Republicans Were For Prevention Before They Were Against It

Sarah Kliff previews the GOP’s big box of ideas for how to force Democrats to vote against their own health care law come January. Last week, House Republicans wanted to attach repeal to next month’s doc fix, now they’re considering taking a page from Sen. Mike Johanns’ (R-NE) original 1099 repeal proposal and using prevention dollars to pay for the impending reimbursement cuts:

Republican Senate aides familiar with the issue told POLITICO they are seriously looking at the new law’s $15 billion public health commitment to finance a one-year doc fix in the next session of Congress. […]

One aide said health reform’s preventive health spending is one of the “top three” offsets in the law that congressional Republican staffers are eyeing, with the idea that a few moderate Democrats facing tough races in 2012 could eventually be brought on board.

As for which part of the health reform law to pull funds from, Republicans have long derided the multibillion Prevention and Public Health Fund as wasteful spending, scoffing at its investment in bike paths and farmers’ markets. One Republican Senate aide quipped that it was a “slush fund for jungle gyms.”

The fund, which began this year with $500 million, will grow to a $2 billion per year allocation by 2015. Totaling $15 billion over the next 10 years, the fund would be nearly enough to offset an entire, yearlong doc fix.

This is fairly galling, not only because a long-term investment in prevention is exactly the kind of thing that might save dollars over the long term, but also because Republicans themselves encourage Americans to take personal responsibility for their health and catch diseases before they turn into costly, chronic conditions. The “slush” fund aspect they’re referring to — as far as I can tell — is a recent HHS decision to use $250 million to expand the primary work force — the very kind of investment that would help build the infrastructure and make sure there were people to help with screenings, immunizations and other needs.


And this, is something Republicans presumably support. In July, Sen. Jon Kyl (R-AZ) tried to take credit for the prevention funds in the Affordable Care Act, something Republicans had long advocated for:

– Sen. Chuck Grassley (R-IA) said the law’s emphasis on preventive care is good “because it costs less to keep people well than to treat them when they’re sick.” [10/18/2010]

– Sen. Mitch McConnell (R-KY): “Congress should be able to work together on our practical ideas that the American people support, such as reforming our medical liability laws to discourage junk lawsuits…encouraging wellness and prevention programs that have proved to be effective in cutting costs and improving care.” [8/26/2010]

– Sen. Saxby Chambliss (R-GA): “I am an original cosponsor of S. 1099, the “Patients’ Choice Act,” …. The legislation would make health care coverage accessible and affordable for all Americans through private insurance coverage, while also promoting prevention and wellness which can improve lives and lower long-term medical costs. [7/19/2009]

Kliff reports that “the idea of tying the doc fix to a partial health reform repeal has legs because it comes with a clear rhetorical message: Congress should not start creating new entitlements without the necessary funding to uphold existing ones.” I would argue that that the opposite argument can be even more persuasive — pulling money out of prevention should be dead in the water since it’s one of the handful of ideas Republicans presented as consensus areas when they urged Democrats to scrap the big bill and rally around just a few popular policies.