Affordable Care Act (PPACA)

With the goal of “bending the cost-curve” in health care spending, Congress included various mandates and incentives within the PPACA to help promote wellness and healthier life styles. The Alliance for Wellness in America has included and overview of the major provisions concerning wellness within the PPACA:

• In September of 2010, employer-sponsored group health plans are prohibited from requiring co-pays for all preventative services recommended by the United States Preventative Services Task Force. Co-pays have also been eliminated for certain immunizations and various preventative screenings for women and children.

• In March of 2011, co-pays were eliminated for certain preventative services provided for Medicare and Medicaid recipients. Medicare beneficiaries also gained the right to receive annual wellness visits, where a physician will review a patient’s condition and design a personalized prevention plan by creating a personal schedule for screenings, exams and updates.

• Beginning in 2014, Congress included “essential health benefits requirements” to take effect. The Department of Health and Human Services (HHS) has the task of determining what those will be, but the law requires that they fall within various categories. These categories include emergency services, hospitalization, maternity and newborn care, prescription drugs, laboratory services, mental health services, preventative and wellness services, and chronic disease management.

• In January of 2010, PPACA establishes wellness discounts by permitting group health insurers to grant a 30% reduction in premiums for those who participate in wellness programs.

• One of the few areas of bipartisan agreement during negotiations over the controversial Patient Protection and Affordable Care Act was to control costs by emphasizing disease prevention and wellness programs in our health care system.