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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:


(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:


(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:


(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:


(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:


(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:


(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:


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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  • zombiexl 04/06/2010 12:38pm
    Link Reply
    + -1

    I understand this is a blog and all, but when I saw the decide for yourself part on the main page I figured it might be a good non-biased evaluation. Boy was I wrong.

    This entire article/blog entry was exactly the kind of thing that turns people away from politics. Completely one-side, with “select” elements pulled from 2500+ pages of law to try to put a pretty face on a bill the majority of people in America oppose.

    Your comments on tanning seem to ignore the fact that the government has no responsibility to protect us from ourselves. I personally don’t tan because my skin is naturally dark, however that doesn’t keep me from realizing that they are dictating behavior. The same can be said for tobacco taxes, alcohol taxes, etc. I don’t smoke, but I realize a BS piece of legislation when I see it. Most people won’t stand up until something affects them. If more people looked and said ‘what will they tax next?’ they may realize that it will someday affect them.

  • zombiexl 04/06/2010 12:47pm
    Link Reply
    + -1

    Continuing on with my comment, since space appears to be limited….

    I would encourage anyone, no matter how they feel about this bill to read the entire bill. If you don’t feel you can do that, at least read the entire content of the things in this blog. The pieces presented here are ‘choice cuts’ that appear to have been used to make these parts appear to be less over-reaching than they actually are.

    Take section 4201 as an example. What the Senator cited said appears very plausible if you read the entire text of that section of the law.

    I have to add that ignoring facts doesn’t make them less factual.

    I wish everyone a wonderful day, no matter what your party affiliation or belief system may be.

  • DerekBledsoe 04/06/2010 1:05pm

    I’m not so sure you can safely lobby that this article is somehow bias. There’s very little opinion offered here, almost then entire thing is made up of direct quotes and language from the bill.

    It sounds to me like you’re only complaining because your side isn’t expressed. The notion that “government has no responsibility to protect us from ourselves” is your opinion, not a fact and it would be erroneous for OpenCongress to express is as such.

    If you feel these are “choice cuts,” I would say to bear in mind that anyone attempting to give a 2-page synopsis of a 2,000+ page bill has no choice but to select “choice cuts.” That does not imply an agenda.

    There is an open suggestion to highlight other sections of the bill that may or may not be questionable to you and the comments section is perfect for starting that conversation. It’s an open forum.

    And regarding section 4201, I don’t think you need the full section to see that this sounds like pretty wasteful spending.


  • J3nnYCP4p 11/15/2011 10:49pm

    Most of these measures are pretty good. Helping smokers quit smoking is a good initiative, especially the counselling for pregnant woman. However, I feel that the tanning tax is a bit overboard. In this current economy, we need our businesses to do well.

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