WELLNESS AND PREVENTION

In the context of health, "prevention" may refer to a range of activities, from a plan for a more walkable community to an immunization, to a colonoscopy, to a diabetes management program. Prevention activities span a continuum of stages often referred to as primary, secondary and tertiary prevention. Primary prevention measures are those that prevent the risk of illness or injury entirely, or at a very early stage. These include public health (i.e. population-based) measures such as anti-smoking campaigns and nutrition and exercise guidelines. Secondary measures detect health problems at an early stage, when they are most amenable to cure. These include clinical preventive services such as cancer screenings. Tertiary measures are remedial, mitigating the effects of an illness or injury once a problem has occurred. Chronic disease management programs are sometimes referred to as tertiary prevention measures. Workplace "wellness" programs may incorporate activities at each stage of the prevention continuum.

There is increasing concern that the prevalence of chronic diseases in the United States is on the rise, and that this development contributes both to a growing burden of illness among individuals, and to challenges in curbing cost growth in health care. According to the Centers for Disease Control and Prevention (CDC):

Chronic diseases such as heart disease, cancer, and diabetes-are the leading causes of death and disability in the United States. Chronic diseases account for 70% of all deaths in the U.S., which is 1.7 million each year. These diseases also cause major limitations in daily living for almost 1 out of 10 Americans or about 25 million people. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Adopting healthy behaviors such as eating nutritious foods, being physically active and avoiding tobacco use can prevent or control the devastating effects of these diseases.

Efforts to reform the nation's health system often include discussion of the role of prevention in reducing the burden of chronic diseases. Current federal law addresses prevention in several ways, including through (1) coverage of certain clinical preventive services under Medicare and Medicaid; (2) community-based research, disease prevention, and health promotion programs, which may be funded through federal grants; (3) support of evidence reviews to determine whether specific clinical and community prevention interventions are effective; and (4) regulation of certain employerprovided wellness programs in order to strike a balance between flexibility and compliance with current federal privacy, civil rights, and other laws.

Many chronic diseases such as obesity and heart disease are worsened by unhealthy behaviors, and may not be amenable to successful management or cure unless such behaviors can be addressed. The federal government's role in encouraging healthy behaviors is varied, and includes developing and disseminating information for public health and medical professionals and the general public. This includes the work of the U.S. Preventive Services Task Force that is administered by the Agency for Healthcare Research

and Quality and that provides recommendations about which preventive services (e.g. cancer screenings) should be incorporated into primary care practice.

Through a variety of programs, the federal government also provides funding and technical assistance to state, local, and tribal health authorities and others to support community, or populationbased, prevention activities. In addition, the CDC supports the Task Force on Community Preventive Services, which evaluates the effectiveness of primary prevention measures, and recommends the use of those interventions shown to be effective. For example, work by the Task Force has identified a number of populationbased strategies that are effective in reducing tobacco use, promoting physical activity, and improving diabetes management, among many others.

HHS Secretary Sebelius, at the Committee on Energy and Commerce's June 2009 hearing, called for comprehensive action on prevention and wellness:

We must make important investments in prevention and wellness. The old adage is true: an ounce of prevention truly is worth a pound of cure. But for too long, we've sunk all our resources into cures and short-changed prevention. Preventing disease and controlling its effects over time must be the foundation of our health care system.

HEALTH DATA COLLECTION

Currently a wide range of public and private data systems are used to monitor the nation's health, access to care, and cost and quality of that care. Key federal tracking initiatives include HealthyPeople 2010 (which tracks health promotion and disease prevention), Health U.S. (which tracks the health status of the nation), and the National Healthcare Quality and National Healthcare Disparities Reports (which track the quality of health care in the United States and disparities related to quality of, and access to, health care).

Each of these efforts draws from a combination of administrative data, vital records, population-based data, provider-based data, surveillance data, and special studies. For example, 190 data systems are used to track HealthyPeople 2010 objectives. Many, but not all, of these data systems and sources are sponsored by the Department of Health and Human Services, but others (such as population estimates used to calculate rates or data on specific populations such as Native Americans) are supported by other federal agencies (such as the Census Bureau or the Indian Health Service). Private and global data sources comprise other measures in the nation's health tracking efforts. For example, comparative international data may come from the World Health Organization or the Organization for Economic Cooperation and Development while pharmaceutical data or data on the managed care population may come from private sources.

There are a large and growing number of public and private data sources that help inform our understanding of health, health care, and the potential effects of proposed policies. At present time, there is no central source of information at HHS or elsewhere, and no central repository for health data. While there are a number of ef

forts to coordinate federal data (such as interagency working groups or coordinating efforts through the Paperwork Reduction Act) and efforts to standardize the collection and reporting of data (through OMB data standards and the efforts of advisory groups such as the National Committee on Vital and Health Statistics), achieving full coordination at the national level remains a challenge.

In calling for action at the Subcommittee on Health's hearing in June, 2009, Jeffrey Levi of the Trust for America's Health testified on the need for better use of information and data:

As we enter a reformed health care system, harnessing the power of health information technology for public health purposes as well as health care is going to be essential. Assuring that the American people have a true sense of our progress . . . will require a commitment to collecting, analyzing, and releasing in an accessible manner, a full range of data about our nation's health.

LEGISLATIVE HISTORY

H.R. 3200 was introduced on July 14, 2009, by Committee on Energy and Commerce Chairman Emeritus Dingell, Chairman Waxman, Subcommittee on Health Chairman Pallone, as well as Chairman Rangel and Subcommittee Chairman Stark of the Committee on Ways and Means, and Chairman Miller of California and Subcommittee Chairman Andrews from the Committee on Education and Labor. H.R. 3200 was referred primarily to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget.

During the 110th Congress, there were 17 hearings held by the Subcommittee on Health on issues relating to healthcare access and problems of those who are uninsured. These hearings also explored areas of health delivery systems, cost containment, and protecting health coverage during an economic downturn.

In the first session of the 111th Congress, the Subcommittee on Health held five days of oversight hearings focused on making health care work for American families. Hearings were held on Tuesday, March 10, 2009; Tuesday, March 17, 2009; Tuesday, March 24, 2009; Tuesday, March 31, 2009; and Thursday, April 2, 2009.

A Discussion Draft of comprehensive health reform legislation was circulated by the Committee to the Members of the Committee and the public on June 19, 2009. The same Discussion Draft was also issued by the Committee on Ways and Means and the Committee on Education and Labor.

The Committee on Energy and Commerce and its Subcommittee on Health held three days of legislative hearings on the Discussion Draft. Hearings by the Subcommittee on Health were held on Tuesday, June 23, 2009; Wednesday, June 24, 2009; and Thursday, June 25, 2009. The full Committee held a hearing on Wednesday, June 24, 2009, to receive testimony from the Secretary of Health and Human Services, the Hon. Kathleen Sebelius.

COMMITTEE CONSIDERATION

The Committee on Energy and Commerce met in open markup session for five days to consider amendments to H.R. 3200. The Committee met on July 16, 17, 20, 30, and 31, 2009. The Committee adopted 78 amendments to the legislation. H.R. 3200 was ordered favorably reported to the House, amended, by a roll call vote of 31 to 28.

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion to report legislation and amendments and motions thereto. The Committee agreed to a motion by Mr. Dingell to order H.R. 3200 favorably reported to the House, amended, by a record vote of 31 yeas and 28 nays. The following is the recorded votes taken during Committee consideration, including the names of those Members voting for and against:

BILL:

COMMITTEE ON ENERGY AND COMMERCE - 111TH CONGRESS

ROLL CALL VOTE # 69

H.R. 3200, the "America's Affordable Health Choices Act of 2009".

AMENDMENT: An amendment to the Waxman amendment in the nature of a substitute offered by Mr. Sullivan, # ID, to add at the end of title V of division C a new Subtitle F entitled "Termination of Duplicative Grant Programs".

DISPOSITION: AGREED TO by a roll call vote of 29 yeas to 27 nays.