Affordable Care Act with Regards to Programs for the Prevention of Disease

The Patient Protection and Affordable Care Act is a significant step in health care reform. The act is designed to provide quality, yet affordable health care, for all Americans through the implementation of multiple public health programs and removing financial barriers for patient access to healthcare. The purpose of this paper is to examine the provisions of Title IV of the Act, specifically as they relate to preventative care.

I. The Act is designed to modernize disease prevention and public health systems (“Patient Protection,” n.d., p. 6).

a. Creation of a new Prevention and Public Health Investment Fund, with annual appropriations of $500 Million in the first year and increasing to $2 Billion by fiscal year 2015 (Koh & Sebelius, 2010, p. 1).

i. Provide expanded and sustained national investment in prevention and public health (“Patient Protection,” n.d., p. 6).

ii. The Secretary of Health and Human Services will convene a national public/private partnership to conduct a national prevention and health promotion outreach and educational campaign (“Patient Protection,” n.d., p. 6).

1. Patients only receive about half of the preventive services that are recommended (Koh & Sebelius, 2010, p. 1).

2. Raise awareness of activity to promote health and prevent disease, including activities related to the National Diabetes Prevention Program and breast and cervical cancer programs (Thorpe, 2010, p. 1; Rosenbaum, 2012, p. 1).

iii. Fund dollars will be used to establish a new interagency prevention council comprised of more than a dozen different federal agencies called the “National Prevention, Health Promotion and Public Health Council” (Koh & Sebelius, 2010, p. 1).

iv. Fund dollars will be used to create a U.S. Preventive Services Task Force (“Patient Protection,” n.d., p. 6).

b. Establish an Advisory Committee on Immunization Practices (“Patient Protection,” n.d., p. 6)..

c. Remove barriers for patients so that they may access clinical preventative services (“Patient Protection,” n.d., p. 6).

II. The Act is designed to increase access to clinical preventive services for patients (“Patient Protection,” n.d., p. 6).

a. Provide for a dental health prevention education campaign (“Patient Protection,” n.d., p. 6).

b. Expand Medicare coverage for patients (with no co-payments or deductibles) (“Patient Protection,” n.d., p. 6)

i. Cover annual wellness visit (“Patient Protection,” n.d., p. 6)

ii. Development of personalized prevention plan for patients (“Patient Protection,” n.d., p. 6)

iii. Waive coinsurance requirements and deductibles for most preventative services, resulting in 100% coverage by Medicare (“Patient Protection,” n.d., p. 6)

iv. Provide additional federal funding (enhanced match) for states that provide Medicaid program coverage for certain preventative services (“Patient Protection,” n.d., p. 6).

1. Cover clinical preventive service recommended by the U.S. Preventive Services Task Force assigned a grade of “A” (strongly recommended) or “B” (recommended); (Koh & Sebelius, 2010, p. 1).

2. Cover adult immunizations recommended by the Advisory Committee on Immunization Practices without cost-sharing (“Patient Protection,” n.d., p. 6) (Koh & Sebelius, 2010, p. 1).

3. Cover preventative care and screening including both existing health guidelines and future guidelines to be developed for women through the U.S. Health Resources and Services Administration (Koh & Sebelius, 2010, p. 1).

v. Private health plans and insurance policies purchased after September 23, 2010 must also provide coverage for preventative services (with no co-payments or deductibles) (Koh & Sebelius, 2010, p. 1).

vi. Require Medicaid coverage for counseling and pharmacotherapy to pregnant women for the cessation of tobacco use (“Patient Protection,” n.d., p. 6).

vii. Award grants to states to provide incentives for Medicaid beneficiaries to participate in programs providing incentives for healthy lifestyles (“Patient Protection,” n.d., p. 6).

viii. Require Medicaid coverage for mental health counseling (“Patient Protection,” n.d., p. 6).

ix. Authorize the Secretary of Health and Human Services to modify coverage of any Medicare-covered preventive service to be consistent with U.S. Preventive Services Task Force recommendations (“Patient Protection,” n.d., p. 6).

III. The Act is designed to create healthier communities in the United States (“Patient Protection,” n.d., p. 6).

a. The Secretary of Health and Human Services is authorized to award grant money to eligible small businesses to promote individual and community health within their companies, and to prevent chronic disease through the offering of comprehensive workplace wellness programs (“Patient Protection,” n.d., p. 6; (Koh & Sebelius, 2010, p. 1).

b. The CDC will provide grants to states and large local health departments to conduct pilot programs for the elderly to:

i. evaluate chronic disease risk factors;

ii. conduct evidence-based public health interventions; and

iii. ensure that individuals identified with chronic disease or at-risk for chronic disease receive clinical treatment to reduce risk. (“Patient Protection,” n.d., p. 6).

c. Authorizes all states to purchase adult vaccines using CDC contracts for reduced amounts (“Patient Protection,” n.d., p. 6).

d. Restaurants that are part of a chain with 20 or more locations (operating under the same name) must disclose calories counts on their menus and make them otherwise available to customers (“Patient Protection,” n.d., p. 6).

IV. The Act will provide additional support for prevention and public health innovation (“Patient Protection,” n.d., p. 6).

a. The Secretary of Health and Human Services will provide funding for research in public health services and systems to examine best prevention practices (“Patient Protection,” n.d., p. 6).

b. The Center for Disease Control will evaluate best employer wellness practices and provide an educational campaign and technical assistance to promote the benefits of worksite health promotion (“Patient Protection,” n.d., p. 6)

c. The Center for Disease Control will help state, local, and tribal public health agencies to improve surveillance for and responses to infectious diseases and other important conditions (“Patient Protection,” n.d., p. 6).

V. Conclusion

There are multiple components to The Patient Protection and Affordable Care Act which will encourage preventative medical care. The implementation of various programs, as well as other activities (including the support of private entities and removal of patient financial barriers), will make the program a viable solution to the ongoing challenges facing healthcare.

References

Koh, H., & Sebelius, K. (2010). Promoting Prevention through the Affordable Care Act. New England Journal of Medicine, 363, 1296-1299. Retrieved November 26, 2013, from http://www.nejm.org.ezproxy.fiu.edu/doi/full/10.1056/NEJMp1008560

Rosenbaum, S. (2012). The ACA: Implications for the Accessibility and Quality of Breast and Cervical Cancer Prevention and Treatment Services. Public Health Reports, 127, 340-344. Retrieved November 26, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314080/

The Patient Protection and Affordable Care Act Detailed Summary. (n.d.). Democratic Policy and Communications Center. Retrieved November 25, 2013, from http://www.dpc.senate.gov/healthreformbill/healthbill04.pdf

Thorpe, K. (2012). Analysis & commentary: The Affordable Care Act lays the groundwork for a national diabetes prevention and treatment strategy. Health Affairs, 31(1), 61-66. Retrieved November 26, 2013, from http://content.healthaffairs.org.ezproxy.fiu.edu/content/31/1/61.full