Bipartisan touchup to ACA could bring better health, lower costs

August 17, 2017 - 10:32am

 Sen. Lamar Alexander, R-Tenn., may have said it most succinctly: “Congress doesn’t do comprehensive well.” Congressional stalemates prove this, especially when it comes to health care. But we’d like to suggest a touch-up to the Affordable Care Act that has bipartisan support and easily could be implemented right now.

The first edition of this change, called Rewards for Better Health, was submitted by Sen. Rob Portman, R-Ohio, and Sen. Ron Wyden, D-Ore., back in 2012 and could knock $200 billion or more annually out of the federal budget.

Alas, their plan stalled. Now it’s time to pass a law like Rewards for Better Health that would work for all Americans, whether privately insured or covered by a government program.

To start with, some basic facts about health and health care in the U.S.:

1. Chronic disease management accounts for more than 84 percent of health care costs.
2. If you achieve at least four of the following “normal” measures of good health, as well as two “behaviors,” you’ll dodge chronic disease about 80 percent of the time. The “normals” are:
—Blood pressure at or below 120/80
—LDL cholesterol below 130 if hearthealthy; below 70 if you have heart/blood vessel disease;
—Hemoglobin A1C of 6.5 percent (with diabetes) and 5.7 percent (without), or a fasting blood glucose level below 100mg/dL;
—A body mass index between 18.5 and 24.9 and/or a waist circumference of less than 40 inches for men, less than 35 for women;
—A blood cotinine level (used to assess exposure to tobacco smoke) that’s below 1ng/mL;
—The ability to fulfill the physical requirements of your job.

The two “behaviors” that help reduce chronic disease are:
—Seeing a primary-care physician regularly.
—Keeping immunizations up to date.
3. Only 2.7 percent of Americans attain even four of the six “normal” health values and two “behaviors.” But entering Medicare with those “normals” will reduce your yearly medical costs by over 70 percent!

A plan like Rewards for Better Health could get more folks to achieve those normals! (See below.)
Fortunately, in 2012 the ACA encouraged corporate America to incentivize employees to adopt healthy lifestyles by offering a reduction in health insurance premiums of up to 50 percent for hitting certain wellness numbers and being

The Cleveland Clinic adopted such a program, working in conjunction with primary-care docs of employees and their dependents. The goal: to achieve the six normals and two behaviors.
The program helped employees make good health decisions by giving them access to free smoking-cessation and weight-control programs, free fitnesscenter usage and by partnering folks with a buddy to build mutual support. The clinic also took fryers out of kitchens that serve employees and patients, removed sugar-added beverages and began to pay employees (initially with a check, then in reduced premiums) to achieve the six health-related normals and behaviors.

The result: The Cleveland Clinic’s and their employees’ health care expenses decreased in each of the past three years, while medical costs, including incentives and administrative costs, remained lower than national benchmarks. Other benefits:
There’s been a 28 percent reduction in unscheduled sick leave, and 63 percent of clinic employees have seen their paycheck go up by $600 to $2,000 annually.
If Congress enacts Rewards for Better Health, everyone could:
—Experience less disability and less need for illness care at any age.
—Save on premiums, co-pays and deductibles. Over your working life, it could, on average, give you $100,000 more savings (in 2017 dollars) for retirement.
—We estimate that by year three, participation by 63 percent of people would save the country over $200 billion annually, and maybe as much as $400 billion by year nine.
—Non-monetary benefits are huge!

They include a more energized, healthier and competitive work force and reduced income inequality. This can be done now; no one loses coverage. So call your representatives, especially if they’re named Ryan, MacArthur, McConnell or Alexander.
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Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into “The Dr. Oz Show” or visit
© 2017 Michael Roizen, M.D. and Mehmet Oz,M.D. Distributed by King Features Syndicate, Inc.

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