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Health Care Reform's Public Wellness Measures

April 6, 2010 - by Eric Naing

Outlets like the New York Times and Miller-McCune have done a good job of documenting the many easily overlooked policies aimed at improving public wellness embedded in the Affordable Care Act (H.R.3590). These policies range from mandatory calorie counts on chain restaurant menus to the infamous tax on indoor tanning. Are these measures a responsible move by the government to improve public health or another example of out-of-control nanny statism? Here is a closer look at some of these provisions. Take a look and I’ll let you decide.

1. The tanning tax: To help pay for the bill, a ten percent tax on indoor tanning will go into effect starting on July 1. Government health experts and medical studies have often argued that tanning can be a danger to your health. Though some argue the tax will hurt small businesses. The language can be found in Section 5000B of the bill:

SEC. 5000B. IMPOSITION OF TAX ON INDOOR TANNING SERVICES.

(a) In General- There is hereby imposed on any indoor tanning service a tax equal to 10 percent of the amount paid for such service (determined without regard to this section), whether paid by insurance or otherwise.

2. Calorie counts: Chain restaurants with 20 or more locations will have to display a calorie count for most items on their menu as well as a suggested daily caloric intake. What little data we have provides mixed results as to whether menu labeling forces people to eat healthier. The language can be found in Section 4205:

SEC. 4205. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN RESTAURANTS

(i) GENERAL REQUIREMENTS FOR RESTAURANTS AND SIMILAR RETAIL FOOD ESTABLISHMENTS- Except for food described in subclause (vii), in the case of food that is a standard menu item that is offered for sale in a restaurant or similar retail food establishment that is part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items, the restaurant or similar retail food establishment shall disclose the information described in subclauses (ii) and (iii)…

(I)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu listing the item for sale, the number of calories contained in the standard menu item, as usually prepared and offered for sale; and …

(bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu and designed to enable the public to understand, in the context of a total daily diet, the significance of the caloric information that is provided on the menu;

3. Breastfeeding breaks: Employers are required to provide mothers with a “reasonable break time” to pump breastmilk. This contentious issue has been a goal of womens groups for some time. The language is in Section 4207:

SEC. 4207. REASONABLE BREAK TIME FOR NURSING MOTHERS

(1) An employer shall provide—

(A) a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk;

4. Federal dollars for smoking cessation: Among the many services that Medicaid will now cover under the Affordable Care Act is coverage for drugs and counseling to help pregnant women quit smoking. The language is in Section 4107:

SEC. 4107. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES FOR PREGNANT WOMEN IN MEDICAID.

(a) Requiring Coverage of Counseling and Pharmacotherapy for Cessation of Tobacco Use by Pregnant Women- Section 1905 of the Social Security Act, as amended by sections 2001(a)(3)(B) and 2303…

5. Wellness visits: Also covered under Medicare will be an “annual wellness visit” in which a doctor can give you a “health risk assessment” and schedule screenings for various diseases. The language is in Section 4103:

SEC. 4103. MEDICARE COVERAGE OF ANNUAL WELLNESS VISIT PROVIDING A PERSONALIZED PREVENTION PLAN.

(hhh)(1) The term ‘personalized prevention plan services’ means the creation of a plan for an individual—

(A) that includes a health risk assessment (that meets the guidelines established by the Secretary under paragraph (4)(A)) of the individual that is completed prior to or as part of the same visit with a health professional described in paragraph (3);

6. Local Grants: The government will hand out “community transformation grants” to state and local governments and community organizations to promote a more active lifestyle. This money could potentially go toward bike paths, sidewalks, streetlights and more. Republicans have criticized this provision for being an example of wasteful government spending. Sen. Tom Coburn [R, OK] went so far as to call it “a slush fund to build sidewalks, jungle gyms, farmers’ markets and other pork barrel projects.” The language can be found in Section 4201:

SEC. 4201. COMMUNITY TRANSFORMATION GRANTS.

(a) In General- The Secretary of Health and Human Services (referred to in this section as the ‘Secretary’), acting through the Director of the Centers for Disease Control and Prevention (referred to in this section as the ‘Director’), shall award competitive grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming.

7. Abstinence education: While more tangentially related to public wellness, I thought it was interesting that the bill provides $250 million in federal dollars for abstinence eduction through 2014. Federal funding for abstinence education had effectively been cut out when Congress adopted an approach for sex-ed that favored programs that have been “proven effective through rigorous evaluation." The language is in Section 2954:

SEC. 2954. RESTORATION OF FUNDING FOR ABSTINENCE EDUCATION.

Section 510 of the Social Security Act (42 U.S.C. 710) is amended—

(1) in subsection (a), by striking ‘fiscal year 1998 and each subsequent fiscal year’ and inserting ‘each of fiscal years 2010 through 2014’; and

(2) in subsection (d)—

(A) in the first sentence, by striking ‘1998 through 2003’ and inserting ‘2010 through 2014’; and

(B) in the second sentence, by inserting ‘(except that such appropriation shall be made on the date of enactment of the Patient Protection and Affordable Care Act in the case of fiscal year 2010)’ before the period.

These are just a handful of the provisions in the affordable care act. I encourage you to look for more. And if anything stands out, good or bad, definitely make use of OpenCongress’ ability to let you comment directly on each line of the bill.

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