The Senate has an opportunity to increase access to preventive health interventions by passing legislation that would better measure the long-term budget savings that these interventions would generate.
Senators should pass that legislation without delay.
The Preventive Health Savings Act, which the House passed in March, would empower the director of the Congressional Budget Office (CBO) to determine whether a proposed measure of "preventive health and preventive health services" would reap budget savings more than 10 years into the future -- and, if so, then require that CBO include that analysis of budget savings in its overall projection of the measure.
Currently, CBO projects the budgetary impact of legislation over a period limited to 10 years. This bill would empower CBO's director to measure the budgetary impact of preventive health interventions for the two decades after those first 10 years.
Why should the Senate pass this measure? Because potential savings from preventive health interventions often come well beyond the first 10 years. The more that lawmakers focus on the longer term, the likelier they are to enact preventive health measures that would not only lead to budget savings but would also improve the health of millions of Americans.
We believe disease prevention must be one of our nation's top health policy priorities.
Chronic and mental health conditions comprise an estimated 90% of the nation's approximately $4.5 trillion healthcare bill. And, to a great extent, healthcare spending drives overall federal spending. In fact, toward the middle of this century, major federal healthcare programs are projected to comprise nearly 40% of all federal spending (not counting interest payments on the national debt). Medicare alone is projected to account for more than two-thirds of the increase in federal health spending over the next 30 years.
To be sure, lawmakers in the near term need to enact structural reforms to how government pays and reimburses healthcare providers. But enacting reforms to address chronic diseases requires a focus beyond 10 years -- prevention measures often take time to demonstrate their full benefits.
Prevention works. Clinical preventive services such as certain cancer screenings, immunizations, and substance use counseling reduce illness and save lives. Community preventive services such as smoke-free policies, motor vehicle injury prevention, and diabetes prevention programs (e.g. physical activity and dietary changes) also improve health.
Prevention can also be cost-effective. In fact, CBO found, "a systematic review of the literature that analyzed hundreds of studies concluded that 20% of preventive medical services improved health and reduced costs." That's particularly true with childhood immunizations, tobacco screening and counseling, secondary prevention with aspirin, and alcohol screening and counseling. It's also true of community prevention services such as community fluoridation and use of motorcycle helmets. Of the remaining 80% of preventive services, many are cost-effective and thus have a good value.
Federal projections of longer-term savings from preventive healthcare measures could incentivize lawmakers to enact more such measures and, thus, improve the health of Americans for decades to come.
For instance, Medicare coverage of anti-obesity medications (coupled with such coverage by private insurers) would likely show greater reductions in Medicare spending beyond the first 10 years, as a result of fewer cases of obesity-related conditions such as diabetes, heart disease, cancer, and other health complications.
Along the same lines, a Medicaid requirement that states provide coverage of all FDA-approved tobacco cessation therapies and behavioral counseling -- and not impose cost-sharing and other obstacles on beneficiaries -- would also likely show federal and state spending reductions in future decades.
As CBO Director Phillip Swagel told the House Budget Committee in late March, his organization is "well positioned" to provide policymakers with information on the long-term budget impacts of preventative healthcare. In fact, he said, CBO is already working on several analyses related to anti-obesity medications in Medicare and proposals to fund screening for and treatment of conditions such as chronic hepatitis C.
The House has passed the legislation in question. Senators Ben Cardin (D.-Md.) and Mike Crapo (R.-Idaho) have introduced an identical companion measure in the Senate. The time for that chamber to act is now.
Anand Parekh, MD, MPH, is chief medical advisor of the Bipartisan Policy Center. He is the author of Prevention First: Policymaking for a Healthier America. G. William Hoagland is senior vice president at the Bipartisan Policy Center, and previously served as one of the first employees of the Congressional Budget Office.