of his legislation:

- An emphasis on a concept known as ‘integrative health,’ in which various practitioners collaborate in coordinated care on a patient’s physical, emotional and mental health

- tax credits for businesses that offer wellness programs such as smoking cessation or depression screening

- annual physicals and other preventive measures - whatever preventive service that gets a recommendation of an “A” or a “B” from the U.S. Preventive Services Task Force - ought to be covered without co-pays or deductibles in any basic benefits private insurance policy

Sen. Tom Harkin, D-Iowa, used a White House regional forum on health reform this week to make a strong case for prevention and wellness initiatives and then elaborated on his plans in a meeting with editors for the Des Moines Register.

Harkin, who is helping write wellness portions of the Senate version of the health-reform bill, said at the Iowa forum that the government should provide better foods in schools and should build walking paths to encourage exercise. He also said doctors should be rewarded for keeping their patients well, as opposed to the current system in which they are paid mainly for treating them after they become sick.

In a meeting Monday with Register editors and reporters, Harkin added that he would favor charging higher health-insurance premiums to people who smoke or are obese. Such people also ought to receive help and encouragement to improve their habits, he said: "I think there ought to be both a carrot and stick."

"Harkin brushed aside reports questioning whether wellness programs would provide savings to the system," the Register reported. He acknowledged that his proposals would add some costs, but he predicted savings would start quickly: "'I don't mean in 10 years, I mean in the next two or three years, we'll see this start to decline.'"