Tuesday, June 18, 2013

Health Services Severely Affected by Sequestration

As most of us are aware, sequestration has had an impact on a variety of national resources that provide vital services to our country. The cap on spending affected defense and nondefense discretionary programs including many public health initiatives. Over the next 10 years, $1 trillion will be cut from such programs because Congress failed to pass a balanced deficit reduction plan in 2011.

In the world of public health, there are substantial cuts to every state’s public health initiatives. Here are the key facts when compared to funding levels from 12 years ago (note that the numbers are adjusted for inflation and population growth):

·         Health Resources and Services Administration: $2 billion reduction. This reduces the health workforce which exists to support training new health professionals.
·         National Institutes of Health: $1.2 billion reduction. This reduces the amount of funding for critical health research such as cancer and diabetes cures.
·         Substance Abuse & Mental Health Services Administration: $813 million reduction. This cut will affect successful smoking cessation programs as well as critical mental health services for low-income groups. This could mean that close to 373,000 seriously mentally ill adults and children will go untreated, leading to increased hospitalizations, criminal cases, and homelessness.
·         Head Start: $968 million reduction. According to the Education Subcommittee on Appropriations, the last decade has already struggled with a significant shortfall from this early childhood education program that eliminated thousands of enrollment slots across the nation. This addition cut will likely result in turning away children who could benefit from Head Start programming in the state.
·         Child Care & Development Block Grant: $592 million reduction. This means that only one in six children will be eligible for child care assistance when far more than that require help. According to the Education Subcommittee on Appropriations, child care remains one of the biggest challenges for working families.
·         Centers for Disease Control and Prevention: $122 million reduction. This affects a plethora of programs from environmental health and immunization to emergency response and preparedness to global health.

The most recent sequestration hit the CDC the hardest causing a $580 million reduction in the centers’ 2014 operating plan. No program went unscathed as the following areas will see reduced funding:
a.       Immunization and respiratory
b.      HIV/AIDS, Hepatitis, STI and TB prevention
c.       Emerging and Zoonotic (animal-transmitted) infectious diseases
d.      Chronic disease prevention and health promotion
e.      Cancer prevention and control program
f.        Birth defects, developmental disabilities, disability and health
g.       Environmental health
h.      Injury prevention and control
i.         Scientific services (surveillance, informatics, career development)
j.        Occupational safety and health
k.       Global health
l.         Emergency response and preparedness

One of the hardest hit areas was the childhood immunization program, which took more than $1 million in cuts from 2013 to 2014. This could essentially create issues with the start of the school year in 2014 when required immunizations will not be as easily accessible to low-income groups.

In addition, the cuts affect food safety programs and up to 2,100 fewer food inspections jobs could be lost, putting families at risk of foodborne illnesses. Furthermore this cut coupled with the reduction in emergency response and preparedness funding could open the door to easier bioterrorism attacks via the nation’s food supply.

The list of issues goes on and on because of the impasse and the exceptionally high national debt. The impact will be nationwide with both services and personnel being cut. The NDD United (with NDD meaning nondefense discretionary) created a video that explains the cuts. You can access it at www.nddunited.org.

There has been a solution on the table through The Prevention and Public Health Fund, created under the Affordable Care Act. This fund had the potential to sink billions of dollars into public health and prevention services. According to the ACA, the fund is to provide $18.75 billion from 2010 to 2022 and then $2 billion per year after that. Unfortunately, a February 2012 piece of legislation cut that $18.75 billion over 12 years to $6.25 billion over 9 years. Further reductions were made thanks to sequestration.



References

American Public Health Association. (2013). Get the Facts: Prevention and public health fund. Retrieved from http://www.apha.org/NR/rdonlyres/3060CA48-35E3-4F57-B1A5-CA1C1102090C/0/APHA_PPHF_factsheet_May2013.pdf.

Office of the Press Secretary. (2013). Fact sheet: Examples of how the sequester would impact middle class families, jobs, and economic security. Retrieved from http://www.whitehouse.gov/the-press-office/2013/02/08/fact-sheet-examples-how-sequester-would-impact-middle-class-families-job.

NDD United. (2013). Stop the Cuts! [video file]. Retrieved from http://www.youtube.com/watch?v=cu0YPgTlAtg&feature=player_embedded.


Tuesday, June 4, 2013

Workplace Wellness Incentives: For Better or for Worse?

For those who have been following the various elements enacted through the Affordable Care Act, you are now fully aware of the new rule that will actually benefit some health enthusiasts but upset many others.

The final rule (TD 9620; CMS-9979-F under Employee Benefits Security Administration) has upheld an increase in rewards and penalties for those participating (or not) in employee wellness programs. What that means is employers can now increase the financial incentives from 20 to 30 percent of health premiums starting in January 2014. Those participating in tobacco cessation programs can receive a 50 percent incentive. Basically, if you participate in an employee wellness program, you could qualify for hundreds or thousands of dollars in premium or deductible discounts.

That’s the good news, but here’s the not-so-great news. If you do not participate or use tobacco products, you could be eligible for a penalty of those same amounts – 30% more for not participating in wellness programs and/or 50% for using tobacco products.

Okay, so there’s good news and not-so-good news. Now, here’s the worst of it…If you are unable to participate in such a program because of valid medical problems or conditions, including pregnancy, you could actually be penalized with an increase in your premium.

I’m a huge proponent of higher premiums for those who knowingly and willingly partake of unhealthy behaviors such as smoking, illicit drug use, and sedentary lifestyles. It is those people who will eventually end up costing the system more money because they run up hospital bills from medical issues associated with those behaviors such as emphysema, lung cancer, diabetes, stroke, heart attack, and more. That “system” is actually the rest of society footing the bill to underwrite the costs of their unhealthy behaviors.

Yet, I am not in favor of penalizing those who truly cannot be part of a wellness program. According to the Kaiser Health, the theory behind the incentives is to encourage people to make healthier choices in an effort to reduce significant health care costs associated with obesity, high blood pressure, and diabetes. Some studies have shown that money can be a strong incentive for changing our behaviors.

But, how fair is it that a woman with a difficult pregnancy would be penalized because she was physically restricted? What about the man bound to a wheelchair from a car accident that wasn’t his fault several years earlier? There are so many valid reasons for not being able to participate in a wellness program that penalties should probably be determined on an individual basis – or not enacted at all.

Two types of wellness programs were outlined in the rules, one which provides the opportunity for all employees to participate – such as sitting through a wellness class/seminar. The other program focuses on meeting goals (such as weight loss, or reducing blood pressure) or participating in activities (such as walking programs or fitness classes). It is this second program type that has produced the controversy.

According to Kaiser Health, the rule, filed on May 29 with the Federal Register, gives employers leeway, saying the programs must simply have a ‘reasonable chance’ of improving health. What does that mean? It means that every individual is given the opportunity to improve their health status starting from where they are today (or rather, as of January 1, 2014).

I am truly in favor of projects like employee wellness programs that can not only improve the health of the employees but improve productivity and overall economic wellbeing for the community. In fact, employers that cover the costs for gym memberships are really making it easy for their employees to improve their health.

Considering that employers have the option of enacting these discounts and penalties, I strongly recommend leaning towards a rewards system. Give those discounts to those participating in wellness activities, whether on site or in the community. And, for cases where there is a valid medical reason for lack of participation, the discount should still be offered. Yet, for those who flat-out refuse, I wouldn’t penalize them; but I certainly wouldn’t offer the reward.

Positive rewards have proven to be more successful than negative reinforcement. Any parent can tell you that!


References

Appleby, J. (2013). Final rule upholds increased rewards, penalties for wellness participation. Retrieved from http://capsules.kaiserhealthnews.org/index.php/2013/05/final-rule-upholds-increased-rewards-penalties-for-wellness-participation/.

Internal Revenue Service, Department of the Treasury, Employee Benefits Security Administration, Department of Labor, Centers for Medicare & Medicaid Services, Department of Health and Human Services. (2013). Final Rule: Incentives for nondiscriminatory wellness programs in group health plans. Retrieved from http://www.ofr.gov/(S(ztwp1tthdztmqqh35iza2ek4))/OFRUpload/OFRData/2013-12916_PI.pdf.