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What’s Preventing Prevention?

Thursday, April 17, 2014

The event was sponsored by the nonpartisan Alliance for Health Reform and the AARP Public Policy Institute.

Preventive services were a priority in the Patient Protection and Affordable Care Act (ACA), which required that a set of services be available to consumers with no cost sharing. This has improved access for some people to some services. But persistent barriers for consumers are limiting the utilization of preventive services. These barriers include the variability of insurance coverage, the affordability of out-of-pocket costs, the challenges of education and outreach, and the funding of public health initiatives.

Illustrative of the problem is cancer screening, in particular colonoscopies. While improved screening techniques make early cancer detection possible, and public health initiatives aim to educate the public about the importance of cancer screening, this class of diseases continues to claim more than half a million lives each year. The effects of barriers to access are especially apparent among vulnerable populations in which cancer prevalence is greater than the national average.

Can the Centers for Medicare & Medicaid Services’ (CMS) rules and regulations remove cost barriers to Medicare beneficiaries to get colonoscopy screenings in recommended numbers? Is legislation needed to accomplish this? With state insurance regulation accounting for geographic variation in access to prevention services, is there an appropriate federal policy remedy such as promoting price transparency? Are state outreach and education initiatives gaining ground? Is there federal funding support for state and local public health efforts? Does prevention need to “save money” to be worth doing?

A distinguished panel of experts addressed these and related questions.

Judy Monroe, deputy director, Centers for Disease Control and Prevention (CDC), and head of the CDC Office of State, Tribal, Local and Territorial Support, talked about the value of prevention in population health and current CDC initiatives in prevention related to provisions in the ACA.

Lynda Flowers, senior strategic policy advisor, AARP Public Policy Institute (PPI), one of the authors of a recent PPI paper, highlighted barriers to preventive services.

Kevin Lucia, professor and project director, Georgetown University Center on Health Insurance Reforms, discussed his report on colonoscopy screening after the ACA and his work on private health insurance.

**ADDED SPEAKER ** Julie Eckstein, director, St Charles County Community Health and the Environment, talked about local public health initiatives and the role of federal, state and local funding in outreach and education.

Ed Howard, Executive Vice President of the Alliance, and Susan Reinhard, Senior Vice President for Public Policy at AARP, co-moderated.

Follow the briefing on Twitter: #PreventionBarriers

Contact: Deanna Okrent (202) 789-2300

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Full Transcript (Adobe Acrobat PDF), 4/17/2014
Full Webcast/Podcast: Recording

Speaker Presentations

Monroe Presentation (Adobe Acrobat PDF), 4/17/2014
Lucia Presentation (Adobe Acrobat PDF), 4/17/2014
Eckstein Presentation (Adobe Acrobat PDF), 4/17/2014
Flowers Presentation (Adobe Acrobat PDF), 4/16/2014

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 4/16/2014
Speaker Biographies (Adobe Acrobat PDF), , 4/16/2014
Materials List (Adobe Acrobat PDF), , 4/16/2014
Selected Experts (Adobe Acrobat PDF), , 4/17/2014

Offsite Materials (briefing documents saved on other websites)

Affordable Care Act Implementation FAQs – Set 12, Centers for Medicare & Medicaid Services, 4/1/2014
Affordable Care Act: Prevention Overview (Adobe Acrobat PDF),American Cancer Society Cancer Action Network, 4/1/2010
Discord Over What to Pay the Doctor, The Wall Street Journal, 4/13/2014
Think Preventive Medicine Will Save Money? Think Again, Reuters, 1/29/2013
Encouraging Appropriate Use of Preventive Health Services (Adobe Acrobat PDF),Mathematica Policy Research, Inc, 5/1/2010
Colonoscopy Screening After the Affordable Care Act: Cost Barriers Persist for Medicare Beneficiaries (Adobe Acrobat PDF),AARP Public Policy Institute, 12/1/2013
Issue Brief #4: Why We Need Pricing Transparency, Preventing Colorectal Cancer, 12/1/2013
Use of Clinical Preventive Services and Prevalence of Health Risk Factors Among Adults Aged 50-64 (Adobe Acrobat PDF),AARP Public Policy Institute, 8/1/2013
ACA: When Is a Screening Not a Screening?, Medpage Today, 11/7/2013
Paying for Preventive vs. Diagnostic Care, Priority Health, 3/1/2014
Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit (Adobe Acrobat PDF),The Henry J. Kaiser Family Foundation, 9/1/2012
Preventive Services Covered by Private Health Plans under the Affordable Care Act (Adobe Acrobat PDF),The Henry J. Kaiser Family Foundation, 9/1/2011
Cancer, Healthy People 2020, 11/13/2013
Does Prevention Really Lower Health Care Costs?, Newsweek, 3/13/2010
Preventive Services without Cost Sharing, Health Affairs, 12/28/2010
Diving in on HHS’ Recent FAQs on Preventive Services, The Center on Health Insurance Reforms Georgetown University Health Policy Institute, 3/1/2013
Side Effects: How Government Micromanagement Could Discourage Access to Some Preventive Services, The Heritage Foundation, 10/14/2010
Financing Prevention: How States Are Balancing Delivery System & Public Health Roles (Adobe Acrobat PDF),Change Lab Solutions, 4/1/2014
The $2.7 Trillion Medical Bill, The New York Times, 6/1/2013
Chapter 14 - Public Health and Prevention, Alliance for Health Reform, 3/21/2014


Seventy percent of deaths in the United States are from preventable causes, but only three percent of national health expenditures are allocated towards prevention, Judy Monroe, deputy director, Centers for Disease Control and Prevention (CDC), and head of the CDC Office of State, Tribal, Local and Territorial Support, stated at an April 17 Alliance briefing, What’s Preventing Prevention? 

Missouri has a budget of $2 million for 115 local health departments, which is only $6.08 per capita. With additional resources, these local health departments could focus on population health, case management, health education, improving health literacy and reducing health disparities, Julie Eckstein, director, St Charles County Community Health and the Environment, stated at a April 17 Alliance briefing, What’s Preventing Prevention?

Kevin Lucia

Only two states are currently meeting targets for colorectal screenings. Disparities in the use of preventive services also exist based on income, race, education and health insurance status, Lynda Flowers, senior strategic policy advisor, AARP Public Policy Institute (PPI), stated at an April 17 Alliance Briefing, What’s Preventing Prevention?


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