Health insurance reform must include an enhanced focus on preventing and managing chronic illnesses in order to transform our current “sick care” system into a true health care system. The United States spends more than $2 trillion on health care each year, but just four cents out of every dollar is invested in prevention and public health, despite studies showing that disease prevention can effectively reduce health care spending. [Centers for Medicare and Medicaid Services, accessed 11/1/2009; The Brookings Institution, 4/2007; Trust for America’s Health, 3/2008] This limited investment results in low utilization of prevention services, with American adults receiving just half of all recommended clinical preventive services. [New England Journal of Medicine, 2003]
Without a focus on prevention and chronic disease management, Americans are suffering and dying from uncontrolled chronic conditions, which are exacerbated by our nation’s obesity epidemic and high smoking rates. Senate health insurance reform will make critical investments in policies that promote prevention of chronic disease and better management for those already living with chronic conditions to reduce health care costs for all Americans.
The Need for Chronic Disease Reduction and Management
Chronic diseases contribute to 70 percent of deaths and increase health care costs. More than half of all Americans live with one or more chronic conditions, and chronic diseases are responsible for seven out of ten deaths in the United States. [Milken Institute, 10/2007; Centers for Disease Control and Prevention (CDC), 2004] The cost of caring for individuals with chronic diseases accounts for approximately 75 percent of the more than $2 trillion Americans spend on health care each year. [CDC, 10/7/2009]
Enhanced prevention and disease management efforts could substantially reduce the incidence of chronic disease, contribute to healthier lives, and save money now spent on treatment. Just a one percent reduction in the adult smoking rate could result in 30,000 fewer heart attacks, 16,000 fewer strokes, and save more than $1.5 billion over five years. [Circulation, 1997] The cost of heart disease treatment could be reduced by $5.6 billion if just 10 percent of Americans began walking regularly. [Critical Pathways in Cardiology, 12/2004]
Obesity contributes to chronic disease and increases health care costs. Increasing rates of obesity represent a challenge to our nation’s health, with more than two-thirds of American adults now classified as obese or overweight. [CDC, 10/2008; U.S. Department of Health and Human Services, 4/3/2008] In addition, approximately 17 percent of children and adolescents ages 2-19 are overweight. [CDC, 4/2006] Obesity and physical inactivity are identified as risk factors for more than 20 different chronic diseases, such as type 2 diabetes, heart disease, and some cancers. [CDC, 9/15/2008] This association with chronic diseases drives up the cost of caring for obese and overweight individuals, with health care costs for obese workers as much as 21 percent higher than for workers of a healthy weight. [Archives of Internal Medicine, 2004] Obesity among Medicare beneficiaries doubled between 1987 and 2002, but the share of spending dedicated to treating obese beneficiaries tripled, jumping from 9.4 percent to 25 percent of total Medicare spending. [Health Affairs, 2006]
Tobacco use contributes to chronic disease, kills Americans, and increases health care costs. Tobacco use is the leading preventable cause of death in the United States. [Trust for America’s Health, 10/2008] Nearly 20 percent of American adults, or more than 43 million people, are addicted to cigarettes. [National Center for Health Statistics, National Health Interview Survey, 2007] Tobacco use kills more than 400,000 Americans each year, and an additional 50,000 nonsmokers die prematurely each year due to exposure to secondhand smoke. [CDC, 11/18/2008] Smoking harms almost every organ in the body and is a contributing factor to many chronic diseases. For example, tobacco causes nearly 90 percent of all lung cancer deaths and at least 30 percent of deaths due to all types of cancer. [American Cancer Society, accessed 11/1/2009] Smoking also causes heart disease, the leading cause of death in the United States, and is responsible for 80-90 percent of all deaths from chronic obstructive lung disease. [Trust for America’s Health, 10/2008]
Health care costs for these individuals are staggering, with $96 billion in total annual public and private health care expenditures attributable to smoking. [CDC, 11/18/2008] Estimates indicate that American taxpayers shoulder $70.7 billion of those costs due to expenditures made by Medicare, Medicaid, and other federal health programs. [Campaign for Tobacco-Free Kids, 9/22/2009]
Senate Health Insurance Reform Will Focus on Chronic Disease and Cost Reduction
Remove financial barriers to preventive care. To help more Americans access critical preventive services, Senate health insurance reform will eliminate co-pays or deductibles for recommended preventive care and screening and will ensure health insurance companies reward the provision of high quality health care. To improve immunization coverage and reduce health care costs, Senate health insurance reform will help states save money on the purchase of adult vaccines. And Senate health insurance reform will promote oral health care, focusing on key populations, including children and pregnant women.
Promote chronic disease prevention for seniors and older Americans. Recognizing the importance of preventive care for seniors, Senate health insurance reform will ensure that Medicare covers, with no co-payment or deductible, an annual checkup and personalized prevention plan services, and waives beneficiary coinsurance requirements for most other preventive services. In addition, Senate health insurance reform will create pilot programs to reduce the incidence of chronic disease among Americans in the years before they are eligible for Medicare, to reduce Medicare costs.
Improve prevention and public health coordination and funding. By better coordinating the work of many federal agencies, and by establishing a national prevention and health promotion strategy, Senate health insurance reform will promote chronic disease prevention policies at the federal level. An expanded and sustained investment in prevention and public health will improve health and help restrain the rate of growth in private and public sector health care costs.
Promote individual and community prevention activities. Promoting health and reducing the incidence of chronic disease at the community level will help prevent the onset of chronic disease and better manage any chronic conditions individuals may have. Supporting community programs to reduce chronic disease associated with things like obesity, tobacco use or mental illness will help create stronger, healthier communities. In addition, Senate health insurance reform will fund efforts to develop a comprehensive and systematic model for reducing childhood obesity.
Promote workplace wellness. Senate health insurance reform allows health insurance plans and employers to offer premium discounts and other awards to individuals who participate in workplace wellness programs, and directs the CDC to study and evaluate best practices in employer-based wellness programs.
Help prevent chronic disease among Medicaid participants. Senate health insurance reform will improve Medicaid funding for states that cover additional preventive services and vaccines for adults, will require coverage of tobacco cessation services for pregnant women enrolled in Medicaid, and will eliminate Medicaid cost-sharing for services and immunizations with a strong recommendation from the U.S. Preventive Services Task Force. Senate health insurance reform will offer incentives to Medicaid beneficiaries who participate in programs for avoiding or managing chronic disease, such as lowering or controlling cholesterol and blood pressure.
Focusing on Prevention and Wellness in Health Insurance Reform
Health insurance reform must truly transform health care in America from a focus on treating and curing disease to a focus on preventing disease and managing chronic conditions in a responsible manner. Through policies and investments designed to promote prevention and disease management at all ages, Senate health insurance reform will help keep health care costs under control.
Transforming our current “sick care” system into a real health care system is no small task, but a new focus on and investments in prevention and public health policies will reduce the number of Americans suffering from chronic disease and reduce health care costs.