Public Health & Prevention

Prevention and wellness components of the federal health reform legislation are designed to transform how health services are viewed and delivered. The Affordable Care Act (ACA) recognizes public health and prevention efforts as an important component of health reform.  Among its many provisions, the federal law establishes:

• A National Prevention, Health Promotion and Public Health Council and a Prevention and Health Promotion Strategy;
• A  Prevention and Public Health Fund;
• Requirements to cover clinical preventive services;
• Nutritional labeling requirements;
• Insurance wellness programs. 

National Prevention Council and Strategy

The ACA created the National Prevention, Health Promotion and Public Health Council to coordinate prevention efforts and leadership across18 federal agencies.  The National Prevention Strategy makes recommendations to help shift the nation’s focus from  sickness and disease to wellness and prevention to help reduce preventable death and disability in the United States.

Prevention and Public Health Fund

The law created a Prevention and Public Health Fund to invest in public health initiatives, health screenings and prevention research to improve health and help contain the rate of increase in private and public sector health costs. The fund allocated $500 million in FY 2010, with $250 million for investment in prevention and public health infrastructure and $250 million to increase training opportunities for new primary care providers. In FY 2011, $750 was allocated to prevent tobacco use, obesity, heart disease, stroke and cancer, and increase immunizations.  Appropriations increase to $1 billion in FY 2012.

• In 2010, public health grants supported activities to increase physical activity, improve nutrition, and prevent smoking and tobacco use.
• In 2011, more than $100 million in funding for community transformation grants was awarded to 61 states and communities nationwide to reduce and prevent chronic disease.

Coverage for Preventive Benefits

The ACA established new requirements for preventive services under private health plans, Medicare and Medicaid. The law cites preventive care recommendations that receive an “A” or “B” rating by the U.S. Preventive Services Task Force (USPSTF), such as immunizations; screenings for diabetes, cholesterol, and breast and colorectal cancer; and prenatal care.

Nutritional Labeling Requirements

The ACA requires nutrition labeling of standard menu items at chain restaurants with 20 or more locations and for operators of vending machines with 20 or more locations. This includes disclosing calories on menu boards and additional information in written form, available on request, to include calories from fat and saturated fat, cholesterol, sodium, carbohydrates, sugars, dietary fiber and protein. On April 6, 2011, the Food and Drug Administration (FDA) published two proposed rules in the Federal Register on nutritional labeling for vending machines and chain restaurants. Establishments whose primary purpose is not selling food, such as movie theaters and bowling alleys, are exempt from the regulations.

Insurance Wellness Programs

The ACA allows higher incentive levels for employer wellness programs than those previously established at 20 percent of coverage costs under the federal Health Insurance Portability and Accountability Act (HIPAA). The ACA permits employers to offer employees rewards of up to 30 percent of the cost of coverage for participating in a wellness program and meeting certain health-related standards such as weight control, smoking cessation, blood pressure and cholesterol control, and diabetes management.

By July 1, 2014, the ACA also establishes 10 pilot programs to evaluate comprehensive workplace health programs to improve the health of workers and their families. The Centers for Disease Control and Prevention announced that two contractors have been awarded $9 million to support this initiative, one will work closely with worksites who receive funding and the other contractor will evaluate the funded programs.