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HHS Announces Prevention and Wellness Regulations

The Department of Health and Human Services and other federal agencies announced today, in conjunction with the Affordable Care Act, new rules that would require private health insurers to provide preventive care services for free, with no co-pays, co-insurance or deductibles. The rule takes effect September 23 of this year.

Services like blood pressure, diabetes and cholesterol tests, certain cancer screenings, vaccinations and immunizations, pre-natal care, pediatric visits and visions and hearing screening for children are covered under the rule.

“Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs,” said HHS Secretary Sebelius. “From the Recovery Act to the First Lady’s Let’s Move Campaign to the Affordable Care Act, the Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy.”

We do not have a culture of prevention in this country, nor do we have the robust health care infrastructure that could absorb Americans getting regular preventive care at recommended rates. This is an excellent step that could in the long run reduce health care costs. But building health care infrastructure and actually getting people to use free preventive services will be an ongoing challenge.

What services will make the cut? That takes us back to the US Preventive Services Task Force. Remember them? They were the group that changed their recommendations on the rate of breast cancer screenings in the middle of the health care debate, to much howling. Well, the USPSTF services rated as A or B are the ones which will be free to all Americans with private insurance:

Evidence-based preventive services: The U.S. Preventive Services Task Force, an independent panel of scientific experts, rates preventive services based on the strength of the scientific evidence documenting their benefits. Preventive services with a “grade” of A or B, like breast and colon cancer screenings, screening for vitamin deficiencies during pregnancy, screenings for diabetes, high cholesterol and high blood pressure, and tobacco cessation counseling will be covered under these rules.

There’s simply no way to prevent USPSTF rulings from becoming highly politicized as a result. Congress sidestepped the breast cancer guideline controversy by adding in additional preventive services for women, and that is included in this rule. However, those guidelines are still “being developed by an independent group of experts, including doctors, nurses, and scientists,” and “are expected to be issued by August 1, 2011.”

The Administration’s allies touted the announcement. Health Care for America Now Director Ethan Rome said in a statement: “This rule marks a significant milestone in the implementation of the new health care law, and it’s a powerful reminder that reform is about results, not rhetoric.” He estimates that, in the first year, the rule makes preventive coverage affordable to 41 million more people, with 90 million covered by the benefit by 2013. House Speaker Nancy Pelosi added:

Opening the door to preventive care means vaccines and flu shots for our children, and regular visits to the pediatrician – key building blocks for a lifetime of health. It means women will be able to get counseling, screening, and vaccines for healthy pregnancies, and have easier access to mammograms and a wide range of critical services. And it means greater access to cancer screenings, routine immunizations, and blood pressure, diabetes, and cholesterol tests for all patients.

She closed with a dig at the Congressional Republicans who opposed the bill. Clearly, advocates of repealing the ACA must address repealing free preventive services. But more work must be done to ensure that the benefits covered by the rule are robust, that people are actually using them, and that there are enough doctors and nurses to make it happen.

The full regulations are available here.

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David Dayen

David Dayen