Chronic disease prevention was an explicit priority of the Secretaries of Health and Human Services in both of the President George W. Bush and President Barack Obama administrations. While the policies and programs may have differed across administrations, there has been a recognition by both parties that promoting wellness is an important policy objective.
Prioritizing prevention can and should remain an essential part of the Trump Administration’s health priorities. Addressing the high and growing costs of chronic disease is critical to ensuring a sustainable health care system, and tackling well-known risk factors that lead to conditions such as diabetes, heart disease, and hypertension must be part of any winning strategy.
The eight years of the Obama administration have yielded particularly significant prevention investments given the passage of the Affordable Care Act (ACA). Prevention related sections of the ACA included provisions focused on individuals, businesses and workplaces, communities and states, as well as national investments such as the Prevention and Public Health Fund. While it may be too early to determine the full health impacts of these investments, the Centers for Disease Control and Prevention’s (CDC) final report, Winnable Battles, demonstrated significant national progress in some areas as well as moderate progress in others. For example, fewer than 15.1 percent of adults and 10.8 percent of youth smoked cigarettes in 2015, exceeding the set target of 17.0 percent and 17.6 percent, respectively. On the other hand, the proportion of children and adolescents aged 2-19 who are obese remained at approximately 17 percent, falling short of the set target of 15.4 percent, although reductions in obesity rates have previously been noted among very young children, ages 2-5.
President Trump & Prevention Policy
Repealing and replacing the ACA is taking center stage after the election of Donald Trump. Using the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, legislation put forward by the new Secretary of Health and Human Services Dr. Tom Price, as a template, it is likely that the Prevention and Public Health Fund could be repealed given its budgetary impact. If full repeal of the ACA happens, the authority for some prevention-focused rules created through the ACA, such as rules on nutrition labeling of standard menu items at chain restaurants, would also disappear.
Beyond the ACA, however, there is reason to believe that prevention can and may play a role in the Trump Administration and Republican Congress, given the core Republican philosophical objective of reducing federal entitlement spending. While Medicare premium support and Medicaid block grants may be strategies pursued by Republican leadership to reduce government spending on health care, overall health care expenditures continue to rise as evidenced by the latest national health spending data from the Centers for Medicare and Medicaid Services. Recent data on US spending on personal health care and public health demonstrate that preventable chronic conditions such as diabetes, ischemic heart disease, and hypertension account for the highest amounts of health care spending. Without reducing the prevalence of chronic diseases, it will be difficult to achieve a sustained moderation of health care costs.
To promote chronic disease prevention, any strategy will likely adhere to two fundamental Republican principles – 1) personal responsibility and 2) locally driven solutions. There are several possible ways the Trump administration could advance prevention consistent with these principles.
Personal Responsibility
Republicans traditionally support the notion that individuals are at least partially responsible for the behaviors and actions that affect their health. To support individuals in embracing healthy behaviors, government can provide the public scientifically sound information. Public health education campaigns have been shown to be an effective evidence-based strategy in a number of prevention areas, including promoting physical activity, increasing smoking cessation, and receiving cancer screenings. The Trump Administration could leverage a number of existing public and private sector prevention campaigns such as Go4Life, an exercise and physical activity campaign from the National Institute on Aging, 80% by 2018, a campaign led by the National Colorectal Cancer Roundtable to have 80 percent of at-risk Americans screened for colorectal cancer by 2018, and the CDC’s Tips From Former Smokers campaign, which has been shown to increase successful quit attempts.
In addition to providing scientifically sound information to the American public, the Trump administration could further encourage personal responsibility by supporting consumer incentives that promote wellness. For example, increasing the evidence-base for worksite wellness programs and supporting employers in establishing programs are two steps that would build upon work started under the ACA.
Second, cost-sharing reductions in public and private insurance could be used to encourage healthy behaviors. In fact, several Republican governors, such as Governor Rick Snyder of Michigan and former Governor Mike Pence of Indiana, recently expanded Medicaid in their states and tied beneficiary cost-sharing reductions to healthy behavior commitments. Third, the administration should support existing Centers for Medicare and Medicaid Services (CMS) payment policies that provide Medicare beneficiary access to evidence-based diabetes prevention programs. And fourth, the Trump administration could build on value-based insurance design principles and support first dollar insurance coverage for high-value clinical preventive services. In addition to reviewing the findings of the U.S. Preventive Services Task Force, the Trump administration should utilize the recently updated rankings of clinical preventive services by the National Commission on Prevention Priorities to promote access to these services.
Locally Driven Solutions
As a second principle, the Trump administration will also likely focus on locally driven solutions versus new “top-down” federal programs. The past decade has seen significant progress and success at the local level, supported by data and metrics around what works in prevention and for which populations. Efforts such as the County Health Rankings and Roadmaps program and the 500 Cities project supported by the Robert Wood Johnson Foundation and partners are allowing localities across the country to have a better picture of the burden of risk factors and illness affecting their population. The Trump administration could support these localities by expanding prevention research efforts at the CDC, National Institutes of Health, and Substance Abuse & Mental Health Services Administration to identify evidence-based interventions for chronic disease prevention.
As a first step, the Trump administration should support existing recommendations of the independent Community Preventive Services Task Force on successful practices for preventing asthma, diabetes, mental health, and obesity and other health issues and ensure that localities receive the technical assistance needed to implement its recommendations. From a funding perspective, federal support to states and localities makes up the largest share of their prevention dollars. The Trump administration should support funding increases for federal prevention programs, particularly in light of the possible repeal of the Prevention and Public Health Fund, and it should direct this funding toward localities ready to implement the Task Force recommendations to achieve maximum impact. Requiring that localities secure private sector matching funds to be eligible for these additional resources could enhance the sustainability of these efforts in light of uncertainty around federal grant programs. We would urge the Administration to give extra consideration to areas in greatest need, in alignment with the longstanding Republican principle of “compassionate conservatism,” so that disparities are not widened as an unintended policy consequence.
The Bipartisan Pursuit Of Prevention
Not all existing federal prevention policy will be maintained in a Trump administration. Certainly, regulatory approaches will be the first to be scrutinized and the new leadership would be wise to maintain gains in tobacco control, nutrition, and cancer prevention. Nevertheless, there are additional opportunities, consistent with traditional Republican principles, to support prevention efforts the administration should pursue. To begin, the administration should review the current goals and objectives of Healthy People, which has been utilized by previous administrations for nearly four decades to set 10-year national objectives for improving the health of all Americans. Ultimately, prevention is, and must continue to be, a bipartisan pursuit. The health of Americans and of our health care system demands nothing less.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2mpn4vK
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