Among the health promotion and cost-control strategies included in the Affordable Care Act (ACA) is a focus on disease prevention. In addition to bolstering coverage of clinical preventive services the ACA includes new funding for evidence-based lifestyle interventions targeting chronic diseases like diabetes, hypertension, heart disease, stroke and renal disease, all of which are growing in prevalence in the U.S. This brief examines the budgetary implications of unchecked prevalence growth, describes promising approaches to reducing that growth, and estimates the potential return on investment in these approaches as envisioned in the ACA, finding ample justification for these efforts in a larger cost-control strategy.