I 
111TH CONGRESS 
1ST SESSION H. R. 1940 
To amend the Public Health Service Act to establish a Wellness Trust. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 2, 2009 
Ms. MATSUI (for herself, Mr. BRALEY of Iowa, Mrs. CAPPS, and Mr. SAR-
BANES) introduced the following bill; which was referred to the Com-
mittee 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 ‘‘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 
is estimated that, if there is no intervention now, by 
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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-
tributing factor to the overall poor health that is 
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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 
in preventive services today that will benefit other 
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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 
public health workforce has no formal public health 
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or prevention training. There is no national, uniform 
credentialing system for public health or prevention 
workers that would ensure that these workers are 
trained in the basics of preventive care. 
(9) A system that promoted full use of high-pri-
ority prevention could save lives. A recent com-
prehensive assessment found that 1,200,000 quality- 
adjusted life years could be saved by achieving 90 
percent use of just the following 3 services: 
(A) Smoking cessation counseling. 
(B) Use of aspirin to prevent heart at-
tacks. 
(C) Screening for colorectal cancer. 
(10) A system that promoted full use of high- 
priority prevention could reduce costs. For example, 
complete, routine childhood vaccination could save 
up to $40,000,000,000 in direct and societal costs 
over time. Promoting screenings and behavioral 
modifications in the workplace can lower absentee-
ism and, in most cases, health costs to firms. Pre-
ventive health care services could reduce government 
spending on health care. If all elderly received a flu 
vaccine, health costs could be reduced by nearly 
$1,000,000,000 per year. Over 25 years, Medicare 
could save an estimated $890,000,000,000 from ef-
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fective 
control 
of 
hypertension, 
and 
$1,000,000,000,000 from returning to levels of obe-
sity observed in the 1980s. 
(11) Investing in community-level interventions 
that promote and enable proper nutrition, increased 
access to physical activity, and smoking cessation 
programs can prevent and mitigate chronic diseases, 
improve quality of life, increase economic produc-
tivity, and reduce healthcare costs. 
(b) PURPOSE.—The purpose of this Act is to create 
a 21st century prevention system called the Wellness 
Trust that assures access to clinical and community-level 
prevention services that improve health, quality of life, and 
reduce healthcare costs. 
SEC. 3. WELLNESS TRUST. 
Title III of the Public Health Service Act (21 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART S—WELLNESS TRUST 
‘‘SEC. 399KK. DEFINITIONS; ESTABLISHMENT OF WELLNESS 
TRUST. 
‘‘(a) DEFINITIONS.—In this part: 
‘‘(1) CERTIFIED PREVENTION HEALTH WORK-
ER.—The term ‘certified prevention health worker’ 
means a licensed health professional, a public health 
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professional employed by a State or local public 
health agency, or any other health worker deemed 
certified by the Trustees. 
‘‘(2) PREVENTION HEALTH ENTITY.—The term 
‘prevention health entity’ means a State or local 
public health agency or other community-based pre-
vention entity deemed to be an eligible Trust partici-
pant by the Trustees. 
‘‘(3) TRUST.—The term ‘Trust’ means the 
Wellness Trust established under subsection (b). 
‘‘(4) TRUSTEES.—The term ‘Trustees’ means 
the members of the Trust Fund Board appointed 
under section 399LL(b). 
‘‘(b) ESTABLISHMENT OF THE WELLNESS TRUST.— 
There is established within the Centers for Disease Con-
trol and Prevention the Wellness Trust. 
‘‘SEC. 399LL. STRUCTURE. 
‘‘(a) TRUST FUND BOARD.—The Trust shall be 
headed by the Trust Fund Board. 
‘‘(b) COMPOSITION.—The Trust Fund Board shall be 
composed of 7 members appointed by the President by and 
with the advice and consent of the Senate. 
‘‘(c) DATE OF APPOINTMENTS.—The initial 7 Trust-
ees shall be appointed not later than December 31, 2009. 
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‘‘(d) STAGGERED TERMS.—Of the members first ap-
pointed under subsection (c)— 
‘‘(1) 4 shall be appointed for a period of 4 
years; and 
‘‘(2) 3 shall be appointed for a period of 3 
years. 
‘‘(e) VACANCIES.—A vacancy on the Trust Fund 
Board— 
‘‘(1) shall not affect the powers of the Trust 
Fund Board; and 
‘‘(2) shall be filled in the same manner as the 
original appointment was made. 
‘‘(f) MEETINGS.—The Trust Fund Board shall meet 
at the call of the Chairperson. 
‘‘(g) QUORUM; REQUIRED VOTES.—A majority of 
Trustees shall constitute a quorum for purposes of voting, 
but a lesser number of members may hold hearings. The 
Chairperson shall require a vote of the Trustees on major 
decisions regarding prevention priorities, resource alloca-
tion, delivery system structure, and other Trust functions. 
‘‘(h) CHAIRPERSON AND VICE CHAIRPERSON.—The 
Trust Fund Board shall select a Chairperson and Vice 
Chairperson from among the Trustees. 
‘‘(i) REMOVAL.—A Trustee may be removed by the 
President only for cause. 
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