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The Centers for Disease Control and Prevention issued a press release on June 18, 2012 that indicates that the up-front cost of benefits under the 2010 federal health reform law could be much higher than expected. The CDC says that 32 million Americans received "free" care under the law and that about half of that was incurred as new expense to health plans because health plan participants did not receive the same level of care when there was a co-payment of deductible associated with the expense.
In theory, increased spending on preventative services reduces overall health care cost in the long term but there is no proof of this relationship. We believe that increased spending on preventative services will simply increase the number of people diagnosed with and treated for various ailments thereby eliminating any savings associated with early detection of health problems. The sharp increase in patient utilization of benefits will directly translate to higher premium costs for policyholders and greater funding needs for public health plans. The following is reprinted from the CDC Web site with emphasis added to the portion addressing the increased utilization:
"Only about half of U.S. adults received selected preventive services such as screenings, consultations and prescriptions, from a health care professional before 2010, according to a study by the Centers for Disease Control and Prevention.
The study, Use of Selected Clinical Preventive Services Among Adults – United States, 2007-2010, offers a comprehensive look at adult clinical preventive services in the United States. These services, identified by CDC as public health priorities, were evaluated prior to the Affordable Care Act, the health care law of 2010.
The report provides baseline data on the use of selected adult preventive services, including aspirin or other blood-thinning therapy, controlling blood pressure, screening for and controlling high cholesterol, and ending tobacco use. The report found:
Of patients with heart disease primarily affecting the blood vessels, only 47 percent were prescribed the recommended daily use of aspirin during visits to their doctors.
The U.S. Preventive Services Task Force guidelines for the prevention of high blood pressure state that adults 18 years old and older with high blood pressure should receive a clinical treatment plan that might include medications and monthly follow-up visits until healthy blood pressure is achieved, yet less than half (44 percent) of people with high blood pressure had it under control.
Similarly, despite strong evidence that screening and treating for high cholesterol reduces sickness and death due to heart disease, about 33.4 percent of men and 25.6 percent of women were not screened during the preceding 5 years. Of those adults identified with high levels of LDL (bad) cholesterol, only about 32 percent of men and 32 percent of women had it under control.
According to data from the National Ambulatory Medical Care Survey and the National Health Interview Summary, fewer than 1 in 13 tobacco users were prescribed medications to help them end their tobacco use when they saw their doctor.
"Clinical preventive services prevent heart attack, stroke, cancer and other diseases and save lives," said CDC Director Thomas R. Frieden, M.D., M.P.H. "This report provides a snapshot of preventive services for U.S. adults before 2010. As we look to the future, we can track how our nation's health is progressing through better prevention in health care."
The data could change in the future because of certain provisions of the Affordable Care Act (ACA). These include a requirement for new private health insurance plans to cover recommended preventive services with no cost-sharing. The health care law also requires coverage for a new annual wellness visit under Medicare and eliminates cost sharing for recommended preventive services provided to Medicare beneficiaries. The law also gives state Medicaid programs financial incentives to cover preventive services for adults and supports initiatives to improve public understanding of the benefits of preventive services.
In 2011, the Affordable Care Act provided approximately 54 million Americans with at least one new free preventive service through their private health insurance plans. An estimated 32.5 million people with Medicare received at least one free preventive benefit in 2011, including the new Annual Wellness Visit.
CDC has several programs in place to increase the use of and improve access to clinical preventive health services. They include Million Hearts initiative through which CDC and its partners work to provide effective treatment for high blood pressure, high cholesterol, and tobacco addiction. The initiative works to increase the number of clinicians who deliver appropriate counseling on the use of aspirin and other blood-thinning therapies for patients at high risk of heart attack or stroke.
CDC and its partners are working with medical systems and health provider organizations to increase the number of physicians who routinely screen patients for tobacco use and provide advice for how to end tobacco use, establish systems of referral to tobacco quit lines and other community resources, and reduce economic barriers by removing copayments and including quit line coaching and cessation medication as covered benefits.
States and communities that receive CDC's Community Transformation Grants are working to promote prevention and control of high blood pressure and high cholesterol.
CDC helps state Medicaid programs to develop systems that identify people who are at risk for various health conditions due to age and risk behaviors, ensure that these people get screened, and that patients with abnormal screening test results are quickly referred to a medical provider."
While it is clear that ACA increases spending and brings more people into the health care system for treatment, there is no reason to believe that this will reduce overall spending on health care. We anticipate cost increases between 15% and 20% per year will be the norm under ACA, a rate of inflation significantly higher than cost increases in the period prior to passage of the new law.
This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator". Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide uncompensated advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the other commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed.