Federal health reform bill includes a new focus on prevention

March 30, 2010

By Daniel Weintraub

The federal health reform bill that President Barack Obama signed into law last week will expand access to health insurance for millions of Americans. But the bill will also pour billions of dollars into programs intended to keep those people from ever needing the kind of care for which they will now be eligible.

Prevention programs, while hardly debated on the floor of Congress or mentioned in the heated national discussion about health reform, are a key part of the legislation.

The bill provides $15 billion over 10 years for a wide range of programs drawn from the wish lists of those who are part of a growing consensus in the country arguing for doing more to prevent illness rather than only treating sickness once it happens.

The legislation will require health insurers and government health programs to provide more check-ups, screenings and health counseling with little or no co-pays by the patient. It will require chain restaurants to provide nutrition information on their menus and menu boards. And it will give grants to small businesses to provide wellness programs for their employees. And it creates a new cabinet-level council to ensure that health and disease prevention are part of the discussion of every major domestic policy change.

But the most intriguing provision in the package might be its grants designed to transform low-income communities so that people will find it easier to develop the habits that can prevent diabetes, heart disease and other chronic ailments that account for a growing share of the nation’s health costs.

“In a normal legislative year4, one or two of these provisions would be considered a huge victory,” said Jeff Levi, executive director of the Trust for America’s Health, a nonprofit group that promotes policies focused on prevention. “This is an unprecedented level of sustained investment in public health and an unprecedented focus on building healthier communities.

“It provides individuals the kind of support they need to make healthy choices, and it provides state and local health departments the resources to make community prevention work.”

Levi described the bill’s “community transformation grants” as the centerpiece of the program. The money will come from the bill’s total prevention package, at the discretion of the Obama Administration and will go to local governments and private, community-based organizations. The grants are intended to change conditions at the community and neighborhood level that prevent healthy living.

The program envisions a decentralized process in which local communities decide for themselves what kind of problems they face and what can be done to solve them. The projects could involve getting healthier food onto the local’s school’s menu, creating multi-use agreements with the schools to keep playgrounds open after hours, or programs to encourage people to reduce their consumption of tobacco and alcohol.

“Because so much of health care costs are driven by chronic disease, there is a recognition that the things proven to be most effective in preventing and even mitigating disease are things that happen outside the clinic,” Levi said. “It’s how active we are, what we eat. Looking at the impediments to making those healthy choices really has become a new focus. It’s changed the nature of the discussion.”

Lucy Johns, a San Francisco-based health consultant who has studied and designed prevention programs for more than a decade, pointed to research that shows a correlation between where you live, how healthy you are and your life expectancy.

“Access to health services is only one piece of a very big puzzle that affects health status,” Johns said. “Income and education are essential for maintaining good health and improving health. Even where access to health care is equal, we know that life expectancy differs by income.”

Johns said she expects the local grants to be used to improve safe routes to school so children can walk rather than being driven, and to provide more and bigger parks so people in low-income communities have a place to exercise. Other projects might be aimed at bringing more fresh food to neighborhoods that now lack grocery stores that sell it. Beyond that, the grant money could be used to reduce pollution, such as that from the diesel trucks that idle for hours outside the ports of Long Beach, Los Angeles and Oakland.

“This bill recognizes that we need to start investing in the health of communities to do something in the long run about poor health status in the United States,” she said. “This bill recognizes that for the first time.”

Note: The California Endowment, which is the initial funder of this web site, sponsors the Building Healthy Communities program, which focuses on transforming 14 California communities in much the same way envisioned by the new community transformation grants in this bill.

Here is a summary of many of the prevention provisions in the federal health reform bill.

Prevention Goals and Priorities:

National Prevention, Health Promotion & Public Health Council – Creates cabinet-level council to coordinate prevention, wellness and health promotion policies and to develop a “National Prevention Strategy.”

National Prevention and Health Promotion Strategy – Requires the council to create a strategy that sets goals for improving health through prevention and public health programs, and establishing measurable actions and timelines.

Community Prevention:

Prevention and Public Health Fund. Establishes a fund to provide for an expanded national investment in prevention and public health programs. The fund will support programs authorized by the Public Health Service Act for prevention, wellness and public health activities, including prevention research and health screenings and initiatives. The fund will receive $500 million this year, $750 million next year and increase by $250 million a year until it reaches $2 billion.

Community Health Centers and the National Health Service Corps Fund. – Creates a Community Health Center Fund that provides enhanced funding for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers.

Targeted Community Prevention Programs:

Community Transformation Grants – Authorizes the Centers for Disease Control to award competitive grants to State and local governmental agencies and community-based organizations for prevention activities that reduce chronic disease rates, prevent the development of secondary conditions, and address health disparities.

National Diabetes Prevention Program – Creates a CDC National Diabetes Prevention Program targeted at adults at high risk for diabetes.

Education & Outreach Campaign Regarding Preventive Benefits
– Directs the Secretary of Health and Human Services to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the lifespan.


Health insurance mandates

Essential Health Benefits Requirements – Requires a health benefits package that covers essential health benefits defined by the Secretary of Health and Human Services and limits cost-sharing. Preventive and wellness services and chronic disease management are to be included in the basic benefits package.

Coverage of Preventive Health Services – Requires group health plans and health insurance companies to provide coverage, without any cost-sharing, for :
(1) evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force;
(2) immunizations that have in effect a recommendation from ACIP;
(3) Evidence-informed preventive care and screenings for infants, children, and adolescents.


Medicare prevention strategies

Removal of Barriers to Preventive Services – Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the US Preventive Services Task Force.

Coverage of Annual Wellness Visit – Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors.

Evidence-Based Coverage of Preventive Services in Medicare
– Provides the Secretary with the authority to modify coverage of existing preventive services, consistent with the prevention task force’s recommendations.

Medicaid (Medi-Cal)

Improving Access to Preventive Services – Expands states’ option to provide prevention services and immunizations with matching funds from the federal government.

Tobacco Cessation Services for Pregnant Women – States would be required to provide Medicaid coverage for counseling and drugs for tobacco cessation by pregnant women without cost-sharing.

Incentives for Prevention of Chronic Diseases – Directs the Secretary of Health and Human Services to award grants to states to provide incentives to Medicaid beneficiaries who successfully participate in a healthy lifestyles program and demonstrate changes in health risk and outcomes.


Other measures

Nutrition Labeling of Standard Menu Items at Chain Restaurants – Requires chain restaurants with 20 or more locations to provide nutrition information on their menus and menu boards.

Employer-Based Wellness Programs – Directs CDC to help employers evaluate wellness programs and employer-based wellness practices.

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs – Award grants to small businesses to provide employees with access to comprehensive workplace wellness programs.

Source: Trust for America’s Health.

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