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PPACA and Public Health: Creating a Framework to Focus on Prevention and Wellness and Improve the Public's Health

Published online by Cambridge University Press:  01 January 2021

Gwendolyn Roberts Majette
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On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA), a major piece of health care reform legislation. This comprehensive legislation includes provisions that focus on prevention, wellness, and public health. Some, including authors in this symposium, question whether Congress considered public health, prevention, and wellness issues as mere afterthoughts in the creation of PPACA. As this article amply demonstrates, they did not.

This article documents the extent of congressional consideration on public health issues based on personal experience working on the framework for health care reform — specifically, my experience as a Fellow for a member of the Health Subcommittee of the Senate Finance Committee from 2008-2009. I also include a review of congressional activity in the United States House of Representatives. Analysis of the congressional meetings and hearings reveals that Congress had a deep understanding about the critical need to reform the U.S. public health and prevention system.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 39 , Issue 3 , Fall 2011 , pp. 366 - 379
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

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References

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The continued availability of the full amount of the appropriation is theoretically at risk. Three attempts have been made in the House of Representatives to defund the prevention fund. The Johanns amendment would have drastically cut the fund. This amendment was defeated in September 2010. Johanns Amendment, section 4273 (a). The current and ongoing attack is through the Pitts proposal. This proposal would eliminate all mandatory funding in PPACA. Setting Fiscal Priorities in Health Care Funding: Hearing Before the H. Comm. on Energy and Commerce, 112th Cong. (2011) (March 7, 2011 Internal Memorandum of the Majority Staff to the Subcommittee on Health). On April 13, the House of Representatives passed H.R. 1217 which would repeal the Prevention and Public Health Fund. The White House expressed opposition to the bill and continued support for the fund. The measure is also unlikely to pass in the democratically controlled Senate. “House Repeals Affordable Care Act's Prevention and Public Health Fund,” Health Lawyers Weekly, vol. IX, no. 15 (April 15, 2011).Google Scholar
See PPACA, supra note 109, at § 4002 (a).Google Scholar
Id., at § 4002 (a)-(b).Google Scholar
PPACA merely authorizes the Prevention Council to make recommendations and submit reports to the President and Congress. See discussion in Parts V.A; see PPACA, supra note 109, at §§ 4001, 4002.Google Scholar
There is a debate about whether investments in prevention will produce cost savings. Many of the witnesses that testified at the hearings discussed in this paper asserted that there will be cost savings: Dr. Jeffrey Levi with Trust for America's Health, Professor Kenneth Thorpe from the School of Public Health at Emory, Dr. Richard Besser, the Acting Director of the CDC, and Dr. Wayne Jonas, President of Samueli. Professor Goetzel and Thorpe wrote articles showing a financial benefit to prevention. Goetzel, R. Z., “The Wrong Debate: Prevention or Treatment Services to Save Money?: Instead of Debating Whether or Not Prevention or Treatment Saves Money, We Should Determine the Most Cost-Effective Ways to Improve Population Health,” Health Affairs 28, no. 1 (2009): 37–41; Thorpe, K. E., “The Rise in Health Care Spending and What to Do about It,” Health Affairs 24, no. 6 (2005): 1436–1445; Economics professor Louise Russell provides an analysis of reasons why prevention might not produce cost savings. Russell, L. B., “Preventing Chronic Disease: An Important Investment, but Don't Count on Cost Savings An Overwhelming Percentage of Preventive Interventions Add More to Medical Costs Than They Save,” Health Affairs 24, no. 1 (2009): 42–47.CrossRefGoogle Scholar
U.N. Economic and Social Council, Committee on Economic, Social, and Cultural Rights, Substantive Issues Arising in the Implementation of the International Covenant on Economic, Social and Cultural Rights, General Comment No. 14 ¶ 43 (f), 53 U.N. Doc. E/C.12/2000/4 (August 11, 2000) (hereinafter cited as Committee on Economic, Social, and Cultural Rights). The United States does not have an international obligation to protect the right to health because it has not ratified the most seminal treaty on the right to health, the International Covenant on Economic, Social, and Cultural Rights. International Covenant on Economic, Social, and Cultural Rights, at art. 12 (entered into force January 3, 1976). For a more in-depth analysis of how the Patient Protection Affordable Care Act creates a framework to protect the right to health, See Majette, G. R., “Coherency within the Patient Protection and Affordable Care Act (PPACA): A Framework to Create a Health Care System that Protects the Human Right to Health” (unpublished manuscript on file with the author).Google Scholar
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See PPACA, supra note 109, at § 4001 (d)(3).Google Scholar
See discussion in Part II.Google Scholar
See IOM 21st Century, supra note 7, at 4. Accountability is a requirement for creation of an effective comprehensive plan to create and strengthen a health system under the core obligations that apply to all treaty parties. See Committee on Economic, Social, and Cultural Rights, supra note 143, at ¶¶ 56–57.Google Scholar
See PPACA, supra note 109, at § 4001 (i).Google Scholar
H. Rep. No. 111–299 at 326 (2009).Google Scholar
Id., at 700.Google Scholar