US Senate Committee on Health, Education, Labor, & Pensions

Statement by Senator Tom Harkin On the Importance of the Prevention Fund to Save Lives and Money

Tuesday, May 07, 2013

WASHINGTON--Today, Senator Tom Harkin (D-IA), Chairman of the Senate Health, Education, Labor, and Pensions Committeeand of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies—and author of the prevention and public health title of the Affordable Care Act—spoke on the floor of the Senate about theimportance of the Prevention and Public Health fund to saving lives and money, and about his disappointment regarding the Administration's decision to raid this critical fund.

Below is the full text of Harkin's remarks, as prepared for delivery:

"Mr. President, I was deeply disturbed, several weeks ago, to learn of the White House’s plan to strip $332 million in critical funding from the Prevention and Public Health Fund and to redirect that money to educating the public about the new health insurance marketplaces and other aspects of implementing the Affordable Care Act.  No one is more interested in ensuring the successful implementation of the health insurance exchanges than I am.  But it is ill-advised and short-sighted to raid the Prevention Fund, which is making absolutely critical investments in preventing disease, saving lives, and keeping women and their families healthy. 

"Not only is this a case of misplaced priorities, but it is, frankly, an outrageous attack on an investment fund that is saving lives by advancing wellness and prevention initiatives in communities all across America.  A major purpose of the Affordable Care Act is to begin to transform our current sick-care system into a genuine health care system – one that is focused on saving lives through a greater emphasis on wellness, prevention, and public health.  Every expert acknowledges that we will never reduce health care costs or have a healthier and more productive society until we focus on prevention.  However, I have no choice but to conclude that, when it comes to prevention, this Administration just doesn’t get it.

"Mr. President, the Prevention Fund already has been a giant step forward for public health in our nation.  Typically, prevention and public health initiatives are an afterthought.  This means that important community-based interventions often go unsupported.  The Prevention Fund is making it possible for us to make national investments in evidence-based programs that promote physical activity, improve nutrition, and reduce tobacco use.

"There is not time to mention all of the many ways that this Fund is already making Americans healthier.  But I want to mention just several representative investments that are happening right now:

"The Prevention Fund is investing $226 million to reduce chronic diseases including diabetes and heart disease.  Heart disease disproportionately affects women; in fact, it is the No. 1 cause of death for women in this country.  Some 42 million women in America are currently living with some form of heart disease, and the World Health Organization estimates that a staggering 80 percent of heart disease, diabetes, and stroke could be prevented as the result of changes to smoking, nutrition, and physical activity alone.

"Moreover, this investment by the Prevention Fund isn’t only saving lives – it’s also saving money. Right now, heart disease costs our nation about $440 billion a year. 

"Cigarette smoking kills an estimated 173,940 women a year.  If current smoking rates persist, more than 6 million kids living in the U.S. today will ultimately die from smoking. This year, the Fund is supporting a second round of the highly successful media campaign called “Tips from a Former Smoker.”  It is estimated that last year’s campaign will save $70 million annually based on just the smokers who successfully quit in reaction to the 12-week campaign.  These ads are extremely powerful and effective.  Within two days of the first ad appearing last year, the number of calls to quit-lines nearly tripled.  Mark my words, these ads are going to save lives.  In fact, the second phase of this ad campaign is expected to inspire half a million quit attempts, and to help at least 50,000 Americans quit smoking forever. 

The Prevention Fund is investing in immunization programs that protect kids and save billions of dollars in downstream costs. For every dollar spent on childhood immunizations, Americans save $16 in the avoided cost of treating entirely preventable illnesses. Furthermore, by ensuring all adults get recommended, routine vaccines, we can prevent 40,000 to 50,000 deaths annually.  The $82 million cut from immunization in the Prevention Fund could have saved our nation up to $1.3 billion in unnecessary health care costs.  This is the very definition of penny-wise, pound-foolish budgeting. 

"Mr. President, investments from the Prevention Fund aren’t just at the national level; they are also in our communities.  The Fund is helping states, cities and towns to implement evidence-based programs that meet their particular, local needs.  For example, the State of Illinois has made improvements to its sidewalks and has marked crossings in order to increase levels of student physical activity.  Because of these improvements, the number of students who are walking to school has doubled.  Not only is this good for their health, it is expected to save the school system about $67,000 yearly on bus costs. 

"In Florida, the school board of Miami-Dade County will soon implement the Play, Eat, Succeed project in order to reduce the prevalence of childhood obesity among students with disabilities and children in the Head Start Program.  The project will focus on improving nutritional habits, increasing physical activity levels, and achieving a healthy weight.

"In California, the Los Angeles County Department of Health has worked with more than 100 clinical teams to provide accessible clinical preventive services to control high blood pressure and cholesterol, reaching approximately 200,000 adults just in the LA County area.

"In my State of Iowa, the Black Hawk County Board of Health is working with the local agency on aging to implement the Better Choices, Better Health program.  This initiative is designed to help individuals who are living with chronic conditions to find practical ways to self-manage pain and fatigue, make healthier nutrition and exercise choices, set realistic goals, understand treatment options, and communicate with family and health care providers about their condition.

"Mr. President, all across America, the Prevention Fund is investing in proven, locally developed programs that promote health and wellness, and save lives. These evidence-based programs not only improve health but also will help us save money in health care costs. 

"According to a study by the Centers for Disease Control and Prevention, programs like the National Diabetes Prevention Program could prevent or delay nearly 885,000 cases of type 2 diabetes, saving our health system about $5.7 billion over the next 25 years. The National Diabetes Prevention Program is a public-private partnership of health organizations that work together to prevent type 2 diabetes through lifestyle-change programs right in our communities.  And given that, in 2007, diabetes alone accounted for about $116 billion in direct medical costs, it’s all the more critical that we continue to invest in proven programs like this. 

"The list goes on and on.  The Trust for America’s Health released a study showing that a five percent reduction in the obesity rate could yield more than $600 billion in savings on health care costs over a 20-year period.  Studies such as this one confirm what common sense already tells us: prevention is the best medicine, for bodies and budgets alike.

"That is why nearly 800 organizations have spoken out against misguided efforts to slash or eliminate the Prevention Fund. 

"Mr. President, despite ill-advised efforts to cut or eliminate the Prevention Fund, most Americans understand what is at stake. Prior to creation of the Prevention Fund, for every dollar spent on health care, 75 cents went to treating patients with chronic diseases, while only four cents were spent on efforts to prevent those diseases.  This chronic under-investment has had devastating consequences: nearly half of American adults have at least one chronic condition, and two thirds of the increase in health care spending between 1987 and 2000 was due to increased prevalence of chronic diseases.

"The Prevention Fund gives us an unprecedented opportunity to bend the cost curve by jumpstarting the transformation of America into a true wellness society – a society that focuses on preventing disease and thereby saves both lives and money.

"This fund is saving lives, and saving money.  To slash this Fund, as the White House intends to do, is bad public policy – and bad priorities.  To take money from the Prevention Fund is to cannibalize the Affordable Care Act in ways that will cost both money and lives.  It is a violation of both the letter and spirit of this landmark law.

"Prior to the Senate’s adjourning for April recess, I put a hold on Ms. Marilyn Tavenner's nomination to serve as Administrator of the Centers for Medicare and Medicaid Services.  Ms. Tavenner, in her role as Acting Administrator, signed a directive in March that channeled critical funds away from prevention. 

"Mr. President, let me emphasize that this was not a secret hold.  Too often in this body, members have blocked the Senate from proceeding and then refused to let anyone else know who was responsible.  I issued my hold publicly.  I did so in order to heighten public awareness of the administration’s ill-advised policy decision, and to give White House officials the opportunity to reconsider.  I wanted to give them the chance to understand that their assault on the Prevention Fund is short-sighted and destructive, and to give them the time to find another source of funding for implementing and overseeing the marketplaces. 

"Sadly, they seem to have no interest in promoting prevention.  Last year, they approved a $5 billion cut to the Fund as part of the Middle Class Tax bill.  And now they have made it clear that they intend to move forward with this latest misguided, shortsighted decision to raid the Prevention Fund.

"So what we are seeing from the administration is, at best, mixed signals, and, at worst, a betrayal of the letter and spirit of the Affordable Care Act.  The White House gives lip service to the importance of prevention.  But, Mr. President, actions speak louder than words.  This administration has reneged on its commitment to prevention.  This is a bad policy choice.  And this choice will have serious, negative consequences for the health of the American people. 

"Regrettably, in recent days, the White House has made it clear that it will not reverse course with regard to its raid on the Prevention Fund.  I do not want to interfere with the important work of the Centers for Medicare and Medicaid Services.  I believe Ms. Tavenner is strongly qualified to be the next CMS Administrator, and that it is urgent to have an effective leader at the helm of CMS as we enter a critical stage in implementing the Affordable Care Act. 

"Accordingly, Mr. President, I am removing my hold on her nomination. However, as I do so, I repeat that it is deeply disappointing and disturbing that this White House apparently does not understand the importance of community-based prevention initiatives. 

"I hope and expect that, going forward, the White House will respect the intent of Congress in creating the Prevention Fund in the first place, as a critical feature of the law.  I expect the administration to join with us in fighting for the Prevention Fund and in making smart, evidence-based investments in prevention and wellness.  This is what real health reform is about.  It is our best bet for creating a healthier and more prosperous nation. 

"To that important end, we should not be working at cross purposes; we should be working together.  We must rededicate ourselves to the great goal of creating a reformed health care system that works not only for the healthy and the wealthy, but for all Americans."

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