[Congressional Record Volume 170, Number 48 (Tuesday, March 19, 2024)]
[House]
[Pages H1204-H1209]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
DR. MICHAEL C. BURGESS PREVENTIVE HEALTH SAVINGS ACT
Mr. BURGESS. 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.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 766
[Report No. 118-426]
To amend the Congressional Budget Act of 1974 respecting the
scoring of preventive health savings.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Dr. Michael C. Burgess
Preventive Health Savings Act''.
SEC. 2. SCORING OF PREVENTIVE HEALTH SAVINGS.
Section 202 of the Congressional Budget and Impoundment
Control Act of 1974 (2 U.S.C. 602) is amended by adding at
the end the following:
``(h) Scoring of Preventive Health Savings.--
``(1) Determination by the director.--Upon a request by the
chairman and ranking minority member of the Committee on the
Budget of the Senate and chairman and ranking minority member
of the committee of primary jurisdiction of the Senate or by
the chairman and ranking minority member of the Committee on
the Budget of the House of Representatives and the chairman
and ranking minority member of the committee of primary
jurisdiction of the House of Representatives, the Director
shall determine if proposed legislation would result in net
reductions in budget outlays in budgetary outyears through
the use of preventive health care.
``(2) Projections.--If the Director determines that
proposed legislation would result in net reductions in budget
outlays as described in paragraph (1), the Director--
``(A) shall include, in any projection prepared by the
Director on such proposed legislation, a description and
estimate of the reductions in budget outlays in the budgetary
outyears and a description of the basis for such conclusions;
and
``(B) may prepare a budget projection that includes some or
all of the budgetary outyears, notwithstanding the time
periods for projections described in subsection (e) and
sections 308, 402, and 424.
``(3) Limitation.--Any estimate provided by the Director
pursuant to paragraph (1) shall be used as a supplementary
estimate and may not be used to determine compliance with the
Congressional Budget Act of 1974 or any other budgetary
enforcement controls.
``(4) Definitions.--As used in this subsection--
``(A) the term `budgetary outyears' means the 2 consecutive
10-year periods beginning with the first fiscal year that is
10 years after the current fiscal year; and
``(B) the term `preventive health care' means an action
that focuses on the health of the public, individuals, and
defined populations in order to protect, promote, and
maintain health and wellness and prevent disease, disability,
and premature death, including through the promotion and use
of effective, innovative health care interventions that are
demonstrated by credible and publicly available evidence from
epidemiological projection models, clinical trials,
observational studies in humans, longitudinal studies, and
meta-analysis.''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas (Mr. Burgess) and the gentlewoman from Minnesota (Ms. Omar) each
will control 20 minutes.
The Chair recognizes the gentleman from Texas.
General Leave
Mr. BURGESS. 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.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BURGESS. 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
[[Page H1205]]
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. BURGESS. 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.
Ms. OMAR. Mr. Speaker, I yield myself such time as I may consume.
[[Page H1206]]
Mr. Speaker, I rise in support of H.R. 766. The Dr. Michael C.
Burgess Preventive Health Savings Act provides Congress with more
information on the budgetary impact of preventive healthcare services.
Investing in prevention, such as early detection screenings, could
improve healthcare outcomes while lowering healthcare costs in the long
run.
Such lifesaving, evidence-based policies often have significant
fiscal benefits for the government. The bill also ensures that the
requests for this outyear estimate are bipartisan.
Both the chair and the ranking member of the Budget Committee and the
primary committees of jurisdiction must all together request this
information.
This request should be about our continued focus on wellness and
disease prevention for the American people and not be used to justify
any partisan policies.
{time} 1630
Finally, the bill ensures that the out-year impact of prevention
healthcare policies are only used as a supplemental estimate. It cannot
be used for any budgetary enforcement controls. This would simply help
Congress make more informed policy decisions and prevent out-year
estimates to be used for any budget gimmicks.
I fully support this sensible piece of legislation, bringing us
closer to more transparent and holistic budget reporting.
Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentlewoman from
Minnesota (Mrs. Fischbach).
Mrs. FISCHBACH. Mr. Speaker, I thank my colleague from Texas for
yielding me the time and for bringing this piece of legislation
forward.
Mr. Speaker, we know that investing in preventive care benefits an
individual's health and pocketbook in the long run. Unfortunately,
current statute only allows the Congressional Budget Office to assess a
10-year cost estimate window, despite the fact that assessing the
impact of preventive care usually takes much longer than that.
I proudly support the Dr. Michael C. Burgess Preventive Health
Savings Act, which allows the CBO to score the long-term cost benefit
of preventive care. This is a simple bill, and it will not only benefit
the health of Americans, but it will also save taxpayer dollars.
Ms. OMAR. Mr. Speaker, I yield 5 minutes to the gentlewoman from
Colorado (Ms. DeGette), the coauthor of the legislation.
Ms. DeGETTE. Mr. Speaker, I rise in strong support of the Dr. Michael
C. Burgess Preventive Health Savings Act.
A great frustration for those of us who work a lot on healthcare
policy is the difficulty in accurately predicting the cost of
preventive care. Right now, as you heard from my coauthor of the bill,
Dr. Burgess, when Congress looks at the cost and benefits of preventive
healthcare, we only look at a 10-year window. That is true even when
the savings associated with preventive care would accrue 15, 20, 30
years in the future.
That is why Dr. Burgess and I wrote this bill, so that we could look
at preventive care over a longer time frame and actually see the cost
savings that it will give us. That will help us refocus our healthcare
legislation on prevention rather than waiting until serious diseases
occur.
Preventive care averts illnesses, helps catch problems before they
get too bad, and also saves lives. It has another benefit. It saves
money. Therefore, Congress should be able to consider how preventive
healthcare saves taxpayers' dollars when we prepare to vote on
legislation.
This bill provides a framework for committees to request an extended
estimate for legislation related to preventive healthcare from the
Congressional Budget Office. With the framework laid out in this bill,
committees can, on a bipartisan basis, request an estimate of the
effects of a preventive healthcare bill up to a 30-year window.
This sounds a little technical but, frankly, I believe it will
revolutionize how Congress considers preventive healthcare legislation.
It is going to make it so Congress will have long-term cost estimates
on preventive care legislation from a nonpartisan, trusted source.
As new innovations to keep Americans healthy are developed, we can
better consider their long-term effects as we try to make them more
available to the American people.
At the same time, as you heard, this bill does not allow any new
budgetary gimmicks. Instead, it just gives us the framework to get the
information we need.
Part of the genesis of this bill was when Dr. Burgess and I and
others were working on the Affordable Care Act. I really wanted to put
in the mandated benefits the inclusion of smoking cessation.
Now, everybody in this room and in the gallery knows, helping
Americans stop smoking cigarettes is one of the most obvious areas
where preventive care can just save lives but also save money. We all
know the terrible results of smoking: higher risks of lung cancer,
diabetes, stroke, heart disease, COPD, and more. Treating these
conditions is expensive, but it is also deadly for people.
CBO was working on this 10-year window when it made an estimate on my
ideas, and they said: Congresswoman, we think the idea of smoking
cessation is a great idea, but, unfortunately, the smoking cessation
programs like the patch and Nicorette and things like that are just too
expensive, and so we can't afford to pay for them as part of the
mandated benefits of the ACA. To me, that is crazy, and that is why we
need this bill.
Dr. Burgess and I have been working on this bill ever since, over 10
years now, and I am proud to see it come to the floor. Here it is now.
It is among the first bipartisan bills from the Budget Committee to be
reported to the full House in years.
We talk a lot about needing a long-term view. I can't think of a
better example of a long-term view than a bill that takes more than 10
years, but yet we persevere.
Finally, I thank Mike Burgess for his partnership on this bill and
his partnership on the Energy and Commerce Committee for many other
bills. We disagree a lot, but we have found a lot of common ground, and
we always work in good faith to deliver for our constituents and the
American people.
This bill is a perfect example of how we work together to write
commonsense legislation that centers on what Americans need to lead
healthy lives. It is truly a bipartisan victory. It is good
legislation. I am going to miss Dr. Burgess and his vision on the
committee. I hope that we can work together to get this bill through
the other body just as quickly as we can. I urge a ``yes'' vote on this
bill.
Mr. BURGESS. 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. ARRINGTON. Mr. Speaker, I thank the gentleman from Texas. What a
great career he has had in public service. He has truly been an
inspiration and a leader among his equals here in the people's House on
healthcare issues. He was the founder of the Doctors Caucus. He was the
Health Subcommittee chair at the Energy and Commerce Committee and the
chair of the Health Care Task Force on the Budget Committee. There is
nobody in this Chamber, and I would submit in the United States
Congress, who knows more about healthcare and who has endeavored more
over the years to make healthcare work.
Mr. Speaker, I thank my Democratic colleagues, Ms. Omar and Ms.
DeGette. This is proof that we can work together in good faith, find
common ground and consensus solutions to make this country and its
government work for the people.
I thank Ms. DeGette for her kind words. We have young people in the
gallery who got to hear something they don't often hear on cable news,
which is a colleague from one side of the aisle complimenting another.
What great decorum. What a great example of civil discourse in their
Nation's Capitol. They need to see more of it.
I am grateful that we have an opportunity to address the triple aim
in healthcare that often is underutilized because of simply the way we
score it.
[[Page H1207]]
Healthcare innovation and technology can improve access and quality
outcomes while bending the curve on costs, not just to our patients and
to our fellow Americans, but also to the taxpayers. Healthcare is a
third of the budget. It is a big driver of our debt, and we have got to
look for commonsense solutions to improve across the board these
important outcomes. Again, I thank Ms. Omar and Ms. DeGette for their
leadership.
To my friend from the great State of Texas, what a legacy. We named
this bill after Dr. Burgess. He was loath to allow that, but it is
appropriate because of all that he has done to leave this country
better than he found it. This no doubt will have a tremendous impact
for the future. May God bless my friend, and Godspeed.
Ms. OMAR. Mr. Speaker, I have no further speakers, and I am prepared
to close. I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from Ohio
(Mr. Wenstrup), the co-chair of the Doctors Caucus.
Mr. WENSTRUP. 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.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. 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. BUCSHON. Mr. Speaker, I recognize the legacy of Dr. Michael
Burgess and support this bill, H.R. 766.
If Members of Congress can agree on one thing, it is that we seek to
improve the lives of our constituents. Unfortunately, CBO's current
approach to how it develops cost estimates for healthcare legislation
interferes with that goal by failing to take into account all the
future benefits of the legislation.
CBO's current approach keeps Federal healthcare programs stuck in the
status quo of simply providing care when you get sick, including
expensive care, instead of focusing on providing care that keeps you
healthy and hopefully from needing more expensive forms of care down
the road.
CBO's current approach defies common sense, and it is imperative that
Congress directs CBO to more accurately reflect the long-term cost
saving potential of preventive healthcare initiatives. That is why I am
proud to support H.R. 766.
To ensure Congress can better evaluate meaningful and impactful
healthcare policies that bolster access and quality of care, Congress
must pass this bill.
Mr. Speaker, I include in the Record a letter from the Community
Oncology Alliance supporting H.R. 766.
Community Oncology Alliance,
Washington, DC, March 18, 2024.
Re Community Oncology Alliance Support of The Dr. Michael C.
Burgess Preventative Health Savings Act (H.R. 766).
Hon. Jodey Arrington,
Chairman, House Budget Committee,
Washington, DC.
Dear Chairman Arrington: On behalf of the Board of
Directors of the Community Oncology Alliance (``COA''), we
applaud the House Budget Committee for advancing The Dr.
Michael C. Burgess Preventative Health Savings Act (H.R. 766)
to a floor vote of this important bipartisan legislation
sponsored by Congressman Dr. Burgess with Congresswoman Diana
DeGette.
As you know, COA is an organization dedicated to advocating
for the complex care and access needs of patients with cancer
and the community oncology practices that serve them. COA is
the only non-profit organization in the United States
dedicated solely to independent community oncology practices,
which serve the majority of Americans receiving treatment for
cancer. Since its grassroots founding over 20 years ago,
COA's mission has been to ensure that patients with cancer
receive quality, affordable, and accessible cancer care in
their own communities where they live and work, regardless of
their racial, ethnic, demographic, or socioeconomic status.
The limitation of the 10-year scoring window is a severe
obstacle to realizing the savings from preventive health care
legislation. It is unrealistic to expect that many, if not
most, preventative health care initiatives can return
positive savings by 10 years. As a result of the current
scoring mandate on the Congressional Budget Office, many, if
not most, preventative health care initiatives
[[Page H1208]]
are not implemented because of funding constraints.
With cancer, we have more effective treatments, but it is
essential that we look for ways of preventing this disease
that impacts so many Americans. Unfortunately, artificial
scoring mandates undermine the adoption of preventive care
initiatives. As a result, COA supports the passage of H.R.
766, and we greatly appreciate your work and that of your
staff in the landmark advancement of this legislation out of
your committee.
Sincerely,
Ted Okon,
Executive Director.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from
Missouri (Mr. Smith), the chairman of the Ways and Means Committee.
Mr. SMITH of Missouri. Mr. Speaker, I wish to commend Dr. Burgess for
his steadfast leadership working in a bipartisan and bicameral manner
to bring this important piece of legislation forward.
This bill ensures that the Congressional Budget Office, the official
scorekeepers of Congress, is more accurately reflecting the long-term
fiscal impact of policies; in this case, policies that have the
potential to lower the cost of the ever-growing Federal spending on
healthcare, a major part of our Nation's annual budget.
It also has the added benefit of encouraging preventive healthcare
policies that can lower the risk of illness and chronic disease among
our fellow citizens, leading to a healthier Nation.
As chairman of the House Ways and Means Committee, these are exactly
the type of policies I want our committee to consider, which can truly
upend the healthcare system as we know it.
In short, this bill promotes both the fiscal health of the country
and the physical health of its people.
{time} 1645
As the former Republican leader of the House Budget Committee, I have
had the honor of fighting alongside Dr. Burgess in the trenches of
fiscal policy. Together, we have worked to ensure CBO is aiding, not
preventing, investments in bold healthcare reform.
This bill is a key victory in every effort.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from
Georgia (Mr. Carter), a fellow member of the Energy and Commerce
Committee.
Mr. CARTER of Georgia. 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.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from
Texas (Mr. Moran).
Mr. MORAN. Mr. Speaker, I rise today in support of the reintroduction
of H.R. 766, the Dr. Michael C. Burgess Preventive Health Savings Act,
named in honor of my fellow Texan, friend, and champion for patients,
Dr. Burgess.
This bipartisan, bicameral, lifesaving legislation would direct the
CBO to more accurately reflect the long-term cost-saving potential of
preventive healthcare initiatives.
Congress should recognize the impact that preventive healthcare can
have on an individual's life, as well as the long-term cost-saving
potential.
Current restrictions prevent the CBO from fully examining the
accurate economic impacts of preventive measures when they evaluate
health legislation, but H.R. 766 goes beyond the normal 10-year window
to allow Congress to better evaluate the potential for budgetary
savings of preventive healthcare legislation and to ensure that it is
done with the best interest of the American taxpayers in mind.
If we are going to tackle the growing cost of medical care for
individuals and find legislative solutions to mandatory healthcare
parameters that account for at least one-third of the Federal budget,
then we must seek transparency first.
Mr. Speaker, I urge my colleagues to support H.R. 766.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 1 minute to the gentleman from
Indiana (Mr. Yakym).
Mr. YAKYM. Mr. Speaker, I rise today to express my strong support for
the Dr. Michael C. Burgess Preventive Health Savings Act.
This bipartisan bill is essential to helping us, as lawmakers, make
the most informed decisions possible when it comes to preventive
healthcare legislation.
So often, when the CBO scores preventive health measures, the 10-year
scoring window greatly limits their ability to show the full impact of
the legislation. This bill would allow such
[[Page H1209]]
measures to be scored over a 30-year timeframe, giving us a more
accurate picture of the impact the policy would have.
I am proud to be a cosponsor of this bill, which originated in the
House Budget Committee. I look forward to voting in favor of this piece
of legislation, and I urge my colleagues to do the same.
Mr. Speaker, I include in the Record a letter from the Bipartisan
Policy Center in support of H.R. 766.
Bipartisan Policy Center Action,
Washington, DC, March 18, 2024.
Hon. Michael C. Burgess, M.D.,
Washington, DC.
Hon. Diana DeGette,
Washington, DC.
Dear Congressman Burgess and Congresswoman DeGette, BPC
Action commends you for your leadership in introducing and
advancing H.R. 766, The Preventive Health Savings Act (PHSA).
BPC Action supports this bipartisan effort to better account
for the full impact of preventive health care in
Congressional Budget Office (CBO) estimates and encourages
all members to support the bill on the House floor this week.
The Bipartisan Policy Center (BPC) has long focused on the
importance of prevention. In 2014, BPC's Prevention Task
Force--advised by former Senate Majority Leader Bill Frist,
Agriculture Secretary Dan Glickman, and former CBO director
Alice Rivlin--recommended that the CBO use ``present discount
accounting'' to bring long-term savings from prevention
``up'' in time and to align better with CBO's current 10-year
scoring window. This could have helped ensure that CBO
accounts for benefits that might be seen 20-25 years out.
While slightly distinct in method but similar on principle,
the Preventive Health Savings Act would provide policymakers
with information related to the benefits of disease
prevention and health promotion beyond the 10-year scoring
window to 20- and 30-years out.
Further, in 2019, BPC Chief Medical Advisor Dr. Anand
Parekh in his book Prevention First (advised by former Senate
Majority Leaders Bill Frist and Tom Daschle) recommended
greater funding for prevention research so that there are
more published studies and a better evidence-base for CBO to
determine the cost-effectiveness of prevention interventions
and more appropriately score future federal legislation
related to prevention.
BPC Action applauds your commitment to this issue and urges
Congress to pass the Preventive Health Savings Act.
Sincerely,
Michele Stockwell,
President.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I reserve the balance of my time.
Ms. OMAR. Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, may I inquire as to how much time is
remaining.
The SPEAKER pro tempore. The gentleman from Texas has 6\1/2\ minutes
remaining.
Mr. BURGESS. Mr. Speaker, I have no further speakers, and I reserve
the balance of my time to close.
Ms. OMAR. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, preventive healthcare services can save lives and lower
costs for families. It is time for Congress to evaluate and prioritize
such innovative policies that have the potential to improve our
healthcare system.
I appreciate the hard work of Representative Burgess and congratulate
him on his retirement and Representative DeGette in championing this
important effort 11 years in the making. I was proud to vote for this
bill in committee, and I urge my colleagues to support it today.
Mr. Speaker, I yield back the balance of my time.
Mr. BURGESS. 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.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Texas (Mr. Burgess) that the House suspend the rules and
pass the bill, H.R. 766, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
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