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The Patient Protection and Affordable Care Act
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The following provisions of the Act will have an affect on prevention and public health strategies in Connecticut.

1) Mandatory Programs: The Trust Fund, National Council, National Strategy, and Task Forces

The Act creates a mandatory Prevention and Public Health Fund, appropriating up to $2 billion per year.  Annual amounts appropriated to the fund are shown in the table below.  Fund dollars are not attributed to any particular program.  Instead, money can be spent on any "prevention, wellness, and public health activity" authorized in the Public Health Service Act.  This includes new programs created in the Act as well as existing programs, and is likely to result in a small amount of money being spread across a wide variety of programs. 

2010
2011
2012
2013
2014
2015 to 2019
Total
$500 million
$750 million
$1 billion
$1.25 billion
$1.5 billion
$2 billion per year
$5 billion
(2010-2014)

$15 billion
(2010-2019)

The Act also creates a National Prevention, Health Promotion and Public Health Council, made up of cabinet and other high-ranking federal officials.  The Council is generally directed to advise the federal government on priorities in prevention and wellness.  In addition, the Council must create a National Prevention and Health Promotion Strategy, identifying key priorities for intervention and research.

Finally, the Act authorizes the U.S. Preventive Services Task Force and the Community Preventive Services Task Force, but does not make them subject to the Federal Advisory Committee Act.  The Senate authorizes but does not appropriate funds for their activities.

2) New Prevention Programs

The Act authorizes many new programs targeted towards prevention and wellness.  These programs may be funded from the Prevention Fund, by the standard appropriations process, both or neither.  The programs include:

  •  Community Transformation Grants to support evidence based community public health interventions (CDC).
  • Epidemiology Laboratory Capacity Grants to support state and local health departments' surveillance infrastructure (CDC).
  • Health Aging-Living Well pilot grants, which fund states to provide community-based interventions and clinical preventive services to individuals 55 to 64 years old (CDC).
  • Grants to support prevention research, focused on the delivery of public health services (CDC).
  • Authority for CDC to conduct research and provide technical assistance related to employer-based wellness programs (CDC).
  • Grants to support oral health education and surveillance (CDC).
  • State authority to purchase vaccines at federally negotiated prices (HHS).
  • Grants to states to improve the delivery of recommended vaccines (CDC).
  • Creation of an Office of Women's Health at CDC and elsewhere.
  • Menu labeling at chain restaurants (FDA).
  • Demonstration program to provide "individual wellness plans" to at-risk individuals seeking care from Federally Qualified Health Centers (HHS).
  • Education and outreach campaigns to promote public awareness of available clinical preventive benefits (HHS).
  • Grants to support school-based health centers (HHS).
  • Funding for evidence based teen pregnancy prevention and for abstinence only programs (HHS).

3) Other Provisions

Insurance Reforms

  • All private insurers are required to provide recommended clinical preventive benefits and recommended vaccinations without cost sharing.

Medicare and Medicaid

  • Medicare preventive benefits and USPSTF recommended services become no-cost-sharing services.  Coverage and cost-sharing for most vaccines remains unchanged.
  • States are encouraged but not required to cover USPSTF and ACIP services without cost sharing in Medicaid.
  • States are no longer permitted to exclude tobacco cessation pharmaceuticals from coverage in Medicaid and pregnant women are offered even more expansive tobacco cessation services.
  • Hospitals are required to report rates of healthcare-associated infection though the mechanism is not specified.

Public Health Workforce

  • Creates a loan repayment program for the public health workforce.
  • Expands existing public health fellowship programs, including EIS.
  • Establishes a Youth Public Health Program.

Monitoring

  • Directs a new independent body to develop Key National Health Indicators.
  • Standardizes data collection related to health disparities across NIH.

Click here for a full version of the Act.

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