DOCSLIB.ORG

Potential Impact of the Affordable Care Act on the Ryan White HIV/AIDS Program

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Potential Impact of the Affordable Care Act on the Ryan White HIV/AIDS Program Potential Impact of the Affordable Care Act on the Ryan White HIV/AIDS Program Final Report November 29, 2012 Margaret Hargreaves Vanessa Oddo Ann Bagchi Boyd Gilman Contract Number: Potential Impact of the HHSH250200646027I/HHSH25034007T Affordable Care Act on the Ryan Mathematica Reference Number: White HIV/AIDS Program 06993.800 Submitted to: Final Report Department of Health & Human Services Health Resources & Services November 29, 2012 Administration 5600 Fishers Lane Parklawn Building, Room 7C-07 Margaret Hargreaves Rockville, MD 20857 Vanessa Oddo Contracting Officer Technical Ann Bagchi Representative: Alice Litwinowicz Boyd Gilman Submitted by: Mathematica Policy Research 955 Massachusetts Avenue Suite 801 Cambridge, MA 02139 Telephone: (617) 491-7900 Facsimile: (617) 491-8044 Project Director: Margaret Hargreaves ACKNOWLEDGMENTS We wish to acknowledge and thank the many individuals who contributed to all aspects of this project, including this final report: Margaret Hargreaves, Ann Bagchi, Vanessa Oddo, Boyd Gilman, Debra Lipson, Margo Rosenbach, and Alexandra Clifford (Mathematica) and Deborah Bachrach (Manatt Health Solutions). In addition, we acknowledge and thank the many experts who participated in this project, as well as the state Medicaid agency and Ryan White HIV/AIDS program managers and administrators from Colorado, Iowa, Maryland, Massachusetts, New York, Oregon, and Texas. Last, we wish to thank our HRSA contracting officer technical representative, Alice Litwinowicz, for her guidance and support throughout the project. iii This page has been left blank for double-sided copying. CONTENTS EXECUTIVE SUMMARY ................................................................................... xi I INTRODUCTION ............................................................................................. 1 A. Study Goals, Methods, and Conceptual Framework .................................. 1 1. Project Methods ................................................................................ 1 2. Conceptual Framework ...................................................................... 1 B. Study Context ......................................................................................... 2 1. HIV/AIDS Epidemic ............................................................................ 2 2. Ryan White HIV/AIDS Program ........................................................... 3 3. Affordable Care Act Provisions .......................................................... 4 4. ACA Implementation Timeline ........................................................... 5 5. State ACA Early Implementation Experiences ..................................... 5 II HEALTH INSURANCE ELIGIBILITY AND EXCHANGES ......................................... 9 A. Introduction ............................................................................................ 9 B. Eligibility Reforms ................................................................................... 9 1. Guaranteed Issue and PCIPs .............................................................. 9 2. Individual Insurance Mandate and Exemptions ................................ 11 3. Expansion of Medicaid Eligibility ..................................................... 12 3. Eligibility Recommendations ............................................................ 16 C. Health Insurance Exchanges .................................................................. 17 1. Creation of Affordable Insurance Exchanges .................................... 17 2. ACA Citizenship Requirements ........................................................ 22 3. Exchange Recommendations ........................................................... 23 III INSURANCE BENEFITS AND COSTS ................................................................ 24 A. Introduction .......................................................................................... 25 B. Insurance Benefits ................................................................................. 25 1. Essential Health Benefits and Benchmark Plans ................................ 25 2. Basic Health Plan ............................................................................. 29 3. Benefit Recommendations ............................................................... 31 C. Insurance Costs ..................................................................................... 32 1. Private Insurance Tax Credits and Cost Sharing Reductions ............. 32 2. Preventive Service Cost Sharing ....................................................... 34 3. Medicare Part D Donut Hole ............................................................ 36 4. Cost Recommendations ................................................................... 37 v Contents Mathematica Policy Research IV SERVICE DELIVERY AND PAYMENT REFORMS ................................................. 39 A. Introduction .......................................................................................... 39 B. Integrated Models of Care ..................................................................... 39 1. Medicaid Managed Care .................................................................. 39 2. Patient-Centered Medical Homes and Medicaid Health Homes ............................................................................................ 41 3. HIV Workforce Capacity ................................................................... 44 4. Service Delivery Recommendations .................................................. 46 C. Provider Payment Reforms ..................................................................... 47 1. Medicaid Provider Reimbursement Rates ......................................... 47 2. Other Integrated Payment Reforms .................................................. 49 3. Payment Recommendations ............................................................. 51 V RECOMMENDATIONS .................................................................................... 53 A. Introduction .......................................................................................... 53 1. Transition Leadership ...................................................................... 53 2. Collaborative Transition Planning .................................................... 54 3. Education and Technical Assistance................................................. 55 4. Future Role for RWHAP .................................................................... 56 B. Conclusions........................................................................................... 56 REFERENCES ................................................................................................. 64 APPENDIX A: STUDY METHODS ....................................................................A.1 APPENDIX B: SEVEN STATE SAMPLE: ACA IMPLEMENTATION EXPERIENCES ............................................................................................... B.1 APPENDIX C: INSURANCE ELIGIBILITY AND EXCHANGES ................................C.1 APPENDIX D: INSURANCE BENEFITS AND COSTS .......................................... D.1 APPENDIX E: PROVIDER SERVICE DELIVERY AND FUNDING REFORMS ............ E.1 vi TABLES II.1 Eligibility Recommendations ........................................................................ 16 II.2 Exchange Recommendations ....................................................................... 23 III.1 Benefit Recommendations ........................................................................... 31 III.2 Cost Recommendations ............................................................................... 37 IV.1 Service Delivery Recommendations .............................................................. 47 IV.2 Payment Recommendations ......................................................................... 52 V.1 ACA Recommendations and Potential Implementers .................................... 58 A.1 Technical Expert Consultation Participants ..................................................A.5 A. 2 HRSA/HAB Potential Impact of ACA Study: States Selected For Medicaid Program Discussions ....................................................................A.8 B.I.1 Seven State Sample: Early ACA Implementation Experiences ........................ B.3 B.I.2 Seven State Sample: Coordination with RWHAP and Other Stakeholders ............................................................................................... B.7 B.II.1 Seven State Sample: Pre-Existing Condition Insurance Plans ........................ B.9 B.II.2 Seven State Sample: Expansion of Medicaid Eligibility ............................... B.11 B.II.3 Seven State Sample: Creation of Health Insurance Exchanges .................... B.13 B.III.1 Seven State Sample: Essential Health Benefits and Benchmark Benefits .................................................................................................... B.17 B.IV.1 Seven State Sample: Integrated New Models of Care .................................. B.19 B.IV.2 Seven State Sample: Provider Capacity Issues ............................................ B.21 B.IV.3 Seven State Sample: Provider Reimbursement Rates .................................. B.23 C.1 Guaranteed Issue and Pre-Existing Condition Insurance Plan .......................C.3 C.2 Individual Mandate and Exemptions ............................................................C.5 C.3 Expansion of Medicaid Eligibility .................................................................C.7
Load more

Recommended publications
  • View the Ryan White HIV/AIDS Program
    F:\COMP\PHSA\PHSA-MERGED.XML 1351 PUBLIC HEALTH SERVICE ACT Sec. 2602 PUBLIC HEALTH SERVICE ACT [As Amended Through P.L. 114–113, Enacted December 18, 2015] øReferences in brackets ø¿ are to title 42, United States Code¿ TITLE XXVI—HIV HEALTH CARE SERVICES PROGRAM 1 PART A—EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES 2 Subpart I—General Grant Provisions SEC. 2601. ø300ff–11¿ ESTABLISHMENT OF PROGRAM OF GRANTS. (a) ELIGIBLE AREAS.—The Secretary, acting through the Ad- ministrator of the Health Resources and Services Administration, shall, subject to subsections (b) through (c), make grants in accord- ance with section 2603 for the purpose of assisting in the provision of the services specified in section 2604 in any metropolitan area for which there has been reported to and confirmed by the Director of the Centers for Disease Control and Prevention a cumulative total of more than 2,000 cases of AIDS during the most recent pe- riod of 5 calendar years for which such data are available. (b) CONTINUED STATUS AS ELIGIBLE AREA.—Notwithstanding any other provision of this section, a metropolitan area that is an eligible area for a fiscal year continues to be an eligible area until the metropolitan area fails, for three consecutive fiscal years— (1) to meet the requirements of subsection (a); and (2) to have a cumulative total of 3,000 or more living cases of AIDS (reported to and confirmed by the Director of the Cen- ters for Disease Control and Prevention) as of December 31 of the most recent calendar year for which such data is available.
    [Show full text]
  • Ryan White HIV/AIDS Program
    Ryan White HIV/AIDS Program Part B Manual U.S. Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau Revised 2015 Ryan White HIV/AIDS Program Part B Manual—Revised 2015 Preface The Ryan White HIV/AIDS Program (RWHAP) Part B Manual is for RWHAP Part B Program Directors and staff and others interested in the RWHAP Part B Program. The Ryan White HIV/AIDS Program is administered in the Federal government by the Health Resources and Services Administration (HRSA), an Operating Division within the U.S. Department of Health and Human Services (HHS). The RWHAP Part B Program awards grants to assist States and Territories in developing and/or enhancing access to a comprehensive continuum of high quality HIV care and treatment for low-income people living with HIV (PLWH). Each State and Territory operates a RWHAP Part B program, including an AIDS Drug Assistance Program (ADAP). RWHAP Part B programs, as well as the ADAPs, vary significantly in their administrative structures and the mechanisms used to ensure access to HIV care and to make HIV/AIDS medications available to eligible individuals living with HIV. This Manual is designed to serve as: • An orientation guide for new RWHAP Part B staff, with sections explaining how the RWHAP Part B and ADAPs are structured at the Federal and State level, and the key issues and strategies used by the RWHAP Part B and ADAPs to broaden access to HIV/AIDS care and treatment to persons in need. • A reference document for RWHAP Part B staff on legislative and program requirements.
    [Show full text]
  • Ryan White CARE Act, Donna Elaine Sweet, MD, MACP, AAHIVS the Nation Embarks on Historic E Xecutive Director Health Care Reform James Friedman, MHA by HOLLY A
    The AmericAn AcAdemy of HiV medicine HIV® S p ecIalist Ryan Patient Care, PraCtiCe ManageMent & Professional Development inforMation for HIV Care ProviDers Summer 2010 www.aahivm.org White Lives Saved, the Battle Continues 340B Pharmacies 3 Health Care Reform & HIV 4 National HIV/AIDS Strategy 8 Deborah Parham Hopson 11 By JaMes M. friedman, MHa, ExEcutivE dirEctor, aahivm LetteR fRom tHe DIR e c t OR Secretary Sebelius and President obama making a Commitment to the HIV Workforce n June, Health and Human Services panded routine testing, is a recipe for disaster. (HHS) Secretary Kathleen Sebelius and Additionally, the anticipated influx of patients Health Resources and Services Admin- resulting from the implementation of many of istration Administrator Mary Wakefield the health reform provisions in 2014 must be Iannounced a one-time investment of $250 mil- met with new and qualified providers. lion to strengthen the primary care workforce. HIV/AIDS workforce continues to be a This new money came from a $500 million high policy priority for the Academy. We have Prevention and Public Health Fund which was engaged Congress and advocated for the ex- a part of the new health reform law that passed pansion of the National Health Service Corps, this year (The Patient Protection and Afford- James Friedman and are pleased to see that the new health re- able Care Act). This investment is not to be confused with form law provides for growth in both funding and capacity the $1.3 billion authorized over five years for the National of the Corps in the future —a move that will certainly help Health Service Corps (also in the health reform bill), or the increase the number of HIV practitioners.
    [Show full text]
  • Statement on the Anniversary of the Founding of Turkey Remarks On
    Oct. 30 / Administration of Barack Obama, 2009 democracy, and our people have forged a and our country, and they continue to play a strong and lasting partnership that is grounded key role in shaping the direction of our Nation. in these shared values. Czech Americans trace their roots back to before our country was NOTE: This statement was released by the Of- founded, they have enriched our communities fice of the Press Secretary on October 30. Statement on the Anniversary of the Founding of Turkey October 29, 2009 The people of the United States join the come many shared challenges. Turkish Ameri- people of Turkey in celebrating the anniversa- cans help to forge the bonds that join our na- ry of the founding of the Republic of Turkey. tions in friendship, and they continue to con- The friendship between our nation is strong, tribute to our society in a wide range of field, and our alliance is enduring. More than 50 including arts, athletics, education, business, years ago, the United States and Turkey began medicine, and science. a partnership based on shared values and mu- tual respect, a partnership and friendship that NOTE: This statement was released by the Of- has deepened over the years as we have over- fice of the Press Secretary on October 30. Remarks on Signing the Ryan White HIV/AIDS Treatment Extension Act of 2009 October 30, 2009 The President. Good morning, everybody. contracted HIV/AIDS from a transfusion. Audience members. Good morning. Doctors assured people that Ryan White The President. We often speak about AIDS posed no risk to his classmates or his commu- as if it’s going on somewhere else, and for nity, but ignorance was still widespread.
    [Show full text]
  • Alabama's Ryan White Part B Program Eligibility Standard
    Alabama’s Ryan White Part B Program Eligibility Standard PURPOSE This document establishes guidelines to determine eligibility of persons seeking services through Alabama’s Ryan White HIV/AIDS Part B and the State’s AIDS Drug Assistance Program (ADAP). This policy is binding to all organizations awarded Ryan White HIV/AIDS Part B funding through the Alabama Department of Public Health (ADPH). PROGRAM AUTHORITY The authority for this policy is the Ryan White HIV/AIDS Treatment Modernization Act of 2009, Public Health Service (PHS) Act under Title XXVI, as administered through the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), and the Division of Service Systems (DSS). The Alabama Department of Public Health (ADPH) is the State’s Ryan White HIV/AIDS Part B Program Recipient. As the official recipient of Ryan White HIV/AIDS Part B program funds, the ADPH is responsible for administering all aspects of the program and compliance to legal requirements. Authority to administer the Ryan White HIV/AIDS Part B Program is delegated by the ADPH to the State’s HIV/AIDS and Prevention Division as the Program Recipient. SOURCE CITATIONS The following policies and regulations are sources used in the development and or requirements stated in Alabama’s Client Eligibility Standard. Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, (HAB) Division of Service Systems Universal Monitoring Standards Part A and B, April 2013 HIV funds are intended to support HIV related needs of only eligible individuals. HRSA Policy Notice – 16-02, February 4, 2016 will replace HRSA Policy Notice 10-02 in FY 17.
    [Show full text]
  • Fighting the Aids Epidemic of Today: Revitalizing the Ryan White Care Act
    S. HRG. 109–409 FIGHTING THE AIDS EPIDEMIC OF TODAY: REVITALIZING THE RYAN WHITE CARE ACT HEARING OF THE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS UNITED STATES SENATE ONE HUNDRED NINTH CONGRESS SECOND SESSION ON EXAMINING REAUTHORIZATION OF THE RYAN WHITE CARE ACT RELATING TO FIGHTING THE AIDS EPIDEMIC OF TODAY MARCH 1, 2006 Printed for the use of the Committee on Health, Education, Labor, and Pensions ( U.S. GOVERNMENT PRINTING OFFICE 26–427 PDF WASHINGTON : 2006 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 VerDate 0ct 09 2002 14:46 Jun 09, 2006 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 S:\DOCS\26427.TXT SLABOR3 PsN: DENISE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS MICHAEL B. ENZI, Wyoming, Chairman JUDD GREGG, New Hampshire EDWARD M. KENNEDY, Massachusetts BILL FRIST, Tennessee CHRISTOPHER J. DODD, Connecticut LAMAR ALEXANDER, Tennessee TOM HARKIN, Iowa RICHARD BURR, North Carolina BARBARA A. MIKULSKI, Maryland JOHNNY ISAKSON, Georgia JAMES M. JEFFORDS (I), Vermont MIKE DEWINE, Ohio JEFF BINGAMAN, New Mexico JOHN ENSIGN, Nevada PATTY MURRAY, Washington ORRIN G. HATCH, Utah JACK REED, Rhode Island JEFF SESSIONS, Alabama HILLARY RODHAM CLINTON, New York PAT ROBERTS, Kansas KATHERINE BRUNETT MCGUIRE, Staff Director J. MICHAEL MYERS, Minority Staff Director and Chief Counsel (II) VerDate 0ct 09 2002 14:46 Jun 09, 2006 Jkt 000000 PO 00000 Frm 00002 Fmt 0486 Sfmt 0486 S:\DOCS\26427.TXT SLABOR3 PsN: DENISE CONTENTS STATEMENTS WEDNESDAY, MARCH 1, 2006 Page Enzi, Hon.
    [Show full text]
  • HIV/AIDS Recommendations for the Obama Administration
    HIV/AIDS Recommendations for the Obama Administration HIV/AIDS Recommendations for the Obama Administration The following documents are being submitted on behalf of and with input from national, state and local organizations representing persons infected and affected by HIV/AIDS, including minority communities, gay men, women, HIV medical providers, HIV housing providers, AIDS service organizations, state AIDS programs, and AIDS legal advocates. We welcome the incoming administration and are encouraged by President Obama’s strong statements in support of working to end the HIV/AIDS epidemic in the United States including the creation of a National AIDS Strategy. The following pages outline very specific actions that the new Administration can take to address the domestic HIV epidemic. Much of the work in this document has taken place in coalition with organizations from AIDS in America, the Federal AIDS Policy Partnership, and others who have worked in support of the National AIDS Strategy. We particularly wish to thank members of the various Federal AIDS Policy Partnership Work Groups who were involved in creating the Section 1 specific recommendations. A tremendous amount of work on this document took place in a short period of time and we are appreciative. Finally, we are pleased to offer our assistance to President Obama and his administration as you work to improve the federal government’s response to the domestic HIV/AIDS epidemic. Table of Contents: The following binder represents the combined efforts of HIV/AIDS community leaders to offer recommendations for actions relating to the HIV/AIDS epidemic that can be taken by the next Administration.
    [Show full text]
  • Smart in Your World
    Smart In Your World It’s More Than a Tag Line Arent Fox Is Arent Fox Is Giving Back Giving Back On October 30, 2009, President Barack Obama entered the Diplomatic Reception Room in the White House to sign the Ryan White HIV/AIDS Treatment Extension Act of 2009 into law. Standing beside the President as he signed Upon President Obama signing the bill into the bill was Jeanne White-Ginder, the mother law, Jon Bouker, who is co-manager of Arent of Ryan White, the courageous youth who, Fox’s government relations practice, reflected after contracting HIV through blood-based on the firm’s role in helping secure passage of products used to treat his hemophilia, had the legislation. “Just weeks after Ryan passed become the nation’s leading voice urging an away in 1990, Sen. Ted Kennedy, who intro- end to discrimination against those with AIDS. duced the original Ryan White Care Act, spoke to his Senate colleagues as they prepared to In signing the legislation, the President autho- vote on the legislation, ‘This courageous young rized a four-year extension of the Ryan White man, stricken with a terminal illness, first fought Program, the largest federal program specifically against unfounded fears and prejudice in his dedicated to providing HIV care and treatment. attempt to continue going to school with his Since its creation in 1990, following Ryan’s peers. Then through his tireless efforts he sought death earlier that year from an AIDS-related to educate and explain the realities of his illness. respiratory infection, the program has assisted Such courage for a young man.
    [Show full text]
  • Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS
    Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS Todd Blum Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Medicine and Health Sciences Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Todd Blum has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. David Segal, Committee Chairperson, Health Services Faculty Dr. Shari Jorissen, Committee Member, Health Services Faculty Dr. Simone Salandy, University Reviewer, Health Services Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Comparison of Affordable Care Act and Ryan White Coverage on Treatment Compliance, Engagement, Affordability, and Health Status for People Living with HIV/AIDS by Todd Blum MHA, Georgia State University, 1996 MBA, Georgia State University, 1995 BSM, Tulane University, 1993 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Sciences Walden University August 2020 Abstract The Ryan White HIV/AIDS Program (RWHAP) provides HIV care to uninsured people living with HIV/AIDS (PLWHA).
    [Show full text]
  • AIDS.Gov 30 Years of HIV/AIDS Timeline
    A TIMELINE OF HIV/AIDS • June 5: The U.S. Centers for Disease Control and an article entitled “Rare Cancer Seen in 41 Prevention (CDC) publish a Morbidity and Mortality Homosexuals.” At this point, the term “gay cancer” 1981 Weekly Report (MMWR), describing cases of a rare enters the public lexicon. lung infection, Pneumocystis carinii pneumonia • September 21: The nation’s first Kaposi’s Sarcoma (PCP), in five young, previously healthy, gay men clinic opens at the University of California, San in Los Angeles. All the men have other unusual Francisco Medical Center. infections as well, indicating that their immune systems are not working; two have already died by • December 10: Bobbi Campbell, a San Francisco the time the report is published. This edition of the nurse, becomes the first KS patient to go public. MMWR marks the first official reporting of what will Calling himself the “KS Poster Boy,“ Campbell writes become known as the AIDS epidemic. a newspaper column on living with “gay cancer” for the San Francisco Sentinel. He also posts photos • June 5-6: The Associated Press, the Los Angeles of his lesions in the window of a local drugstore to Times, and the San Francisco Chronicle report alert the community to the disease and encourage on the MMWR article. Within days, CDC receives people to seek treatment. numerous reports of similar cases of PCP and other opportunistic infections among gay men—including • By year’s end, there is a cumulative total of 270 reports of a cluster of cases of a rare, and unusually reported cases of severe immune deficiency among aggressive, cancer, Kaposi’s Sarcoma (KS), among a gay men, and 121 of those individuals have died.
    [Show full text]
  • Ryan White Care Act Amendments of 1996 110 Stat
    PUBLIC LAW 104±146ÐMAY 20, 1996 RYAN WHITE CARE ACT AMENDMENTS OF 1996 110 STAT. 1346 PUBLIC LAW 104±146ÐMAY 20, 1996 Public Law 104±146 104th Congress An Act May 20, 1996 An Act to amend the Public Health Service Act to revise and extend programs [S. 641] established pursuant to the Ryan White Comprehensive AIDS Resources Emer- gency Act of 1990. Be it enacted by the Senate and House of Representatives of Ryan White the United States of America in Congress assembled, CARE Act Amendments of SECTION 1. SHORT TITLE. 1996. 42 USC 201 note. This Act may be cited as the ``Ryan White CARE Act Amend- ments of 1996''. SEC. 2. REFERENCES. Whenever in this Act an amendment is expressed in terms of an amendment to a section or other provision, the reference shall be considered to be made to a section or other provision of the Public Health Service Act (42 U.S.C. 201 et seq.). SEC. 3. GENERAL AMENDMENTS. (a) PROGRAM OF GRANTS.Ð (1) NUMBER OF CASES.ÐSection 2601(a) (42 U.S.C. 300ff± 11) is amendedÐ (A) by striking ``subject to subsection (b)'' and inserting ``subject to subsections (b) through (d)''; and (B) by striking ``metropolitan area'' and all that follows and inserting the following: ``metropolitan area for which there has been reported to the Director of the Centers for Disease Control and Prevention a cumulative total of more than 2,000 cases of acquired immune deficiency syn- drome for the most recent period of 5 calendar years for which such data are available.''.
    [Show full text]
  • PUBLIC HEALTH Public Health CHAPTER 11
    11 PUBLIC HEALTH Public Health CHAPTER 11 The nation's public health KEYFACTS system is something that many In 1900, the average lifespan in the United States was 47 years. Today, the Americans take for granted — average lifespan has been lengthened by more than 30 years to 78. until things go wrong. Following Advances in public health are responsible for 25 of those 30 extra years.a the attacks of September 11, More than 90 million Americans live with chronic illnesses, which account 2001, and the anthrax mailings a for 70 percent of all deaths and 75 percent of health care costs in the month later, the workings and United States.b mechanisms of hundreds of The direct medical costs associated with smoking totaled more than $75 public health agencies within billion per year during 1995 - 1999, and another estimated $82 billion per federal, state, and local year in lost productivity. For each adult smoker in 1999, these costs represented $1,623 in excess medical expenditures and $1,760 in lost governments came under intense productivity.c scrutiny by the media and Approximately $300 billion was spent treating heart disease in 2001. Lost Congress. worker productivity caused by cardiac disease that year was estimated at $129 billion.d That examination identified a multitude of problems: outdated laboratories, poor Americans have been getting steadily fatter. Surveys show that the coordination, and serious workforce percentage of children and teens classed as overweight has surged from shortages. Congress responded by 5 percent to nearly 16 percent over the last 30 years. Similarly, among sharply increasing funding for adults, surveys have found that the rate of obesity — about 30 pounds or more overweight — is now 15 percent or higher in all states.e bioterrorism preparedness.
    [Show full text]