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Affordable Care Act, Culture, Economy, Government, Government Programs, Government Spending, Health Care, Health Care Reform, Health Disparities, Health Insurance, Health Reform, Healthcare, Mental Health Care, Obama, Obamacare, Politics, Public Health, Public Policy, Social Justice, Society, Uncategorized, Women's Health

Ten Things In The Affordable Care That You (Probably) Don’t Know About

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Most people think that the purpose of the Affordable Care Act is to expand access to health insurance coverage. While reducing the number of uninsured Americans is certainly a primary goal of the ACA (and, by the way, it’s already doing just that), that’s only part of it. The health care law includes hundreds of pages that touch on a variety of issues and initiatives that have, for the most part, remained under the public’s radar. Here’s a sampling:  

1. Postpartum Depression (Sec. 2952)

Expands and intensifies research activities related to postpartum depression by encouraging the DHHS secretary to continue research to expand the understanding of the causes of, and treatments for, postpartum conditions.  The law also enables the director of the National Institute of Mental Health to conduct a nationally representative longitudinal study of the relative mental health consequences for women of resolving a pregnancy in various ways.  In addition, the law authorizes appropriations of $3 million for new grants to states (starting in fiscal year 2010) to provide services to individuals with, or at risk, of postpartum depression and their families. Activities include delivering or enhancing home-based and support services, including case management and comprehensive treatments; inpatient care management services ensuring the well being of the mother, family and infant; improving support services and providing counseling; and promoting earlier diagnosis and treatment and providing information to new mothers.

Teen Pregnancy Prevention (Sec. 2953)

Provides funding to state programs to educate adolescents and young adults on both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections, including HIV/AIDS. The State program component must fund teen pregnancy prevention and personal responsibility education programs that have been proven on the basis of rigorous scientific research, to change behavior, which means delaying sexual activity, increasing condom or contraceptive use for sexually active youth, and/or reducing pregnancy among youth. In addition to education on abstinence and contraceptive use, funded programs must also offer services to prepare young people for adulthood by implementing activities that address three or more of the following six subject areas:

1) Healthy relationships, including development of positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage and family interactions; 2) Positive adolescent development, to include promotion of healthy attitudes and values  about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects; 3) Financial literacy, to support the development of self-sufficiency and independent living skills; 4) Parent-child communication skills; 5) Education and employment preparation skills; and 6) Healthy life skills, such as goal-setting, decision making, negotiation, communication and interpersonal skills, and stress management.

Centers of Excellence for Depression (Sec. 10410)

Provides grant support for the purpose of establishing National Centers of Excellence for Depression. Centers will conduct research in order to develop evidence-based interventions, develop a research agenda after consulting with “a broad cross-section of stakeholders,” train mental health professionals, and educate the public, policy makers, community leaders, and employers about depressive disorders in an effort to reduce the stigma associated with treatment. Centers must collaborate with other Centers to create treatment guidelines and protocols, facilitate communication with providers regarding “co-occurring physical health conditions” (e.g. cancer, diabetes), develop “self-management” plans,” and “use electronic health records and telehealth technology to better coordinate and manage, and improve access to, care, as determined by the coordinating center.”

Grants to Small Businesses for Wellness Programs (Sec. 10408)

Establishes grant funding for comprehensive workplace wellness plans for small businesses and non-profits. Organizations with less than 100 employees who work 25 hours or greater per week will qualify. The wellness program must be made available to all employees with four components: health awareness initiatives; efforts to maximize employee participation in the wellness program; initiatives to change unhealthy behaviors and life-style choices; and provide a supportive environment.

Oral Health Care (Sec. 4102)

Extends funding to all states, territories and tribes for cooperative agreements with the Centers for Disease Control and Prevention to improve states’  oral health infrastructure. This provision also instructs the Centers for Disease Control and Prevention to embark on a five-year national public education campaign to promote oral health care measures such as “community water fluoridation and dental sealants.” Additional provisions include increased surveillance, like the requirement that oral health components be included in the Pregnancy Risk Assessment and Monitoring System (interestingly, oral health problems are a serious risk factor during pregnancy). Further, the law guarantees coverage with no out-of-pocket costs for services such as oral health risk assessments for children and fluoride supplements for children whose water source does not contain fluoride.

Privacy Breaks for Nursing Mothers (Sec. 4207)

Requires employers with to provide a reasonable amount of break time to express milk as frequently as needed by the nursing mother. The frequency of breaks needed to express milk as well as the duration of each break will likely vary. A bathroom, even if private, is not a permissible location under the Act. The location provided must be functional as a space for expressing breast milk. If the space is not dedicated to the nursing mother’s use, it must be available when needed in order to meet the statutory requirement. A space temporarily created or converted into a space for expressing milk or made available when needed by the nursing mother is sufficient provided that the space is shielded from view, and free from any intrusion from co-workers and the public.

Transparency on Drug Samples (Sec. 6004)

Requires pharmaceutical manufacturers that provide doctors or hospitals with samples of their drugs to submit to the Department of Health and Human Services the names and addresses of the providers that requested the samples, as well as the type and amount of drugs they requested and received. This provision is just one part of the ACA’s push toward enhanced transparency of industry relationships. There is a concern that drug companies are having an outside influence on prescribing practices, creating a major conflict of interest. Physicians and hospitals who receive large quantities of free samples may make decisions about medication practices based on the interests of the drug company supplying those samples, rather than making these decisions solely based on the best interest of patients. Increasing transparency in transactions between pharmaceutical companies and health care providers and organizations is designed to combat this problem.

Diabetes & Death Certificates (Sec. 10407)

The Secretary of Health and Human Services and CDC must work with federal and state agencies to improve the collection of vital statistics. This includes “training physicians on the importance of birth and death certificate data” and how to properly complete the documents, promoting the adoption by states “of the latest standard revisions of birth and death certificates,” and helping states to “re-engineer their vital statistics systems in order to provide cost-effective, timely, and accurate vital systems data.” The Secretary has discretion to also “promote improvements to the collection of diabetes mortality data. Death certificates are a primary source of data for characterizing mortality patterns in the United States, but current reporting practices underestimate the actual number of deaths caused by diabetes. The persistent under-reporting of diabetes on death certificates underestimates the burden of the disease and the influence of diabetes on death rates. By improving reporting practices, public health officials w

Breast Cancer Awareness (Sec. 10413)

Instructs the CDC to conduct an education campaign to raise young women’s awareness regarding “the occurrence of breast cancer and the general and specific risk factors in women who may be at high risk for breast cancer based on familial, racial, ethnic, and cultural backgrounds such as Ashkenazi Jewish populations.” Additionally, the law calls for research by the CDC and NIH to develop and validate preventive tactics such as new screening tests and early detection methods of breast cancer to reduce the occurrences of breast cancer in younger women. This is one of many provisions in the law aimed at achieving health equity and reducing health disparities based on socioeconomic status and racial, ethnic, and cultural characteristics.

Maternal, Infant and Early Childhood Home Visiting Program (Sec. 2951)

Amends Title V of the Social Security Act to fund family support programs, which are known as home visiting because they take place in the homes of vulnerable families. These programs are a proven strategy for strengthening families and saving money. This voluntary program is for families that ask to be empowered with better knowledge, better health, and better opportunities for their children. The provision facilitates collaboration and partnership at the federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs, and to provide comprehensive services to improve outcomes for families who reside in at-risk communities. Programs that receive funding must demonstrate improvement among participating families in the following six benchmark areas:

1) Improved maternal and newborn health; 2) Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits; 3) Improvement in school readiness and achievement; 4) Reduction in crime or domestic violence; 5) Improvements in family economic self-sufficiency; and 6) improvements in the coordination and referrals for other community resources and supports.

Decades of research show that these family support programs are effective and ultimately save money for taxpayers.When quality programs, carried out in local communities, are properly implemented, they lead to increased family self-sufficiency, lower health care costs, and reduced need for remedial education. For every dollar spent on these efforts, at least $2 in future spending is saved.

***

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The Affordable Care Act is a watershed in U.S. public health policy. Through a series of extensions of, and revisions to, the multiple laws that together comprise the federal legal framework for the U.S. health-care system, the Act establishes the basic legal protections that until now have been absent: a near-universal guarantee of access to affordable health insurance coverage, from birth through retirement. When fully implemented, the Act will cut the number of uninsured Americans by more than half. The law will result in health insurance coverage for about 94% of the American population, reducing the uninsured by 31 million people, and increasing Medicaid enrollment by 15 million beneficiaries.

Consisting of 10 separate legislative Titles, the Act has several major aims. The first—and central—aim is to achieve near-universal coverage and to do so through shared responsibility among government, individuals, and employers. A second aim is to improve the fairness, quality, and affordability of health insurance coverage. A third aim is to improve health-care value, quality, and efficiency while reducing wasteful spending and making the health-care system more accountable to a diverse patient population. A fourth aim is to strengthen primary health-care access while bringing about longer-term changes in the availability of primary and preventive health care. A fifth and final aim is to make strategic investments in the public’s health, through both an expansion of clinical preventive care and community investments.

It’s already achieving many of these goals — including saving thousands of American lives — and while there will surely be bumps along the way, we are undoubtedly headed in the right direction. Our old health care system was simply unsustainable; we couldn’t continue down that road much longer.

The ACA is sweeping in a new era of health care — one that will be better for consumers, and that will ensure that everyone has access to the basic human right that is health care.

And for that, we should all be thankful.

 

Be well, my friends!

-C

 

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