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.
