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Federal health care reform won’t start in earnest until this autumn, but on the third anniversary of the law that gave us Obamacare, the New Hampshire Democratic Party wanted to make sure that the public knew about all the benefits the law already has produced. In an interestingly worded press release, NHDP Communications Director Harrell Kirstein tallied the gains since 2010.
Kirstein began his release by stating "Health care reform has helped Granite Staters save money and live healthier lives." His list of evidence began with a bullet point declaring the Affordable Care Act "Expanded preventative care coverage with no cost-sharing for 365,000 Granite Staters with private health insurance in 2012, including 253,000 women. While more than 160,000 New Hampshire citizen[s] on traditional Medicare also accessed free preventative care services."
The numbers Kirstein cites are based on an administration analysis that takes the national level findings of an independent group, the Kaiser Family Foundation, and applies them to various groups of insured people in New Hampshire.
As PolitiFact has noted before, there is a complicated relationship among preventive care, costs and health. The quick assumption that an ounce of prevention is worth a pound of cure can be wrong.
When President Obama said "preventive care saves money," PolitiFact ruled that statement False. Obama was speaking about the health care system as a whole, and there’s a lot of evidence that when millions of healthy people use preventive services, their health status remains the same, but all those doctor visits add up to higher costs.
A 2008 study published in the New England Journal of Medicine found that, in some cases, preventive care can save money and improve health. Counseling people to quit smoking, eat a better diet, and giving the most common vaccinations provide a win-win outcome of low cost and avoiding diseases that are expensive to treat.
But the authors cautioned "Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs."
"Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."
And whether preventive services lead to better health is also debatable. Preventive services absolutely can make a person healthier when a potential problem is diagnosed early and treated. However, preventive care on a system-wide level leads to batteries of tests and procedures that lead to positive outcomes for a few, but make little difference for many.
A study by Danish researchers on the value of annual physicals found that they did little or nothing to reduce the risk of dying from cancer or heart disease.
In addition, Ateev Mehrotra at the University of Pittsburgh School of Medicine estimated the yearly cost of routine physical exams at $8 billion. He said the limited benefits "underline the need to maintain other means of delivering preventive care beyond annual [physicals]."
The key finding from all the studies is prevention makes sense when it is targeted. The right strategy picks out the people at risk and offers them the screening or prevention treatment they need. In general, that is the approach in Obamacare.
The online journal Health Affairs notes that Section 2713 of the Affordable Care Act is "one of the most straightforward provisions" in the legislation. The law requires services that are backed up by evidence and have been rated by certain bodies, such as the U.S. Preventive Services Task Force.
"Items and services are rated by the Preventive Services Task Force only with respect to individuals who fit into certain categories determined by age, gender, or medical conditions or risks," the author writes, "and the rule only requires that services be provided to individuals in those categories."
Take something as common as cholesterol levels. Under the Task Force guidelines, not everyone would get tested for free; the federal recommendations specify men 35 and older, and women and men of any age with heart disease or risk factors for heart disease.
Even the most targeted regime of preventive services comes with two caveats. By one estimate published in Health Affairs, if 90 percent of Americans took advantage of the most proven services, overall spending would decline by just 0.2 percent. The health benefits would be "huge", but the added doctor visits and tests would cause insurance premiums to rise, by as much at 1.5 percent.
At the end of the day, the author writes," increased benefits will be accompanied by increased costs, but neither will be dramatic and an accurate understanding of which will be greater is simply not possible."
The New Hampshire Democratic Party claimed that health care reform helped people save money and lead healthier lives. Its list began with better access and use of preventive care. The statement brushes over the mixed outcomes of preventive services. They can lead to better health for some, but can also result in batteries of tests that have little health effect for many. Likewise, the Affordable Care Act requires many preventive procedures be offered at no cost to patients, which can save individuals some money, but on a system-wide basis many of those practices are wasteful and they always come at some cost. We rate the statement Half True.
On third anniversary, healthcare reform continues to save money and save lives in New Hampshire, New Hampshire Democratic Party press release, March 26, 2013
How the health care law is making a difference for the people of New Hampshire, U.S. Department of Health and Human Services
Seventy-one million additional Americans are receiving preventive services coverage without cost-sharing under the Affordable Care Act, U.S. Department of Health and Human Services, March 2013
Barack Obama says preventive care saves money, Louis Jacobson, PolitiFact, February 10, 2012
Think preventive medicine will save money? Think again, Sharon Begley, Reuters, January 29, 2013
Does preventive care save money?, Joshua T. Cohen, Ph.D., Peter J. Neumann, Sc.D., and Milton C. Weinstein, Ph.D., New England Journal of Medicine, February 14, 2008
Prevention Saves Lives as Well as Money, New Research Confirms, Medscape News, 2010
Implementing Health Reform: Preventive Services, Timothy Yost, Health Affairs, July 15, 2010
Preventive Health Examinations and Preventive Gynecological Examinations in the United States,Ateev Mehrotra, MD, MPH; Alan M. Zaslavsky, PhD; John Z. Ayanian, MD, MPP, JAMA Network, September 24, 2007
Study Questions Value of Annual Physical Exam, Brenda Goodman, WEbMD Health News, October 16, 2012
Prevention, wellness and comparing providers, U.S. Department of Health and Human Services, accessed April 2, 2013
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