The Affordable Care Act: Preventing Chronic Diseases

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health. 

Did you know that switching the focus from treating chronic illnesses to preventing the diseases will not only improve the health of individuals and families all over the country, but will also rein in health care costs and strengthen the economy?

The Affordable Care Act (ACA) is applying this logic in its fight to lower the rate of preventable chronic illnesses, produce real savings in the health care sector, and recover lost economic activity at the local, state, and national levels. And it’s doing it in the name of prevention through effective public health initiatives.

The prevalence of chronic health conditions in the United States is taking a huge toll on our citizens, our nation’s health care spending, and our workforce. More than half of the people living in the United States have at least one chronic health condition, such as heart disease, stroke, diabetes, obesity, and cancer. Chronic health conditions account for 7 out of 10 deaths in America and rack up 75% of our nation’s health care spending. The cost for treating people with type 2 diabetes, heart disease, hypertension, and stroke, alone, amounts to $238 billion each year. In 2010, the United States spent almost $2.6 trillion on health care, meaning we spent around $1.9 trillion just last year on treating and managing chronic illnesses, most of which are largely preventable. Here in Illinois, more than 6.7 million people have reported being diagnosed with a chronic health condition, costing the state $12.5 billion in annual health care expenses.

What’s more is that the cost of chronic health conditions goes beyond the money spent on health care services. The toll these illnesses take on our workforce productivity is telling. According to the Gallup Poll, 7 out of 8, or 83 percent of American workers either have a chronic health condition or are obese. The poll estimates that this prevalence of chronic illness and obesity in our workers could be costing our economy $153 billion a year in lost productivity due to increased sick days. Other reports that take into account other chronic conditions and factors like lost productivity from workers who show up on the job while sick estimate that chronic health conditions are costing the United States more than $1 trillion each year in lost economic activity. To bring these statistics home, chronic disease plaguing Illinois’s workforce cost the state $14.3 billion in lost productivity. And the commonality of chronic disease is rapidly increasing. It is estimated that the number of Americans living with a chronic health condition will increase by 36%, or 46 million people by the year 2030, and that we could be spending $685 billion a year on medical treatment for chronic disease by 2020. Other sources estimate the total economic toll of chronic health conditions to reach $6 trillion a year by the middle of the century.

But it doesn’t have to be this way. As the CDC states, “Access to high-quality and affordable prevention measures (including screening and appropriate follow-up) are essential steps in saving lives, reducing disability and lowering costs for medical care.” And research has proven that for every dollar invested in effective prevention and public health initiatives, $5.60 is saved. The same study reveals that, if we invest $10 per person every year in effective community-based public health programs, we could save the United States more than $16 billion in just five years. 

Fortunately, the Affordable Care Act recognizes the benefits to be had from investing in smart and effective preventive and public health efforts. The ACA established the National Prevention, Health Promotion and Public Health Council within the Department of Health and Human Services (HHS), made up of secretaries from various federal departments and chaired by the Surgeon General. The Council is responsible for developing our first ever National Prevention and Health Promotion Strategy, which was released in June of 2011 and identifies four strategic directions for preventing disease and improving health nationwide. The four strategic directions are: creating healthy and safe community environments; expanding access to quality clinical and community preventive health service; empowering people to make healthy choices; and eliminating health disparities. The Council is charged with providing leadership moving forward with the National Prevention and Health Promotion Strategy.

The ACA also established a Prevention and Public Health Fund, which is administered by the Secretary of HHS, Kathleen Sebelius, and provides financial support for state and community-wide efforts to prevent disease and promote healthy lifestylesThe Fund is a 10-year, $15 billion commitment to support prevention and public health programs across the country, like the Community Transformation Grants, which fund community-level programs geared towards reducing the prevalence of chronic disease and promoting healthy lifestyles.   Already, $103 million in grant money has been issued to 61 different state and community programs across the country, reaching 120 million people.

So what does all of this mean for chronic disease in Illinois? Already, the State of Illinois has received $17.14 million out of the Prevention and Public Health Fund to support community- and state-level wellness and prevention programs aimed at preventing chronic disease and raising awareness about healthy living. For a breakdown of what programs received funding and for how much, visit HealthCare.gov online.

The Secretary of HHS will continue to issue funds for prevention and public health programs across the country to reverse the trend of chronic disease, so stay tuned as health reform continues to make a positive impact in our communities. To find out what other kinds of initiatives the Affordable Care Act has taken to increase access to preventive health measures and decrease illness in America, visit the Shriver Brief online.

                                                                                                                                                       

Interested in an in-person presentation on how health reform is rolling out in Illinois and what it means for individuals? Are you a direct service provider or advocate for vulnerable populations and interested in how the Affordable Care Act will impact the population you serve? Rachel Gielau, health policy expert at the Shriver Center, is giving free in-person presentations to Illinois audiences on how health reform is affecting individual and families in Illinois. Contact Rachel Gielau at 312-368-1154 to set up a presentation for your organization!

This blog post was coauthored by Rachel Gielau.

 

 

Health Care Reform Is Here!

Child Playing DoctorIt’s finally here.

Families across the country can breathe a sigh of relief now that we have reached a major milestone of the new health care law. Starting today, many of the provisions of the new health reform law go into effect! Because of the new law, families will no longer have to worry about their children being denied coverage because of a pre-existing condition (and starting in 2014, no one will have that worry), being dropped from insurance, or facing bankruptcy because of reaching the “lifetime limit” on insurance coverage and still needing expensive health care. Health plans don't have to implement the provisions until their next annual renewal date (so for plans that begin their coverage year on Jan. 1, 2011, that's when the changes will start). Thanks to the Affordable Care Act, the law is finally on our side!

However, some people have spread confusion about the new law. That’s why it’s so important that all of us to get the facts out about our new health care rights under this new law. We need to make sure our families, friends and neighbors understand how the new law will help them.

Take a look at the health care changes going into effect on September 23, 2010, and then send them along to your friends and family:

And if you want more information, visit Healthcare.gov or Families USA's summary of the new health reform law.

No More Getting Dropped After You Get Sick:  You can no longer be cut after the fact.

Free Preventive Care: New health insurance plans must provide preventive services such as mammograms and immunizations without patients paying deductibles or co-payments.

Expanded Coverage to Young Adults:  Young adults can stay on their parents’ health plan until age 26. See Young Invincible website for more information.

Immediate Access for Children, Even If They Have Pre-Existing Conditions: Children under 19 can no longer be rejected from health care plans due to pre-existing conditions or have their health condition be uncovered. New plans cannot exclude children from coverage for a pre-existing condition. And in 2014, adults cannot be denied coverage due to a pre-existing condition. (Uninsured adults with a pre-existing condition may qualify for Illinois’ Pre-existing Condition Insurance Plan (IPXP).)

No More “Lifetime Limits”:  Insurers can no longer stop your benefits because you have “maxed out.”

Tax Credits for Small Businesses Providing Coverage to Workers:  Already effective, qualified small businesses get tax credit for up to 35% of their premiums for covering their workers.

Medicare Prescription Drugs Rebates for Seniors: Medicare Part D enrollees who hit the Medicare prescription drug benefit gap in 2010 will automatically receive a $250 rebate check.

Direct access to OB/GYNs: The new health reform law provides direct access to in-network OB/GYNs for women in health plans that require them to designate primary care providers. This means that, if you are a female, you can see an OB/GYN without prior authorization from the health plan or referral from another doctor, such as your primary care provider.

Access to out-of-network emergency room services: The new law prevents health plans from requiring higher copayments or co-insurance) for out-of-network emergency room services. The new law also prohibits health plans from requiring you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network.

We need your help to set the record straight about these changes – share them with your friends and family now!

And there is more to come! Here are some other changes coming in the next year:

Insurers Must Spend More of Your Premium Dollars on Medical Care: Starting in January 2011, your health insurer must spend 80 to 85 cents of your premium dollar on actual health care and quality improvement, or you get a rebate.

Cost-savings to Seniors on Medicare: Effective January 1, 2011, seniors who reach the coverage gap will receive a 50-percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020.

Free Preventive Services for Seniors on Medicare: Effective January 1, 2011, the law provides certain free preventive services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare. 

Reducing Health Disparities: Effective March 2012, to help understand and reduce persistent health disparities, the law requires any ongoing or new federal health program to collect and report racial, ethnic, and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities.

Increasing Medicaid Payments for Primary Care Doctors: Effective January 1, 2013, As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government.

Increasing Access to Medicaid: Effective January 1, 2014, Americans who earn less than 133 percent of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support this expanded coverage, phasing to 90 percent federal funding in subsequent years.

Access to Insurance Options, Subsides, and Public Programs on the Exchange: Effective January 1, 2014, Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy insurance directly in an Exchange -- a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans.  Exchanges will offer you a choice of health plans that meet certain benefits and cost standards.  Starting in 2014, Members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges too.

Help with Purchasing Private Insurance: If you can’t find affordable, quality coverage, you’ll have new options and help purchasing insurance.  Starting in 2014, people will be able to buy cheaper coverage through the “exchange”—one-stop shopping access point for insurance. Exchanges will also set standards to keep insurers honest and provide value for premium dollars. If you earn up to roughly $88,000 a year (family of four), you’ll be eligible for new premium tax credits to help you afford coverage.

And much, much more!