[House Report 118-426]
[From the U.S. Government Publishing Office]


118th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                       {     118-426

======================================================================



 
          DR. MICHAEL C. BURGESS PREVENTIVE HEALTH SAVINGS ACT

                                _______
                                

 March 15, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

           Mr. Arrington, from the Committee on the Budget, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 766]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on the Budget, to whom was referred the bill 
(H.R. 766) to amend the Congressional Budget Act of 1974 
respecting the scoring of preventive health savings, having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Summary and Purpose of Legislation...............................     2
Background and Need for Legislation..............................     3
Section-by-Section Analysis......................................     4
Legislative History and Consideration............................     4
Hearings.........................................................     4
Votes of the Committee...........................................     5
Committee Oversight Findings and Recommendations.................     7
Congressional Budget Act Compliance..............................     7
Committee Cost Estimate..........................................     8
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Applicability to the Legislative Branch..........................     8
Duplication of Federal Programs..................................     8
Performance Goals and Objectives.................................     9
Earmark Statement................................................     9
Changes in Existing Law Made by the Bill, as Reported............     9

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

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.''.

                   Summary and Purpose of Legislation

    H.R. 766, the Dr. Michael C. Burgess Preventive Health 
Savings Act, establishes a mechanism for the Congressional 
Budget Office (CBO) to provide Congress budgetary savings 
estimates of preventive health care legislation beyond the 
current 10-year budget window. The bill amends the 
Congressional Budget and Impoundment Control Act of 1974 by 
inserting a new subsection after (2 U.S.C. Sec. 601(g)), under 
which upon a bipartisan request by the chair and ranking member 
of the Committee on the Budget and the chair and ranking member 
of the committee of primary jurisdiction, in either the Senate 
or the House of Representatives, the CBO Director shall make a 
determination if preventive health legislation would result in 
a net reduction in budgetary outlays over a 30-year budget 
window. If the CBO Director determines the proposed legislation 
would result in net budgetary outlay reductions over the 30-
year window, the Director shall provide in the cost estimate 
for the legislation projections of longer-term savings and the 
basis for such conclusions. Further, the bill includes an 
explicit limitation that any supplementary estimate provided by 
the CBO Director under this subsection shall not be used to 
determine compliance with Congressional budget enforcement 
controls, including the Congressional Budget and Impoundment 
Control Act of 1974.

                  Background and Need for Legislation

    CBO plays a critical role in the budget and legislative 
process by providing objective, nonpartisan information to 
lawmakers through cost estimates of legislation and analytic 
reports. The Congressional Budget and Impoundment Control Act 
of 1974 established the Congressional Budget Office (CBO) and 
requires CBO to provide congressional committees with cost 
estimates of legislation reported by committees.\1\ Section 402 
of the Congressional Budget and Impoundment Control Act of 1974 
requires the Director of CBO to submit a cost estimate to any 
committee of the House of Representatives or the Senate (except 
the Committee on Appropriations of each House) that reports a 
bill.\2\
---------------------------------------------------------------------------
    \1\Congressional Budget and Impoundment Control Act of 1974 Pub. L. 
93-344, Sec. 402(1974).
    \2\Congressional Budget and Impoundment Control Act of 1974 Pub. L. 
93-344, Sec. 402(1974).
---------------------------------------------------------------------------
    Cost estimates prepared by CBO of the budgetary effects of 
various legislative proposals serve as a guide of the fiscal 
impact of legislation considered by Congress.\3\ Section 402 of 
the Congressional Budget and Impoundment Control Act of 1974 
also states such cost estimates are to capture ``the costs 
which would be incurred in carrying out such bill or resolution 
in the fiscal year in which it is to become effective and in 
each of the four fiscal years following such fiscal year.'' 
Importantly, cost estimates of changes in direct spending and 
revenues generally cover the current year, the budget year, and 
the subsequent nine years, while estimates of changes in 
authorized spending subject to appropriation often cover only 
the subsequent five years.\4\
---------------------------------------------------------------------------
    \3\Congressional Budget Office, CBO's Cost Estimates Explained 
(Feb. 2020).
    \4\Ibid.
---------------------------------------------------------------------------
    While CBO's current scoring window for cost estimates is 
generally 10 years, the full cost-saving potential of 
preventive health care legislation often occurs over a longer 
period. In fact, research has demonstrated that preventive 
health care can generate budgetary savings when longer-term 
effects are examined, but that such cost savings may not be 
apparent when only analyzing the first 10 years. As 
acknowledged by CBO, preventive medical services can reduce 
costs by ``lessening the incidence of a disease or by detecting 
it early, when treatment may be more effective and less 
costly.''\5\ However, CBO further notes that ``CBO's shorter 
time frame may not capture the full effects of the 
policies.''\6\ As a result, CBO's current 10-year scoring 
window for cost estimates does not capture potential longer-
term savings from proposed preventive health care legislation. 
Furthermore, CBO has the technical capability to produce cost 
estimates and long-term analyses over a 30-year window, 
including through the production of annual Long-Term Budget 
Outlook reports.\7\
---------------------------------------------------------------------------
    \5\Congressional Budget Office, How CBO Analyzes Approaches to 
Improve Health Through Disease Prevention (June 2020).
    \6\Ibid.
    \7\Congressional Budget Office, The 2023 Long-Term Budget Outlook 
(June 2023).
---------------------------------------------------------------------------
    Accordingly, H.R. 766 provides a mechanism for CBO to 
provide Congress supplementary analysis of potential longer-
term savings from proposed preventive health legislation to 
help lawmakers more accurately determine and debate the merits 
of policies, with a more comprehensive analysis of the 
corresponding impact to the federal budget.

                      Section-by-Section Analysis


Section 1. Short title

    This section establishes the short title of the bill as the 
``Dr. Michael C. Burgess Preventive Health Savings Act''.

Section 2. Scoring of Preventive Health Savings

    Section (2) amends section 202 of the Congressional Budget 
and Impoundment Control Act of 1974 (2 U.S.C. 602) by inserting 
at the end a new subsection on scoring of preventive health 
savings.
    Paragraph (1) requires the Director of the Congressional 
Budget Office (CBO), upon receiving a bipartisan request from 
Congress, to determine if proposed legislation would reduce net 
outlays outside of the 10-year budget window (budgetary 
outyears) through the use of preventive health care.
    Paragraph (2) requires that if the Director determines such 
proposed legislation would result in net reductions in budget 
outlays over the budgetary outyears, the Director shall include 
estimates of such net reductions in any projection published by 
the Director on the legislation.
    Paragraph (3) stipulates the estimates provided pursuant to 
paragraph (1) are supplementary estimates and cannot be used to 
determine compliance with the Congressional Budget and 
Impoundment Control Act of 1974 and any other budgetary 
enforcement controls.
    Paragraph (4) defines budgetary outyears as the two 
consecutive 10-year periods following the current 10-year 
budget window. The paragraph also defines preventive health 
care as ``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 is demonstrated by credible and publicly 
available evidence from epidemiological projection models, 
clinical trials, observational studies in humans, longitudinal 
studies, and meta-analysis.''

                 Legislative History and Consideration

    On February 2, 2023, Representatives Michael C. Burgess (R-
TX-26) and Diana DeGette (D-CO-1) introduced H.R. 766, and the 
bill was referred to the Committee on the Budget.
    On February 6, 2024, the Committee considered H.R. 766, and 
ordered the measure, as amended, reported to the House by a 
vote of 30 ayes to 0 noes.

                                Hearings

    Pursuant to clause 3(a)(6) of rule XIII of the Rules of the 
House of Representatives, the following hearing was used to 
develop H.R. 766, the Dr. Michael C. Burgess Preventive Health 
Savings Act:
    On January 31, 2024, the Committee held a hearing titled 
``Creating a Culture of Fiscal Responsibility: Assessing the 
Role of the Congressional Budget Office.'' The Committee 
received testimony from:
    The Honorable Phillip Swagel, Ph.D., Director of the 
Congressional Budget Office.

                         Votes of the Committee

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires each committee report to accompany any 
bill or resolution of a public character to include the total 
number of votes cast for and against each roll-call vote, on a 
motion to report and any amendments offered to the measure or 
matter, together with the names of those voting for and 
against.
    Listed below are the actions taken by the Committee on the 
Budget of the House of Representatives on H.R. 766, the Dr. 
Michael C. Burgess Preventive Health Savings Act.
    On February 6, 2024, the Committee met in open session, a 
quorum being present.
    Chairman Arrington asked unanimous consent to be 
authorized, consistent with clause 1(a)(2) of rule XI of the 
Rules of the House of Representatives, to declare a recess at 
any time during the committee meeting.
    There was no objection to this unanimous consent request.
    Chairman Arrington asked unanimous consent to dispense with 
the first reading of the bill, the bill be considered read and 
open to amendment at any point, and to dispense with the 
reading of any amendments.
    There was no objection to this unanimous consent request.
    The Committee adopted and ordered reported H.R. 766, the 
Dr. Michael C. Burgess Preventive Health Savings Act. The 
Committee on the Budget took the following votes:

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


   AMENDMENT IN THE NATURE OF A SUBSTITUTE OFFERED BY REPRESENTATIVE 
                                BURGESS

    The amendment was offered in the nature of a substitute to 
H.R. 766 and was made in order as original text. The amendment 
was agreed to by unanimous consent.

                AMENDMENT OFFERED BY CHAIRMAN ARRINGTON

    An amendment offered by Chairman Arrington to change the 
short title of the bill.
    The amendment was agreed to by a voice vote.

              ON FAVORABLY REPORTING, H.R. 766, AS AMENDED

    The bill was ordered reported, as amended, by a vote of 30 
ayes to 0 noes.

            Committee Oversight Findings and Recommendations

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the Committee's oversight findings and recommendations are 
reflected in the descriptive portions of this report.

                  Congressional Budget Act Compliance

    The provisions of clauses 3(c)(2) and (3) of rule XIII of 
the Rules of the House of Representatives and Section 308(a)(1) 
of the Congressional Budget and Impoundment Control Act of 1974 
(relating to estimates of new budget authority, new spending 
authority, new credit authority, or increased or decreased 
revenues or tax expenditures) are not considered applicable. 
The estimate and comparison required to be prepared by the 
Director of the Congressional Budget Office pursuant to clause 
3(c)(3) of rule XIII of the Rules of the House of 
Representatives and sections 402 and 423 of the Congressional 
Budget and Impoundment Control Act of 1974 submitted to the 
committee prior to the filing of this report are as follows:

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    H.R. 766 would amend the Congressional Budget Act of 1974 
to direct the Congressional Budget Office, at the request of 
the Chair and Ranking Member of the Committee on the Budget and 
of the relevant authorizing committee, in each respective 
chamber, to estimate the budgetary effects over a 30-year 
period of legislation related to preventive health care 
services. Under current law, CBO is required to estimate the 
cost of legislation approved by Congressional committees for 
the period specified in law, typically 10 years.
    Under H.R. 766, if CBO determined that a bill would result 
in preventive health savings sufficient to reduce federal 
spending in subsequent decades, the agency would provide 
additional long-term projections to the Congress. Such long-
term estimates could not be used for budget enforcement, 
however.
    Because H.R. 766 would not significantly increase the cost 
of producing legislative cost estimates, CBO estimates that the 
administrative expenses associated with implementing the bill 
would total less than $500,000 over the 2024-2029 period; any 
spending would be subject to the availability of appropriated 
funds.
    The CBO staff contacts for this estimate are Matthew 
Pickford and Lara Robillard. The estimate was reviewed by Chad 
Chirico, Director of Budget Analysis.

                                         Phillip L. Swagel,
                             Director, Congressional Budget Office.

                        Committee Cost Estimate

    Pursuant to clause 3(d) of rule XIII of the Rules of the 
House of Representatives, the committee report incorporates the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to Sections 402 and 423 of the 
Congressional Budget and Impoundment Control Act of 1974.

                       Federal Mandates Statement

    Pursuant to section 423 of the Unfunded Mandates Reform 
Act, the Committee has determined that the bill does not 
contain federal mandates on the private sector. The Committee 
has determined that the bill does not impose a federal 
intergovernmental mandate on state, local, or tribal 
governments.

                      Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                Applicability to the Legislative Branch

    The committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act (P.L. 104-1).

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, no provision of H.R. 766, the Dr. 
Michael C. Burgess Preventive Health Savings Act, establishes 
or reauthorizes a program of the Federal government known to be 
duplicative of another Federal program, a program that was 
included in any report from the Government Accountability 
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most 
recent Catalog of Federal Domestic Assistance.

                    Performance Goals and Objectives

    With respect to the requirement of clause 3(c)(4) of rule 
XIII of the Rules of the House of Representatives, the 
performance goals and objectives of this legislation are to 
allow greater authority for the Congressional Budget Office to 
provide Congress with more comprehensive cost estimates 
detailing longer-term budgetary savings from proposed 
preventive health legislation. This bill would amend the 
Congressional Budget and Impoundment Control Act of 1974 to 
create a mechanism for the Congressional Budget Office to 
create budgetary savings estimates of proposed preventive 
health care legislation over a 30-year budget window, while 
protecting against the manipulation of these supplementary 
estimates to justify partisan policies or be used to determine 
compliance with existing budget enforcement requirements.

                           Earmark Statement

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 766 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(e), 9(f), or 9(g) of rule XXI 
of the Rules of the House of Representatives.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italics and existing law in which no change is 
proposed is shown in roman):

        CONGRESSIONAL BUDGET AND IMPOUNDMENT CONTROL ACT OF 1974



           *       *       *       *       *       *       *
TITLE II--CONGRESSIONAL BUDGET OFFICE

           *       *       *       *       *       *       *


                          duties and functions

  Sec. 202. (a) Assistance to Budget Committees.--It shall be 
the primary duty and function of the Office to provide to the 
Committees on the Budget of both Houses information which will 
assist such committees in the discharge of all matters within 
their jurisdictions, including (1) information with respect to 
the budget, appropriation bills, and other bills authorizing or 
providing new budget authority or tax expenditures, (2) 
information with respect to revenues, receipts, estimated 
future revenues and receipts, and changing revenue conditions, 
and (3) such related information as such Committees may 
request.
  (b) Assistance to Committees on Appropriations, Ways and 
Means, and Finance.--At the request of the Committee on 
Appropriations of either House, the Committee on Ways and Means 
of the House of Representatives, or the Committee on Finance of 
the Senate, the Office shall provide to such Committee any 
information which will assist it in the discharge of matters 
within its jurisdiction, including information described in 
clauses (1) and (2) of subsection (a) and such related 
information as the Committee may request.
  (c) Assistance to Other Committees and Members.--
          (1) At the request of any other committee of the 
        House of Representatives or the Senate or any joint 
        committee of the Congress, the Office shall provide to 
        such committee or joint committee any information 
        compiled in carrying out clauses (1) and (2) of 
        subsection (a), and, to the extent practicable, such 
        additional information related to the foregoing as may 
        be requested.
          (2) At the request of any committee of the Senate or 
        the House of Representatives, the Office shall, to the 
        extent practicable, consult with and assist such 
        committee in analyzing the budgetary or financial 
        impact of any proposed legislation that may have--
                  (A) a significant budgetary impact on State, 
                local, or tribal governments;
                  (B) a significant financial impact on the 
                private sector; or
                  (C) a significant employment impact on the 
                private sector.
          (3) At the request of any Member of the House or 
        Senate, the Office shall provide to such member any 
        information compiled in carrying out clauses (1) and 
        (2) of subsection (a), and, to the extent available, 
        such additional information related to the foregoing as 
        may be requested.
  (d) Assignment of Office Personnel to Committees and Joint 
Committees.--At the request of the Committee on the Budget of 
either House, personnel of the Office shall be assigned, on a 
temporary basis, to assist such committee. At the request of 
any other committee of either House or any joint committee of 
the Congress, personnel of the Office may be assigned, on a 
temporary basis, to assist such committee or joint committee 
with respect to matters directly related to the applicable 
provisions of subsection (b) or (c).
  (e) Reports to Budget Committees.--
          (1) On or before February 15 of each year, the 
        Director shall submit to the Committees on the Budget 
        of the House of Representatives and the Senate, a 
        report for the fiscal year commencing on October 1 of 
        that year, with respect to fiscal policy, including (A) 
        alternative levels of total revenues, total new budget 
        authority, and total outlays (including related 
        surpluses and deficits), (B) the levels of tax 
        expenditures under existing law, taking into account 
        projected economic factors and any changes in such 
        levels based on proposals in the budget submitted by 
        the President for such fiscal year, and (C) a statement 
        of the levels of budget authority and outlays for each 
        program assumed to be extended in the baseline, as 
        provided in section 257(b)(2)(A) and for excise taxes 
        assumed to be extended under section 257(b)(2)(C) of 
        the Balanced Budget and Emergency Deficit Control Act 
        of 1985. Such report shall also include a discussion of 
        national budget priorities, including alternative ways 
        of allocating new budget authority and budget outlays 
        for such fiscal year among major programs or functional 
        categories, taking into account how such alternative 
        allocations will meet major national needs and affect 
        balanced growth and development of the United States.
          (2) The Director shall from time to time submit to 
        the Committees on the Budget of the House of 
        Representatives and the Senate such further reports 
        (including reports revising the report required by 
        paragraph (1)) as may be necessary or appropriate to 
        provide such Committees with information, data, and 
        analyses for the performance of their duties and 
        functions.
          (3) On or before January 15 of each year, the 
        Director, after consultation with the appropriate 
        committees of the House of Representatives and Senate, 
        shall submit to the Congress a report listing (A) all 
        programs and activities funded during the fiscal year 
        ending September 30 of that calendar year for which 
        authorizations for appropriations have not been enacted 
        for that fiscal year, and (B) all programs and 
        activities for which authorizations for appropriations 
        have been enacted for the fiscal year ending September 
        30 of that calendar year, but for which no 
        authorizations for appropriations have been enacted for 
        the fiscal year beginning October 1 of that calendar 
        year.
  (f) Use of Computers and Other Techniques.--The Director may 
equip the Office with up-to-date computer capability (upon 
approval of the Committee on House Oversight of the House of 
Representatives and the Committee on Rules and Administration 
of the Senate), obtain the services of experts and consultants 
in computer technology, and develop techniques for the 
evaluation of budgetary requirements.
  (g) Studies.--
          (1) Continuing studies.--The Director of the 
        Congressional Budget Office shall conduct continuing 
        studies to enhance comparisons of budget outlays, 
        credit authority, and tax expenditures.
          (2) Federal mandate studies.--
                  (A) At the request of any Chairman or ranking 
                member of the minority of a Committee of the 
                Senate or the House of Representatives, the 
                Director shall, to the extent practicable, 
                conduct a study of a legislative proposal 
                containing a Federal mandate.
                  (B) In conducting a study on 
                intergovernmental mandates under subparagraph 
                (A), the Director shall--
                          (i) solicit and consider information 
                        or comments from elected officials 
                        (including their designated 
                        representatives) of State, local, or 
                        tribal governments as may provide 
                        helpful information or comments;
                          (ii) consider establishing advisory 
                        panels of elected officials or their 
                        designated representatives, of State, 
                        local, or tribal governments if the 
                        Director determines that such advisory 
                        panels would be helpful in performing 
                        responsibilities of the Director under 
                        this section; and
                          (iii) if, and to the extent that the 
                        Director determines that accurate 
                        estimates are reasonably feasible, 
                        include estimates of--
                                  (I) the future direct cost of 
                                the Federal mandate to the 
                                extent that such costs 
                                significantly differ from or 
                                extend beyond the 5-year period 
                                after the mandate is first 
                                effective; and
                                  (II) any disproportionate 
                                budgetary effects of Federal 
                                mandates upon particular 
                                industries or sectors of the 
                                economy, States, regions, and 
                                urban or rural or other types 
                                of communities, as appropriate.
                  (C) In conducting a study on private sector 
                mandates under subparagraph (A), the Director 
                shall provide estimates, if and to the extent 
                that the Director determines that such 
                estimates are reasonably feasible, of--
                          (i) future costs of Federal private 
                        sector mandates to the extent that such 
                        mandates differ significantly from or 
                        extend beyond the 5-year time period 
                        referred to in subparagraph 
                        (B)(iii)(I);
                          (ii) any disproportionate financial 
                        effects of Federal private sector 
                        mandates and of any Federal financial 
                        assistance in the bill or joint 
                        resolution upon any particular 
                        industries or sectors of the economy, 
                        States, regions, and urban or rural or 
                        other types of communities; and
                          (iii) the effect of Federal private 
                        sector mandates in the bill or joint 
                        resolution on the national economy, 
                        including the effect on productivity, 
                        economic growth, full employment, 
                        creation of productive jobs, and 
                        international competitiveness of United 
                        States goods and services.
  (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.

           *       *       *       *       *       *       *


                                  [all]