I 
110TH CONGRESS 
2D SESSION 
H. R. 7287 
To amend the Public Health Service Act to establish a Wellness Trust. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 19, 2008 
Ms. MATSUI (for herself, Mr. MCGOVERN, and Ms. ROYBAL-ALLARD) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce 
A BILL 
To amend the Public Health Service Act to establish a 
Wellness Trust. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘21st Century Wellness 
Trust Act’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress finds as follows: 
(1) Preventable and chronic diseases are the 
epidemic of the 21st century. The number of people 
with chronic conditions is rapidly increasing and it 
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is estimated that, if there is no intervention now, by 
2025 nearly half of the United States population will 
suffer from at least 1 chronic disease. About 70 per-
cent of deaths and health costs in the United States 
are attributable to chronic diseases (such as cardio-
vascular disease and cancer), some of which may be 
preventable. Nearly 90 percent of Medicare bene-
ficiaries have some type of chronic illness. 
(2) This affects Americans’ health. The United 
States has the highest rate of preventable deaths 
among 19 industrialized nations and lags behind 28 
other nations in life expectancy. For example, obe-
sity, which is rising rapidly, contributes to a wide 
range of problems, from diabetes to stroke to cancer. 
The life expectancy for a 20-year old man may be 
reduced by 17 percent due to obesity. If trends con-
tinue, children’s life spans may be shorter than 
those of their parents for the first time in about a 
century. 
(3) The wellness gap also affects health care 
costs. About 78 percent of all health spending in the 
United States is attributable to chronic illness, much 
of which is preventable. Chronic diseases cost the 
United States an additional $1,000,000,000,000 
each year in lost productivity, and are a major con-
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tributing factor to the overall poor health that is 
placing the Nation’s economic security and competi-
tiveness in jeopardy. 
(4) Unlike some health care challenges, proven 
preventive services and programs exist. If effective 
risk reduction were implemented and sustained by 
2015, the death rate due to cancer could drop by 29 
percent. Improved blood sugar control for people 
with diabetes could reduce the risk for eye disease, 
kidney disease, and nerve disease by 40 percent. 
Similarly, blood pressure control could reduce the 
risk for heart disease and stroke by 33 to 50 per-
cent. 
(5) Yet, only half of recommended clinical pre-
ventive services are provided to adults. About 20 
percent of children do not receive all recommended 
immunizations, with higher rates in certain areas. 
Nearly 70 percent of people with high blood pressure 
do not now control it. And racial disparities in use 
of prevention exist. 
(6) The United States faces low use of preven-
tive services because of the low value placed on pre-
vention, a delivery system bent toward fixing rather 
than preventing problems, and financial disincentives 
for prevention. Insurers have little incentive to invest 
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in preventive services today that will benefit other 
insurers tomorrow. This is especially true for those 
preventive services that reduce chronic diseases that 
develop over a period of several years or decades. 
The costs of prevention are incurred immediately 
but most of its benefits are realized later, often by 
Medicare. 
(7) There is a low investment in prevention. 
The United States spends only an estimated 1 to 3 
percent of national health expenditures on preventive 
health care services and health promotion. This has 
not increased as much as one might expect since 
1929, 1.4 percent, despite the development of expen-
sive screenings, early interventions, and the growth 
of the preventable disease burden. 
(8) The workforce to deliver prevention is also 
insufficient. The supply of providers who are trained 
to emphasize prevention is shrinking. Between 1997 
and 2005, the number of medical school graduates 
entering family practice residencies dropped by 50 
percent. There is an acute shortage of community 
health workers. Between 25 and 50 percent of the 
existing Federal, State, and local public health work-
force is eligible for retirement in the next 5 years. 
As of 2008, more than 75 percent of the existing 
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