Prevention Matters

The defeat of the Johanns Amendment was named the “Best News for Prevention” while the report showing that Americans are not eating enough fruits and veggies was named the “Worst News for Prevention.”

BEST

Senate Defeats Effort to Eliminate Prevention and Public Health Investment Fund

On a procedural vote of 46 to 52, the Senate today defeated an effort to eliminate the Prevention and Public Health investment fund; one of the signature initiatives Partnership and other prevention advocates worked to include in the recently passed health reform legislation.

“We are grateful the Senate has affirmed the value of investing in evidence-based programs to help individuals and families live healthier lives. The passage of health reform represented an important compact with the American people to transform our current sick care system into a health care system that places value on keeping people healthy,” said Robert J. Gould, President and CEO of Partnership for Prevention.

The Johanns (R-NE) Amendment was offered to HR 5297, the “Small Business Jobs and Credit Act.” The amendment proposed to offset the costs of eliminating a tax code reporting requirement by eliminating funding Congress reserved to support community-based programs to reduce chronic disease rates, address health disparities and strengthen the “evidence-base for effective prevention programming.” Had the amendment passed, over $10 billion in prevention funding would have been cut from vital public health and prevention programs.


WORST

Americans still skipping fruits, veggies


Most Americans still don't eat vegetables often enough, and fruit consumption is actually dropping a little, according to a new government report released Thursday.

The Centers for Disease Control and Prevention found that last year about one-third of U.S. adults consumed fruit or fruit juice at least twice a day. That's down slightly from more than 34 percent in 2000.

Only about 26 percent ate vegetables three or more times a day, the same as in 2000. The statistics come from a national telephone survey of hundreds of thousands of Americans..


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

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

ActiontoQuit is a tobacco cessation initiative sponsored by Partnership for Prevention. It urges all sectors - employers, insurers, health care systems, quitlines, and policymakers - to work together to ensure that all tobacco users have access to comprehensive cessation treatments.

Senior Program Officer for the Partnership for Prevention, David Zauche, recently spoke with the Smoking Cessation Leadership Center about current activities and future projects of ActionToQuit.  We posted part one of the interview last Monday, August 2.  Here is part two:

5. How does the [Save Lives and Money - Help People on Medicaid Quit Tobacco] guide address the passage of health reform for Medicaid and cessation coverage? For example: I understand the new health reform bill requires that all state Medicaid programs provide comprehensive tobacco cessation care to pregnant women. What are some of the recommendations in the guide for state Medicaid programs to implement these changes?

The passage of health reform will do much to advance tobacco cessation in the United States. Shortly, private health plans will be required to extend coverage of many clinical prevention services recommended by the U.S. Preventive Services Task Force. This coverage will include tobacco cessation interventions. All state Medicaid plans will be required to provide tobacco cessation coverage for pregnant women, but to them only. Partnership for Prevention and other national partners believe that this is the right time for states to voluntarily extend tobacco cessation coverage to all Medicaid beneficiaries, not just pregnant women. The six states I mentioned have done this because it made sense from the health promotion and fiscal angles. When people quit smoking successfully, they realize many health benefits. But states can benefit too.

6. Action to Quit has many cessation resources and partnership activities listed on the website. Are there specific resources Partnership offers around implementing tobacco free policy changes which you can share with our audience?

Three guides, all available for free download on www.actiontoquit.org, come to mind. "Smoke-Free Policies - An Action Guide" is a resource for workplaces and community leaders that want to establish ordinances to protect the public from secondhand smoke. It translates the evidence-based recommendations in "The Community Guide" into implementation strategies. "Investing in a Tobacco-Free Future" is a tool kit for the workplace. It outlines the costs of smoking to businesses, the impact on worker productivity, and how to implement tobacco use treatment policies through a health plan. "Investing in Health - Proven Health Promotion Practices for Workplaces" charts a course for businesses to implement three inexpensive strategies to save lives from tobacco. They are: implementing tobacco-free policies, offering tobacco use treatment benefits, and providing access to a telephone quitline for tobacco users.

7. What other tools and resources can people anticipate in the future?

Partnership for Prevention recently extended funding to the Joint Commission to develop and test a global set of tobacco cessation quality standards which would be applicable to all hospitalized patients. If adopted, these measures will require hospitals to identify all patients who use tobacco and offer them counseling, medications and limited follow-up. Later in 2010, when the final standards are published, Partnership will create and disseminate an implementation guide for hospitals. Additionally, Partnership will produce case studies for each of our funded ActionToQuit grantee states. These will describe their journey in forming a state tobacco cessation alliance, holding a summit meeting, and creating a state action plan to advance cessation.

8. What recommendations do you have for those interested in creating their own partnership around cessation or improving one that already exists?

Two things have been proven in recent years:

• First, the highly successful tobacco tax and smoke-free state campaigns have proven that tobacco control advocates can come together and, through a strong synergistic effort, change policies and save lives. It's happened across the country.
• Second, we've learned just recently that a state can cover all its Medicaid subscribers for tobacco cessation treatment and see positive short term results. Massachusetts implemented a comprehensive tobacco cessation benefit in July of 2006 and has seen smoking rates for beneficiaries drop 26% in two and a half years. The state has also seen significant decreases in hospitalizations for heart attacks, emergency room visits for asthma symptoms, and adverse maternal birth complications.


The ActiontoQuit Network is a group of over 500 professionals who are committed to tobacco cessation.

For more information contact:
Brandi Robinson at brobinson@prevent.org, 202-384-1505 or
David Zauche at dzauche@prevent.org, 202-375-7807.

ActiontoQuit is a tobacco cessation initiative sponsored by Partnership for Prevention. It urges all sectors - employers, insurers, health care systems, quitlines, and policymakers - to work together to ensure that all tobacco users have access to comprehensive cessation treatments.

Senior Program Officer for the Partnership for Prevention, David Zauche, recently spoke with the Smoking Cessation Leadership Center about current activities and future projects of ActionToQuit:

1. Could you tell us a about the ActionToQuit State Grant Program? Which States are recipients? What are the states striving to accomplish? How does the program play a part in Partnership’s mission?

ActionToQuit is Partnership for Prevention's tobacco cessation initiative. Partnership's mission is to be the nation's most trusted resource, educator and advocate for disease prevention and health promotion. To that end, ActionToQuit works through policy and system change to increase access to tobacco cessation treatments for all Americans. Our website is www.actiontoquit.org and we offer a free monthly tobacco cessation e-newsletter and listserv, both by subscription.

Partnership for Prevention awarded six ActionToQuit state grants in 2010 for the implementation of innovative strategies to advance to tobacco cessation, with funds used for the development of state alliances/summit meetings and the creation of strategic plans. The projects will involve various sectors that can impact access to tobacco cessation including employers, health care systems, insurers, quitlines, and policymakers. The state grant projects are:

• Colorado - Cessation Coverage/Treatment for Colorado's Uninsured

• Florida - Tobacco Cessation Summit & Action Plan

• Nevada - Increasing Cessation Access for All Nevadans

• New England - New England Partnership for Smoking Cessation Policy

• New York - New York State Access to Tobacco Use Treatment Strategic Planning Project

• Virginia - Virginia Partnership for Tobacco Use Cessation

A brief on each grantee's initiative has been posted to the ActionToQuit website here.

2. Your website offers some valuable resources for those interested in expanding access to tobacco cessation treatment. Could you tell us about the recent creation of Save Lives and Money - Help People on Medicaid Quit Tobacco? What was the history behind the creation of the guide?

Save Lives and Money - Help People on Medicaid Quit Tobacco is a new resource from Partnership and the American Lung Association. It's the second guide of its kind from these national partners, the first one dealing with state employee tobacco cessation coverage. This resource is important because of the high rates of tobacco use among the Medicaid population and the associated costs. The big idea is that because so much of Medicaid's funding goes toward tobacco-related diseases, an up-front investment in prevention (i.e. tobacco cessation) must be given serious consideration. In 2004, U.S. Medicaid expenditures for illnesses caused by tobacco totaled $30 billion, or 11% of the entire Medicaid budget. The point is that we must do more to help people on Medicaid quit tobacco - if we do we'll save both lives and money.

3. Why did you feel there is a need for such a resource?

ActionToQuit wants to spotlight the states that are doing the best job at providing Medicaid coverage for their tobacco users. The six states that lead the way by covering all treatments recommended by the U.S. Public Health Service are Indiana, Massachusetts, Minnesota, Nevada, Oregon, and Pennsylvania. In particular, we applaud their efforts to cover all medications and counseling treatments since most smokers will need many attempts and (possibly) several different tools to quit successfully.

4. What audience is the guide intended for?Partnership for Prevention believes that all Medicaid plans should be required to cover all cessation treatments. To this end the new guide is intended for advocates that comprise state tobacco control coalitions, insurers/health plans, state Medicaid leaders, and policymakers. States have achieved many outstanding advances in smoke free air laws and increased tobacco taxes and these accomplishments are to be commended. However, tobacco control policies related to cessation have often lagged behind. One area in which much progress is needed involves the unnecessary barriers that exist which make it harder for people to make quit attempts. Insurers and policymakers should focus on removing these barriers, which include co-pays, duration limits, annual limits on quit attempts, and dollar limits. There are policy solutions for these problems.

5. How does the guide address the passage of health reform for Medicaid and cessation coverage?

...to be continued: read part two of the interview this Thursday, August 5, 2010

1. Require health plans to cover all three types of counseling deemed effective by the PHS Guideline for tobacco cessation: individual (face-to-face), group and proactive telephone counseling.
2. Require health plans to cover all seven medications FDA-approved to treat tobacco addiction.
3. Comprehensive tobacco cessation treatments should be promoted to encourage tobacco users to quit.

There’s good news in the health reform law for small businesses that pay at least half the cost of their employees’ health insurance. Beginning this year, businesses with fewer than 25 employees and with average wages under $50,000 can claim a tax credit on their income tax return. Small non-profit organizations also qualify. As an example, an employer with 10 or fewer full-time employees and with average annual wages under $25,000 (not including what the owner makes), will receive a 35% tax credit on the amount the business pays for employees’ health insurance in 2010. An online calculator to estimate savings can be found at http://www.smallbusinessmajority.org/.

This tax credit will be available to small businesses until 2014; when the credit is scheduled to increase and be available from state-based insurance exchanges which will be operating by that time.

Having health insurance makes a difference. On average, people without health insurance are less likely to get preventive care such as immunizations or mammograms, more likely to miss work, and to have worse health outcomes when they do get sick than people with insurance.

Susan K. Maloney
Managing Senior Fellow
Partnership for Prevention

The passage of a health reform bill that emphasizes prevention and wellness was named the “Best Prevention Idea of the Week,” while reduced life expectancy due to preventable risk factors was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Obama Signs Historic Health Reform Law, Steps Up Focus on Prevention and Wellness

On March 23, 2010, President Barack Obama signed the health care bill into law. The new federal health reform law (HR 3590) includes many provisions aimed at disease prevention and promoting healthy lifestyles. The law creates a $15 billion fund for programs designed to promote prevention and wellness, such as efforts to address obesity and to help patients manage chronic diseases. The law also establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal efforts to promote healthy living. In addition, the health care reform law:

• Eliminates copayments for Medicare and Medicaid beneficiaries receiving preventive services;
• Increases reimbursement rates for physicians who offer certain preventive services;
• Provides grants to small business for establishing wellness programs and incentives for employers to offer workers as much as 50% off their premiums for participating in such programs; and
• Requires chain restaurants and vending machines to disclose nutritional information.

WORST

Four Preventable Risk Factors Reduce Life Expectancy in U.S. and Lead to Health Disparities

A new study led by researchers from the Harvard School of Public Health (HSPH) in collaboration with researchers from the Institute for Health Metrics and Evaluation at the University of Washington estimates that smoking, high blood pressure, elevated blood glucose and overweight and obesity currently reduce life expectancy in the U.S. by 4.9 years in men and 4.1 years in women. It is the first study to look at the effects of those four preventable risk factors on life expectancy in the whole nation.

At Partnership we focus much on issues and policies affecting prevention which, happily, are significant components of the recently passed health reform legislation. But beyond the details of specific provisions we must pause to give credit to the work of the House Speaker, Nancy Pelosi of California, who made possible -- comprehensive health reform – when many “political experts” thought the task was impossible.

There will be many commentators who will dissect the Speaker’s leadership style and seek to explain the nature of her success. But I am interested and impressed more by the substance of what she has achieved and the philosophy that guided her efforts.

Before the final vote last night on passage of HR 3590, the “Patient Protection and Affordable Care Act” the Speaker entered the well of the House and delivered a final call to action on behalf of the American people. Her words, powerfully delivered, came at the conclusion of seemingly bitter and contentious legislative process.

The Speaker spoke of the legislation’s passage as an “historic moment” that would lead to healthier lives.

She said “we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans that is a right and not a privilege.”

She spoke of a letter sent to President Obama from the late Edward Kennedy who wrote ‘At stake are not just the details of policy but…the character of our country.’

The Speaker’s words evoked the best of American values. They captured, better than any Committee report or legislative history, why passage of the legislation was a duty, and important, not just to individual families but to moving us closer to the Founding Father’s goal of a more perfect union.

I commend the reading of the full text of the Speaker’s Remarks.

Ripley Forbes
Director, Government Affairs
Partnership for Prevention


Statement on the floor of the US House of Representatives by Speaker Nancy Pelosi, on passage of HR 3590, the “Patient Protection and Affordable Care Act.” (March 21, 2010):


“Thank you, my colleagues. Thank you, Mr. Speaker. I thank the gentleman for yielding. I thank all of you for bringing us to this moment.

“It is with great humility and with great pride that we tonight will make history for our country and progress for the American people. [Applause] Just think—we will be joining those who established Social Security, Medicare, and now tonight health care for all Americans. [Applause]

“In doing so, we will honor the vows of our founders, who in the Declaration of Independence said that we are ‘endowed by our Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.’ This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people. This is an American proposal that honors the traditions of our country. [Applause]

“We would not be here tonight, for sure, without the extraordinary leadership and vision of President Barack Obama. [Applause] We thank him for his unwavering commitment to health care for all Americans.

“And this began over a year ago under his leadership in the American Recovery and Reinvestment Act, where we had very significant investments in science, technology, and innovation for health care reform. It continued in the President’s budget a few months later, a budget which was a statement of our national values, which allocated resources that were part of our value system. And in a way that stabilized our economy, created jobs, lowered taxes for the middle class and did so, and reduced the deficit, and did so in a way that had pillars of investment, including education and health care reform—health care reform and education, equal opportunity for the American people. [Applause]

“And this legislation tonight, if I had one word to describe it would be ‘opportunity,’ with its investments in education and health care as a continuation of the President’s budget. We all know, and it has been said over and over again, that our economy needs something new, a jolt. And I believe that this legislation will unleash tremendous entrepreneurial power into our economy. Imagine a society and an economy where a person could change jobs without losing health insurance, where they could be self-employed or start a small business. Imagine an economy where people could follow their passions and their talent without having to worry that their children would not have health insurance, that if they had a child with diabetes who was bipolar or pre-existing medical condition in their family, that they would be job-locked. Under this bill, their entrepreneurial spirit will be unleashed. [Applause]

“We all know, we all know that the present health care system and insurance system, health insurance system in our country is unsustainable. We simply cannot afford it. It simply does not work for enough people in terms of delivery of service and it is bankrupting the country with the upward spiral of increasing medical costs.

“The best action that we can take on behalf of America’s family budgets and on behalf of the federal budget, is to pass health care reform. [Applause]


“The best action we can take to strengthen Medicare and improve care and benefits for our seniors is to pass this legislation tonight, pass health care reform. [Applause]

“The best action we can do to create jobs and strengthen our economic security is pass health care reform. [Applause]

“The best action we can take to keep America competitive, ignite innovation, again unleash entrepreneurial spirit is to pass health care reform. [Applause]

“With this action tonight, with this health care reform, 32 million more Americans will have health care insurance. And those who have insurance now will be spared being at the mercy of the health insurance industry with their obscene increases in premiums, their rescinding of policies at the time of illness, their cutting off of policies even if you have been fully paying but become sick, the list goes on and on about the health care reforms that are in this legislation: insure 32 million more people, make it more affordable for the middle class, end insurance company discrimination based on pre-existing conditions, improve care and benefits under Medicare, and extending Medicare’s solvency for almost a decade, creating a healthier America through prevention, through wellness and innovation, create 4 million jobs in the life of the bill and doing all of that by saving the taxpayer $1.3 trillion dollars. [Applause.]

“Another Speaker, Tip O’Neill once said: ‘All politics is local.’ And I say to you tonight that when it comes to health care for all Americans, ‘All politics is personal.’

“It’s personal for the family that wrote to me who had to choose between buying groceries and seeing a doctor. It’s personal to the family who was refused coverage because their child had a pre-existing condition — no coverage, the child got worse, sicker. It’s personal for women — after we pass this bill, being a woman will no longer be a pre-existing medical condition. [Applause.]

“It’s personal for a senior gentleman whom I met in Michigan, who told me about his wife who had been bed-ridden for 16 years. He told me he didn’t know how he was going to be able to pay his medical bills. As I said to you before, I saw a grown man cry. He was worried that he might lose his home — that they might lose their home because of his medical bills and he didn’t know how he was going to pay them. And most of all, he was too embarrassed to tell his children and ask them for help. How many times have you heard a story like that?

“And it’s personal for millions of families who’ve gone into bankruptcy under the weight of rising health care costs. In fact, many, many, many — a high percentage of bankruptcies in our country are caused by medical bills that people cannot pay. And it’s personal for 45,000 Americans and their — families who have lost a loved one each year because they didn’t and couldn’t get health insurance.

"That is why we’re proud and also humbled today to act with the support of millions of Americans who recognize the urgency of passing health care reform. And more than 350 organizations, representing Americans of every age, every background, every part of the country, who have endorsed this legislation. Our coalition ranges from the AARP, who said that our legislation ‘improves efforts to crack down on fraud and waste in Medicare, strengthening Medicare for today’s seniors and future generations.’ I repeat: ‘Improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today’s and future generations of seniors.’ To the American Medical Association, the Catholic Health Association, the United Medical — the United Methodist Church, and Voices of America’s Children. From A to Z — they are sending a clear message to Members of Congress: Say yes to health care reform. [Applause.]

“We have also reached this historic moment because of the extraordinary leadership and hard work and dedication of all the Members of Congress, but I want to especially recognize our esteemed Chairs — Mr. Waxman, Mr. Rangel, Mr. Levin, Mr. Miller, Mr. Spratt, Ms. Slaughter — for bringing this bill to the floor today. Let us acknowledge them. [Applause.]

“And I want to acknowledge the staff of the committees and of the leadership — they have done a remarkable job — dazzling us with their knowledge and their know-how. [Applause.] I would like to thank on my own staff: Amy Rosenbaum, Wendell Primus, and Arshi Siddiqui.

“And now, I want to just close by saying this. It would not be possible to talk about health care without acknowledging the great leadership of Senator Edward Kennedy, who made health care his life’s work. [Applause.]

“In a letter to President Obama before he passed away — he left the letter to be read after he died. Senator Kennedy wrote that: ‘Access to health care is the great unfinished business of our society.’ That is until today. [Applause.]

“After more than a year of debate, and by the way, the legislation that will go forth from here has over 200 Republican amendments, and while it may not get Republican votes and be bipartisan in that respect, it is bipartisan in having over 200 Republican amendments. [Applause.]

“After a year of debate and hearing the calls of millions of Americans, we have come to this historic moment. Today, we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans that is a right and not a privilege. [Applause.]

“In that same letter to the President, Senator Kennedy wrote, what is ‘at stake’ he said, ‘At stake are not just the details of policy but…the character of our country.’

“Americans will look back on this day as one which we honored the character of our country and honored our commitment to our nation’s founders for a commitment to ‘life, liberty, and the pursuit of happiness.’

“As our colleague John Lewis has said, ‘We may not have chosen the time, but the time has chosen us.’ We have been given this opportunity. I urge our — an opportunity — stay right up there with again, Social Security, Medicare, health care for all Americans. I urge my colleagues in joining together in passing health insurance reform — making history, making progress, and restoring the American dream.

“I urge an aye vote. Thank you.”

At the recent health summit in Washington, President Obama repeatedly emphasized his commitment to pass meaningful health reform. Despite strong opposition from Republicans in Congress, President Obama is showing the mettle he demonstrated throughout the 2008 campaign. He isn’t giving up and he won’t back down. His commitment to insurance reform and extending high quality health coverage, including access to vital clinical preventive services to millions of uninsured Americans shows courage and character.

But the issue of smoking is one where we value quitters. According to press reports President Obama’s recent physical revealed that he continues to struggle to quit smoking. Most smokers have trouble quitting tobacco so the President’s situation is not unusual. It is ironic that the President who has done so much to protect children from tobacco, and through health reform, increase the availability of tobacco cessation therapies, would struggle to win his personal cessation campaign. But Obama is human and difficulty quitting tobacco is an all too common experience among the millions of smokers who try to quit each year.

Writing in the March 1st Christian Science Monitor, Ron Scherer notes that “anti-smoking advocates view the president’s cigarette struggles not so much as a setback, but rather as an opportunity to try to get more Americans to quit. And they place more importance on his desire to snuff out his tobacco usage than on his success in those efforts.”

Now that’s something we should all be able to agree with. That the President has struggled to quit smoking underscores why it is so important that insurance plans, employers, friends and family members do all they can to support and encourage smokers seeking to quit what is all too often a lifelong and life threatening addiction.

A CBS TV News Healthwatch segment (“Up in Smoke”) added important commentary from medical correspondent and physician Jennifer Ashton. Dr. Ashton cautioned that most former smokers find success only after trying to quit multiple times. She urged that smokers take advantage of available treatments including counseling, OTC nicotine replacement products and prescription medications. Ashton said the decision to quit smoking is really “a life or death issue and the single most important thing you can do for your health.”

Good advice for the public…and for our President.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

Writer Sarah Wildman suggests that one asset President Obama has yet to use in getting health reform over the goal line would be to enlist help from the First Lady. In an engaging piece of “what if” writing, Wildman argues that Mrs. Obama’s enormous popularity gives her a potentially powerful platform to show Americans that health reform is an “apolitical” problem that affects us all.

Wildman is disappointed that the Mrs. Obama stayed in the family garden focusing her time on the important but “safe” First Lady-like issue of childhood obesity.

“At a moment when an entire year's worth of bickering over health care reform has unraveled into a partisan wrestling match, and the very word "reform" has nearly ceased to be meaningful, tackling obesity is cheerfully unobjectionable. Laudable even. But it's not the most important thing on the agenda right now… As a concept it vaguely brushes up against the health care reform debate but without, in reality, getting anywhere close.”

Wildman argues that the First Lady should use her popularity “to get America to understand how very nonpartisan health care reform might be? … The First Lady could have gathered together a task force comprised of a clutch of women -- moms, mostly -- and presented their stories, simply and without fanfare, to highlight how un-family friendly our current insurance policies are. How anti-woman. How anti-mother."

She might have brought in, say, a widow who lost health insurance after her husband died, therefore leaving the family uninsured. Women, she would have pointed out, are more likely to be on their husband's insurance than vice versa, leaving them vulnerable in the event of divorce, or death, or job loss. She might have invited a young, entrepreneurial would-be mother who desperately sought health insurance to cover a potential future pregnancy, but discovered there was no way to sufficiently cover maternity on the individual insurance market. She might have shown America a mother who owns her own business and discovered, happily, she was pregnant and that, unhappily, she could not find health insurance to cover the prenatal care, labor, and delivery.”

Wildman writes that the First Lady could have told the country that “On the individual market, pregnancy … is a pre-existing condition. Most insurance companies will not allow a woman to purchase insurance once she is already with child. Worrisome, the First Lady would have said, because this woman now has to decide between caring for her fetus and going into debt. Maternity benefits, she would have explained to the cameras, are never a guarantee.”

At the moment health reform appears stuck between a partisan divide. Although many of us are rightfully focused on the important nuances of prevention coverage and policy, the larger context of health reform – coverage, fairness, quality -- is fundamental to our national character. The First Lady can do much to remind us of this even as we are called to become more physically active and less attracted to junk food.

As we enter the final quarter of play lets remember that health reform is a team sport and no one should be left on the bench.

Posted by:
Ripley Forbes
Director, Government Affairs
Partnership for Prevention

President Obama today released his proposal for resolving the impasse with Congress over health reform. The proposal is summarized in an 11 page document released this morning by the White House. Initially prevention advocates were shocked to discover that the words “prevention” and “wellness” were not included in the summary draft. Fortunately, these concerns were premature as the release of additional information highlighted the key role that prevention plays in the Administration’s plan for reform.

We have since discovered that the 11 page summary was intended primarily to highlight proposed changes in the Senate passed health reform bill; HR 3590, the “Patient Protection and Affordable Care Act.”

The White House has developed a detailed web site which discusses the President’s proposal in greater detail. Most encouraging to those of us who believe REAL Health Reform Starts with Prevention, the President has made crystal clear his Administration’s continued support for the key prevention, public health and wellness provisions contained in Title IV of the Senate passed health reform bill. By retaining the Senate proposal for the prevention trust fund, the proposal “provides for unprecedented investments in prevention, public health, disease research, and screening. The national investment in preventing disease and finding cures will save lives and money in the long run for American families, small businesses, and the Nation.”

The President’s commitment to prevention is reflected in the following description of the Prevention and Public Health provisions of Title IV.

“If we want to truly reform health care to benefit American families, we need to transition from a system focused primarily on treating the sick to one that helps keep people well throughout their lives…It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States. The Act relies on the innovation of small businesses and state and local governments to find the best ways to improve wellness in the workplace and in our communities. And it strengthens America’s capacity to respond to public health emergencies. The Act empowers families by giving them tools to find the best science-based nutrition information, and it makes prevention and screenings a priority by waiving co-payments for America’s seniors on Medicare. By attacking disease before it hits, the Act helps to improve health, save lives, and avoid more costly complications down the road.”

Additional details about the President’s health reform proposal are summarized on a white house web site that has been developed in preparation for the bipartisan health summit scheduled for February 25. The summit will begin at 10am and will be broadcast live at whitehouse.gov/live.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention