Prevention Matters

Writer Sarah Wildman suggests that one asset President Obama has yet to use in getting health reform over the goal line would be to enlist help from the First Lady. In an engaging piece of “what if” writing, Wildman argues that Mrs. Obama’s enormous popularity gives her a potentially powerful platform to show Americans that health reform is an “apolitical” problem that affects us all.

Wildman is disappointed that the Mrs. Obama stayed in the family garden focusing her time on the important but “safe” First Lady-like issue of childhood obesity.

“At a moment when an entire year's worth of bickering over health care reform has unraveled into a partisan wrestling match, and the very word "reform" has nearly ceased to be meaningful, tackling obesity is cheerfully unobjectionable. Laudable even. But it's not the most important thing on the agenda right now… As a concept it vaguely brushes up against the health care reform debate but without, in reality, getting anywhere close.”

Wildman argues that the First Lady should use her popularity “to get America to understand how very nonpartisan health care reform might be? … The First Lady could have gathered together a task force comprised of a clutch of women -- moms, mostly -- and presented their stories, simply and without fanfare, to highlight how un-family friendly our current insurance policies are. How anti-woman. How anti-mother."

She might have brought in, say, a widow who lost health insurance after her husband died, therefore leaving the family uninsured. Women, she would have pointed out, are more likely to be on their husband's insurance than vice versa, leaving them vulnerable in the event of divorce, or death, or job loss. She might have invited a young, entrepreneurial would-be mother who desperately sought health insurance to cover a potential future pregnancy, but discovered there was no way to sufficiently cover maternity on the individual insurance market. She might have shown America a mother who owns her own business and discovered, happily, she was pregnant and that, unhappily, she could not find health insurance to cover the prenatal care, labor, and delivery.”

Wildman writes that the First Lady could have told the country that “On the individual market, pregnancy … is a pre-existing condition. Most insurance companies will not allow a woman to purchase insurance once she is already with child. Worrisome, the First Lady would have said, because this woman now has to decide between caring for her fetus and going into debt. Maternity benefits, she would have explained to the cameras, are never a guarantee.”

At the moment health reform appears stuck between a partisan divide. Although many of us are rightfully focused on the important nuances of prevention coverage and policy, the larger context of health reform – coverage, fairness, quality -- is fundamental to our national character. The First Lady can do much to remind us of this even as we are called to become more physically active and less attracted to junk food.

As we enter the final quarter of play lets remember that health reform is a team sport and no one should be left on the bench.

Posted by:
Ripley Forbes
Director, Government Affairs
Partnership for Prevention

Partnership Executive Vice President Corinne G. Husten, MD, MPH, tells the New York Times that some workplace wellness incentive programs that tie an employee's health insurance premiums to targets such as weight have raised concerns among some health and prevention advcocates.

“Actually, achieving a target is not necessarily within someone’s control,” says Husten, noting that genetic predisposition is a factor in many conditions like heart disease and diabetes, and the environment also plays a role. “If you live in a neighborhood with only convenience stores and fast-food, you don’t necessarily have access to the food that will help you to eat healthier,” she adds.

Provisions in health care legislation under consideration in Congress would allow employers and insurers to offer premium discounts of as much as 50 percent to employees in workplace wellness programs who meet specific health targets, such as keeping their weight, cholesterol and blood pressure within healthy ranges. Under current law, discounts for meeting these kinds of health targets can be no greater than 20 percent of the total premium. An amendment passed by the Senate Finance Committee would raise that cap to 30 percent and permit the secretaries of Health and Human Services, Labor and Treasury to increase the cap to 50 percent at their discretion. A similar provision appears in a Senate Health, Education, Labor and Pensions Committee bill.

Health insurers aren't getting the return on investment that they want to see when they cover clinical treatments for pediatric obesity. That's one reason there is a shortage of programs in that area, according to Roberta Clarke, an associate professor in Boston University's Health Sector Management Program who just closed down one of the few pediatric obesity treatment clinics in New England.

"With families changing their insurance plans on average every three years, the insurers reasoned that by the time one of (our) children avoided diabetes or other obesity-related health problems due to the program intervention, that child would no longer be covered by that insurer," Clarke writes in a Boston Globe column. "Therefore, the insurer would lose its investment in making that child less obese."

Insurers are talking up a proposal backed by Partnership for Prevention that was successfully added to the House version of the health reform bill. Gannett's Maureen Groppe cited the amendment, sponsored by Rep. Lois Capps, D-Calif., in a story about "a move by Democrats to replace references to “health-care reform” with references to “health-insurance reform.”

"Dallas Salisbury, head of the Employee Benefit Research Institute, said a proposal to eliminate copays for preventive and wellness care could have the biggest impact on individual behavior," Groppe writes.

“'Employers and insurers that have experimented with this, at the point that they eliminate those copays, they do get dramatic increases in the number of employees that use the services,' Salisbury said.

"The Partnership for Prevention estimates that only 67 percent of women 40 and older get screened for breast cancer. An additional 3,700 lives could be saved each year if 90 percent did, according to the organization, which wants Congress to remove deductibles and copays for preventive services.

“'The main purpose of cost-sharing is to discourage the use of medical services,' said Robert J. Gould, the group’s president. 'But clinical preventive services are currently underutilized.'"

U.S. health plans "appear to be getting the message" that they should offer free tests to encourage prevention, but they aren't rushing to embrace a proposed government mandate of first-dollar coverage of clinical preventive services.

Phil Galewitz of Kaiser Health News talked to insurance officials to get their take on first-dollar coverage.

"Aetna, one of the nation’s largest insurers, this year began introducing health plans for small employers that charge patients no co-pays for preventive care such as routine physicals, vision and gynecological exams, and well-child visits," Galewitz wrote.

"The company says it is pricing that new plan the same or nearly the same as what the existing plans would have cost, although it has increased co-pays on certain other benefits.

"Aetna spokesman Mohit Ghose on Friday said the company strongly supports efforts to promote prevention in health reform. He declined to say whether the company would support a government mandate eliminating copayments for preventive services.

"America’s Health Insurance Plans, the industry’s top lobbying group, opposes the mandate, said spokesman Robert Zirkelbach. He cited the need to give insurers flexibility in designing benefit packages.

"Wellpoint, the largest Blue Cross and Blue Shield company, said it sees the benefit for waiving cost sharing but doesn’t want the government mandate.

“'Many of WellPoint’s affiliated health plans’ benefits already offer preventive services with no co-pay or deductible as we feel these are important services,' said spokeswoman Cheryl Leamon. 'We also believe it is important for our members and others to have the choice in the type of health plan and benefits that fit their needs.'”

President Obama recently cited "no cost sharing for preventive services" as one of eight protections he wanted a health reform bill to provide.

The bills currently working their way through Senate and House committees all mandate Medicaid coverage of clinical preventive services. The House Energy and Commerce Committee last week approved an amendment by Rep. Lois Capps, D-Calif., that would prohibit cost-sharing for clinical preventive services provided to Medicaid patients.

Partnership for Prevention today applauded President Obama’s call for a health reform bill that requires no cost-sharing by patients who obtain preventive services.

The preventive services proposal was among eight “core consumer protections” that Obama said would be provided by health reform legislation. He listed the eight protections during a Thursday town hall meeting in Raleigh, N.C. A fact sheet issued by the White House on Thursday said their cost-sharing protections mean that “Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.”

“We applaud the president for seeking this type of protection for patients,” Partnership President Robert J. Gould said. “Proven preventive services will help save lives and reduce the incidence of chronic disease that is a leading driver of spiraling health care costs.

“It makes no sense to seek cost-sharing for preventive services,” Gould said. “The main purpose of cost-sharing is to discourage the use of medical services. But clinical preventive services are currently under-utilized.”

Gould said the president’s stance should strengthen support for an amendment that Partnership is helping members of the House Energy and Commerce Committee to craft that would prohibit cost-sharing for preventive services funded under Medicaid.

A study by Partnership for Prevention’s National Commission on Prevention Priorities found that increased utilization of just five clinical preventive services – daily aspirin use, tobacco cessation counseling, adult pneumococcal immunization, and breast and colon cancer screening – would save an additional 100,000 lives a year, while all five services either save money or are cost-effective.

Partnership for Prevention is a non-profit organization of business, health care and government leaders who are trying to make evidence-based disease prevention and health promotion a national priority.

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The Wall Street Journal's Jacob Goldstein blogs a brief but interesting profile on Kathleen Sebelius, the Kansas governor who currently appears to top the list of candidates for Secretary of Health and Human Services.

"Sebelius spent eight years as her state’s insurance commissioner — key experience for a job that includes overseeing Medicare, the gargantuan federal insurance program for the elderly," Goldstein writes. "During that time, she blocked the sale of Blue Cross and Blue Shield to an out-of-state company because it would have raised premiums, the NYT says, and served as president of the National Association of Insurance Commissioners.

"During her two terms as governor, her administration has been notably bipartisan — she was elected to her first term with a former Republican businessman as her running mate, and ran a second time with the former state Republican party chairman on her ticket, the NYT reports. That’s important, given the polarizing nature of health-care questions, and the power Republicans still wield in the Senate.

"Still, she’d be unlikely to hold the dual role planned for Daschle, which included not only running HHS but also holding down an office in the White House to spearhead Obama’s health-reform plans."

The Kennesaw, Ga., city council Monday night approved a plan that would impose a health insurance surcharge on high-risk employees who don't take part in city-sponsored wellness programs. Under the policy, high-risk employees can join stop-smoking and weight-loss programs or meet weekly with a coach to address other risk factors. Smokers who don't do so will pay a surcharge of $25 per pay period, while high-risk non-compliant employees will pay a surcharge of $50 per every two-week pay period.

Currently, 125 of Kennesaw’s 233 employees attend wellness programs, which began a year ago. Mandatory health screenings began in the fall. The state of Georgia's insurance charges are $40 a month more for employees who smoke and are not in a smoking cessation program.

The National Health Statistics Group reports that health care spending in 2007 grew 6.1%. The overall response to that news has been an interesting mix - one that gives you the impression that while the oncoming train is still headed for your car stuck on the crossing, at least it's slowed down a bit.

Several media reports focused on the fact that it was the lowest level of growth in health care spending in nine years. But, as Forbes noted, since the total economy grew by only 2.3% in 2007, the 6.1% hike in health care costs still means everyone’s losing ground.

Drug costs grew by only 5%, as a number of low-priced generics came on the market. But hospital and doctor spending grew 7.3% and 6.5%, respectively, and health insurance premiums grew by 6 percent.

Meanwhile, Health Affairs published a study that shows out-of-pocket medical expenses in the U.S. have grown by 40% over the last decade. Study author Kathy Paetz says it's due largely to the fact that middle-aged Americans today are 10 percent more likely to suffer from more than one chronic disease. Prevention, anyone?