Dr. Michael C. Burgess Preventive Health Savings Act

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 766) to amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material into the bill.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in support of H.R. 766, the Dr. Michael C. Burgess Preventive Health Savings Act.

This pivotal piece of legislation seeks to establish a mechanism for the Congressional Budget Office to more accurately reflect the long- term, cost-saving potential of preventive healthcare initiatives.

This bipartisan, bicameral effort underscores our commitment to promoting the health and well-being of all

Americans. We encourage the use of data-informed preventive health measures, and we are taking proactive steps toward not only saving lives, but also saving taxpayer dollars in the long run.

Chronic illnesses account for over 70 percent of all our healthcare spending, and they continue to pose a significant burden on our system and our economy.

However, by enacting measures like H.R. 766, we can begin to bend the cost curve and provide a more accurate understanding of the long-term cost savings from preventive healthcare policies.

H.R. 766 specifically allows the Congressional Budget Office, upon the instruction of Congress, to extend its analysis beyond the existing 10-year budget window to two additional 10-year periods. This provision will enable us to conduct a fuller analysis of the potential budgetary savings and the impact of preventive health legislation, ensuring that we make informed decisions based on sound evidence and data.

Moreover, the Dr. Michael C. Burgess Preventive Health Savings Act narrowly defines preventive health to encompass actions that focus on the health of the public, individuals, and defined populations.

By relying on credible and publicly available evidence from various sources, such as epidemiological projection models, clinical trials, and meta-analysis, we can ensure that our policies are both meaningful and impactful.

Lastly, H.R. 766 protects against estimates being used to justify partisan policies that might be used as budget gimmicks by requiring the request for a long-term estimate to be bipartisan and by stipulating such estimates cannot be used to comply with budget rules.

The successes of past legislation, such as the passage of Medicare part D in 2003, under a Republican majority in Congress, serves as a reminder of the profound impact preventive care can have on our healthcare. Despite initial concerns about its costs, Medicare part D has proven to be a wise investment, yielding savings and benefits that far outweigh its initial expenses.

In conclusion, I believe that an ounce of prevention is, indeed, worth a pound of cure, and preventive care in 2003 has yielded more than a pound of cure today. This undeniable truth underscores the case for preventive, personalized medicine and should only serve to encourage us to redouble our efforts and pass this important bill.

Mr. Speaker, I include in the Record a letter of support signed by 53 organizations as part of H.R. 766.

March 4, 2024.

Hon. Mike Johnson,

Speaker, House of Representatives,

Washington, DC.

Hon. Hakeem Jeffries,

Minority Leader, House of Representatives,

Washington, DC.

Dear Speaker Johnson and Minority Leader Jeffries: We, the

53 undersigned organizations, would like to express our

support for H.R. 766, the ``Dr. Michael C. Burgess Preventive

Health Savings Act,'' which removes outdated statutory

constraints which currently prevent Congressional Budget

Office (CBO) estimates from correctly assessing preventive

health initiatives that might achieve long-term health

savings in federal programs.

As leaders in health care representing patients, providers,

associations, and employers, we all agree on the need for a

continued focus on wellness and disease prevention if

healthcare costs are to be contained. We share a bipartisan,

bicameral view with many in Congress that to move forward

with policy solutions to address the growing burden of long-

term chronic disease, Congress needs new tools to rise above

traditional legislative approaches to health care.

Simply put, we know we can't ``cut'' our way to a healthier

America by shaving dollars from federal programs that provide

care to people in need every time Congress finds a new

approach. As such, we all agree that the statutory

constraints that CBO must currently follow to ``score''

legislation severely constrains the ability of policymakers

to accurately assess legislation that would prevent chronic

disease. We believe this legislation represents a significant

step toward the goal of including new ideas and tactics to

improve care that have proven successful in the private

sector, or in health systems abroad that don't have the same

regulatory or budgetary constraints.

Chronic disease places a significant burden on our health

and economy, but it can be reversed:

We know that chronic diseases are responsible for 7 of 10

deaths among Americans each year, and they account for 90

percent of the $4.1 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,

tobacco use, and alcohol and substance misuse.

Preventing or delaying the onset of new cases and

mitigating the progression of chronic disease will improve

the health of people in America 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 health interventions 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.

Also, in 2012, CBO published a study which found greater

prescription drug access and adherence can reduce healthcare

costs in other areas.

In the 118th Congress, the House of Representatives

continues to require CBO to score certain large bills by

considering projected impacts on revenue and spending from

assumed economic effects 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 the

budgetary out years.

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 are 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 the public's 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 policy 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 wellbeing for all.

Sincerely,

Academy of Nutrition and Dietetics, Alliance for Aging

Research, American Academy of Family Physicians, American

Association of Clinical Endocrinology, American Association

of Nurse Practitioners, American College of Gastroenterology,

American College of Lifestyle Medicine, American College of

Occupational and Environmental Medicine, American College of

Preventive Medicine, American Society for Nutrition,

Ascension, Association of Diabetes Care & Education

Specialists, Avery's Hope.

Biocom California, Blooming Health, Inc., California

Chronic Care Coalition, Caregiver Action Network, Chronic

Care Policy Alliance, Connected Health Initiative, COPD

Foundation, Council For Affordable Health Coverage,

Determined Health, Fight Colorectal Cancer, FundPlay

Foundation, Geneoscopy, Gerontological Society of America,

Global Liver Institute.

Healthcare Leadership Council, HealthyWomen, HIV +

Hepatitis Policy Institute, Johnson & Johnson, Marshfield

Clinic Health System, MemorialCare Health System, Merck,

National Minority Quality Forum, Nevada Chronic Care

Collaborative, NourishedRx, NTM Info & Research, Obesity

Action Coalition, Obesity Medicine Association.

Partnership to Fight Chronic Disease, Partnership to Fight

Infectious Disease, PLAY Sports Coalition, Premier Inc.,

Sports & Fitness Industry Association, Team Titin, Texas

Health Resources, The Obesity Society, Tivity Health,

UsAgainstAlzheimer's, Vizient, Wellvana, YMCA of the USA.

Mr. Speaker, I urge all my fellow colleagues to join me in supporting H.R. 766 and ensuring that we continue to prioritize preventive healthcare initiatives for the betterment of all Americans, and I reserve the balance of my time.

Mr. Speaker, I yield 1 minute to the gentlewoman from Minnesota (Mrs. Fischbach).

Mr. Speaker, it is now my great privilege and high honor to yield 3 minutes to the gentleman from Texas (Mr. Arrington), the chairman of the Budget Committee, as we debate the first bipartisan budget bill to pass the floor of the House I think in the history of Congress.

Mr. Speaker, I yield 1 minute to the gentleman from Ohio (Mr. Wenstrup), the co-chair of the Doctors Caucus.

Mr. Speaker, I yield 1 minute to the gentleman from Indiana (Mr. Bucshon), a member of the Energy and Commerce Committee and a member of the Doctors Caucus.

Mr. Speaker, I yield 2 minutes to the gentleman from Missouri (Mr. Smith), the chairman of the Ways and Means Committee.

Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr. Carter), a fellow member of the Energy and Commerce Committee.

Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Moran).

Mr. Speaker, I yield 1 minute to the gentleman from Indiana (Mr. Yakym).

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, may I inquire as to how much time is remaining.

Mr. Speaker, I have no further speakers, and I reserve the balance of my time to close.

Mr. Speaker, I yield myself the balance of the time.

Mr. Speaker, I express my sincere gratitude to the gentleman from Texas (Mr. Arrington), my friend and the chairman of the Budget Committee, for his leadership. Also, I extend my appreciation to my fellow members of the Budget Committee for their unwavering support of this critical legislation.

I thank my former and current staff: James Paluskiewicz, Alexa Roberts, and Jacquelyn Incerto. Additionally, I express my appreciation for the Budget Committee staff--namely, Gary Andres, Paige Decker, Braden Murphy, and Charles Chapman--for their work in advancing this incredibly important bill.

I introduced the Preventive Health Savings Act back in 2012, driven by the belief that, too often, potentially transformative legislation is sidelined due to short-sighted budget constraints. We cannot afford to overlook the long-term benefits of preventive health measures for the well-being of our patients and the well-being of our Nation.

Preventive healthcare is not just about addressing immediate health concerns. It is about laying a foundation for a healthier future by proactively managing risks, reducing the incidence of chronic illnesses, and, ultimately, cutting down on healthcare costs.

With over 70 percent of healthcare spending attributed to chronic diseases, it is clear that investing in prevention is not just prudent but essential.

H.R. 766 is a crucial step forward. By establishing a mechanism for the Congressional Budget Office to accurately assess the long-term cost-savings potential of preventive health initiatives, this legislation enables us to make a more informed and forward-thinking policy decision.

Once again, I am grateful to everyone who played a part in moving this bill. I express my gratitude to Congresswoman DeGette for her invaluable partnership. I thank the gentlewoman from Minnesota (Ms. Omar), for her kind words today. Donna Christian-Christensen, our former colleague from the Virgin Islands, also assisted in this effort.

Words cannot express how grateful and honored I am. Let me just say, as a general rule, Mr. Speaker, I don't think it is a good idea that things be named after people while they are still alive. However, in this case, I actually made an exception. I am happy that my name is attached to this critical piece of legislation.

Let's continue to work together toward a future where preventive health is not just an afterthought but a cornerstone of our national healthcare policy and our public strategy.

Mr. Speaker, I yield back the balance of my time.

Mr. President, in a moment, I am going to be making a unanimous consent request. I am going to wait for Senator Grassley to be on the floor.

Let me just, if I might, explain what the unanimous consent will be. It deals with H.R. 766. I am a proud sponsor of the Preventive Health Savings Act since the 113th Congress as it stands. The Congressional Budget Office scores budgetary implications of preventive health legislation in a 10-year timeframe, limiting Congress's ability to understand the long-term impacts of meaningful prevention policies.

This bicameral, bipartisan legislation would direct CBO to more accurately reflect the long-term cost saving potential of preventive healthcare initiatives and encourage the use of data-informed preventive health measures.

On March 19 of this year, the House of Representatives passed this legislation by voice vote.

Now, here is the challenge we have. This legislation will allow us to implement preventive healthcare sooner. That will save lives and will save dollars. To just give you one example, we now have a multicancer blood screening test that could be implemented for certain targeted populations.

The longer that is delayed--and being reimbursable under our healthcare system--the more people are not going to have the advantage of that, and more lives are going to be lost. And later detection of cancer, we know, is a more costly type of care that is needed, and it costs more money.

So we have a chance today, because this is a House-passed bill, to send this bill to the President, and that is why I will be making a unanimous consent request in regards to the bill.

I know that Senator Grassley has other legislation that he has been trying to get attached. I will urge him not to do that because it will, obviously, mean this bill will not pass. His issue is not related to the issue that this bill is about.

I want to thank Senator Whitehouse and Senator Grassley for their help on the Budget Committee itself. But this is our last opportunity to do something meaningful to implement preventive healthcare that will save lives and actually save dollars for the taxpayers of this country. There is no question about it. This bill saves money, and we can get it done now.

Any amendment on it, obviously, would have to go back to the House, and there is no possibility that the House would agree to it.

Mr. President, as if in legislative session, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 766, which was received from the House and is at the desk; further, that the bill be considered read a third time and passed; and that the motion to reconsider be considered made and laid upon the table.

Mr. President, reserving the right to object, if I might--and, again, I appreciate Senator Grassley's comments about this Senator. I feel the same about Senator Grassley. He has been an incredible voice in the U.S. Senate, particularly on transparency, particularly against waste, and has taken on some of the most challenging battles here on the floor of the U.S. Senate.

I have worked on this legislation now for several Congresses. My partners are Senator Crapo, Senator Cramer, Senator King. We have all worked on this bill together.

And the bill is very simple. It just allows a more realistic budget window for preventive healthcare. And it is something that we have been talking about for a long time so that we don't get trapped with high upfront costs that have large savings, and we never get to the savings because CBO cannot score it under the current budget rules.

The challenges that Senator Grassley is raising are not in this bill. We have worked very closely with the budget people to make sure that this bill does not contain the concerns that Senator Grassley is raising.

The Senator might be raising a very legitimate concerns, but it is not this legislation that is causing it. This legislation only allows us to be able to implement in a more realistic way preventive healthcare services with legitimate cost estimates and offsets so that we can get the savings from preventive healthcare and implement preventive healthcare sooner, saving lives and dollars.

We can make progress on this issue now. The problem is twofold with the request that is being made. First, the potential abuse is not in this legislation. It deals with a broader issue. And then, secondly, if this bill is amended, I think Senator Grassley also understands the chances of passage are zero. There is no possibility that this bill can be taken up in the House at this late stage.

So this is our last opportunity. I came to the floor today and not before because I respect greatly Senator Grassley and his concerns, and I was hoping we could find a path forward for that to happen. But there is no path forward for that to happen now, and by including the request, I would be sacrificing both bills. And I would hope the Senator would recognize that and allow this modest improvement for preventive healthcare to go forward.

With that, I regretfully object.

Mr. President, I suggest the absence of a quorum.

Mr. Speaker, I am here today in support of the Dr. Michael C. Burgess Preventive Health Saving Act, a bill aptly named after my colleague and friend, my co-chair on the Doctors Caucus, Dr. Michael Burgess.

This important legislation is going to allow the Congressional Budget Office to measure the long-term impact of health policies, breaking free from the arbitrary 10-year budget window that currently constrains our ability to help our fellow Americans to live a healthier and longer life.

This is something that we as the Doctors Caucus have met with CBO on. They were not sure how to do it. Dr. Burgess put forward a way that we can get this done. We worked in a bipartisan manner to enact policies that can bring patients more access to drugs, treatments, cures.

Yet, when looking at the initial cost of bringing new treatments and drugs to patients, the long-term savings that are associated with keeping Americans healthier for longer are not considered. They need to be. The Congressional Budget Office should have the ability to fully score the impact that reductions in obesity, access to early and preventive treatments, and keeping patients healthier will have on Medicare, for example.

It has been my great honor to serve with Dr. Burgess on the Doctors Caucus and here in Congress. I am glad to support this bill led by Dr. Burgess, whose expertise and desire for quality care for all Americans has inspired many to practice medicine and encourage them to get involved with government. I encourage support of this bill.

Mr. Speaker, I include in the Record a letter from the American Medical Association supporting H.R. 766.

American Medical Association,

Chicago, IL, March 18, 2024.

Hon. Mike Johnson,

Speaker, House of Representatives,

Washington, DC.

Hon. Hakeem Jeffries,

Minority Leader, House of Representatives,

Washington, DC.

Dear Speaker Johnson and Minority Leader Jeffries: On

behalf of the physician and medical student members of the

American Medical Association (AMA), I am writing in support

of H.R. 766, the ``Dr. Michael C. Burgess Preventive Health

Savings Act.'' This bipartisan bill would provide leaders in

Congress with the ability to request that the Congressional

Budget Office (CBO) provide an estimate of the long-term

health savings that are possible from preventive health

initiatives.

Chronic disease is a leading cause of death and disability

in the United States. According to the Centers for Disease

Control and Prevention, each year more than 877,500 Americans

died of heart disease or stroke, more than 1.7 million people

were diagnosed with cancer, and more than 37.3 million

Americans have diabetes, with an additional 96 million adults

diagnosed with prediabetes, which puts them at risk for type

2 diabetes. These diseases, along with other conditions such

as obesity, Alzheimer's, and mental health issues, place a

significant burden on the economy, accounting for 90 percent

of our nation's $4.1 trillion in annual health care spending.

These figures will undoubtedly worsen as the population ages.

Congress should be able to consider the long-term economic

benefits of legislation that would promote wellness and

disease prevention initiatives that reduce chronic

conditions. However, the way in which the CBO currently

``scores'' legislation severely constrains the ability of

policymakers to accurately assess legislation that would

prevent chronic disease. For example, while research has

demonstrated that certain expenditures for preventive

medicine generate savings when considered in the long term,

those cost savings may not be evident when evaluating only

the first 10-year ``scoring'' window.

We believe this legislation represents a significant step

towards providing Congress with the means to obtain a more

relevant long-term economic picture of the benefits of

legislation to prevent chronic diseases. The legislation

would allow, among other things, the Chair and Ranking member

of the budget and health-related committees in the House or

Senate to jointly request an analysis of the two 10-year

periods beyond the existing initial 10-year window. The

provisions requiring these requests to come jointly from the

Chair and Ranking Member of the budget and health-related

committees in the House or the Senate will ensure the CBO is

not diverted to frivolous or overly partisan analyses.

Furthermore, the legislation's definition of ``preventive

health'' appropriately captures the unique nature of this

concept by including actions that focus on the health of the

public, individuals, and defined populations to protect,

promote, and maintain health and wellness, as well as prevent

disease, disability, and premature death as demonstrated in

credible, publicly available studies and data.

The AMA applauds your leadership in bringing this important

legislation to the House floor for consideration and looks

forward to working with you on this and other efforts to

promote wellness and increase chronic disease prevention.

Sincerely,

James L. Madara, MD.

Mr. President, reserving the right to object, I have a counteroffer. But before I get to that, I want to say, first of all, it is not easy for me to stand here and object to something the Senator from Maryland wants to bring up, because he is a gentleman in the 100 percent way in the U.S. Senate. So it is not easy to go against his ideas.

But I want you to know, I have been working on the this with Representative Burgess, the leader in the House of Representatives, and we offered four amendments to him. In the negotiations, he agreed to two of them, and two of them he didn't agree to. And we agreed not to push for that amendment.

So we felt that we had good discussions with Representative Burgess. But now we are working on the House bill here, and none of those things that Burgess agreed to could be. So where we are is that, even though Burgess agreed to some compromise, Senators over here have issues with preventing Congress from depositing savings into the Medicare Improvement Fund in budget years 11 through 30, based upon CBO estimates of preventing health savings legislation.

Now, I have no doubt that preventive medicine saves money, but putting money in a fund for 11 to 30 years out can only lead to what we know happens too often here in the U.S. Senate of budget gimmicks, saying that we are going to use funds in a certain fund. Well, that is a perfectly legitimate thing to do, but you have to have confidence that what CBO says about that is going to be legitimate and have credibility.

And so what I have been trying to work out with Representative Burgess

is just exactly to do that: Put this fund out there. As you say, it is going to save money. But I want to make sure that CBO, when they say something, we have a way of verifying that.

So I want to say that I appreciate the intentions of this bill. Increasing preventive healthcare to improve health outcomes and help patients and taxpayers avoid costly treatment and services down the road is a laudable goal. However, I am concerned that, as currently constructed, this bill will lead to budget gimmicks that will ultimately increase rather than decrease health spending.

The sponsors are well aware of my concerns. I worked in good faith to offer up ideas to address my budget gimmick concerns. I made it clear I am willing to compromise. I have already done so with my most recent offer and dropped commonsense budget process reform provisions that I thought were important. And these budget process reforms were what was in the famous Enzi-Whitehouse bill that Senator Enzi--former-Senator Enzi--and, now, Senator Whitehouse worked out in Budget Committee reform. And I have said that Burgess was willing to go along with my changes to establish commonsense guardrails and to prevent budget gimmicks. But these changes have been rejected in the Senate, and my concerns haven't been addressed.

The bill before us contains no commonsense guardrails, such as requiring a disclaimer that a supplementary estimate doesn't replace a CBO 10-year cost estimate, ensuring supplementary estimates are separate and distinct from the 10-year cost estimates, and requiring the Congressional Budget Office to be transparent in their modeling.

That latter point is based on the proposition that we expect CBO to show us how they arrived at figures dealing with cost savings of some particular preventive medicine program.

The bill also doesn't address concerns about how supplementary analysis could be used for budget gimmicks in the future, such as depositing uncertain out-year savings into the Medicare and Medicaid Improvement Funds.

The bill needs commonsense guardrails to prevent budget gimmicks. So I would like to suggest this alternative.

So I ask the Senator from Maryland to modify his request to include my amendment, which is at the desk; that the amendment be considered and agreed to; that the bill, as amended, be considered read a third time and passed; and that the motion to reconsider be considered made and laid upon the table.

Mr. President, yes, I object. I would like to--

Around here, we use the words ``budget gimmickry'' pretty freely. And I want to say, as an example, that every Senator in this Senate knows the term ``Medicare sequester'' as a budget gimmick, so something at the end of the 10-year window we are going to draw in to spend money today. That is one example of a budget gimmick. I just want to make sure that we don't widen that down the road.

I yield the floor.

Mr. Speaker, I rise today in strong support of H.R. 766, the Dr. Michael C. Burgess Preventive Health Savings Act.

This bipartisan legislation will reform the Congressional Budget Office's scoring to better reflect the savings from preventive health initiatives by expanding the budgetary window that CBO evaluates. Currently, CBO scores a bill's budget impacts over a 10-year window, often missing the long-term savings achieved through preventative care.

As we all know, preventative healthcare lowers costs and ensures Americans can live healthier lives, while also saving money for patients and taxpayers. However, current restrictions prevent CBO from considering long-term savings generated by preventative healthcare when it evaluates legislation.

The Dr. Michael C. Burgess Preventive Health Savings Act would allow CBO to expand its analysis beyond the existing 10-year budget window to two additional 10-year periods, which will enable Congress to better evaluate meaningful and impactful policies.

As Dr. Burgess often says, an ounce of prevention is worth a pound of cure. This bipartisan bill is commonsense legislation that would help bend the cost curve and provide better patient care.

I thank Dr. Burgess for working on this important issue, and I urge my colleagues to support this legislation.

Mr. Speaker, I include in the Record a letter from the Council for Affordable Health Coverage supporting H.R. 766.

Council for Affordable

Health Coverage,

March 18, 2024.

Hon. Jodey Arrington,

Chairman, Committee on the Budget,

Washington, DC.

Hon. Brendan Boyle,

Ranking Member, House Budget Committee,

Washington, DC.

Dear Chairman Arrington and Ranking Member Boyle: The

Council for Affordable Health Coverage (CAHC) writes to

express our support for H.R. 766, the Dr. Michael C. Burgess

Preventive Health Savings Act because it will begin to change

how Congress views preventing health illnesses before they

become expensive chronic conditions.

In any given year, the healthiest half of the population

accounts for less than 3 percent of health care spending.

Most spending goes toward the treatment of chronic

conditions, such as heart failure or diabetes, which are long

in duration and have no definite cure. Patients with two or

more chronic diseases account for 84 percent of health

spending. Left untreated, chronic conditions multiply. For

example, diabetes carries high risks of heart disease and

hypertension, which in turn carry high risks of heart attacks

and strokes. For this reason, self-neglect is a major driver

of medical spending. Many patients under care for chronic

conditions fail to take their medicines--a problem that could

cost as much as $6 trillion over the next decade. Obesity, a

precursor to diabetes, is among the most expensive cost

drivers.

When Congress first enacted the Medicare Modernization Act,

Medicare Part D, CBO gave Congress no savings that would

accrue to the benefits of taking medicines that prevent heart

attacks, stroke, cancers, diabetes, obesity, and other

chronic conditions. None. Faced with mountains of evidence,

CBO revised their methodology in 2012 to reflect the benefit

of adherence to medications as a way to lower spending on

medical services, giving partial savings to increased drug

utilization. That change reflects common sense--people take

medicines to stay healthy and treat disease.

The way CBO scores legislation downplays the long term

benefit of preventing illness in the first place. This

constrains the ability of Congress to judge the merits of

health legislation by skewing costs in favor of benefits. A

balanced approach is required to allow sound decisions.

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.

Without an independent and unbiased understanding of how

these benefit mandates impact premiums, we cannot understand

how policy changes may impact taxpayer and individual costs.

We applaud your leadership on this critical issue and

encourage Congress to pass the legislation quickly to bring

more clarity to its deliberations.

Sincerely,

Joel C. White,

President.