Guest Commentary: Promoting Prevention Through the Affordable Care Act

Rob Simmons, DrPH, MPH, CHES, CPH
Director, Master of Public Health (MPH) Program
Jefferson School of Population Health


It has been nearly six months since the Patient Protection and Affordable Care Act (PPACA) passed Congress and was signed by President Obama. There has been much discussion on the future impact of the new law. Many of the questions raised about the improvement of the health care system and whether it will reduce the skyrocketing increases in healthcare expenses over the past several decades are yet to be answered since significant provisions of the PPACA will not take effect until 2014 or later.

What is clear is that the PPACA will greatly expand health promotion, preventive health services, and the public health infrastructure as a large number of the prevention provisions of the PPACA will begin to take place within the next 6-12 months.

Assistant Secretary of Health Howard Koh, MD, MPH, and Secretary of Health and Human Services Kathleen Sebelius, MPA, provided a perspective on the preventive sections of the PPACA in a recent article in The New England Journal of Medicine. They describe 28 different preventive health sections in the PPACA divided into categories of impact for individuals, businesses and workplaces, communities and states, and the national level.

At the individual level, the most significant provisions are those that provide incentives to participate and pay for risk reduction and for preventive services for those with private health insurance as well as those with both Medicare and Medicaid public health insurance. No longer will there be financial barriers for individuals to obtain evidence-based preventive health screenings, immunizations, risk reduction services such as tobacco cessation, and wellness visits with their health care provider.

For businesses and workplaces, grants will be provided to small businesses to offer comprehensive wellness services. Employers with 15 or more employees will be required to provide reasonable break time and appropriate facilities for nursing mothers to encourage breastfeeding. The Centers for Disease Control will be providing evaluation technical assistance to private industry for their worksite wellness initiatives.

At the community and state government level, grants will be provided to community organizations and state governments to develop, implement, and evaluate evidence-based prevention programs and to provide incentives to promote and maintain healthy behaviors.

At the national level, a wide range of funding is provided to improve and expand health care delivery and patient outcomes, national coordination and leadership, public health infrastructure, the National Health Services Corps., community health centers, private-public partnerships for prevention, diabetes prevention, breast health awareness, oral healthcare preventive activities, and nutrition labeling for restaurant and vending machine menu items.

Since Secretary Sebelius and Assistant Secretary Koh have the primary responsibility for implementation, assessment, and assurance of the PPACA through the development of regulations and subsequent federal actions to support and enforce its provisions, their perspective and priorities are important to note and follow over the next few years. I look forward to reading and, as a public health professional, experiencing, this most significant political effort in the history of our nation to promote health and the use of preventive health services. Whether it will significantly reduce health risks such as obesity and tobacco use and increase protective factors such as breastfeeding and healthy eating, only time will tell. I welcome the ideas of others as outcomes of these initiatives are evaluated and published over the next several years.

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