Improving current scoring practices would help elevate the importance of currently-undervalued programs that enable Americans to lead healthier lives.
Contact: Jon Purves
Associate Director, Media Relations
The Aspen Institute
Washington, DC, March 31, 2022 – Today, the Health, Medicine & Society Program (HMS) of the Aspen Institute is releasing a new report recommending structural changes to current federal estimating and scorekeeping practices. These recommendations are designed to clarify the value of clinical and population-level programs that elevate health through prevention activities.
The report, entitled Budgeting for Disease Prevention and Health Promotion: Improving the Federal Scorekeeping Process, is based on conversations among former senior leaders at the Congressional Budget Office (CBO) and the federal Office of Management and Budget (OMB) and on a body of research that informed their consensus recommendations. Dan Crippen, PhD, former CBO director and former executive director of the National Governors Association, and Nancy-Ann DeParle, JD, former associate director for health and personnel at OMB (and currently managing partner of Consonance Capital Partners) chaired the group, which was convened by HMS.
CBO is required to estimate the costs of ongoing federal programs and of any legislation that would alter them or create new programs. It then publishes a score to reflect their expected budgetary effects. Although prevention-related programs are politically popular and contribute significantly to longer life expectancy and better quality of life, federal financing rules tend to understate their value. Budgeting for Disease Prevention and Health Promotion: Improving the Federal Scorekeeping Process examines features of the CBO scoring process that pose barriers to legislation that might otherwise garner bipartisan support, and identifies immediate opportunities to address them.
While technical in nature, these recommendations have very concrete implications for the health of all Americans. Together, they can make it easier to fund both clinical prevention (e.g., vaccinations, mammograms, diabetes treatment) and population-based prevention (e.g., removing lead from the water supply, sampling air quality for contaminants, supporting exercise classes for people with heart disease). Specifically, the group recommends the following measures:
- Transparency of analysis: CBO should improve transparency by displaying the major analyses that generated the overall score. Providing only the bottom line of costs can be confusing and can obscure important information about what is actually included in the price.
- Distribution of costs and savings: Wherever possible, the CBO should disaggregate its overall totals and include the distribution by race, ethnicity, gender, and other demographic categories. Displaying only aggregates and averages can obscure both the problems and the benefits of legislation.
- Context of costs and savings: Supplementary information that puts the costs and savings of preventive health legislation in context, including the likelihood that these will accrue over the long term and possibly outside the federal system, should be included in CBO scores. Isolated figures can be easily misconstrued or inappropriately taken as complete.
- Periodic in-depth analyses: Periodic in-depth analyses by the CBO of the budget implications of specific health prevention activities and proposals (e.g., lead abatement, water fluoridation, or clinical services to the uninsured) would better inform legislative activities. Estimating individual pieces of legislation gives too fragmentary a picture of some complex budgetary and health questions.
- Congressional action on population-based services: Congress should reform the statute governing the Prevention and Public Health Fund, created under the Affordable Care Act to fund population-based prevention services. Both the legislative and executive branches have often diverted these funds to other uses, limiting the resources available for services recommended by the Community Preventive Services Task Force, an independent advisory body to the US Department of Health and Human Services.
Budgeting for Disease Prevention and Health Promotion concludes that the CBO will need additional resources, staff, and modeling capacity to undertake this work, noting that the added costs will be dwarfed by the value of improving the information available to Congress about health financing. Implementing the report’s recommendations will make it easier to pass legislation designed to prevent disease and promote health—and foster a healthier nation as a result.
About the Health, Medicine & Society Program
The Health, Medicine & Society Program brings together influential groups of thought leaders, decisionmakers, and the informed public to consider health challenges facing the US in the 21st century and to identify practical solutions for addressing them.
About the Aspen Institute
The Aspen Institute is a global nonprofit organization committed to realizing a free, just, and equitable society. Founded in 1949, the Institute drives change through dialogue, leadership, and action to help solve the greatest challenges facing the United States and the world. Headquartered in Washington, DC, the Institute has a campus in Aspen, Colorado, and an international network of partners.