Billions To Fight Obesity At Issue

Health Care Measure's Wellness Provision Stirs Debate On Savings

August 03, 2009|By Kristina Sherry | Kristina Sherry,Tribune Newspapers

WASHINGTON - - As one house of Congress moves toward a September vote on offering insurance to millions of Americans, the other is wading into a controversy over whether such coverage should include billions of dollars aimed at keeping people well.

A draft Senate bill would provide up to $10 billion annually for a "prevention and public health investment fund" - a portion of which could be used for infrastructure projects such as bike paths, sidewalks, farmers' markets and other community interventions meant to curb chronic and costly conditions such as obesity.

But while some lawmakers believe these initiatives could trim pork from American waistlines and cut costs in the long run, others consider them pork-barrel spending.

One critic, Sen. Mike Enzi of Wyoming, the top-ranked Republican on the Health, Education, Labor and Pension panel and an accountant, called the provisions "an $80 billion slush fund for additional pork-barrel projects" and "wasteful spending" during a time of record deficits.

"The [Health Committee] bill will pave sidewalks, build jungle gyms and open grocery stores," Enzi said, "but it won't bring down health care costs or make quality coverage more affordable." But advocates say preventive efforts will bring down costs.

"We know these programs work," said Rich Hamburg, director of government relations for the Trust for America's Health, a nonpartisan organization that works to make disease prevention a national priority. "In and of itself, prevention makes sense," Hamburg said.

Trust for America's Health joined more than 300 organizations in urging lawmakers to include public health and prevention funds in the bill. The group also led a 2008 report suggesting that an investment of $10 per person per year in "proven community-based programs" - such as providing access to fresh produce through farmers' markets - could save America more than $16 billion annually within five years in lower health care costs.

Hamburg acknowledged Republican objections: "Their talking points are: 'Hey, this is gonna build jungle gyms.' " But he added: "Frankly, building healthy parks and making them easier to access is a good thing." Hamburg said public health has been "chronically underfunded" for years and that the wellness and prevention provisions would help reduce chronic disease in the long term.

"How can you tell people to go exercise if there aren't sidewalks?" he said.

Debate over the draft Senate provisions on wellness is taking shape as House Democrats gear up for a full floor vote in September after forging a compromise late Friday on a bill that would offer insurance to nearly 50 million uninsured Americans.

The 31-28 vote in the House Energy and Commerce Committee, along party lines, would cap increases in the cost of insurance sold under the bill, and also give the federal government authority to negotiate directly with drug companies for lower prices under Medicare.

Republicans on Saturday quickly blasted the Democrats' proposals as a "dangerous and costly experiment" that will run up the federal deficit and overwhelm state budgets.

President Barack Obama has said repeatedly that he won't sign a bill that isn't "deficit-neutral," and a great deal of hope toward this end has been placed in preventive efforts, including the health "infrastructures" that are in the Senate legislation.

But prevention's potential payoffs have been largely overlooked by recent Congressional Budget Office estimates indicating that the drafted bill would likely keep health care costs rising.

Some lawmakers, including House Speaker Nancy Pelosi, a California Democrat, and Sen. Tom Harkin, D-Iowa, criticized CBO analyses for not taking into account potential savings from prevention and wellness measures.

But the CBO is careful to point out that over its 10-year window of cost estimates, it only takes into account evidence of significant, measurable savings. And although the proposed law authorizes these wellness measures, additional legislation would be required to fund and implement them.

Meanwhile, infrastructure provisions have drawn more explicit assessments from other lawmakers:

Republican Sen. Tom Coburn of Oklahoma, a physician on the Health Committee, also opposed the wellness provisions and offered an amendment that would have prohibited funds from being used on "wasteful construction projects" like farmers' markets. It failed.

Rep. Tim Murphy, R-Pa., a psychologist and co-chair of both the Mental Health Caucus and the GOP Doctors Caucus, stresses the importance of preventive measures, personal responsibility and promoting healthy living - particularly through lower health insurance rates for healthy behaviors.

"Shouldn't there be more credit given if someone's a nonsmoker?" he said.

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