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  • Public Affairs

  • ACOEM Joins Coalition Urging Change to CBO Scoring Rules for Disease Prevention Programs

    August 17, 2016

    Dear Senators King, Cardin, Crapo, Shaheen, and Udall:

    The undersigned organizations, representing healthcare groups, associations, patients, and employers, would like to express our support for the Preventive Health Savings Act.

    We share the conviction that the way in which the Congressional Budget Office (CBO) currently “scores” legislation severely constrains the ability of policymakers to accurately assess legislation that would prevent chronic disease. We agree wholeheartedly with existing bipartisan agreement on the need for a continued focus on wellness and disease prevention if healthcare costs are to be contained. We believe this legislation represents a significant step toward this goal.

    Chronic disease places a significant burden on our health and economy, but it can be reversed.
    • Chronic diseases are responsible for 7 of 10 deaths among Americans each year, and they account for more than 80 percent of the $2.7 trillion our nation spends annually on medical care. These figures will worsen as the population ages.
    • Much of the illness, suffering, and early death related to chronic diseases is caused by modifiable health risk behaviors such as lack of physical activity, poor nutrition, and tobacco use.
    • Preventing or delaying the onset of new cases and mitigating the progression of chronic disease will improve the health of Americans while lowering healthcare costs and overall spending.

    The current scoring process does not give Congress a complete picture of efforts to combat chronic disease.
    • Research has demonstrated that certain expenditures for preventive medicine generate savings when considered in the long term, but those cost savings may not be apparent when assessing only the first ten years—those in the “scoring” window.
    • Long-term benefits from current preventive health expenditures may not be fully reflected, if at all, in cost estimates from CBO.
    • Lawmakers need sound information, and today’s methods and procedures may not work as well as needed in analyzing certain efforts to prevent costly complications of chronic diseases.

    CBO has already begun to examine prevention in new ways.
    • In 2012, CBO published long-term estimates of the effect of a hypothetical tobacco tax on the federal budget.
    • In 2013, CBO published a study which found greater prescription drug access and adherence can reduce healthcare costs in other areas.
    • Beginning in the 114th Congress, CBO has responded to a new House of Representatives requirement to score certain large bills by taking into account projected impacts on revenue and spending from assumed economic effects of the bills.

    The Preventive Health Savings Act will permit leaders in Congress to request that CBO estimate the long-term health savings that are possible from preventive health initiatives.
    • This legislation provides that the Chairman or Ranking member of either budget or health-related committees can request an analysis of the two 10-year periods beyond the existing 10-year window.
    • The bill requires CBO to conduct an initial analysis to determine whether the provision would result in substantial savings outside the normal scoring window.
        * CBO must include a description of those future-year savings in its budget projections, but would retain the option of creating a formal projection that includes some or all of the budgetary outyears.
        * This bill is necessary to bring greater attention to the longer-term value of wellness and prevention policies specifically.
    • The bill defines preventive health as an action designed to avoid future healthcare costs that is demonstrated by credible and publicly available epidemiological projection models, incorporating clinical trials or observational studies in humans.
    • This narrow, responsible approach discourages abuse while encouraging a sensible review of health policies and programs Congress believes will further public health.

    As the chronic disease epidemic continues to worsen, so does the need for legislation that will properly allow Congress to see the full savings of enacting prevention-focused measures. We applaud your efforts in sponsoring this important legislation and look forward to joining with you in transforming our nation to one that prioritizes efforts to achieve wellness and well-being.


    Academy of Nutrition and Dietetics
    ACT | The App Association
    Alliance for Aging Research
    Alzheimer’s Association
    America’s Essential Hospitals
    America’s Health Insurance Plans (AHIP)
    American Association for Respiratory Care
    American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
    American Association of Clinical Endocrinologists (AACE)
    American Association of Diabetes Educators
    American Clinical Laboratory Association
    American College of Gastroenterology
    American College of Occupational and Environmental Medicine
    American College of Osteopathic Family Physicians
    American College of Preventive Medicine
    American College of Radiology
    American Council on Exercise
    American Diabetes Association
    American Osteopathic Association
    American Pharmacists Association
    American Podiatric Medical Association
    American Society for Metabolic and Bariatric Surgery
    American Society of Bariatric Physicians
    AmerisourceBergen Corporation
    Ascension Health
    BioReference Laboratories
    BlueCross BlueShield of Tennessee
    Boehringer Ingelheim
    Campaign to End Obesity Action Fund
    Cancer Support Community
    Cardinal Health
    Cleveland Clinic
    Connected Health Initiative
    Council for Affordable Health Coverage
    Diabetes Hands Foundation
    Dialysis Patient Citizens
    Eli Lilly and Company
    Healthcare Information and Management Systems Society (HIMSS)
    Healthcare Leadership Council
    IHRSA: International Health, Racquet & Sportsclub Association
    Indiana University Health
    Johnson & Johnson
    LifeWIRE Corp.
    Marshfield Clinic
    McKesson Corporation
    MemorialCare Health System
    National Alliance of State Pharmacy Associations
    National Alliance on Mental Illness
    National Association of ACOs
    National Association of Chain Drug Stores (NACDS)
    National Association of Pediatric Nurse Practitioners
    National Association of Spine Specialists
    National Business Coalition on Health
    National Business Group on Health
    National Center for Weight and Wellness
    National Kidney Foundation
    National Retail Federation
    Nestle Health Science
    Novo Nordisk
    NTCA–The Rural Broadband Association
    Obesity Action Coalition
    Omada Health
    Ovarian Cancer Research Fund Alliance
    Partnership for Prevention
    Partnership to Fight Chronic Disease
    Population Health Alliance
    Premier healthcare alliance
    Prescriptions for a Healthy America
    Prevent Cancer Foundation
    Rite Aid
    Sanofi US
    SCAN Health Plan
    Society for Women’s Health Research
    Spine Foundation
    Sports & Fitness Industry Association
    Stroll Health
    Takeda Pharmaceuticals
    Texas Health Resources
    The Endocrine Society
    The Obesity Society
    Third Way
    Underwriters Laboratories Inc.
    University of Mississippi Medical Center -– Center for Telehealth
    VSP Vision Care
    Weight Watchers
    Women Heart: The National Coalition for Women with Heart Disease
    YMCA of the USA

    cc: Representatives Burgess and DeGette