Michelle Obama's Campaign Against Obesity is a Campaign for Taxing 'Junk Food' and Rationing Healthcare for the Obese under Obamacare (Updated 10/4/11)
October 3, 2011
Denmark has become the first country in the world to impose a "fat tax" on unhealthy foods. The move will place a surcharge on foods high in saturated fat. Butter, milk, cheese, pizza, meat, oil and processed food will all be subject to the levy.
The aim is to reduce people's intake of fatty foods. But consumers have begun hoarding provisions ahead of the price rise and some scientists have suggested that it would be better to target people's salt or sugar intake.
The Nordic country introduced the tax Saturday, of 16 kroner (£1.85) per kilogram of saturated fat in a product.
The tax was approved by large majority in a parliament in March as a move to help increase the average life expectancy of Danes.
In September, Hungary introduced a new tax popularly known as the "Hamburger Law," but that only involves higher taxes on soft drinks, pastries, salty snacks and food flavorings.
The outgoing conservative Danish government planned the fat tax as part of a goal to increase the average life expectancy of Danes, currently below the OECD average at 79 years, by three years over the next 10 years.
"Higher fees on sugar, fat and tobacco is an important step on the way toward a higher average life expectancy in Denmark," health minister Jakob Axel Nielsen said when he introduced the idea in 2009, because "saturated fats can cause cardiovascular disease and cancer."
Linnet Juul says the tax mechanism is very complex, involving tax rates on the percentage of fat used in making a product rather than the percentage that is in the end-product.
Linnet Juul's organization is pressuring lawmakers to simplify the tax, but said he is unsure what will happen when the new, centre-left government takes office.
October 02, 2011
Denmark on Saturday became the second country to impose a fat tax, leading consumers to hoard butter, pizza, meat and milk, AFP reports.
The new tax, designed by Denmark’s outgoing government in an effort to limit the population’s intake of fatty foods, will add 16 kroner ($2.87, or 2.15 euros) per kilo (2.2 pounds) of saturated fats in a product.
For example, according to the AFP, the tax will increase the cost of 250 grams of butter by 2.20 kroner, to more than 18 kroner.
"It has been a chaotic week with a lot of empty shelves. People have been filling their freezers," Christian Jensen of an independent local Copenhagen supermarket told AFP.The new tax will be levied on all products including saturated fats -- from butter and milk to pizzas, oils, meats and pre-cooked foods -- in a costing system that Denmark’s Confederation of Industries (DI) says is a bureaucratic nightmare for producers and outlets.
"But actually I don’t think the tax will make that much difference. If people want to buy a cake, they will buy it. But right now they’re saving money," he added.
"The way that this has been put together is an administrative nightmare, and I doubt whether it will give better health. It’s more just a tax," DI foodstuffs spokeswoman Gitte Hestehave told AFP, adding that the costs of levying the tax would be passed on to consumers.Denmark is one of several European countries to tax sodas, and it has imposed a levy on candy for nearly 90 years, according to Der Spiegel. The country was the first in the world to pass a law banning trans fats, with Austria and Switzerland following closely after.
Last month, Hungary implemented a law imposing special taxes on foods with high fat, salt and sugar content.
On Sept. 1, Hungarians began paying a 10 forint (0.37 euros) tax on foods with high fat, sugar and salt content, as well as increased tariffs on soda and alcohol. The expected annual proceeds of 70 million euros will go toward state health care costs, including those associated with addressing the country's 18.8 percent obesity rate, which is more than 3 percent higher than the European Union average of 15.5 percent according to a 2010 report by the Organization for Economic Cooperation and Development. In Germany, by comparison, 13.6 percent of adults are obese, with Romania at the bottom of the list with 7.9 percent.
September 5, 2011
Four obese children are on the brink of being permanently removed from their family by social workers after their parents failed to bring their weight under control.
In the first case of its kind, their mother and father now face what they call the ‘unbearable’ likelihood of never seeing them again. Either way, the family’s only hope of being reunited will be if the children attempt to track down their parents when they become adults.
The couple, who have been married for nearly 20 years and are not being named to protect their children’s identities, were given a ‘draconian’ ultimatum three years ago – as reported at the time by The Mail on Sunday.
Warned that the children must slim or be placed in care, the family spent two years living in a council-funded ‘Big Brother’ house in which they were constantly supervised and the food they ate monitored. But despite subjecting them to intense scrutiny, social workers did not impose rules on what food the children should eat, and there was apparently little or no improvement.
News of the decision to remove them was broken to the couple, from Dundee, on Tuesday. Critics called it a disgraceful breach of human rights and a chilling example of the power of the State to meddle in family life.
In an emotional interview, the 42-year-old mother said:
‘We might not be the perfect parents, but we love our children with all our hearts. To face a future where we will never see them again is unbearable.The couple have not committed any crime and are not accused of deliberate cruelty or abuse. Their solicitor, Joe Myles, said there was ‘nothing sinister lurking in the background’ and accused social workers of failing to act in the family’s best interests.
‘They picked on us because of our size to start with and they just haven’t let go, despite the fact we’ve done everything to lose weight and meet their demands. We’re going to fight this to the bitter end. It feels like even prisoners have more human rights than we do.’
‘Dundee social services department appear to have locked horns with this couple and won’t let go,’ he said, adding that the monitoring project caused more problems than it solved. ‘The parents were constantly being accused of bad parenting and made to live under a microscope.’The couple have three older children who are all distraught and angry at the ruling. Speaking through tears, their 15-year-old daughter said:
‘The social workers should hang their heads in shame. A person’s weight is their own business and only we can do anything about it, not them. My parents are good people and they love us all. The four little ones don’t know what is about to happen to them.’Social workers became aware of the family in early 2008 after one of the sons accused his father of hitting him on the forehead. In truth, he had fallen and hit his head on a radiator – a fact he later admitted. However, the allegation opened the door to the obesity investigation.
While the couple admit experiencing what their lawyer calls ‘low grade’ parenting problems, which would have merited support, they were aghast when the issue of weight was seized on as a major concern. A council report at the time said:
‘With the exception of [one of the names], the children are all overweight. Advice has been given regarding diet but there has been no improvement. Appointments with the dietician have been missed.’At that point their then 12-year-old son weighed 16 stone; his 11-year-old sister weighed 12 stone; and his three-year-old sister weighed four stone. It is not known how much the four younger children weigh now.
The couple were ordered to send their children to dance and football lessons and were given a three-month deadline to bring down their weight. When that failed, the children were placed in foster homes but were allowed to visit their parents.
After the couple objected to this arrangement, the council agreed to move them into a two-bedroom flat in a supported unit run by the Dundee Families Project. They insisted on the couple living with only three of their children at a time.
At meal times, a social worker stood in the room taking notes. Doctors raised concerns that the children put on weight whenever they spent time with their parents, a claim they vehemently denied.
The couple and their children also had to adhere to a strict 11pm curfew. This involved ‘clocking’ in and out by filling in a sheet held by an employee who lived on site.
Although the children’s weight was the major concern, other allegations were included in a report. It showed that social workers were worried when the youngest child was found crawling unsupervised. The parents point out they were never far away and the flat had no stairs. They also found her ‘attempting to put dangerous objects’ in her mouth. The family say this is natural in toddlers and she was never successful.
Social workers were further worried when she crawled through the contents of an upturned ashtray – an ‘unfortunate one-off incident’, claim the parents. All the concerns were dismissed by the family’s legal team as ‘low grade’ problems.
It is understood the father crumbled under the strain of being so closely monitored in January this year and moved into a council flat elsewhere in the city. In the next few months, the mother breached the lunch and dinner meal observations, by her own admission, on ‘several’ occasions while taking the children to see their father. She personally never broke the 11pm curfew but once allowed her seven-year-old daughter to remain at her father’s flat after she fell asleep. She did not want to disturb her and argued the child had ‘two parents, not one’ and was in ‘good hands’.
These breaches led staff to declare the trial a failure and the mother was asked to leave the unit in April this year. She moved in to her husband’s flat but the children were then handed over to foster parents.
Her solicitor said he planned to use independent experts to prove that the children want to live with their parents and have been damaged by the social workers’ intervention. He added:
‘We may ultimately look towards human rights laws.’The father, aged 56, said:
‘We have tried very hard to do everything that was asked of us. My wife has cooked healthy foods like home-made spaghetti bolognese and mince and potatoes; we’ve cut out snacks and only ever allowed the kids sweets on a Saturday. But nothing we’ve done has ever been enough.It is estimated 26 million British adults will be obese by 2030, with obesity levels running at an all-time high among children. Official statistics show those who are overweight spend 50 per cent more time in hospital, placing extra strain on the NHS.
‘The pressure of living in the family unit would have broken anyone. We were being treated like children and cut off from the outside world. To have a social worker stand and watch you eat is intolerable. I want other families to know what can happen once social workers become involved. We will fight them to the end to get our beloved children back.’
Tam Fry, honorary chairman of the Child Growth Foundation, said:
‘This is a disgrace. These parents have clearly attempted to comply. They have, if you like, played Dundee City Council’s game and yet they are still losing their children.’Dundee City Council said:
‘The council always acts in the best interests of children, with their welfare and safety in mind.’
November 1, 2010
To get HITECH incentive money, providers are required to use their electronic health record systems to report clinical quality measures. That requirement could prove as challenging to meet as all the others put together.
"It's the hardest requirement because there's a lot of complexity and the data is diverse," says Jason Mitchell, M.D., assistant director of the Center for Health Information Technology at the American Academy of Family Physicians.He compares it with PQRI, the physician quality reporting initiative of the Centers for Medicare and Medicaid Services. Many physicians were reluctant to participate in that program to get the small amount of incentive payment involved (about $1,200 per-doctor per-year on average, according to AAFP), because extracting the data by hand from patient charts was just too much trouble.
HITECH participants stand to make many times more money than PQRI ever offered, and can (indeed must) use an EHR to collect the data, which beats slogging through paper charts any day.
The potential benefit is almost certainly worth the trouble, but that doesn't mean there won't be any trouble. Quality reporting isn't yet the simple push-button operation it may someday become, and most providers will have to work hard-both with their EHR vendors and internally-to make sure they're prepared.
For HITECH Stage 1, hospitals have to report 15 measures altogether, focusing on three areas: emergency department throughput, stroke, and venous thromboembolism (VTE).
Physicians must report six measures. Three must be core measures (adult blood pressure screening, weight screening, and tobacco use assessment/intervention), or alternate core measures (childhood immunization status, child and adolescent weight screening and counseling, and flu vaccinations for patients 50 or older) depending on which correlate best with their patient populations.
The other three can be chosen from a menu of 44 that includes measures appropriate for specialty practices.
To qualify for financial incentives the first year, providers have to report the data to CMS and attest that they were able to draw it from their EHR. In the second year, the EHR has to be able to send a report directly to CMS.
Aside from being able to attest the first year, hospitals don't have any leeway on the quality reporting requirement, as they do on other requirements.
Most have modest first-year thresholds: more than 30 percent of patients with at least one medication ordered using CPOE, or one clinical decision support rule implemented (out of hundreds possible). But there's no provision for partial quality reporting...
New federal regulations issued by Obama’s administration will require doctors to record their patient’s body mass index (BMI) ratio. No longer will your weight problems be a matter between you and your doctor. Thanks to Obama, now your doctor will be required by law to snitch to the feds on how fat you are.
Like most of what goes on in Washington, this new little regulation was stuck a bill otherwise wholly unconnected to healthcare, the stimulus bill (section 301).
According to the government’s new HIT Standards (Health Information Technology), each patient’s BMI numbers will be recorded and must be available to the federal government on a national database exchange.
(e) Record and chart vital signs.
(1) Vital signs. Enable a user to electronically record, modify, and retrieve a patientâ€™s vital signs including, at a minimum, the height, weight, blood pressure, temperature, and pulse.
(2) Calculate body mass index. Automatically calculate and display body mass index (BMI) based on a patientâ€™s height and weight.
(3) Plot and display growth charts. Plot and electronically display, upon request, growth charts for patients 2-20 years old.
Naturally all these electronic health records will be under the thumb of yet another government agency that will “assure” that the records are being gathered and stored correctly and can be retrieved from the national database.
But of what use is a BMI reading? Many researchers and doctors now believe that the BMI system is not a reliable determinant of health problems. Some researchers now think that “BMI should be disregarded as a clinical and epidemiological measure of cardiovascular risk.”
And what use will the Obama administration make of this information? Will Obama use this info as another excuse for government spending? Of that you can be sure.A bill introduced this month in Congress would require states that receive federal grants under the bill to annually track the Body Mass Index of children ages 2 through 18 annually and to report that information to the U.S. Department of Health and Human Services for analysis.
May 12, 2010
A bill introduced this month in Congress would put the federal and state governments in the business of tracking how fat, or skinny, American children are.
States receiving federal grants provided for in the bill would be required to annually track the Body Mass Index of all children ages 2 through 18. The grant-receiving states would be required to mandate that all health care providers in the state determine the Body Mass Index of all their patients in the 2-to-18 age bracket and then report that information to the state government. The state government, in turn, would be required to report the information to the U.S. Department of Health and Human Services for analysis.
The Healthy Choices Act--introduced by Rep. Ron Kind (D-Wis.), a member of the House Ways and Means Committee--would establish and fund a wide range of programs and regulations aimed at reducing obesity rates by such means as putting nutritional labels on the front of food products, subsidizing businesses that provide fresh fruits and vegetables, and collecting BMI measurements of patients and counseling those that are overweight or obese.
Section 101 of the bill amends the Public Health Services Act by stating that health care providers must record the Body Mass Index of all children ages 2 through 18.
"The provision relates to all children in states that accept grants under the bill," a spokesperson for Rep. Kind told CNSNews.com. "However, it is important to note that no one is forced to come in for a doctor’s visit to get their BMI tested. BMI will be taken at times when the child makes an otherwise scheduled doctor’s visit."BMI is calculated by taking one’s weight in pounds and height in inches, multiplying that number by one’s height in inches and then multiplying that number by 703. Any number over 24 is considered overweight, with higher numbers resulting in a diagnosis of obese (BMI = [weight / (height x height)] x 703).
To pay for implementing BMI data gathering, Sec. 102 of the bill states that the federal government will give grants to states that meet certain criteria, including having “the capacity to store basic demographic information (including date of birth, gender and geographic area of residence), height, weight, and immunization data for each resident of the state.”
The grants also will pay for personnel and equipment necessary to measure patients’ BMI.
The grants also require that if a child’s BMI is greater than the 95th percentile for the child’s age and gender, the state will provide “information on how to lower BMI and information on state and local obesity prevention programs.”
Rep. Kinder's spokesperson said that any data used to generate a report on the BMI data collected would not include patients’ names.
The bill also requires HHS to share with Congress and other government officials, including the secretaries of education and agriculture, its analysis of the BMI data collected not more than one year after it gathers all of the data from states.
This analysis, the bill states, would attempt to identify obesity trends in regions of the United States and how those trends vary according to gender and socioeconomic status--although the bill does not spell out how socioeconomic status of patients would be determined.
On May 6, the bill was referred to the House subcommittee on Highways and Transit.
Co-sponsors of the bill are Reps. Earl Blumenauer (D-Ore.), Mary Bono Mack (R-Calif.), Marcia Fudge (D-Ohio) and Gregorio Sablan (D-Mich.)
At a press conference last week to announce the introduction of the bill, Kind emphasized it would help “busy American families.”
“Making the healthy choice the easy choice for our families is essential to ensuring our quality of life,” Kind said. “I am pleased to work on legislation that helps provide the opportunities that meet the needs of busy American families.”
March 23, 2010
With Sunday’s vote in the House of Representatives, the long-awaited health care reform legislation is on track become law. A great deal has been written about health care reform during the past year but little attention has been paid to how reform might affect the obesity epidemic.
Obesity is the most prevalent, fatal, chronic disease in the United States. 68% of American adults are overweight or obese, constituting a majority of the US population. This Q&A is not intended to cover the entire scope of the health care reform legislation but only to explain how it is likely to affect persons with obesity and the future of the obesity epidemic. (N.B. At several points, the legislation incorporates recommendations of the U.S. Preventive Services Task Force (USPSTF) meaning that these recommendations become covered services.
The USPSTF has two obesity specific recommendations at level B: one for screening for obesity and the second for intensive behavioral counseling. The intensive behavioral counseling could open the door for extensive new services.)
1. What does the bill do to help the millions of Americans with obesity?
If you have obesity, have a medical condition and have not had health insurance for six months, you will be able to purchase coverage through a temporary high risk pool. (The pool is ‘temporary’ until the health exchanges are implemented).
If you have obesity and receive Medicare or Medicaid, you will see more preventive services fully covered.
If you have obesity and employer provided health insurance several provisions may affect you.
A. If you have had claims denied because of a pre-existing condition (either obesity or an obesity-related co-morbid condition), you should have an easier time getting such claims paid starting in 2014.
B. If you have reached lifetime caps on coverage, within six months of enactment, insurers will be prohibited from placing lifetime limits on the dollar value of coverage and from rescinding coverage, except in the case of fraud. Insurance companies will also be prohibited from canceling policies on people who get sick. (These are called recissions and ‘height and weigh’ is one of the four most common health reasons for a recissions according to a December 2009 report from the National Association of Insurance Commissioners).
C. Six months after enactment, private, qualified health plans will have to provide, without cost-sharing, preventive services with an A or B recommendation of the U.S. Preventive Services Task Force.
D. More expensive “Cadillac” health plans will start being taxed in 2018. To the extent that these plans may provide coverage of bariatric surgery and related services, they may scale back.
2. Is it all good?
Briefly, yes and no.
If you have obesity and have employer-paid health insurance, you may be paying more – potentially a lot more-for it. While the new law will ban discrimination on the basis of health status, an exception exists whereby persons in an employee wellness program can be charged up to 50% of the value of their health insurance premium if they do not meet specific health criteria, such as weight.
Intensive behavioral counseling for obesity will become more available. Whether insurers will have to provide bariatric surgery or drugs for treating obesity will be decided by a Health Benefits Advisory Board which will make recommendations to the Secretary of Health and Human Services.
Third, the tax deduction for medical expenses will change. Currently, individuals can deduct unreimbursed medical expenses (including physician recommended weight loss costs) to the extent they exceed 7.5% of adjusted gross income. The threshold will rise to 10%. This potentially hurts individuals with multiple chronic conditions and/or high, unreimbursed medical costs.
3. Does Medicare coverage of obesity change?
Medicare beneficiaries would receive a comprehensive health risk assessment and a personalized prevention plan. Incentives would be provided to Medicare beneficiaries to compete behavioral modification programs.
Medicare’s current coverage of bariatric surgery does not change.
The ban for drugs to treat obesity under Part D continues in effect.
4. What about coverage of obesity in Medicaid?
Current state-by-state coverage in Medicaid for bariatric surgery and drugs to treat obesity should not change. (Medicaid may cover drugs for obesity if the state applies for a waiver from a prohibition in the Medicaid statute.)
The Medicaid program will go through its largest expansion since its inception.
If cost-sharing is removed for covered recommendations of the US Preventive Services Task Force (see above), state Medicaid programs will have their federal matching rates increased. The Secretary of Health and Human Services (HHS) is also instructed to develop preventive and obesity-related services for Medicaid enrollees, including obesity screening and counseling for children and adults. Each state is directed to develop a public awareness campaign to educate Medicaid enrollees regarding the “availability and coverage of such services with the goal of reducing incidences of obesity.”
HHS will develop incentives to encourage behavioral change in Medicaid enrollees.
A new state option will be developed for Medicaid, allowing enrollees with multiple chronic conditions to select a medical home.
5. What does the law do about childhood obesity?
While often overlooked, the expanding coverage includes providing health insurance to millions of children whose parents do not have coverage now. For the increasing numbers of children and adolescents with obesity, their related conditions, like type 2 diabetes and hypertension, will now be covered. Starting in 6 months, children cannot be denied coverage because of pre-existing conditions.
In addition to the coverage components, the law provides funding for a childhood obesity demonstration project.
6. What about prevention of obesity?
The bill establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness and public health activities and develop a national strategy to improve the nation’s health. The strategy is due one year after the enactment. A Prevention and Wellness Trust is authorized to carry out the national strategy.
A grant program is developed for 5 years to support the delivery of evidence-based and community based prevention and wellness service aimed at reducing chronic disease rates.
Under Section 4201, the Secretary of HHS shall develop a competitive grant program for states and local governments for “the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions and address health disparities.”i. This includes creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of health lifestyle, emotional wellness, and prevention curricula.”
ii. Also included are “developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity;”
iii. “assessing and implementing worksite wellness programming and incentives; working to highlight healthy options at restaurants and other food venues.
iv. Grantees must report changes in weight, nutrition, physical activity.
b. Section 4202(a) provides a health aging program. Grants are to be provided to states and local governments for the 55 to 64 year old population “to improve nutrition, increase physical activity.” Covered are screenings to identify those with risk factors for cardiovascular disease, cancer, stroke and diabetes.” Those identified with such risk factors are to be referred to clinical services.
c. Section 4202(b) provides for an evaluation and plan for community-based prevention and wellness programs for Medicare beneficiaries to reduce their risk of disease, disability and injury by making healthy lifestyle choices, including exercise, diet and self-management of chronic diseases.
7. Does the law affect research on obesity?
a. The bill establishes a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research which compares the clinical effectiveness of medical treatments. This is effective on enactment.
b. Section 4301 provides for research on optimizing the delivery of public health services.
c. Section 399MM1 provides for studies of worksite health policies and programs. No part of such recommendations, data or assessments can be used to mandate requirements for workplace wellness programs.
d. Section 4402 also provides for effectiveness research of health and wellness programs for federal employees.
e. Under the reconciliation changes passed by the House of Representatives and on its way for approval by the Senate, the Administrator of the Centers for Medicare and Medicaid will identify the most cost-intensive services for Medicare which shall ‘inform’ research priorities within the Department of Health and Human Service to improve prevention, treatment or cure of such diseases and conditions.
8. What are the other parts of the bill affect obesity?
The Secretary of HHS is mandated to develop, within one month of passage, an education and outreach campaign regarding preventive health services. The campaign must address proper nutrition, regular exercise and obesity reduction. It is mandated that the Secretary develop a website for health care providers and consumers to provide science-based information on guidelines for nutrition, exercise, obesity reduction and specific chronic disease prevention. Another website is to be developed with a “personalized prevention plan tool. This would include determining individual disease risk, based in part on Body Mass Index.
a. Of particular value for persons with morbid obesity, Section 4203 provides for the removal of barriers to medical devices for individuals with disabilities. Under this provision, standards will be developed to ensure that medical diagnostic equipment used in physician’s offices, clinics, hospitals and other medical settings to ensure that the equipment is accessible to and usable by individuals with accessibility needs to allow independent entry to and use of such equipment.
b. Restaurants which are part of a chain of 20 or more locations doing business under the same name must disclose for ‘standard menu items’ the nutrient content including calories in the item with the suggested daily caloric intake on the menu as well as a drive-through menu board. Self-service items must also display the calorie information. Restaurants and others, such as vending machine operators, may voluntary register to be part of the program. Regulations must be issued within a year of enactment.
c. In some studies, breast-feeding has been found to be preventive for the development of obesity in the child. For breast-feeding women, employers with over 50 employees must a reasonable break time to express breast milk for one year after the child’s birth, each time the employee has a need to express the milk and a place, other than a bathroom that is shielded from view and free from intrusion. Employers need not provide compensation for such time.
d. The Secretary of Labor is authorized to set up a grant program for employer wellness programs. Behavioral change is encouraged which provides for altering employee healthy lifestyles through counseling, seminars, on-line programs or self-help materials. Obesity is specifically listed as a focus. Participation cannot be mandated or conditioned on obtaining a health insurance premium discount, rebate or other financial reward.
9. What is not in the bill?
A proposed tax on sugar-sweetened beverages is not in the legislation.
10. What next?
The bill is large and complex. Many issues, especially regarding inclusion of surgery and drugs in health benefit plans, be have to be resolved by regulations from the Department of Health and Human Services. For example, while the USPSTF recommendation for intensive behavioral counseling does not include frequency, intensity and duration. These will need to be specified.
The federal healthcare reform law, known as the Patient Protection and Affordable Care Act (PPACA), mandates 100 percent coverage—pre-deductible—for many preventive services. Beginning October 1, 2010, upon renewal,* employer health plans will be required to cover these designated preventive health services, as outlined by the federal Interim Final Regulations.
Regulations are based on recommendations from the following government organizations:
• U.S. Preventive Services Task Force
• U.S. Centers for Disease Control and Prevention
• Health Resources and Services Administration (HRSA)
Key points of the preventive healthcare services federal mandates:
• Preventive health services are defined as primary healthcare that is aimed at screening for and prevention of disease.
• Coverage must follow ongoing recommendations by the U.S. Preventive Services Task Force, Advisory Committee of Immunization Practices of the Centers for Disease Control and Prevention, and the Health Resources and Services Administration.
• New federal rules go into effect for plans that begin on or after September 23, 2010 as well as plans that renew on or after that date.
• Plans must offer coverage for newly recommended preventive services no later than one year after the recommendation is made by one of the above organizations.
• Cost sharing cannot be imposed on mandated preventive health services when those services are provided by an in-network provider.
• Cost sharing can be imposed on services provided by out-of-network providers.
• Grandfathered plans are exempt from these preventive services coverage requirements.
• When state law is more generous than the federal mandates when it comes to coverage for preventive services, state law takes precedence.
Top line changes in preventive healthcare services. The following preventive services are covered at 100 percent:
• Annual preventive health exams with associated screenings such as blood pressure, weight, BMI, etc.
• Children up to 30 months receive up to 11 well-baby visits at prescribed intervals.
• Prenatal visits and women’s annual exams including Pap smears and mammograms.
• Smoking cessation and nutritional counseling.
• Immunizations (BCBSRI already covers these at 100 percent) including administration.
• Colorectal screenings.
• Over-the-counter aspirin, folic acid, iron supplements, and smoking cessation medications.
Federally mandated preventive services from birth to age 18:
Full coverage for well-baby exams — birth to 30 months:
Well-baby exams at birth, 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months (11 visits). Infants discharged less than 48 hours after delivery need a visit two to four days after birth. These typically include advice about the child’s safety, health, nutrition, and development. These exams may also include immunizations and the following screenings:
• Hearing: For newborn and as the child’s healthcare provider advises
• Weight, length, and head circumference
• Hemoglobin or hematocrit: once between 9 and 12 months
• Lead testing at ages 1 and 2, unless lead exposure can be confidently excluded
• Age-appropriate developmental/behavioral assessments
Full coverage for annual well-child exams — ages 3 to 18 years:
Well-child exam should occur once a year for children ages 3 to 18. Well-child exams may include immunizations, discussions on health and wellness issues (nutrition, physical activity, healthy weight, injury prevention, avoidance of tobacco, alcohol and drugs, sexual behavior, dental health, mental health and second hand smoke) and the following screenings:
• Blood pressure
• Height, weight and body mass index (BMI) percentile-for-age
• Age-appropriate developmental/behavioral assessments
• Vision and hearing: at ages 12, 15, and 18 or as the child’s healthcare provider advises
• Chlamydia screening for sexually active females
• Age-appropriate developmental/behavioral assessments
Federally mandated preventive services for adults 19 and older:
• Annual preventive health exams with associated screenings such as blood pressure, weight, BMI, etc.
• Blood pressure screening
• Height, weight, and body mass index (BMI) screening
• Cholesterol screening (every five years from age 20-39) and yearly from age 40
• Counseling on health and wellness issues (nutrition, exercise, injury prevention, misuse of drugs and alcohol, tobacco cessation, second hand smoke, sexual behavior, dental health, and mental health)
• Hearing: as recommended by the healthcare provider
Colorectal cancer screening:
Beginning at age 50, screening recommendations include one of these six testing options:
• Fecal occult blood test each year
• Flexible sigmoidoscopy every five years
• Double-contrast barium enema every five years
• Colonoscopy every 10 years
• CT colonography may be an appropriate alternative to colonoscopy
• Clinical breast exam by healthcare provider every two to three years
• Cervical cancer screening beginning within three years of sexual activity or age 21 (whichever comes first); every two to three years ages 30 and older with three consecutive normal Pap tests
• Chlamydia test for sexually active women
• Osteoporosis: Bone density testing should begin no later than age 65; earlier screening may be appropriate for some women
• Abdominal aortic aneurysm: One time for ages 65 to 75 who have ever smoked
• Prostate cancer**
Preventive services for pregnant women:
Pregnant women will be covered for the following visits, tests, screenings, and immunizations:
• Initial visit with OB/GYN in the first trimester.
• Rubella immunity to identify women needing rubella vaccine after giving birth
• Rh(D) blood type and antibody testing; if Rh(D)negative, repeat testing at 26 to 28 weeks
• Hepatitis B
• Urinalysis as healthcare provider advises
• Education regarding diet and activity during pregnancy
• Education and counseling regarding tobacco and other substance avoidance
• Recommended immunizations
For more information on preventive services mandated by healthcare reform, please visit healthcare.gov, Medical Coverage Policies on the Provider section of BCBSRI.com, or contact your BCBSRI Account Representative.
February 18, 2011
People are generally more likely to pass on high-calorie food when there is a tax on it -- though it might not matter to everyone, a small study suggests.
In a computer-based experiment with 178 U.S. college students, researchers found that the students generally "bought" fewer lunchtime calories when sugary, high-fat fare came with a tax of 25 percent or more.
The exception was when calorie-conscious eaters were given calorie information on their lunch options; the tax did not seem to sway their decisions.
Junk food taxes and greater openness with calorie information have both been advocated as ways to help consumers limit their calories -- and, the hope is, keep their weight in the healthy range.
In the U.S., proponents of taxes on soda and junk food argue that it would not only discourage people from buying them, but could also help offset the estimated $147 billion cost of treating obesity-related ills.
Supporters also point to research suggesting that cigarette taxes have helped curb tobacco use.
Policies to require restaurants and other vendors to be frank with calorie information have made greater gains. In 2008, New York City became the first U.S. city to mandate that fast-food and coffee chains put calorie information on their menus. And in 2010, the federal healthcare reform law set national labeling requirements for certain restaurants and vending machines.
But just how effective such measures have been, or could be, is controversial. A study reported on Tuesday, for example, found that New York City's law has so far done little to change children and teenagers' eating habits at fast-food restaurants. The current study, reported in the American Journal of Clinical Nutrition, suggests that the effectiveness of junk food taxes might partly depend on whether calorie information is given or not -- and the customer's own calorie-consciousness.
For the study, researchers led by Dr. Janneke Giesen of Maastricht University in the Netherlands had 178 U.S. college students choose a hypothetical lunch from a computer menu on three separate occasions. Each time, the prices for high-calorie items -- like bacon cheeseburgers, brownies and chips -- were increased, first by 25 percent and then 50 percent. About half of the students were given calorie information at all lunches, while the rest were not.
Overall, Giesen's team found, students tended to order fewer calories when a junk food tax was in place. They curbed their average calorie intake by about 100 to 300 calories depending on the tax in place.
The only students who did not respond to the price increases were those who were already watching their diets and were given calorie information. They ate fewer calories than their peers without any food tax, and showed little change in their eating when taxes were added.
"The most important finding of our study is that a tax of 25 percent or more on (high-calorie) foods makes nearly everyone buy fewer calories," Giesen told Reuters Health in an email.
For people who are weight- and diet-conscious, calorie information might trump price, according to Giesen.
"However, if one wants to help people in general to prevent caloric overconsumption," the researcher said, "then our results indicate that imposing a high tax on (high-calorie) food items is much more efficacious."
A researcher not involved in the study noted that it had a number of limitations, including a small sample size.
Still, it jibes with larger experiments suggesting that food taxes might work, said Dr. Barry Popkin, a professor of nutrition at the University of North Carolina, Chapel Hill, who has studied the potential effects of junk food taxes on people's food choices.
In an email, he pointed to a recent study by Harvard researchers in which they added a 35-percent tax to sugary sodas sold in the cafeteria at Brigham & Women's Hospital in Boston. They found that sales of sugar-sweetened sodas dropped by 26 percent, and that people tended to replace those drinks with diet soda or coffee. In contrast, an educational campaign -- where signs were posted recommending that people cut back on sugary soft drinks -- failed to make a dent in sales.
According to Giesen, studies are still needed to see whether smaller tax increases -- something closer to 10 percent, which would be more politically viable -- influence people's buying habits.
Industry trade groups like the American Beverage Association and anti-tax activists like Americans Against Food Taxes (which has industry backing) argue that there is no evidence that junk food taxes will fight the U.S. obesity problem. They also assert that such taxes will only unduly burden low-income families.Maryland lawmakers are proposing a tax on specific snack foods to help fund an anti-obesity program for kids.
Savage Guilford Patch
March 11, 2011
Buying a bag of potato chips could soon help Maryland children get fit.
A group of Maryland lawmakers has proposed taxing certain snack foods to help fund the Maryland Combating Childhood Obesity Grant Program, which would provide grants for organizations fighting obesity, keeping children active and teaching them about healthy eating.
“Childhood obesity is a growing problem, not just in Maryland but across the United States,” said Del. Jay Walker, a Prince George’s County Democrat who sponsored the bill to create the program.Lack of exercise and consumption of unhealthy foods, like snack items, contribute to the problem, he said.
Opponents of the bill say they support efforts to fight childhood obesity – just not a 6 percent sales tax on specific snacks.
“There’s no such thing as a good food or bad food,” said Jim McCarthy, president of the Snack Food Association, an international trade association. “There are good diets and bad diets.”The Bill
House Bill 716 calls for creation of the Maryland Combating Childhood Obesity Grant Program. To help fund the program, the bill also imposes the state’s 6 percent sales tax on potato chips and sticks, corn chips, pretzels, cheese puffs and curls, pork rinds, extruded pretzels and chips, popped popcorn, nuts and edible seeds and specified snack mixtures.
The state taxed these snacks through retail sales from 1992 until 1997, when the General Assembly repealed the tax. The snacks have not been taxed in area grocery stores or vending machines since.
Fruits and vegetables purchased in grocery stores are not taxed in the state, but items like candy and ice cream sold in containers of less than one pint are.
As written, the bill calls for 40 percent of the sales tax generated annually to go to the fund. The remaining 60 percent would go to the state’s general fund.
But during a hearing last month before the House Health and Government Operations Committee, Walker said he would change the percentage to an overall dollar amount of about $10 million. Walker said he is also willing to change some of the snacks up for the tax, including the nuts and edible seeds listing, as well as snack mixtures like trail mix.
“I’m not trying to treat the snack industry unfairly,” he said. “To do nothing is irresponsible.”State Sen. Bill Ferguson, a Baltimore city Democrat who sponsored a similar bill on the Senate side, agreed. Ferguson, who taught U.S. history and government in a Baltimore City high school, recalled mornings when students ate four bags of chips for breakfast.
“How is a child supposed to learn when that’s a daily nutrition staple for them?” he asked. “Essentially, we subsidize snack food in Maryland.”Still, potato chips are not the enemy, many food retailers say. Potato chips have both Vitamin C and potassium, said McCarthy.
“It’s become popular for legislators to quickly identify something they deem as unhealthy without really looking into it,” he said.During the House hearing, McCarthy questioned why certain snacks were identified for the tax and not other high-end snacks like brie cheese and foie gras.
“We don’t support singling out any kinds of foods for taxation,” he said.Growing Population
According to First Lady Michelle Obama’s Let’s Move Campaign, childhood obesity rates have tripled in the United States over the past three decades. The campaign started in 2010 to solve childhood obesity within a generation.
In Maryland, almost 30 percent of Maryland children ages 10 to 17 are overweight, according to a study published last year in the Archives of Pediatric and Adolescent Medicine. About 13 percent are obese. That’s compared to 32 percent and more than 16 percent nationwide.
The study defines overweight as having a body mass index above the 85th percentile for a child’s age and sex, while obese is having a body mass index above the 95th percentile. Children who are overweight and obese are at higher risk for heart disease, Type 2 diabetes, asthma and sleep apnea.
There are many programs throughout the state that can fight these statistics, said Jon Kaplan, executive director of Baltimore Fitness Academy, a non-profit organization that educates and mentors urban teens and young adults in health, fitness and nutrition. They just need funding to do it, he said.
Kaplan supports the grant program, as well as the tax that goes with it.
“Given the fact that we used to have a snack tax, I am in favor of it,” he said. “I feel we need to do something to help with our statewide budget deficit, and this is a way that can help.”
September 30, 2009
Despite opposition from more than 50 health groups, the Finance Committee approved an amendment Wednesday allowing employers to increase premiums by up to 50 percent for people who engage in unhealthy behaviors.
That means smokers, obese individuals and others may face higher premiums if they do not participate in wellness programs.
Sen. John Ensign (R-Nev.) and Sen. Tom Carper (D-Del.) described their amendment as a common-sense measure aimed at providing a financial incentive for people to change unhealthy behaviors.
But opponents – which included four Democratic senators and groups such as the American Cancer Society, American Heart Association and the AFL-CIO — said it allows insurers and self-insured businesses to continue to base coverage decisions on preexisting conditions, which the underlying bill would prohibit.
“While we appreciate the amendments’ intent to encourage healthy behaviors, we believe that allowing employers to vary premiums by up to 50 percent of the total cost of employee coverage could lead to discriminatory practices and make health coverage unaffordable for those who need it the most,” the groups signed in a joint letter.Currently, employers can vary premiums by 20 percent, the letter stated.
Sen. Mike Enzi (R-Wyo.) said the Health, Education, Labor and Pensions Committee adopted a similar bipartisan amendment by unanimous consent during its markup in July, but the language has since “unilaterally changed.”
“My colleagues were never consulted and the Democratic majority staff removed it,” Enzi said. “We had to discover it on our own. I hope it will get into this bill so it will be considered in a merged bill.”
September 16, 2011
Chicago Mayor Rahm Emanuel is giving city workers an important health choice: enroll in a new wellness plan, expected to be unveiled Friday, or pay a higher premium. The price if they don't enroll: $50 a month.
The program includes an initial screening that focuses on preventative care for asthma, heart disease and diabetes. City employees would then receive wellness training to achieve long-term health goals, including weight loss.
Smokers wouldn't be penalized, but they would be encouraged to quit. Advisers overseeing the program will monitor progress on a bimonthly basis, and those who reach their goals could see their health care premiums reduced.
"We will help you be a good steward for your health," Emanuel said Friday, "but if you choose not to, you'll pay that price and that is the price you'll have to pay."
The mayor believes the program will help cut the annual $500 million bill for health care for city employees.
"We are going to implement a citywide wellness plan for city employees," Emanuel confirmed at a recent press conference, "because health care costs for the city are being driven by 10 percent a year, and we're not seeing revenue grow that way."
Most city unions have signed on to the agreement, according to the Chicago Sun-Times, except the Fraternal Order of Police, which represents more than 10,000 city employees.
The FOP says its members have different health concerns and it doesn't want members to pay higher premiums if they decide not to enroll in the program.
But Emanuel says the program is a necessary step to getting healthcare costs under control.
"You can't ask the taxpayers to pay for a healthcare problem that you can manage and do a good job," Emanuel said. "You can do that with cholesterol, you can do that through diabetes, you can do that through smoking, through heart, blood pressure. Every one of those is manageable."One of the latest rumors to circulate on the internet about the Obamacare nightmare is that it will require all Americans to undergo BMI (Body Mass Index) screening by 2014. Presumably, the BMI results will be used to ration health care in some manner as finite numbers of doctors, nurses, and hospitals struggle to cope with unlimited demand for their services. A document named HIT (Health Information Technology) Standards purports to show Secretary Kathleen Sebelius’ new certification standards for electronic health records (EHRs). Further, the stimulus bill states that the National Coordinator shall “update the Federal Health IT Strategic Plan” with “utilization of an electronic health record for each person in the United States by 2014.” This constituted the basis for Sebelius’ new EHR standard. On page 61 in The Code of Federal Regulations Part 170 it states that EHRs will calculate BMIs. An additional document refers to certification criteria for EHRs and specifically shows that BMI will be part of the vital signs included in EHRs. Therefore, it appears that the rumor is true as far as the claims that Obamacare will require an EHR for all Americans and that the EHR will be required to include a calculation for BMI. - Healthcare Reform Law Mandates Biometric Screening and Electronic Health Records by 2014
March 2, 2011
My spouse has worked for the same company for the past 15 years. The company seems to be forcing the issue of a biometric health screening. Under the heading of “Is this mandatory?” it says..
"For salaried employees, in order to participate in the 2010 Medical Plans you are required to go through the on-site biometric screen process, and the online Health Risk Assessment. If a salaried employee chooses not to participate in either the Biometric Screen, or the online Health Risk Assessment, they will not be eligible for 2010 Medical Insurance, and you will receive COBRA notification to your home if you were previously participating in the medical plans."Is this crap legal? Can a company terminate your insurance for not completing this so called health assessment?
Yes. Welcome to the wonderful world of risk-based, profit-driven health coverage.
A company has no legal duty to give insurance at all, generally. In states where it does it MAY be illegal (for companies of a certain size) but I’m pretty sure you would have to take it to court, and the government wants EVERYONE’s private records online, 4th amendment or not (look at Obamacare); so I think you’d have a hard time with it. Is there an implication you won’t be covered if you have preexisting conditions? Because if that is the case, it may not satisfy legal standards IF there are legal standards. Note that there often are not, particularly for small companies.
July 19, 2010
One of the latest rumors to circulate on the internet about the Obamacare nightmare is that it will require all Americans to undergo BMI (Body Mass Index) screening by 2014. Presumably, the BMI results will be used to ration health care in some manner as finite numbers of doctors, nurses, and hospitals struggle to cope with unlimited demand for their services.
To find the truth, I examined the full text of HR 3590, The Patient Protection and Affordable Care Act, as well as its companion bill HR 4872, the Health Care and Education Reconciliation Act. This takes some time, even scanning with the search function on a browser, since the HR 3590 contains a whopping 906 pages and HR 4872 adds an additional 55 pages. That is quite a number of dead trees for a law that is supposed to simplify and lower the cost of health care.
I conducted my examination by searching both documents for “bmi.” This resulted in a large number of hits, but only two referred to “Body Mass Index.” The majority were some form the word “submit,” which says a lot about Obamacare in itself.
- The first reference is in section 2703 State Option to Provide Health Homes for Enrollees with Chronic Conditions on page 203. BMI is mentioned here as one of the medical conditions that defines the term “chronic condition” (specifically a BMI over 25). There is no mention of mandatory screening for BMI.
- The second reference to BMI was in section 4004 Education Outreach Campaign Regarding Preventive Benefits on page 428. In this section, BMI is mentioned as one of the factors that people will use to determine their disease risk on a website. Again, there is no mention of mandatory BMI screening.
The second bill, HR 4872, contained several references to “submit,” but no references to Body Mass Index.
At this point, I was ready to declare the mandatory BMI screening a hoax.
Just before I published this article, however, someone pointed me in the direction of a document called HIT (Health Information Technology) Standards 170.302. This document purports to show Secretary Kathleen Sebelius’ new certification standards for electronic health records (EHRs). Further, a CNS News report (http://cnsnews.com/news/article/69436) refers to section 3001 Office of the National Coordinator for Health Information Technology of the American Recovery and Reinvestment Act of 2009, the stimulus bill, rather than the Obamacare law itself.
Section 3001 in Part C Duties of the National Coordinator Subpart 3 paragraph (a) (ii) states that the National Coordinator shall “update the Federal Health IT Strategic Plan” with “utilization of an electronic health record for each person in the United States by 2014.” This constituted the basis for Sebelius’ new EHR standard.
On page 61 (of 228) in The Code of Federal Regulations Part 170 (http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf) it states that EHRs will calculate BMIs. An additional document (http://healthcare.nist.gov/docs/170.302.e.2_BMI_v0.2_fulldoc.pdf) refers to certification criteria for EHRs and specifically shows that BMI will be part of the vital signs included in EHRs.
Therefore, it appears that the rumor is true as far as the claims that Obamacare will require an EHR for all Americans and that the EHR will be required to include a calculation for BMI. The speculative claim that the BMI will be used to ration health care is so far unsubstantiated. I will leave it up to the reader to decide whether and how much to be alarmed by the BMI requirement.
I will say that it is extremely likely that Obamacare will result in health care rationing. Massachusetts enacted what President Obama called an “essentially identical” plan in 2006 and the result has been skyrocketing costs (http://bit.ly/dvTxyU). Rapidly increasing demand with a static level of supply led to sharply increasing costs. To deal with these increasing costs, Governor Deval Patrick enacted price controls in the form of denying insurance companies to increase rates.
Jon Kingsdale, who directed in Massachusetts’ version of Obama’s health insurance exchanges, said recently,
"If you're going to do health-care cost containment, it has to be stealth. It has to be unsuspected by any of the key players to actually have an effect."He further stated that:
The solution to the problem was finding a “significant systematic way of pushing back on the health-care system and saying, 'No, you have to do with less'” (http://bit.ly/dvTxyU).In other words, the government will have to quietly ration care.
This shows the ultimate importance of efforts to defeat Obamacare. If you value your health care, vote for candidates who will repeal and defund the new law. Also support state and local candidates who will support efforts such as the lawsuit by Georgia and several other states against the law.
Reform the reform!
October 26, 2008
Onsite Employee Health Screening and Biometric Testing means better heath risk assessment baselines and better security
“Onsite Employee Health Screening and Biometric Testing” is a hot phrase these days, but it can help your workers with health management, too. When the pundits talk about Onsite Employee Health Screening and Biometric Testing, they’re usually referring to retinal scanners, fingerprint readers, and other high-tech security measures. However, if you trace the phrase “Onsite Employee Health Screening and Biometric Testing” back to its roots, it refers to the measurement of unique human physical and behavioral characteristics.
Corporate Health Promotion Programs are of critical importance to the modern business. As a result, Onsite Employee Health Screening and Biometric Testing should be one of the tools in the arsenal of a forward-thinking organization.
Onsite Health Screening and Biometric Testings aren’t just a “feel-good” measure for your employees. Assessments of employee health help your workers to prioritize their well-being, which results in happier, more productive employees.
Health risk assessments also build your database of employee biometric data.
Onsite Employee Health Screening and Biometric Testing, when handled worksite by our experienced professionals, is hassle-free and smoothly organized. The biometric data we collect then can be stored digitally for years or even decades, helping you and your workers build better health risk assessment baselines that you can use to analyze workers fitness and the efficacy of your corporation’s Health and Productivity Programs. Collected biometric data can even allow an employee’s doctor to assess that individual’s health over many years, helping him or her spot trends and diagnose disease.
Onsite Employee Health Screening and Biometric Testing extends to a wide variety of health risk tests, including measurements of blood pressure, blood type, body fat, substance abuse, and susceptibility to cardiovascular disease. Collecting biometric data for security purposes – like fingerprints, facial recognition imprints, or hand geometry – can be dovetailed with our health tests to minimize workflow disruption.
March 28, 2011
A biometric screening is a short health examination that determines the risk level of a person for certain diseases and medical conditions. Many employers and universities encourage staff or students to complete this type of health screening so they can start thinking about their health and pursue treatment if needed.
A biometric screening is a general health check that can identify any significant cardiovascular or nervous system problems. This health check provides several biometric measures including: cholesterol levels for full lipid panel and glucose; blood pressure; blood glucose levels and also includes a measurement of height, weight and body mass index (BMI). Results are typically available within a few days after the screening, and are kept confidential.
The biometric screening can be one of several components of a complete health and wellness check. Most doctors and clinics perform a biometric screening as part of a wellness program that includes the completion of a health risk assessment (HRA) questionnaire, and a consultation. Results of the biometric screening can help to identify various diseases or health problems, and allow the patient to work with their physician to lower their health risks for certain conditions.
The typical biometric screening test can take up to 15 minutes, and is performed at a physician's clinic, or on site at an employment facility or college campus. It can consist of all or some of the following screening tests: carotid artery ultrasound screening; blood pressure check; blood draw; diabetes screening; and cholesterol screening.
The blood pressure screening is completed with a standard blood pressure check. The blood test is conducted by drawing a vial of blood; patients are required to fast for a short period of time before having blood drawn. The diabetes screening is performed by measuring glucose levels in the blood from the blood test. The cholesterol screening is performed with a "finger-stick" test that measures full lipid and glucose levels. The carotid artery ultrasound test determines the risk factor of having a stroke. This test measures how much plaque has accumulated in the arteries.
Biometric screenings allow the patient to learn about her current health status, and determine her risk for common diseases including diabetes, heart disease, asthma and other medical conditions. The physician or nurse conducting the tests can review the results of the screening with patients and follow up to do further tests, or recommend a treatment plan or wellness program based on immediate needs.