Prevention Matters

The passage of the Affordable Care Act created a renewed emphasis on community prevention and population health. With the Prevention and Public Health Fund and the Community Transformation Grants, resources are now available to improve the health of communities around the country. But how do you know how healthy your community is?

On Wednesday, the Robert Wood Johnson Foundation (http://www.rwjf.org/) and the University of Wisconsin Population Health Institute (http://uwphi.pophealth.wisc.edu/) released the 2011 County Health Rankings (http://www.countyhealthrankings.org/). The County Health Rankings are a key component of the Mobilizing Action Toward Community Health (MATCH) project—a nationwide call to action for improving community health—first released last year. The rankings generate 50 state reports, ranking each county within the 50 states according to its health outcomes and the multiple health factors that determine a county’s health. The four different types of health factors are health behaviors, clinical care, social and economic factors, and the physical environment. Specific county-level data (as well as state benchmarks) are also available. The Rankings are built on America’s Health Rankings, an annual comprehensive assessment of the nation’s health on a state-by-state analysis, which is published jointly by United Health Foundation, the American Public Health Association and Partnership for Prevention.

Many counties around the country have used the Rankings to implement strategies and initiate interventions to positively influence health factors and improve their health outcomes. One specific example is Wyandotte County, Kansas, where Mayor Joe Reardon worked with other local stakeholders to create a Healthy Communities initiative after seeing his state’s low rank in last year’s County Health Rankings report.

A new development with this year’s Rankings is the launch of an innovative tool, the County Health Calculator (http://chc.humanneeds.vcu.edu/). The calculator is a new interactive online application that simulates the affect of higher levels of education and income on health in a county. It was developed by Center of Human Needs at Virginia Commonwealth University (http://humanneeds.vcu.edu/) with funding by Robert Wood Johnson Foundation.

Read more on Partnership’s community prevention efforts here.

Only one year after the landmark legislation was signed, the Affordable Care Act (ACA) is already improving women’s access to high quality, affordable health care. When the law is fully implemented in 2014, it will signify the greatest leap forward for American women’s health in decades.

New protections for women under the ACA include:

• Improved Access to Affordable Coverage: Under the ACA, adolescents and young adults up to age 26 may now remain on their families’ plans. Due to substantial new tax credits, more small businesses are now offering health care coverage to their employees. And beginning in 2014, expanded Medicaid eligibility means improved access to healthcare coverage for lower income women and families.
• Free Preventive Care: Under the ACA, women receive recommended preventive services without copayments or deductibles. This includes U.S. Preventive Services Task Force A- and B-rated services such as mammograms, screenings for cervical cancer and chlamydia, prenatal care and more.
• The End of Gender-Based Discrimination: Before the ACA, women could be charged higher premiums than men for the same insurance policy. Beginning in 2014, it will be illegal for insurance companies to charge women higher premiums on the basis of gender.
• Being a Woman is No Longer a Pre-Existing Condition: Before the ACA became law, insurers could deny women coverage for “pre-existing conditions” such as pregnancy, Cesarean sections, and breast cancer. Beginning in 2014, insurers cannot deny coverage to anyone based on pre-existing conditions. Already under the ACA, children cannot be denied coverage because of pre-existing conditions.
• The End of Lifetime Limits: Under the ACA, insurance companies cannot place a lifetime limit on the amount of coverage an individual receives. Beginning in 2014, annual limits are banned as well.

For more information about the important rights and benefits the ACA provides for women and their families, see healthcare.gov’s new page on Women and the Affordable Care Act.

The Affordable Care Act (ACA) will celebrate its one year anniversary March 23, 2011. Signed into law last year, the ACA puts into place comprehensive health insurance reforms designed to lower health care costs by enhancing the quality of health for all Americans.

The ACA’s small business provisions focus on finding ways for business owners to reduce their heath care costs by ensuring their employees have access to quality, affordable health insurance.

Small business provisions include:

• Small Businesses with fewer than 25 full time employees may qualify for the business tax credit.
• Employer-based health plans that provide health insurance to retirees aged 55-65 can get financial help through the Early Retiree Reinsurance Program.
• Insurance companies will no longer be able to deny individuals with a pre-existing condition, who may now be eligible to join the Pre-Existing Condition Insurance Plan.
• Employees can receive recommended preventive services like mammograms and flu shots without any additional cost to the employee.
• Insurance companies are prohibited from capping the dollar amount of care an employee can receive in a lifetime, or dropping coverage due to a mistake on your application when you get sick.
• Insurance companies must spend at least 80% of premium dollars on healthcare.

Currently four million small business owners have been able to claim a tax credit up to 35% of their health insurance costs. But tax credits are not the only benefit for small business owners. By 2014, small businesses will be able to increase their buying power through state-based health insurance marketplaces. Employers will be able to identify health insurance plans that better meet their needs. The ACA has allowed small business employers to provide health benefits to their employees.

Throughout this week the Small Business Majority will host a series of roundtables and webinars designed to better understand what the ACA has meant to small businesses. Today, the Secretary of the U.S. Dept of Health and Human Services, Kathleen Sebelius will kick off the series in Ohio. The Secretary will join The Consortium of African American Organizations and the National Policy Director of the Small Business Majority. 

Partnership for Prevention is pleased to learn that in only two months over 150,000 Medicare beneficiaries have received the annual wellness visit authorized in the Affordable Care Act (ACA). This good news comes on the heels of an HHS report earlier this week indicating that those over 65 are not getting the preventive services they need.  Click here for HHS news release.

The ACA requires a health risk assessment (HRA) for Medicare beneficiaries to assist in developing personalized prevention plans. Partnership has been working with the Centers for Disease Control and Prevention (CDC) and the Centers for Medicaid and Medicare Services (CMS) to develop guidance for implementing this important tool. Specifically, Partnership organized and helped lead a Public Forum meeting in response to a Federal Register Notice for public comments and submitted, with Thomson Reuters, a report that CDC will use to inform CMS on the development of guidance for the HRA.

For additional information about Partnership’s work on the annual wellness visit and HRA, please click here or contact Jason M.M. Spangler, MD, MPH, FACPM, Chief Medical Officer, Partnership for Prevention, jspangler@prevent.org.

Adults over the age of 65 are not getting the preventive services that they need, according to a report released by the Department of Health and Human Services on Monday. The report found that preventive services, including vaccinations, tobacco cessation, and screening for cancer, diabetes, lipid disorders, and osteoporosis are underutilized. The report emphasizes that adults over 65 should be taking advantage of preventive services on a regular basis, and notes that many beneficiaries don’t know what services are covered by Medicare.

As a provision of the Affordable Care Act, certain USPSTF A and B recommended preventive services are covered without cost sharing by Medicare patients. In order to promote uptake of preventive services, including those services that are currently underutilized, Medicare has instituted an annual wellness visit. The wellness visit will allow Medicare beneficiaries access to preventive services on a regular and continued basis. It will be based on a detailed Health Risk Assessment (HRA), which allows patients and providers to create a personalized prevention plan. Partnership for Prevention, along with the CDC, has assisted the Centers for Medicare and Medicaid Services (CMS) in the effort to design and implement the HRA by interviewing and convening a group of HRA experts.

Medicare coverage, along with outreach and education for the annual wellness visit, will help to bring awareness to the need for and use of preventive services for those over the age of 65.


Rebecca Doigan, MPH
Research Fellow and Program Associate

The Associated Press (“Obama has kicked smoking habit, first lady says”) reported earlier this week that President Obama had “given up smoking.” The source for the report wasn’t the White House Press office but First Lady Michelle Obama. Mrs. Obama confirmed that the President had successfully quit smoking and had been smokefree “almost a year.”

This is wonderful news for the Obama family and for millions of Americans who struggle to quit smoking and wonder if they will ever be successful.

The President’s success sends an unmistakable message of hope to those struggling to quit. Now children whose parents smoke can refer to the President’s example and his struggle. Quitting is possible…even if you are President of the United States.

In a recent meeting of Partnership’s ActionToQuit state grantees, the news from Mrs. Obama was greeted with much excitement and admiration. In a letter of congratulations to the President these state tobacco cessation leaders wrote: “Your experience in quitting smoking gives hope to millions who struggle with their (tobacco) addiction. Your example – that quitting … is possible with the right combination of therapy and family support will encourage others to make the effort and realize the success, even in one of the world’s most stressful jobs.”

The ActionToQuit members joined Partnership VP Diane Canova in urging the President to take pride in his accomplishment and “consider sharing your experience to help other smokers seek out the smoke-free pathway to a longer, healthier life.”

The President’s experience with quitting tobacco is all too human. Quitting takes time. His example demonstrates perseverance and should encourage all of us to redoubling our efforts to expand access to tobacco cessation and encourage the types of social and family supports that increase smoking cessation success. The Affordable Care Act expands access to tobacco cessation through health insurance plans including Medicare and Medicaid. The new Prevention and Public Health Fund will make financial assistance available to help communities promote health and wellness including preventing and reducing tobacco use. These are important tools that can accelerate progress towards a healthier, smokefree nation.

But let’s not underestimate the important motivational role that examples of successful quitters can play. We hope the President’s struggle and his success will motivate others to successfully quit.

The good news is that 30 million women who are currently uninsured or underinsured will benefit from the recently passed Affordable Care Act (ACA). These women and their children will enjoy a full range of comprehensive benefits through private insurance, or the Medicare and Medicaid programs. A recently released study by the Commonwealth Fund, “Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010,” examined the ACA’s provisions to identify their impact on access to health services, as well as future cost implications. Provisions eliminating the pre-existing condition exclusion, requiring coverage for maternity and newborn care, providing insurance purchase subsidies, limiting out-of-pocket expenses and prohibiting higher premiums based on gender, all contribute to a significantly more positive future for women seeking health care.

The report also highlights the new preventive care benefits that will provide increased access to high value recommended services from the U.S. Preventative Services Task Force (USPSTF) without cost-sharing. However, the report missed the mark by failing to mention tobacco cessation. Tobacco-related disease is the leading cause of death in the U.S. causing over 170,000 deaths per year among women. In 2006, 18 percent of adults with private health insurance were current smokers, compared to 35 percent of Medicaid recipients and 34 percent of the uninsured population. All USPSTF recommendations are linked to a letter grade that reflects the level of certainty of the evidence supporting the preventive service. The ACA will make access to the “A” ranked smoking cessation treatments a reality for more women. And, their children will benefit from reduced exposure to secondhand smoke, thereby decreasing incidence of asthma and other related conditions. Under the federal Medicaid program, tobacco cessation services are a mandated benefit for pregnant women. A good start, but all Medicaid enrollees should have access to smoking cessation counseling and medications.

Preventive services not only help keep people healthy, they also save lives. 42,000 lives can be saved each year by helping more smokers quit.

Read the full report - Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010.


Diane Canova
Vice President, Policy & Programs
Partnership for Prevention