Public Health and Health Reform

Improving Public Health: The Links to Affordable Health Reform

Health reform proposals to expand coverage also aim to change both public health and the health care delivery system, to improve quality and to control costs. This page helps link public health and health care reform, including documents that articulate what public health is, and what it contributes to health. It also presents public health statements on the debate on how to finance and provide coverage.  Other pages present testimony from the 5 Congressional committees that are designing health reform bills.

Senate: Prevention & Public Health Amendments Filed on December 6 and 7, 2009

(link below to full text)

1. SA 2953 – MARK UDALL – Amends the section on community transformation grants to add a nonprofit hospital, clinic, or entity involved in health care delivery or health promotion as an eligible grantee. Also directs the Secretary to ensure, to the extent practicable, that community transformation grants equitably serve racially, economically, and geographically diverse populations and include grants to rural local government agencies or organizations located in, and focused on serving, rural communities.

2. SA 2954 – MARK UDALL - Establishes a three year CDC pilot program to reduce the increasing prevalence of overweight/obesity among children from birth through five years of age. CDC would provide grants to five state health departments (or other childcare licensing entities within the State) to provide or contract to provide training to staff at childcare centers and family childcare homes. The training would focus on healthy eating and physical activity policies and practices that could be implemented in child care settings. Childcare centers with trained staff would then receive grant funds to implement these practice and policy changes.

3. SA 2956 – MARK UDALL – Directs the Secretary of HHS, at least every 5 years, to publish a report entitled “Physical Activity Guidelines for Americans”. Each report shall contain

physical activity information and guidelines for the general public, and shall be promoted by each Federal agency in carrying out any Federal health program. Establishes a National

Foundation on Fitness and Sports.

4. SA 2957 – BENNET – Amends the section on school-based health center programs to include programs to promote healthy, active lifestyles and wellness for students.

5. SA 2960 – SHAHEEN – Recognizes certified diabetes educators as certified providers for the purposes of Medicare diabetes outpatient self-management training services.

6. SA 2964 – COBURN – Strikes Section 4105, which provides the Secretary of HHS with the authority to modify or eliminate coverage of preventive services, to the extent that such modification is consistent with the recommendations of the USPSTF.

7. SA 2968 – COBURN – Strikes subtitle D of Title IV “Support for prevention and public health innovation,” which includes the following sections: research on optimizing the

delivery of public health services; understanding health disparities: data collection and analysis; CDC and employer-based wellness programs; epidemiology-Laboratory Capacity

Grants; advancing research and treatment for pain care management; and funding for the Childhood Obesity Demonstration Project. Replaces it with language that would prohibit comparative effectiveness research for the purpose of determining cost and coverage decisions.

8. SA 2970 – CASEY – Directs the HHS Secretary, acting through the Director of the Centers for Disease Control and Prevention, to carry out an educational campaign to increase public awareness of pulmonary hypertension and to carry out an educational campaign to increase awareness of pulmonary hypertension among health care providers.

9. SA 2979 – BEGICH – Specifies that a State may award grants to health care providers who treat a high percentage, as determined by such State, of medically underserved populations or other special populations in such State. Establishes incentive payments for primary care

physicians who treat a certain percentage of new Medicare patients. Directs the Secretary of HHS to establish an American Primary Care Corps for the purpose of encouraging health

care practitioners who are recent graduates of a health care program to enter into primary care practice, by providing incentive payments to eligible primary care practitioners.

10. SA 2982 – REID (for Mr. Byrd) – Includes infant eye and vision assessment promotion in the Maternal and Child Health Services Program.

11. SA 2983 – REID (for Mr. Byrd) – Directs the HHS Secretary, acting through the Administrator, to establish a program (consisting of awarding grants, contracts, and

cooperative agreements) on mental health and substance abuse screening, brief intervention, referral, and recovery services for individuals in primary health care settings.

12. SA 2990 – MENENDEZ – Expands access to vaccines.

(thanks to Trust for America;s Health for this list.  Also see Prevention Institute, CPHA-N, and APHA for related resources.)

Click here for Full Text of Senate Amendments

EQUAL TESTIMONY: PUBLIC HEALTH AND EFFECTIVE COST CONTROL: ESSENTIAL FOR HEALTH REFORM; PUBLIC INSURANCE PLAN MUST AMPLIFY MEDICARE. June 1, 2009

Public health is integral to health reform. Health reform is essential to public health. Proposals to encourage prevention, fund public health functions, expand the public health workforce, and reduce health disparities could improve the health of our nation, and help reduce the burden and the costs of illness.  But these measures can only help to control unsustainable health care costs if they are aligned with reforms of the fragmented system for reimbursing and financing care. Our fragmented, investor-driven financing system routinely defeats savings from improvements in health status and in the quality of care.   Private insurers, drug companies, hospital chains and equipment suppliers are able to divert every dollar we might save into high administrative expenses and profits. Congress should improve and expand Medicare, and:

I.      Establish a Public Insurance Plan, with key features to assure that it improves coverage, affordability and quality of care.

Our goals are  universal, affordable coverage, with fair and stable financing, that controls costs; an accountable delivery system that offers quality, appropriate, accessible and equitable care; eliminating social and economic disparities that undermine health; and a strong public health system.

II.       Medicare: Implement incentives to control costs and improve quality, and extend eligibility to people under age 65.

Finance Committee proposed incentives can control costs and improve the quality of care through Medicare, which will be strengthened if applied to a larger population through the public insurance plan.

III.      Improve public health, reduce health inequalities and address social determinants of health.
Expand Finance Committee initiatives to improve preventive health services through Medicare, to address health disparities, and to expand the health care workforce; add initiatives to strengthen the public health infrastructure, and prevention at the community-level, and to implement national policies and programs that address the political, social, economic and environmental forces and policies that shape health and can prevent illness.

Click here for EQUAL Testimony – Summary

Click here to download full testimony

APHA 2009 Agenda for Health Reform: The Public Plan

1. All individuals and families should be eligible for the public plan, regardlessof income.

2. The public plan must be affordable to consumers. Affordability means thecosts to consumers including any premium, copayments, or out of pocket costsare reasonable.

3. The public plan should serve as a model that shifts the emphasis of health systems from acute medical care toward prevention and wellness by:

  • Enhanced provider payments for prevention and early intervention
  • First dollar coverage of clinical preventive health services
  • Moving to outcome based reimbursement payments
  • Requiring the use of health information technology (IT)
  • Requiring linkage to the nation’s public health system
  • Using proven population based strategies at the provider, health plan and community level

4. Coverage should at a minimum use the actuarial equivalent of the FederalEmployees Health Benefit Plan standard option benefit package and shouldinclude the following public health services:

  • Evidence-based clinical preventive services
  • Behavioral health services
  • Dental & vision care
  • Reproductive health services
  • Disease management

5. The public plan should ensure the inclusion of the current network of safety net providers.

6. The public plan’s practices and policies should serve as a model for affordability for other health plans within the existing health system. This should be reflected in setting provider payments, which should also be adequate enough to ensure patient access to providers. The plan must be organized and governed to be administratively efficient, keeping administrative costs low consistent with other public programs.

Click here for APHA Public Plan criteria

The final report of the WHO Commission on Social Determinants of Health describes important links between society and health.  It includes a section on health care.

Click for WHO Commission on Social Determinants – Final Report
IOM: Public Health in the 21st Century

Population health – also referred to  as the health of the population, or the public’s health – is the focus of public health efforts. It refers to “the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development and health services.”

In 1988, the landmark report by the Institute of Medicine (IOM), The Future of Public Health, defined public health as what society does collectively to assure the conditions for people to be healthy, and presented strong evidence to indicate that the public health system—the organizational mechanism for achieving the best population health—was in disarray.  It focused specifically on ways to strengthen the governmental public health infrastructure.

The IOM’s Committee on Assuring the Health of the Public in the 21st Century noted that despite leading the world in health expenditures, the United States is not fully meeting its potential in health status and lags behind many of its peers. 95% of health care spending is directed toward medical care and biomedical research. However, there is strong evidence that behavior and environment are responsible for over 70 percent of avoidable mortality, and health care is just one of several determinants of health. The benefits of our current investments in health care are inaccessible to many due to lack of insurance or access to services.

Click here to read IOM 21st Century report

The American Public Health Association (APHA) 2009 Agenda for Health Reform highlights the key provisions for health reform legislation. “Universal coverage for health care is a first essential step. However, to optimize our nation’s health, we must ensure the social and economic conditions that allow individuals and communities to be healthy. Shifting from a focus on treating illness, to providing community-based health promotion and preventive health services, will measurably improve health and help control costs.”  The Agenda supports population-based services, and reforms in financing and delivering health care.

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