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Prevention and Health Care Reform

The leading causes of death in the United States include heart disease, cancer, stroke, diabetes, and kidney disease (1). These conditions are strongly associated with poor diet, sedentary lifestyle, and excessive weight gain. Currently, 2 out of 3 Americans are either overweight or obese (2). As such, 75% of total healthcare costs are used for the treatment of these chronic conditions (3). Research continues to show that nutrition intervention can drastically improve one’s health and reduce the risk for many of these chronic diseases. Nutrition counseling by a registered dietitian nutritionist (RDN) can make a world of difference for chronic disease management, treatment, and prevention. Nutrition counseling that promotes lifestyle changes to include healthier diets and more physical activity have the potential to reduce incidence of type II diabetes by 34% (4), heart disease by 31%, and stroke by 20% (5). Utilizing these services can make a profound difference in the trajectory of health outcomes and healthcare costs for American’s. However, only 3% of all healthcare expenses are spent on preventive services (3). This is primarily due to a lack of coverage for these services by insurance companies. Medicare covers dietetic services only for patients who have diabetes or kidney disease. As such, patients who are prediabetic, obese, or have cardiovascular disease are not covered by Medicare to see a dietitian. Many people seek nutrition services and choose to pay out of pocket, recognizing the long term benefits these services provide. Yet, many individuals who need these services simply can’t afford to pay for them, costing around $118 an hour (6).

Under the Affordable Care Act (ACA), preventive services are covered more now than ever. The ACA mandated that insurance companies cover preventive services that were identified by the U.S. Preventive Services Task Force (USPSTF) (7). These services include “healthy diet and physical activity counseling” and “obesity screening and counseling (8).” Congress is currently proposing the American Health Care Act which threatens to discontinue the inclusion of these services. Such reform would be a step backwards in reducing the rates of chronic diseases and the rising healthcare costs. According to the Academy of Nutrition and Dietetics President Lucille Beseler, the American Healthcare Act will, “reverse advancements made in disease prevention and chronic care management (9).” With healthcare costs continuously on the rise, investing in prevention is a much-needed solution for our nation’s healthcare costs.

In addition to the inclusion of prevention services, the ACA also includes the Prevention and Public Health Fund. These funds are distributed to the states to be used for community specific programs, including prevention initiatives, surveillance, and research (10). Investing in these types of community programs can reduce healthcare costs. For every $1.00 spent, $6.60 in healthcare costs are saved over a five year period (3). The current healthcare reform proposal will repeal this fund, hurting the communities that have been benefiting from these public programs. The House of Representatives passed the American Health Care Act in May sending it to the Senate for deliberation. In June, the Senate released their revised version of the bill and titled it the Better Care Reconciliation Act. The Senate was unable to repeal the ACA by the September 30th deadline. In October, President Trump passed an Executive Order Promoting Healthcare Choices and Competition, which allows agencies to modify how they implement the ACA. As nutrition professionals, the implications of preventive services is extremely apparent, yet without proper support for these services we risk their exclusion from future healthcare reforms.

  1. FastStats. (2017). Available at: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. (Accessed: 15th December 2017)
  2. Overweight & Obesity Statistics | NIDDK. Available at: https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity. (Accessed: 15th December 2017)
  3. Prevention and Public Health Fund. Available at: https://www.apha.org/topics-and-issues/health-reform/prevention-and-public-health-fund. (Accessed: 15th December 2017)
  4. The data are in: Eat right, reduce your risk of diabetes – Harvard Health Blog – Harvard Health Publishing. Available at: https://www.health.harvard.edu/blog/the-data-are-in-eat-right-avoid-diabetes-2017010510936. (Accessed: 15th December 2017)
  5. Guide to Insurance and Reimbursement – Today’s Dietitian Magazine. Available at: http://www.todaysdietitian.com/newarchives/0217p40.shtml. (Accessed: 15th December 2017)
  6. Preventing Heart Disease | The Nutrition Source | Harvard T.H. Chan School of Public Health. Available at: https://www.hsph.harvard.edu/nutritionsource/disease-prevention/cardiovascular-disease/preventing-cvd/. (Accessed: 15th December 2017)
  7. Health Care Reform and Preventive Services. www.eatrightpro.org Available at: https://www.eatrightpro.org/resource/payment/nutrition-services/health-care-reform/healthcare-reform-and-preventive-services. (Accessed: 15th December 2017)
  8. USPSTF A and B Recommendations – US Preventive Services Task Force. Available at: https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/. (Accessed: 15th December 2017)
  9. Academy of Nutrition and Dietetics Announces Opposition to American Health Care Act. www.eatrightpro.org Available at: http://www.eatrightpro.org/resource/media/press-releases/public-policy/academy-announces-opposition-american-health-care-act. (Accessed: 15th December 2017)
  10. Prevention and Public Health Fund | HHS.gov. Available at: https://www.hhs.gov/open/prevention/index.html. (Accessed: 15th December 2017)
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