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Prevention in Health Reform

Categories: Policy and Programs

President Obama signing the health insurance reform bill, March 23, 2010.

President Obama signing the health insurance reform bill, March 23, 2010. (Official White House Photo by Lawrence Jackson)

Health reform or the Patient Protection and Affordable Care Act was passed by the House of Representatives on March 21, 2010, and signed by the President on March 23, 2010. While even the passive follower of health reform surely recognizes the historic nature of this event, many of the details are not well understood—specifically the prevention provisions in the bill and the implications for workplace safety and health. I have summarized a few of the prevention provisions below and some of the possible implications for occupational safety and health.

A mandatory Prevention and Public Health Fund will be created under the bill investing $2 billion per year for public health programs (beginning with $500 million in FY 2010, rising to the full level in FY 2015). The funds can be spent on any “prevention, wellness, and public health activities” authorized in the Public Health Service Act. This includes new programs created in the bill, as well as existing programs.

The bill also creates a National Prevention, Health Promotion, and Public Health Council; a National Prevention and Health Promotion Strategy to guide federal investment in prevention and public health; and formal legislative authorization for the Community Preventive Services Task Force and the U.S. Preventive Services Task Force.

Additionally, the bill authorizes many new programs targeting prevention and wellness. These programs may be funded from the Prevention Fund, by the standard appropriations process, both, or neither. Included in these programs is the authority for CDC to conduct research and provide technical assistance related to employer-based wellness programs. The bill directs the CDC Director to:

  • Provide employers with technical assistance, consultation, tools, and other resources to evaluate employer-based wellness programs including evaluating such programs as they relate to changes in employees’ health status, absenteeism, productivity, medical costs, and the rate of workplace injury.
  • Build evaluation capacity among workplace staff by training employers on how to evaluate employer-based wellness programs utilizing mechanisms such as web portals, call centers, etc.
  • Within two years, conduct a national worksite health policies and programs survey to assess employer-based health policies and programs followed by a report to Congress with recommendations for the implementation of effective employer-based health policies and programs.

At this time, it is uncertain whether NIOSH would be tasked by the CDC Director to implement these duties.

Of particular interest to the health care industry is a provision in the bill that establishes the National Health Care Workforce Commission whose membership will include health professionals, employers, third party payers, and labor unions to name a few. Included in the responsibilities of the Commission is a requirement to “submit recommendations to Congress, the Department of Labor, and the Department of Health and Human Services about improving safety, health, and worker protections in the workplace for the healthcare workforce.”

Additionally, to address current and future shortages in the healthcare workforce, the bill includes provisions for increasing the supply of the health care workforce (direct care workforce, allied health professionals and the public health workforce), enhancing health care workforce education and training, and providing support to the existing health care workforce to improve access to and the delivery of health care services for all individuals. Knowing that our field is facing a looming crisis in terms of a shortage of occupational safety and health professionals, I hope that the OSH community will take advantage of the components of the bill that:

  • Create a loan repayment program for the public health workforce.
  • Expand existing public health fellowship programs, including the Epidemic Intelligence Service (EIS).
  • Establish a Youth Public Health Program.

On a broader scale, the advantages of simply having access to insurance are obvious. The bill provides coverage to 32 million uninsured people and provides tax credits to about 4 million small businesses to help cover the cost of insurance for their employees. By providing coverage for workers, we can hope for better preventive care and that workplace illnesses and injuries will be diagnosed and managed more effectively.

A key advantage in the bill for workers and all Americans is the provision that insurance companies cannot drop an individual’s coverage when they become sick or discriminate on the basis of preexisting conditions—a consideration for many workers as they contemplate changing jobs or even divulging or testing for a workplace illness. Furthermore, the bill eliminates lifetime limits and restrictive annual limits on benefits in all insurance plans—a benefit for workers dealing with chronic occupational illness or an expensive occupational injury. Another aspect of the bill will make it easier for coal miners disabled by black lung disease to collect benefits.

While many of the changes will not take place for several years, the Patient Protection and Affordable Care Act promises to go a long way towards improving the health of Americans and, in turn, American workers. While we don’t know specifically how the bill might affect NIOSH, or how we might further the occupational safety and health opportunities identified in the bill, we welcome your perspectives on the potential opportunities. NIOSH will continue to follow the legislation and update our partners with new developments.

Director, National Institute for Occupational Safety and Health

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. March 29, 2010 at 1:00 pm ET  -   Marc Axelrod, CIH, CSP

    Dr. Howard – I really didn’t know about these provisions regarding protection strategies for our health care workers. Having been on the front line for a little while now, I can see that there are opportunities that deserve some attention and resources.

    Thanks for your message and for keeping us all in the loop.

    Marc Axelrod, Safety Director
    Kaiser Permanenete Orange County

    Link to this comment

    • AUTHOR COMMENT March 29, 2010 at 3:25 pm ET  -   John Howard

      Thank you for your comment. Stay tuned as we learn more about how the provisions of HR 3590 will be implemented.

      Link to this comment

  2. March 29, 2010 at 1:43 pm ET  -   Kathy D'Andrea

    Because of the very real epidemic the U.S. is experiencing with obesity in children, a good start might be to reinstate physical education programs in the schools. That would be a good opportunity to at least mobilize those children for an hour a day for five days of the week–build up the heart rate and burn calories. What better way to start a health program than with our children?

    Link to this comment

  3. March 30, 2010 at 8:43 am ET  -   P M Grammer

    This is more interference in the lives of private citizens and private business. It will cost us untold amount of money that most can ill afford.

    Link to this comment

    • AUTHOR COMMENT March 30, 2010 at 10:40 am ET  -   John Howard

      Thank you. Indeed, the cost implications of the health care reform legislation, and its role in the lives of Americans, have been discussed and debated for quite sometime, and will probably continue to be debated for some time to come.

      Link to this comment

  4. March 31, 2010 at 1:36 pm ET  -   Anonymous

    More info here “Promoting Prevention and Improving Public Health”:
    http://dpc.senate.gov/healthreformbill/healthbill75.pdf

    Link to this comment

  5. March 31, 2010 at 1:57 pm ET  -   Kimberly L. Peabody

    Dear Dr. Howard,
    Hopefully this will lead to a revitalization of the innovative program spearheaded by NIOSH, Steps to a Healthier Workforce. Since CDC’s focus is on policy and environmental changes, a renew commitment to effect healthier work environments and promote employee wellness is in order.

    What can health promotion professional do to support these efforts?

    NIOSH Supporter,
    Dr. Peabody

    Link to this comment

    • AUTHOR COMMENT April 1, 2010 at 9:48 am ET  -   John Howard

      Thank you for your comment, Dr. Peabody. The best way to support preventive efforts arising from the healthcare reform bill is to monitor closely the implementation of the Prevention and Public Health Trust Fund by the Department of Health and Human Services.

      Link to this comment

  6. April 5, 2010 at 9:03 am ET  -   Carl Bialorucki

    Dr. Howard,

    Our successful program developed for Law Enforcement in CA has been supported by several LE Agencies. Although a low cost option, funding is typically mentioned as a barrier for others who would like to implement our Train the Trainer model. Any chance, City & County Employers will be able to access the funding mentioned? Carl Bialorucki – Pursuit Performance Training

    Link to this comment

    • AUTHOR COMMENT April 5, 2010 at 1:22 pm ET  -   John Howard

      Thank you for your comment. At this time, it is uncertain the exact criteria for funding proposals under the Patient Protection and Affordable Care Act of 2009. More will surely be known as time moves forward.

      Link to this comment

  7. April 5, 2010 at 1:25 pm ET  -   Ginnie Thomas

    Dr. Howard, I appreciate your keeping us in the loop. I have two questions:

    1) The University of California has been attempting to build voluntary wellness programs for faculty and staff at all campuses, medical centers and labs, and is also running into the challenge of tight budgets as Carl B. mentions. Managing successful wellness programs does take money. Will the campuses of state universities, such as UC, be able to tap into this new funding?

    2) Has there been any discussion re: abolishing or changing our current system that separates medical care for people injured on the job from medical care for people injured away from the work? Does our current work/non-work medical care system make sense with the new provisions that will be taking place?

    Link to this comment

    • AUTHOR COMMENT April 5, 2010 at 2:40 pm ET  -   John Howard

      Thank you. I think that once the funding criteria for the Prevention and Public Health Trust Fund are announced, we’ll know more of what types of programs may be eligible for funding. Regards the two different systems for non-occupational and occupational healthcare, I am unaware of any efforts to unify the two. One of the obstacles in doing so is that workers’ compensation insurance is regulated by the 50 states, not the Federal government. But who knows what may happen in the future.

      Link to this comment

  8. April 7, 2010 at 5:08 am ET  -   genniechan

    I agree that the best way to support preventive efforts arising from the health care reform bill is to monitor it all. Thank you for this very informative article of yours. You have explained everything well. I appreciate that you shared this to us.

    Link to this comment

    • AUTHOR COMMENT April 7, 2010 at 10:19 am ET  -   John Howard

      Thank you for your comment. Lots to monitor over the next couple of years!

      Link to this comment

  9. April 8, 2010 at 1:35 pm ET  -   Kathy Walker RRT

    As a Respiratory Therapist for 35 years I have provided and seen multiple smoking cessation programs. Even though the quit rates are not outstanding over the long term, the single most important wellness activity is to quit smoking. I hope the commission does not idgore this issue.

    Link to this comment

    • AUTHOR COMMENT April 12, 2010 at 7:38 am ET  -   John Howard

      Thank you. I believe that tobacco smoking cessation will be a significant aspect of any prevention effort.

      Link to this comment

  10. April 8, 2010 at 4:32 pm ET  -   Gregory Williams, M.S., CIH, CSP

    As a 30 year professional in the field of industrial hygiene/occupational health & safety, my personal opinion is that the new “Health Care Reform Legislation” does NOT even come close to addressing MAJOR ISSUES in occupational medicine, industrial hygiene, and safety! I have written numerous letters to President Obama, VP Joe Biden, Sen. Durbin, Sen. Murray, Repr. George Miller, etc. — to point out the fact that most people spend at least 40 hours per week, for 40 years at a “job” and “the activities that people perform at work”, can have a great effect on those individuals’ health! I had a 25+ year career for a very large, international corporation, and working for some EXCELLENT Medical Directors (Medical Directors who had graduate degrees in Occupational Medicine). I did a lot of “IH grunt work”, “on the shop floor”, even when I became the Corp. Mgr. of IH. From experience I can tell you that 99% of physicians get NO training what so ever in Medical School, in regards to occupational medicine. They aren’t even taught to take any information during their “examination history”, such as by asking, “what is your occupation?”! The new “Health Reform Legislation” could have at least, suggested that all physicians ask their patients, “WHAT IS YOUR OCCUPATION?”! For example, an employee at work could be exposed to enough “cutting fluid mist”, that the employee could have a bad case of “hypersensitive pneumonitis” — and that employee’s family physician (such as, Internal Medicine) and/or “allergy specialist” would have no idea of “HP”, and could spend thousands and thousands of dollars treating such an individual, running up the cost of prescription medications, NOT curing their patient!—RESULT: HEALTH CARE DOLLARS WASTED! OCCUPATIONAL MEDICINE IS A WHOLE LOT MORE THAN JUST “WELLNESS”!!! Most older IH’s will know exactly what I am talking about — I even believe that NIOSH has “LOST ITS DIRECTION”, to what the agency was specified to be in the “OSHA Act”, and what direction was taken years ago by the “U.S. Public Health Service”! LET’S GET BACK TO THE BASICS OF OCCUPATIONAL HEALTH!

    Link to this comment

    • AUTHOR COMMENT April 12, 2010 at 7:39 am ET  -   John Howard

      Thank you for your comment. I agree that the provisions of the new legislation do not address the major issues in occupational medicine, industrial hygiene, and safety. Since health and safety are specifically mentioned in Title V as items the Commission should give their attention to when it comes to healthcare workers, there may be some hope. But, from the perspective of the larger workforce, you are right.

      Link to this comment

  11. April 13, 2010 at 12:02 pm ET  -   Mike Williamson, Ph.D.

    I am a research investigator with over 24 years of successful research, conducted in the School of Medicine at the University of Sourthern California, Los Angeles. I have developed technologies that predict wellness, risk-reduction, high performance, character competencies (integrity/honesty, a character quotient (CQ)) and many other benefits to employers.

    I need financial help to implement these services, either through private funding or government grants. Are government grants available for helping make these technologies available online for broad application? I know how to instruct webdevelopers to create an interactive website that would do that, but I need financial support to make it happen? Could I get that support through a grant?

    Link to this comment

  12. April 14, 2010 at 10:36 am ET  -   Gary Keller DDS

    Dr.Howard, I am a healthcare worker and have been doing informal studies on breathing air inside surgical facemasks for 3 years now. I have been using a respected industrial multigas monitor configured for confined spaces to test the oxygen and carbon dioxide levels inside surgical facemasks. To date I have not found a facemask that meets the published safe air standards within the confines of a surgical facemask. My findings are consistent and repeatable. Oxygen levels of 18-17% and carbon dioxide levels of 35,000ppm-+40,000ppm depending on “talking” or “nontalking” in the surgical facemasks. I have shared this information with the facemask people at the NPPTL and have not received a response. Shouldn’t CDC/NIOSH/NPPTL be taking care of issues that affect healthcare workers health and safety in a timely fashion? What are the short term and long term health affects of wearing a surgical facemask that do not meet the published standards for safe breathing air? Are these published standards valid? Have their been any formal studies on this? Do these oxygen and carbon dioxide levels cause impairment? I started in 2007 and notified people in the CDC back then. I made it to the NPPTL in 2009 with no response. This affects healthcare workers, military, firefighters and consumers. I sincerely hope the new programs discussed will help the governmental agencies empowered with protecting the people be able to do just that. I applaud the intent of the new healthcare program to protect the people. I hope this doesnt get referred back to the same unit that has ignored me in the past and you will see if there is a problem or not.

    Thanks in advance.

    Link to this comment

    • AUTHOR COMMENT April 15, 2010 at 2:31 pm ET  -   John Howard

      Thank you for the great comment with all the interesting data. Please get your data peer reviewed and published.

      Link to this comment

  13. April 29, 2010 at 6:39 pm ET  -   Fred Drennan

    I’m glad your back at the helm. NIOSH and folks in this field can be part of unprecedent opportunities to make a difference in work site safety and wellness. The hard part is to stay focused and steer into a hundred directions.

    Link to this comment

    • AUTHOR COMMENT April 30, 2010 at 3:28 pm ET  -   John Howard

      Thanks, Fred. Your comment about focus is very insightful!

      Link to this comment

  14. October 26, 2010 at 6:48 pm ET  -   Becky

    Thank you for the updated information. Once more information comes out, do you think NIOSH will provide some sort of fact sheet that would assist employers with knowing how to obtain grant money for wellness programs? So far, there is lots of information out there about these grants coming (and possibly some already in place) but there is not really anything we can point an employer to in order to knowing the steps to obtain funds for this initiative

    Link to this comment

    • AUTHOR COMMENT November 1, 2010 at 11:13 am ET  -   John Howard

      NIOSH does plan to inform potential grantees about funding opportunities under health reform legislation for wellness programs.

      Link to this comment

  15. April 11, 2011 at 8:36 am ET  -   Slips and trips Toronto

    Hopefully this will lead to a revitalization of the innovative program spearheaded by NIOSH, Steps to a Healthier Workforce. Since CDC’s focus is on policy and environmental changes, a renew commitment to effect healthier work environments and promote employee wellness is in order. The University of California has been attempting to build voluntary wellness programs for faculty and staff at all campuses, medical centers and labs, and is also running into the challenge of tight budgets as Carl B. mentions. Managing successful wellness programs does take money. I agree that the provisions of the new legislation do not address the major issues in occupational medicine, industrial hygiene, and safety. Since health and safety are specifically mentioned in Title V as items the Commission should give their attention to when it comes to healthcare workers, there may be some hope. But, from the perspective of the larger workforce, you are right.

    Link to this comment

    • AUTHOR COMMENT April 11, 2011 at 9:54 am ET  -   John Howard

      I appreciate your comment and thank you for accessing the NIOSH Blog.

      Link to this comment

  16. June 27, 2011 at 1:40 am ET  -   Priya Talreja

    Dr. Howard, Would you happen to have information on the 200$ million employee wellness grant allocation for small businesses, under the Affordable Care Act?

    Link to this comment

    • AUTHOR COMMENT June 28, 2011 at 8:32 am ET  -   John Howard

      The Patient Protection and Affordable Care Act (The Health Reform bill) provides funding for grants for developing comprehensive wellness programs for employees. The grants will be given through the Department of Health and Human Services. It is important to note that this solicitation is only for total dollar amount of up to $10M in grants for this funding cycle and will be open to businesses of all sizes (equal numbers small, medium and large desired). Here is the official press release for this program.

      The overall provisions are described at:
      http://www.healthcare.gov/news/factsheets/wellness06232011a.html

      Link to this comment

  17. July 17, 2011 at 3:32 pm ET  -   Marco Teigen

    As a physical therapy business owner, I can tell you that this is a welcome step in the right direction. Our representatives in Congress have been trying to achieve this since 1997. I hope all the healthcare professions can work collectively as part of the National Health Care Workforce Commission to submit recommendations to Congress. This is a huge step forward to improve standards for patients and providers. We thank you for your efforts.

    Link to this comment

  18. October 5, 2011 at 10:09 am ET  -   novi health

    I agree with this

    the provisions of the new legislation do not address the major issues in occupational medicine, industrial hygiene, and safety

    This affects healthcare workers, military, firefighters and consumers. I sincerely hope the new programs discussed will help the governmental agencies empowered with protecting the people be able to do just that. I applaud the intent of the new healthcare program to protect the people.

    Link to this comment

    • AUTHOR COMMENT October 5, 2011 at 10:58 am ET  -   John Howard

      Thank you for your comment and thank you for reading the NIOSH Science Blog.

      Link to this comment

  19. October 12, 2011 at 5:50 am ET  -   IPL

    Hoping such act will really safeguard the public health .Wishing luck for success in implenting and following strictly with it.Thanks for such post.

    Link to this comment

  20. November 3, 2011 at 1:44 am ET  -   Terry

    it about time for this funding. things these days are out of control.Im in construction will this help us that much thanks Terry

    Link to this comment

  21. July 27, 2012 at 10:03 am ET  -   Paul F Davis

    Thank you commitment and continued efforts to improve public health.

    Link to this comment

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