What’s In The ACA Anyway? (Part 7)

Welcome back! As always, you can follow along at congress.gov, which offers a (very dry) summary and a (even drier) full text version.

Title IV:  Prevention of Chronic Disease and Improving Public Health

One of the things that leads to a high cost of care is, put bluntly, people getting sick. Especially if they’re getting sick with preventable diseases; every person who refuses a vaccine and has to be treated for measles or whooping cough takes up resources that could be used to treat someone with a broken arm or pneumonia, leading to longer waiting lists, crowded hospitals, and so on. So it makes sense to include programs to try and improve the overall health of individuals when you’re talking about health care reform.

Subtitle A: Modernizing Disease Prevention and Public Health Systems

This subtitle created the “National Prevention, Health Promotion and Public Health Council”, and appointed the Surgeon General as its chairperson. Like everything else created by this act, they have a website, so its not hard to see what they’re working on: reducing the number of smokers, preventing drug abuse and excessive drinking, “healthy eating”, active living, “injury and violence-free” living, reproductive and sexual health, and mental well-being. I won’t talk here about my feelings on our country’s emphasis on dieting to control health, but most Americans would agree that these things are generally meant to improve the health of individuals, right?

This section also created an Advisory Group. I believe the difference is that the council is made of government employees, while the advisory group is collecting non-government-employees, to ensure that there’s input from experts in the field as well.

Along with the council and advisory group are the usual slew of reports, funding, and studies. This also instructs the CDC to be involved, particularly in creating a “national science-based media campaign on health promotion and disease prevention” and a website where people can put together a personalized health plan. I am not certain what this is; I’m seeing things like this website, but I’m also seeing mentions of helping providers produce personalized plans for their patients, so this might be aimed at them instead. It’s through the CDC, so maybe it’s just this portal? The text specifies that it should be “a source of the most up-to-date scientific evidence relating to disease prevention for use by individuals”, and that it should include “a component that enables
an individual to determine their disease risk (based on personal health and family history, BMI, and other relevant information) relating to the 5 leading diseases in the United States, and obtain personalized suggestions for preventing such diseases.” If you can find that, let me know in the comments!

Subtitle B: Increasing Access to Clinical Preventive Services

This section begins by providing funding for school-based health centers. You can find an overview of what these are, where they are, and who they serve in the census that comes out every few years.

The next section is concerned with dental disease: it asks the CDC to put together a campaign for oral health, including creating a program to provide dental sealants to schoolchildren, and public education on oral health. Oral health is also added to the Pregnancy Risk Assessment Monitoring System, the National Health and Nutrition Examination Survey, and the Medical Expenditure Panel Survey.

Fun fact: Did you know that gum disease is linked to heart disease and low birth weight? You know, the leading cause of death in the US and one of the biggest factors for infant mortality? So dental care is definitely not something to overlook.

The next bit establishes personal prevention plan coverage for Medicare. Basically,  for free, everyone with medicare gets to have a physical (or “annual wellness visit”) with their doctor, followed by a consult to establish a plan to get them healthier tailored to their lifestyle and needs; the ACA provides for tooling to help physicians accomplish this. This plan includes a list of risk factors, and a schedule for followups to make sure you’re on track.

It also eliminates copays under Medicare for items that are recommended by the US Preventative Services Task Force, and authorizes the Secretary to continue adding anything they recommend in the future to this list. Right now this is mostly screenings for common issues, like hepatitis and tuberculosis, plus counseling for things like tobacco use, and some supplements. Vaccines are also called out by the ACA as explicitly free. Finally, there’s the usual grants to states who manage to come up with innovative new ways to improve general public health.

Subtitle C: Creating Healthier Communities

This section starts out with a carrot: money for states and cities who come up with innovative evidence-based programs for

  • create healthier school environments (including reforming school food, adding more physical activity, promoting emotional wellness, and preventing chronic disease)
  • creating infrastructure to give more people healthy food and an active lifestyle
  • developing programs for all ages that increase nutrition, physical activity, and socal and emotional wellness
  • developing programs for all ages that reduce smoking and chronic disease
  • creating workplace wellness programs
  • highlighting “healthy” food options at restaurants
  • reducing racial and ethnic disparities in health
  • meeting health needs of special populations

It also specially calls out programs for seniors aged 55 to 65 for physician screenings and referrals, probably aiming to reduce the burden of seniors 65+ by helping them get healthier earlier. The secretary is similarly asked to investigate programs for Medicare recipients to help them develop healthier habits. Another pilot program is commissioned later for people who use “community health centers” to be given access to the same kind of information.

This section also calls for the creation of standards around medical equipment to ensure it’s disability-accessible. This includes examination tables, chairs, scales, x-ray machines, and so forth.

There’s also a section on vaccines for adults, authorizing the state to purchase and deliver vaccines. An older act authorizing the states to hand out free vaccines (for adults and kids) was extended, and a study is commissioned to ensure that adults 65 and older are getting the vaccines they need. We usually talk about vaccines as though that’s something that only affects children, but flu and HPV vaccines can be enormously helpful for adults.

Do you remember when fast food places started putting calorie counts on the menu? That’s the ACA too, trying to solve the “obesity epidemic”. Their hearts were in the right places, I guess.

This is also the place where nursing mothers get a boost: employers must offer a place for them to express breast milk that is not a restroom, and must allow time to do so for a year after a child is born. However, that is not required to be a paid break.

Subtitle D: Support for Prevention and Public Health Innovation

This is where the science really kicks in! We open with funding for research into public health services and symptoms. This research specifically includes

  • evidence-based practices aimed at preventing diseases
  • how well academic models translate to reality, and
  • effective strategies for delivering services in the real world

This comes in the form of an annual report.

Next, some changes to research standards. All reports or survey for the federal government must include the following:

  • data on race, ethnicity, sex, primary language, and disability status
  • data at the smallest practical geographical level (so that comparisons of regions can be made)
  • enough data to come up with “statistically reliable estimates” grouped by racial, ethnic, sex, primary language, and disability status

Each of the demographic categories listed above are held to certain standards, to prevent gaming the data by redefining groups. There are also standards to be developed in how the data is collected, and in the interoperability of systems so that the data can be shared. All of this is considered health data, and held to high privacy standards.

The Secretary is then asked to put together tools to help employers measure how well their employee wellness programs are going; this is explicitly forbidden from becoming a standard on how employee wellness programs must be carried out, but instead just a set of tools to help employers help themselves.

$190 million dollars is set aside for grants for studies into disease management and the prevention of epidemics.

As someone with a chronic pain condition, this is my favorite part: the ACA digs into pain specifically. It begins with the Conference on Pain, the findings of which were laid out in this document. Then, a committee is created to continue researching pain after the conference. Money is laid out for education in the area of pain management, including both acute and chronic pain. More and more we’re beginning to realize that chronic pain is very different than acute pain, and is a condition in its own right, requiring more nuanced treatment than an opiate prescription. Unfortunately, we have a lot of people hooked on opiates because we didn’t realize that sooner.

Finally, funds are laid out to tackle childhood obesity.

Subtitle E isn’t worth a heading; the senate concludes that the effects of wellness programs are hard to measure, and allocated some funds toward fixing that in the future.

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