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What’s in the new health care law? Part 4: Prevention

Discussions about health care reform usually, in one way or another, focus on what happens when people get sick.  We want to expand coverage and reduce costs, to ensure that people can go to the doctor or hospital without going bankrupt.  We look at ways to improve health care quality so that when people get sick, they get the best care possible.

It goes without saying that those are incredibly important goals.  But we’re still missing something.   Tom Harkin (D-Iowa), chairman of the Senate health committee, has put it this way:

“We don’t have a health care system in America. We have a sick care system. If you get sick, you get care. But precious little is spent to keep people healthy in the first place.”

The new law begins to change that.  Today, Part 4 of What’s in the New Health Care Law: Prevention.

Coordinating Prevention
Real prevention involves more than just the health care system– our neighborhoods, workplaces, schools, environment, and food all play a huge role in our health.  The new law creates a National Prevention, Health Promotion and Public Health Council to get the federal departments that oversee those different areas all on the same page.

The council will be made up of the Secretaries of Health, Agriculture, Education, Labor, Homeland Security, the Administrator of the EPA and other department heads, as well as an advisory group made up of experts in these fields.   They’ll have one year to develop a national strategy to improve the nation’s health.

The health care legislation creates two other important committees:

  • Preventative Services Task Force: An independent panel of experts that will make recommendations for preventative services.  Insurance companies will have to provide coverage for these services, and without any cost-sharing requirements (like deductibles or copays).
  • Community Preventative Services Task Force: Sort of like the Preventative Services Task Force above, except instead of making recommendations for treating individuals, this task force will focus on health at the community level.

Along with these committees there will also be an Education and Outreach Campaign about the benefits of using preventative services.

Community Transformation Grants
The new law lets Health and Human Services award grants to government agencies and non-profits for projects that could improve the health of a community.  These projects could include things like

  • creating healthier school environments,
  • building infrastructure to support active living and access to nutritious foods (think bike lanes and farmers markets, for example),
  • highlighting healthy food options, and
  • addressing population needs (for example, ways to help people with disabilities).

Menu Labels
Chain restaurants with 20 or more locations are going to have to post a calorie count for each item on the menu. Same goes for vending machines.  According to the New York Times:

Margo G. Wootan, director of nutrition policy at the Center for Science in the Public Interest, a research and advocacy group, said consumers appeared to be choosing lower-calorie foods as a result of calorie-posting laws and regulations adopted in New York City and several other places. Equally important, she said, some restaurants have changed their menu offerings, shrinking portion sizes, reducing the fat in pastries or substituting low-fat milk for cream.

Improving Prevention in Medicare and Medicaid
In Medicare:

  • Proven preventative services will now be covered under Medicare without cost-sharing.
  • Beneficiaries will also be able to get a comprehensive health risk assessment and a personalized prevention plan if they choose.

In Medicaid:

  • For states that remove cost-sharing for prevention in Medicaid, the federal government will pick up more of the tab.
  • States can get grant money to provide incentives for people to participate in chronic disease prevention programs.
  • Medicaid in every state will now cover tobacco cessation services for pregnant women.

Grants for School Based Health Centers
When you think of health care in schools, you might think of a school nurse simply handing out medicine and calling parents when a student is sick.  School based health care centers are different, providing a comprehensive range of primary care services depending on the needs of their community.

SBHC’s employ a multidisciplinary team of providers to care for the students: nurse practitioners, registered nurses, physician assistants, social workers, physicians, alcohol and drug counselors, and other health professionals.

Currently there are about 2000 SBHC’s, providing care to around 1.7 million students in high need areas.  For some kids, they’re the only source of care, yet local and state budget cuts could force some SBHC’s to close their doors.  The new law provides $200 million in emergency funding for SBHC’s over the next four years and creates a federal SBHC grant program, which will allow them to expand them into more schools.

Employee Wellness
Small businesses will be able to get grants and technical assistance to start employee wellness programs– programs designed to encourage employees to lose weight, stop smoking, get more exercise, or improve their health in other ways.  Employers will also be able to offer rewards equal to 30 percent of the cost of coverage  (up from 20 percent under prior law) to employees who participate in these wellness programs.

Breast Feeding
This provision has popped up in one of the crazier rumors we’ve seen floating around.  Apparently, some health reform opponents are saying that the new law means that new mothers are going to be forced to bring their babies to work to breast feed them.

Here’s a good rule of thumb: any time you hear something about the new health care bill that sounds that insane, assume it’s not true.

In this case, the law really just says that employers must provide new mothers with “a reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth.”  As Slate’s Timothy Noah Noah points out, “Expressing breast milk (typically with a breast pump) is what mothers do when they’re away from their babies all day, not when they bring them to the office in a Snugli.”

According to a study published in the medical journal Pediatrics, if 90 percent of U.S. women fed their babies breast milk only for the first six months, it would save the lives of 900 babies each year, along with $13 billion.  Breast feeding helps babies develop a stronger immune response, and reduces the chance of developing illnesses like stomach viruses, ear infections, asthma, juvenile diabetes, Sudden Infant Death Syndrome and even childhood leukemia.

Really, doing all of these things just make sense– spend a little money now to save a lot of money and suffering later.  Anyways, that’s it for Part Four (don’t worry, we’re almost done with this thing).  Next time Part Five: Recruiting more doctors and nurses.

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