The Obama administration is trying to defend the health improvement funding authorized by the Patient Protection and Affordable Care Act of 2010 (PPACA).
PPACA allocated $15 billion in funding for a Prevention and Public Health Fund. The U.S. Department of Health and Human Services (HHS) was supposed to use the money over 10 years to prevent chronic disease, detect it early and manage conditions before they become severe.
President Obama has given the Joint Select Committee on Deficit Reduction – the 12-member “Super Committee” that is racing to come up with $1.2 trillion in deficit reduction proposals by Thanksgiving – a proposal that would cut program funding to about $14 billion over 10 years.
The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing Wednesday on how the government should manage chronic disease prevention efforts.
Sen. Tom Harkin, D-Iowa, the chairman of the committee spoke with pride about his role in getting the prevention fund provision into PPACA.
“This fund is only a small down payment compared with the size of the problem,” Harkin said.
An Obama administration witness, Howard Koh, an assistant secretary for health at HHS, noted that chronic disease accounts for about 75% of the $2.5 trillion that the United States each year on health care.
The country also spends hundreds of billions of dollars on support programs aimed at people who are unable to work or unable to perform the normal activities of daily living because of the effects of preventable chronic conditions.
But some Republican critics have suggested that HHS might be using the prevention fund as a “slush fund.”
Sen. Pat Roberts, R-Kan., said in his opening remarks that any prevention funding available must be carefully distributed, that priorities must be set with great thought, and that oversight over any prevention spending must be vigorous.
Koh testified at the hearing that the prevention fund has provided $750 million for fiscal year 2011, and that HHS has used the fund to pay for initiatives such as $222 million community and state prevention grant program that supports efforts to reduce tobacco use, prevent obesity and reduce health disparities. The fund also has provided $60 million for anti-tobacco-use campaigns and $16 million for obesity prevention and fitness campaigns.
In North Carolina, for example, public health officials are using prevention fund money to support farmers’ markets, farm stands and efforts to get fresh product into convenience stories, Koh said.
Tevi Troy, a former Bush administration health promotion official who is new a fellow at the Hudson Institute, Washington, acknowledged that developing effective chronic disease prevention programs is an important goal.
Both the Bush administration and the Obama administration have set up programs to encourage children to play more outside, but neither program has done much or will do much to affect obesity levels, Troy said.
“Going forward,” he testified, “we need not just good intentions, but also strong principles to guide us, such as the need for the right process, a recognition of our dire fiscal situation, a need for focused and not vaguely defined programs, and a recognition that many so-called prevention savings never materialize.”
The government also must take care to use narrow definitions and tight rules when spending what prevention money is available, Troy said.
“Already there has been criticism around one program authorizing federal funding for the construction of sidewalks and jungle gyms,” Troy said. “Programs should be targeted so as not to incur such criticism, which can damage the prevention ‘brand.’”
Another problem with loose definitions and goals is that cash-strapped local governments could find ways to use prevention money for other purposes, Troy said.
Troy added that calling a service a “preventive” service will not necessarily lead to prevention.
The government should make sure that it is targeting effective preventive services at the people who really need the services, Troy said.
“If we can target those with the greatest risk, we will be more likely to have cost-effective interventions,” Troy said.
The government also should take care to avoid setting up new, government-run wellness programs that end up crowding the many employer-sponsored wellness programs already in place, Troy said.