Wellness Provisions Escape PPACA Controversies
After the House voted in January to repeal the Patient Protection and Affordable Care Act, the Senate refused to go along. Meanwhile, the law had four hearings in court; two found it unconstitutional, and two affirmed it. Now, as the Act works its way toward the Supreme Court, some states are implementing its provisions while others are skirting them.
Amidst all the controversy, a few areas of bipartisan agreement in the Act are found in measures designed to curtail growth in medical treatment spending through wellness and protection initiatives. If implemented in appropriate situations, these provisions will help contain long term health care costs. With health care costs making up about a third of the nation’s economy, containing them is a savings that the whole nation can enjoy.
The well-publicized trend of rising obesity in the U.S. has parallels worldwide. This interactive graphic from the Washington Post show how men and women in six regions of the world have gained weight since 1980.
The range of initiatives is broad, including one that requires restaurant chains to post the calorie count of items on their menus (see February LIFELINES ONLINE: Restaurants Begin Listing Calories of Menu Items). The requirement extends to buffet items and vending machines. Eventually, it is expected to cover all items on all restaurant menus – chain or not – and to require sodium, transfat and other nutritional information as well.
In another measure, effective last September, employer-sponsored and health insurance issuers are prohibited from requiring co-pays for prevention services that may be recommended by an independent expert panel known as the United States Prevention Services Task Force. Co-pays were also eliminated for certain recommended vaccinations, breast cancer screenings and other care or screenings for women and children. However, this provision does not apply to “grandfathered” health plans. Eligibility for grandfather status requires that a plan have had at least one participant continuously enrolled, even if it is not the same person, since March 23, 2010, the date on which PPACA was enacted. Many LIUNA health and welfare funds qualify for grandfathered status, and a decision to eliminate these co-pays (in order to stimulate use of wellness services which could save money in the long run) should be made in the context of a comprehensive re-evaluation of a plan’s schedule of benefits.
In a move also designed to save money in the long run, co-pays were eliminated for many Medicare and Medicaid recipients, and they will now be entitled to one annual wellness visit with a physician who will review their health status and design a “personalized prevention plan” that includes a custom-tailored screening schedule for future years.
By 2014, plans will be required to cover certain “essential health benefits,” such as emergency services, hospitalization, maternity and newborn care, prescription drugs, laboratory services, mental health services, chronic disease management and preventive and wellness services.
Wellness discounts will be enhanced after January 1, 2014. For plans whose participants pay a portion of an employer-provided insurance premium, the Act will allow discounts of up to 30 percent for participants who participate in voluntary wellness programs such as maintaining a healthy weight, refraining from smoking or keeping blood pressure and cholesterol levels low.
The act also appropriates amounts ranging up to $2 billion a year by 2015, to support prevention and public health programs, and school-based health facilities get additional funding through 2013. These funding levels may be jeopardized by developing efforts to cut the federal deficit. Meanwhile, a new National Prevention, Health Promotion and Public Health Council, chaired by the Surgeon General, will coordinate wellness practices throughout federal departments and agencies and will issue recommendations to the President and Congress regarding obstacles to reducing smoking, sedentary lifestyles and poor nutrition.
The law also requires employers to provide reasonable break time and a private space to nursing mothers so that they can express milk for up to one year after the birth of a child. Employers with less than 50 employees may qualify for an exemption to this rule. While this requirement has little applicability in construction settings, it may apply to other workplaces where non-construction Laborers are employed.
With federal and state budget battles intensifying, the long-term prospects of many of PPACA’s provisions remain uncertain. Whatever the ultimate outcome, however, the law’s embrace of wellness initiatives is a healthy sign for the nation.