HEALTH CARE REFORM : GOVERNMENT: Government Sources and Research Studies about Health Care Reform PART ONE

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HEALTH CARE REFORM : GOVERNMENT: Government Sources and Research Studies about Health Care Reform PART ONE

David P. Dillard


Government Sources and Research Studies about Health Care Reform PART ONE


Research Guide Directory :

Discussion Group Directory


Improving Health for All Americans President Obama promised that he would
make quality, affordable health care not a privilege, but a right. After
nearly 100 years of talk, and decades of trying by presidents of both
parties, that's exactly what he did. Today, 20 million more adults gained
access to health coverage. We've driven the uninsured rate below 10
percent the lowest level since we started keeping records and built
stronger, healthier communities through advancements in public health,
science, and innovation.

President Obama Speaks on Health Care in America

An American Life, With or Without the Affordable Care Act3 Letters That Explain
Why President Obama Is Signing the Cures ActThe Story of Health Care Reform in
AmericaRead Letters to the President on Health CareWatch Videos on Health Care
Improved Access to Care

Prohibited coverage denials and reduced benefits due to pre-existing conditions

129 Million Americans with Pre-Existing Conditions Can No Longer Be Denied
Health Coverage

Today, as many as 129 million Americans with pre-existing conditions can no
longer be denied health coverage.
"Prohibited coverage denials and reduced benefits due to pre-existing
conditions" ?

Eliminated lifetime and annual limits on insurance coverage and established
annual limits on out-of-pocket spending on essential health benefits Ending Lifetime & Yearly Limits

"Insurance companies cant set a dollar limit on what they spend on essential
health benefits for your care during the entire time youre enrolled in that


Required health plans to cover dependent children up to age 26

Adult Uninsured Rates 1997-2014

2.3 million additional young adults (aged 19-25) gained health insurance
coverage between the enactment of the Affordable Care Act in 2010 and the start
of open enrollment in October 2013 due to the ACA provision allowing young
adults to remain on a parents plan until age 26.


Prohibited retroactive cancellation of policies, except in the case of fraud,
eliminating the practice of people developing costly illnesses and then losing
their coverage Rescission

"Rescission is the retroactive cancellation of a health insurance policy.
Insurance companies will sometimes retroactively cancel your entire policy if
you made a mistake on your initial application when you buy an individual
market insurance policy. Under the Affordable Care Act, rescission is illegal
except in cases of fraud or intentional misrepresentation of material fact as
prohibited by the terms of the plan or coverage."

Expanded Medicaid to all previously ineligible adults with incomes under 133
percent of the federal poverty level with unprecedented federal support (the
Supreme Court directed that this expansion be at the discretion of states)

Medicaid is Expanding Insurance Coverage

The U.S. has seen the sharpest reduction in the uninsured rate since the decade
following the creation of Medicare and Medicaid in 1965, and the nations
uninsured rate is now at its lowest level ever.

Established a system of state and federal health insurance exchanges or
marketplaces to make it easier for individuals and small-business employees to
purchase health plans at affordable prices

To learn more about the Health Insurance Marketplace, visit


Simplified health choices by requiring individual and small business plans to
offer four standard categories at various costs, plus a catastrophic option for
people under age 30 and people who cannot otherwise afford coverage How to Choose a Plan in the Health Insurance Marketplace

Watch on YouTube How to Choose a Plan in the Health Insurance Marketplace ?

Established individual responsibility by requiring all Americans who can afford
insurance coverage to purchase it or pay a fee

IRS: Individual Shared Responsibility Provision

Established employer responsibility under which mid-size and large companies
provide health coverage to their workers or contribute to their coverage
through a fee The Employer Shared Responsibility Payment

"Some employers with 50 or more FTE employees who dont offer insurance, or
whose offer of coverage is not affordable or doesnt meet certain minimum
standards, are subject to Employer Shared Responsibility provisions. They may
owe a payment if at least one of their full-time employees enrolls in a plan
through the Health Insurance Marketplace and receives a premium tax credit."

Ensured individual and small business health plans include essential health
benefits, covering emergency services, hospitalization, maternity and newborn
care, preventive care such as annual physicals, and more

What Marketplace Health Insurance Plans Cover

Any plan shown in the Marketplace includes these essential health benefits.
This is true for all plan categories (all metal levels, including Catastrophic
plans) and all plan types (like HMO and PPO).

Simplified eligibility and enrollment requirements in Medicaid and the
Childrens Health Insurance Program (CHIP)

CMS: CHIP has provided meaningful health coverage to over eight million

"This program has helped cut the uninsured rate among children by nearly 60
percent since its start in 1997  with more than one-quarter of that reduction
since the President signed  legislation reauthorizing the program in 2009."

Expanded Community Health Centers and incentives for primary care providers to
practice in the communities that need them most
Expanded Community Health Centers & incentives for primary care providers to
practice in communities that need them:

Created a new FDA approval pathway to advance biosimilars, which offer the
potential to lower treatment costs for patients on high-cost biologics
Created a new pathway to advance biosimilars, with the potential to lower costs
for patients on high-cost biologics:

Provided new home- and community-based options for elderly and disabled
Americans who require long-term care services

Improving Access to Home- and Community-Based Services

In recent years, the Administration has expanded efforts to ensure that older
adults and individuals with disabilities have access to person-centered
services in community settings.  For example, the Money Follows the Person
Rebalancing demonstration helps states rebalance their Medicaid long-term
services and supports systems and provides opportunities for older Americans
and people with disabilities to transition back to the community from
institutions. The Affordable Care Act extended and expanded this program.

Introduced new coverage options and other improvements for Native Americans
through an improved Indian Health Service

Strengthening Health Care in Indian Country

Another critical step forward is implementing the Affordable Care Act, which
contains many important benefits for American Indians and Alaska Natives. First
and foremost, it includes the permanent reauthorization of the Indian Health
Care Improvement Act, ensuring that the IHS is here to stay. It also improves
benefits and protections for American Indians and Alaska Natives who have
insurance, whether they receive care inside or outside the IHS. And it gives
them more choices for health coverage, including Medicaid and the Federal
Employees Health Benefits Program.

Created a temporary reinsurance program to sustain group coverage for early
retirees prior to 2014 reforms

CMS: Early Retiree Reinsurance Program

"The Early Retiree Reinsurance Program (ERRP) was included in the Affordable
Care Act (ACA) to provide financial assistance to employment-based health plan
sponsorsincluding for-profit companies, schools and educational institutions,
unions, State and local governments, religious organizations and other
nonprofit plan sponsorsthat make coverage available to millions of early
retirees and their spouses, surviving spouses, and dependents."

Created a temporary high-risk pool program to cover uninsured people with
pre-existing conditions prior to 2014 reforms

Kaiser Family Health Foundation: Explaining the temporary high-risk pool

The health reform law created a temporary national high-risk pool to provide
health coverage to people with pre-existing medical conditions who had been
uninsured for six months. It was a temporary measure designed to bridge the gap
until the implementation of other coverage provisions in the law that took
effect in January 2014.

Created health plan disclosure requirements and simple, standardized summaries
so consumers can evaluate coverage information and compare benefits
Created health plan disclosure requirements & summaries so consumers can
evaluate coverage info & compare benefits:

Provided funding for a voluntary home-visiting program to support mothers and
young children in underserved communities

HHS: Maternal, Infant, and Early Childhood Home Visiting

"HRSA, in close partnership with the Administration for Children and Families
(ACF), funds States, territories and tribal entities to develop and implement
voluntary, evidence-based home visiting programs using models that are proven
to improve child health and to be cost effective. These programs improve
maternal and child health, prevent child abuse and neglect, encourage positive
parenting, and promote child development and school readiness."

Covered HIV screening for millions without additional cost and prohibited
discrimination due to pre-existing conditions like HIV

This Administration updated its comprehensive 2010 National HIV/AIDS Strategy
for the United States through 2020, and implemented it alongside requirements
to cover HIV screening for millions without additional cost and prohibit
discrimination due to pre-existing conditions like HIV.

Read the Updated National HIV/AIDS Strategy:

Created a new funding pool for Community Health Centers to build, expand and
operate health-care facilities in underserved communities

What is a Health Center?

Health centers have played an essential role in the implementation of the
Affordable Care Act and continue to be a critical element of the nations health

Expanded health provider training opportunities, with an emphasis on primary
care, including a significant expansion of the National Health Service Corps

HHS Awards More Than $240 Million to Expand the Primary Care Workforce

The Affordable Care Act included funding for health provider training
opportunities, with an emphasis on primary care, including a significant
expansion of the National Health Service Corps. As of September 30, 2015, there
were 9,600 Corps clinicians providing primary care services, compared to 3,600
clinicians in 2008.

Improved policy and extended funding for the Childrens Health Insurance
Program, which provides coverage for millions of low-income children, in 2009
and extended those policies in 2015

Since 2008, more than 3 million additional children have gained health

Children have also seen important gains in insurance coverage in recent years,
thanks in large part to improvements to CHIP signed into law by President Obama
in 2009 and broader coverage expansions as a result of the ACA.

Advanced Biomedical Research to Improve Health Outcomes

Launched the Precision Medicine Initiative to revolutionize how we improve
health and treat disease.

     The Precision Medicine Initiative: The next great revolution in medicine
will emerge from an ability to use genomic, lifestyle, behavioral,
environmental, imaging, and clinical data to understand health and disease, and
to use those insights to develop tailored prevention approaches and medical
treatments. The Precision Medicine Initiative, launched by President Obama,
will revolutionize how we improve health and treat disease.

     FACT SHEET: Obama Administration Announces Key Actions to Accelerate
Precision Medicine

Launched the BRAIN Initiative to develop neuro-technologies that could uncover
new ways to treat, prevent, and cure brain disorders

     President Obamas BRAIN InitiativeBrain Research through Advancing
Innovative Neurotechnologieshas catalyzed more than $1.5 billion in public and
private funds for novel neurotechnologies aimed at revolutionizing
understanding of the human brain. BRAIN Initiative researchers and
public-private collaborating organizations are pursuing an ambitious 10-year
research agenda.

     Read More: Obama Administration Proposes Over $434 Million in Funding for
the BRAIN Initiative

     REPORT: Priorities for Accelerating Neuroscience Research Through Enhanced
Communication, Coordination, and Collaboration

Embarked on a new national effort to end cancer as we know it

     The Vice Presidents Cancer Moonshot SM encourages public and private
efforts to double the rate of progress in cancer prevention, diagnosis,
treatment, and care in order to make a decades worth of advances in 5 years.
     Learn more about the Vice President's Cancer Moonshot? here.

Developed a strategy to combat the rise of antibiotic-resistant bacteria

Read More: The Obama Administration issued a national strategy and a national
action planfor domestic and international efforts to prevent, detect, and
control illness and death related to infections caused by antibiotic-resistant

Launched the first update of biotechnology regulations in a quarter century

     The Obama administration openly reviewed and modernized the regulatory
system for biotechnology products to improve transparency and ensure continued
safety in biotechnology.

Made Health Care and Coverage More Affordable

Established financial assistance to help individuals and families who otherwise
cannot afford health coverage purchase it through state and federal

Millions of Americans who are enrolled in Marketplace plans are receiving
financial assistance to help them afford quality coverage.

Created a tax credit for small businesses that provide health coverage to their

Businesses with fewer than 25 employees may qualify for a tax credit worth up
to 50 percent of their premium costs (up to 35 percent for tax
exempt/non-profit employers).

Prohibited charging more for women to receive coverage

Since September of 2013, the uninsured rate for women has dropped nearly 50
percent, meaning that about 9.5 million adult women have gained coverage.

Required health insurers to provide consumers with rebates if the amount they
spend on health benefits and quality of care, as opposed to advertising and
marketing, is too low

Thanks to a provision in the Affordable Care Act, if your insurance company
isnt spending at least 80 percent of your premium dollars on medical care, they
have to send you some money back.

Allowed employer health plans to provide incentives for workers related to
wellness programs

The Affordable Care Act creates new incentives to promote workplace wellness
programs and encourages employers to take more opportunities to support
healthier workplaces. Effective for plan years after January 1, 2014, final
rules allow the maximum reward to employers using a health-contingent wellness
program to increase from 20 percent to 30 percent of the cost of health
coverage, and the maximum reward for programs designed to prevent or reduce
tobacco use will be as much as 50 percent.

Phases out the donut hole coverage gap for Medicare prescription drug coverage
to save Medicare beneficiaries money

Nearly 10.7 million Medicare beneficiaries have received discounts over $20.8
billion on prescription drugs  an average of $1,945 per beneficiary since the
enactment of the Affordable Care Act.

Expanded competitive bidding in Medicare to lower costs for durable medical
equipment such as wheelchairs and hospital beds

CMS Fact Sheet: Medicare Competitive Bidding Program Finds $42 Billion in

"The overall savings to Medicare and beneficiaries as a result of the
competitive bidding program for Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies is expected to total more than $42 billion over the
first ten years of the program, according to the CMS Office of the Actuary.
The $42 billion savings comes from a combination of savings of more than $25
billion in Medicare expenditures, and savings of over $17 billion for
beneficiaries as a result of lower coinsurance payments and the downward effect
on monthly premium payments."

Created new Medicare payment and delivery models to pay for the value rather
than the volume of services provided, as well as the new Centers for Medicare &
Medicaid Innovation to promote improvement in health care quality and costs
through the development and testing of innovative health care payment and
service delivery models

The economic case for deploying new health care payment models:

Ensured Medicare Advantage plans are paid accurately and required plans to
spend at least 85 percent of Medicare revenue on patient care, while enrollment
has grown by over 60 percent and average premiums have dropped by 13 percent
since passage of the Affordable Care Act.

Affordable Care Act Update: Implementing Medicare Cost Savings

Reduced drug costs through increased Medicaid rebates, expanded discount
programs, and established a new system for approval of more affordable versions
of biologic drugs

Some cutting edge drugs are simply too expensive for many seniors. Creating a
pathway for the approval of generic biologic drugs will improve affordability
of medications for seniors and all Americans.

Improved Accountability, Efficiency, and Quality of Care

Established new transparency requirements and a star rating system for
hospitals, nursing homes, Medicare Advantage plans, physicians, and other
providers to give consumers information related to quality and cost

CMS: CMS expands quality data on Physician Compare and Hospital Compare to help
consumers choose health care providers

Consumers want trustworthy, reliable, and understandable information about the
quality of health care delivered by providers, said CMS Deputy Administrator
and Chief Medical Officer Patrick Conway, M.D., MSc. Both Physician Compare and
Hospital Compare show consumers that they have a choice. This large release of
quality measures for hospitals and physicians empowers consumers with
information to make more informed health care decisions, encourages health care
professionals to strive for higher levels of quality, and drives overall health
system improvement.

Provided incentives to hospitals in Medicare to reduce hospital-acquired
infections and avoidable readmissions

Patients Safer as Hospital-Acquired Conditions Decline?

From 20102015, 21 percent of hospital-acquired conditions (HACs) such as
adverse drug events, healthcare-associated infections, and pressure ulcers have
been prevented in hospital patients. Reducing these HACs has saved an estimated
125,000 lives and nearly $28 billion in health care costs, according to HHS'
annual report on patient safety.

Linked Medicare payments to physicians, hospitals, and other providers to
quality of care improvements and lower costs

The Administration set goals of tying 30 percent of traditional Medicare
payments to alternative payment models by the end of 2016 and 50 percent by the
end of 2018, and met its 2016 goal 11 months early.

Improved coordination of care between Medicare and Medicaid to better serve
individuals who receive care through both programs. Formed the Elder Justice
Coordinating Council to identify and prevent elder abuse, neglect and

Examining Medicare and Medicaid coordination for dual-eligibles.

Elder Justice Policy Brief

Elder abuse is a serious public health problem affecting millions of older
Americans each year, with some studies suggesting that as few as one in 23
cases is reported to authorities.  Elder abuse is defined as intentional
actions that cause harm or create a serious risk of harm to an older person
(whether or not harm is intended).  Elder abuse encompasses physical abuse,
neglect, financial exploitation, sexual abuse, as well as emotional and
psychological abuse.

Included tools to combat fraud, including increased sentencing guidelines for
criminal health care fraud with over $1 million in losses and new prevention
and detection efforts that identify fraudulent activity and prevent
inappropriate payments

CMS Fraud Prevention Initiative ?

By using innovative predictive modeling technology similar to that used by
credit card companies, CMS has stopped, prevented or identified $820 million in
fraudulent payments over the past three years.  The system identified or
prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on

Increased consumer protection and community service requirements for charitable

IRS: New Requirements for 501(c)(3) Charitable Hospitals Under the Affordable
Care Act

The Affordable Care Act added new requirements that hospitals must adhere to in
order to qualify as a 501(c)(3) charitable hospital. The new requirements
provide additional benefits to patients and their communities.

Raised the Medicare hospital insurance tax and imposed a new tax on net
investment income for high income taxpayers in order to strengthen the Medicare
Hospital Insurance Trust Fund

Questions and Answers for the Additional Medicare Tax

Required drug and medical-device manufacturers to publicly disclose payments
and other compensation, like gifts and travel, to physicians and teaching
hospitals to limit conflicts of interest (also known as the "sunshine"

Why Open Payments is Important to You

Section 6002 of the Affordable Care Act requires the establishment of a
transparency program, now known as Open payments. The program increases public
awareness of financial relationships between drug and device manufacturers and
certain health care providers.

Visit the Open Payments homepage.

The @WhiteHouse Record on Health Care: Required drug & medical-device
manufacturers to publicly disclose info:

Required the posting of calorie information on menus of chain restaurants with
20 or more locations and vending machines
The @WhiteHouse Record on Health Care: Required the posting of calorie
information on menus of chain restaurants:

Promoted the adoption and usage of certified electronic health records by
doctors, hospitals, and other providers

Until the President made investments in health information technology by
signing the American Recovery and Reinvestment Act, our health care system ran
largely on paper. Now, more than 75 percent of doctors now use electronic
health records thanks to Administration policies.

Electronic Health Records

Learn more about electronic health records.

Delivered a fix to the Medicare physician payment problem, eliminating cliffs
for payments to physicians, while protecting patient-doctor relationships and
creating incentives for quality of care improvements, lower costs, and adopting
alternative payment models HHS finalizes streamlined Medicare payment system that rewards
clinicians for quality patient care

Created new policies to improve nursing home quality and safety

HHS finalized regulations to improve care and safety for nursing homes
residents; Revisions mark first major rewrite of long-term care conditions of
participation since 1991

The Centers for Medicare & Medicaid Services (CMS) issued a final rule to make
major changes to improve the care and safety of the nearly 1.5 million
residents in the more than 15,000 long-term care facilities that participate in
the Medicare and Medicaid programs. The policies in this final rule are
targeted at reducing unnecessary hospital readmissions and infections,
improving the quality of care, and strengthening safety measures for residents
in these facilities.

Addressed the Prescription Opioid and Heroin Epidemic

Signed into the 21st Century Cures Act, which funds the President's $1 billion
proposal to combat the opioid epidemic and enacts mental health reforms focused
on serious mental illness, suicide prevention, and mental health parity

Remarks by the President and the Vice President at the 21st Century Cures Act
Bill Signing

"Today, I could not be prouder that this legislation takes up the charge I laid
out in my budget to provide $1 billion in funding so that Americans who want
treatment can get started on the path to recovery and dont have to drive six
hours to do it. It is the right thing to do, and families are ready for the

Watch on YouTube

SAMHSA to award nearly $1 billion in new grants to address the nations opioid

Developed a comprehensive, intergovernmental strategy to combat outbreaks of
the flu (H1N1), Ebola, and other infectious diseases, and to address critical
prescription drug shortages

Fact Sheet: Obama Administration Takes Action to Reduce Prescription Drug
Shortages in the U.S.

Expanded access to medication-assisted treatment of opioid use disorders

The Administration finalized a regulation to expand access to opioid treatment
by increasing the number of patient's physicians who can treat with the opioid
use disorder treatment medication buprenorphine.

The change allows qualified physicians to prescribe buprenorphine to more
patients. As of October 2016, 2,400 practitioners have applied for and been
granted waivers to prescribe at the increased limitimproving access to
buprenorphine, which is prescribed along with psychosocial supports as part of
Medication-Assisted Treatment.

Read more about HHS change here.

The HHS also took action to enable nurse practitioners (NPs) and physician
assistants (PAs) to begin taking the required training to prescribe the opioid
use disorder treatment, buprenorphine.

The Administration also awarded $94 million in Affordable Care Act funding to
271 health centers across the country to increase substance use disorder
treatment services, with a specific focus on expanding medication-assisted
treatment of opioid use disorders in underserved communities.

Released a new guideline for prescribing opioids for chronic pain to help
primary care providers ensure the safest and most effective treatment for their

Read the CDC Guideline here.

Download the CDC checklist here.

The Administration also released an Opioid Overdose Prevention Toolkit for
community members, first responders, prescribers, and patients and family
members. The toolkit, developed by the Substance Abuse and Mental Health
Services Administration, can be found here.

Announced a new $11 million funding opportunity to States to purchase the
opioid overdose reversal drug, naloxone, and train first responders and others
in its use

Fact Sheet: Obama Administration Announces Additional Actions to Address the
Prescription Opioid Abuse and Heroin Epidemic

Additionally, the Administration awarded $1.8 million to rural communities to
expand access to naloxone  a drug that reverses an opioid overdose and released
Medicaid guidance to states identifying Best Practices for Addressing
Prescription Opioid Overdoses, Misuse and Addiction including steps to increase
the use of naloxone to reverse opioid overdose and to expand coverage of opioid
use disorder treatment.

Announced a Presidential Memorandum requiring Federal Departments to provide
training on appropriate opioid prescribing to Federal health care professionals
and requiring Departments to develop plans to address barriers to opioid use
disorder treatment in Federal programs.

Read the Presidential Memorandum here:

Required substance use disorder benefits to be included in all health plans
offered in the individual and small group insurance markets

Learn about the Health Insurance Marketplace:

Finalized mental health and substance use disorder parity rules to ensure
greater equity between these benefits and medical and surgical care benefits in
group, individual and Medicaid health plans. Administration issues final mental health and substance use disorder
parity rule

The Administration also finalized a rule to implement parity protections in
TRICARE, including expanding mental health and substance use disorder treatment
to include coverage of intensive outpatient programs and treatment of opioid
use disorders with medication-assisted treatment.

Collected a record amount of unused prescription drugs through the 2016
National Prescription Drug Take-Back Day

More than 893,000 pounds of unwanted medicines or about 447 tons were collected
-- to help make homes safe from potential prescription drug abuse. Take-back
days have collected and destroyed 5.5 million pounds of unused prescription
drugs over five years.

Learn more about Tack-Back Day here:

The Administration also finalized a rule making it easier for communities to
establish ongoing drug take-back programs to reduce the amount of unused
prescription drugs in homes.

Read more about the US Drug Enforcement Administrations final rule here.

Launched a heroin response strategy through public health-public safety
partnerships in regional High Intensity Drug Trafficking Areas in Appalachia,
New England, Philadelphia/Camden, New York/New Jersey, Washington/Baltimore,
Ohio and Michigan

White House Drug Policy Office Funds New Projects in High Intensity Drug
Trafficking Areas

Amplified the first-ever Surgeon General Report on Alcohol, Drugs, and Health
covering prevention, treatment and recovery

Read the Report here.
Increased Access to Mental Health Services

Eliminated out-of-pocket costs for recommended preventive services, including
depression screenings for adults and adolescents, through the Affordable Care

See the list of preventive services.

Formed the Mental Health and Substance Use Disorder Parity Task Force to work
together to ensure that Americans are benefiting from the mental health and
substance use disorder parity protections under the Affordable Care Act

The Task Force met with parents, advocates, clinicians, health plans,
regulators and others and developed a series of action steps and
recommendations for future action to help ensure that mental health and
substance use disorder benefits are treated at parity with medical and surgical

Signed the Clay Hunt Suicide Prevention for American Veterans (SAV) Act, to
improve mental health care and suicide prevention programs for veterans

Learn more about the Clay Hunt Suicide Prevention for American Veterans (SAV)
Act and the Administration's commitment to help veterans.

Hosted the White House National Conference on Mental Health to reduce stigma
and help the millions of Americans struggling with mental health problems

The White House hosts a National Conference on Mental Health at the White House
as part of the Administrations effort to launch a national conversation to
increase understanding and awareness about mental health.

Issued an Executive Order to improve mental health services for veterans,
service members, and military families

In response to the Executive Order, VA increased its mental health staffing,
expanded the capacity of the Veterans Crisis Line, and enhanced its
partnerships with community mental health providers; DoD and VA worked to
increase suicide prevention awareness and, DoD, VA and the National Institutes
of Health jointly developed the National Research Action Plan on military and
veterans mental health to better coordinate federal research efforts.

Announced 19 new executive actions that the Departments of Defense and Veterans
Affairs are taking to improve the mental health of service members, veterans
and their families

The mental health executive actions fell under the following six categories:

     Improving service members' transition from DoD to VA and Civilian Health
Care Providers

     Improving access and quality of mental health care at DoD and VA

     Continuing our commitment to improve treatments for mental health
conditions including PTSD

     Raising awareness about mental health and encouraging individuals to seek

     Improving patient safety and suicide prevention

     Strengthening community resources for service members, veterans, and their

FACT SHEET: President Obama Announces New Executive Actions to Fulfill our
Promises to Service Members, Veterans, and Their Families

Invested $100 million to improve access to mental health services

Vice President Biden Announces $100 Million to Increase Access to Mental Health

Strengthened Nutrition Standards and Promoted Healthy Living

Promoted public-health initiatives that target heart disease, diabetes, and
other conditions that afflict large segments of the population

New investments in the Recovery Act, expanded through the Prevention and Public
Health Fund in the Affordable Care Act, supported public-health initiatives
that target heart disease, diabetes, and other conditions that afflict large
segments of the population.

HHS: Prevention and Public Health Fund

The Affordable Care Act established the Prevention and Public Health Fund to
provide expanded and sustained national investments in prevention and public
health, to improve health outcomes, and to enhance health care quality. To
date, the Fund has invested in a broad range of evidence-based activities
including community and clinical prevention initiatives; research, surveillance
and tracking; public health infrastructure; immunizations and screenings;
tobacco prevention; and public health workforce and training.

Created new powers for the Food and Drug Administration to regulate tobacco
products, offering significant new tools to combat preventable diseases

FACT SHEET: The Family Smoking Prevention and Tobacco Control Act of 2009

Created new laws and regulations to improve food safety

FDA: Background on the FDA Food Safety Modernization Act (FSMA)

The FDA Food Safety Modernization Act (FSMA), signed into law by President
Obama on Jan. 4, 2011, enables FDA to better protect public health by
strengthening the food safety system. It enables FDA to focus more on
preventing food safety problems rather than relying primarily on reacting to
problems after they occur.

Established Lets Move!, an initiative led by First Lady Michelle Obama
dedicated to helping kids and families lead healthier lives

In 2009, First Lady Michelle Obama planted the White House Kitchen Garden on
the South Lawn to initiate a national conversation around the health and
wellbeing of the country. In time, that conversation led to Let's Move!.
Through policy, programs, public awareness, and partnerships, Lets Move! is
about putting children on the path to a healthy future during their earliest
months and years; giving parents helpful information and fostering environments
that support healthy choices; providing healthier foods in our schools;
ensuring that every family has access to healthy, affordable food; and helping
children become more physically active.

Established practical, science-based nutrition standards for school meals

The Healthy, Hunger-Free Kids Act updated school meal nutrition standards for
the first time in 15 years and increased school meal funding for the first time
in 30 years. The law boosted the quality and nutrition of meals for over 50
million children through the National School Lunch and Breakfast Programs. Its
regulations substantially increased offerings of fruits, vegetables, and whole
grains, and reduced the amount of saturated fat, trans fat and sodium.

Enacted Smart Snacks in School: practical, science-based nutrition standards
for snack foods and beverages sold to children during the school day

Ensured that any food or beverage that is marketed on school campuses during
the school day meets the Smart Snacks in School nutrition standards

Smart Snacks in School standards apply to foods sold a la carte, in the school
store, and vending machines. This allows schools to offer healthier snack foods
to children, while limiting junk food. Any food sold in schools must: Be a
whole grain-rich grain product; or have as the first ingredient a fruit, a
vegetable, a dairy product, or a protein food; or be a combination food that
contains at least  cup of fruit and/or vegetable; or contain 10% of the Daily
Value of one of the nutrients of public health concern in the 2015 Dietary
Guidelines for Americans (calcium, potassium, vitamin D, or dietary fiber).

Many of the foods and beverages that have been heavily marketed to children
contribute to poor diet quality, high calorie intake, and excess weight gain.
Foods offered and marketed to students during the school day now must be
consistent with nutrition standards, so that any food or beverage that cannot
be sold in school cannot be marketed in school either.

Enabled schools and local educational agencies with high poverty rates to
provide free breakfast and lunch to all students

As part of the Healthy, Hunger-Free Kids Act, the Community Eligibility
Provision impacts more than 18,000 schools in high poverty across the country
that are eligible to serve free lunches and breakfasts to all students.  It
helps give 8.5 million American children access to free nutritious meals with
no stigma and less time spent in cashier lines.

Modernized the Nutrition Facts label to help consumers make healthier choices

First Lady Michelle Obama announced the modernized Nutrition Facts label for
packaged foods reflecting the latest science, the most relevant nutrition
information and a refreshed design. Found on nearly 800,000 products, the label
had not been significantly updated since its initial release twenty years ago.

Cut artificial trans fat from the food supply

In 2015, the Food and Drug Administration finalized its determination that
partially hydrogenated oils (PHOs), the primary dietary source of artificial
trans fat in processed foods, were no longer "generally recognized as safe for
use in human food. Food manufacturers are required to remove PHOs from products
by 2018. This step is expected to reduce coronary heart disease and prevent
thousands of fatal heart attacks every year.

Updated the Dietary Guidelines for Americans in 2010 and 2015 to reflect the
latest body of science and encourage healthy eating patterns and created
MyPlate and its Spanish-language version MiPlato

     The Dietary Guidelines for Americans (DGA) is the nations trusted resource
for evidence-based nutrition recommendations. They are required to be updated
every 5 years and serve as the foundation for vital nutrition policies and
programs across the U.S. The DGA is designed for nutrition and health
professionals to help all individuals ages 2 years and older and their families
consume a healthy, nutritionally adequate diet. The 2015-2020 Dietary
Guidelines for Americans focus on the importance of a healthy eating pattern.

     In 2010, MyPlate replaced MyPyramid as the governments primary food group
symbol. MyPlate is based on the Dietary Guidelines for Americans and serves as
a visual reminder for consumers to follow a healthy eating pattern. MiPlato was
released in 2011. Read more.

Initiated the Healthy Lunchtime Challenge and Kids State Dinner to encourage
cooking and healthy eating among young people

Through the Healthy Lunchtime Challenge, First Lady Michelle Obama, in
collaboration with the U.S. Departments of Agriculture and Education and a
media partner, invited children ages 8-12, with the help of a parent or
guardian, to create a lunch recipe that was original, healthy, affordable, and
delicious. One winner from each U.S. state, territory, and the District of
Columbia won the opportunity to attend the Kids State Dinner at the White
House, where a selection of the winning recipes were served. Altogether, over
6,000 recipes were submitted and more than 270 young chefs and their families
were welcomed to the White House for a total of five annual Kids State Dinners.

Improved food safety to ensure the U.S food supply is safe by shifting the
focus from responding to contamination to preventing it

The Food and Drug Administration (FDA) Food Safety Modernization Act (FSMA),
the most sweeping reform of our food safety laws in more than 70 years, was
signed into law by President Obama on January 4, 2011. It enables FDA to better
protect public health by strengthening the food safety system and to focus more
on preventing food safety problems rather than relying primarily on reacting to
problems after they occur.

Required the posting of calorie information on menus of chain restaurants with
20 or more locations and vending machines
The @WhiteHouse Record on Health Care: Required the posting of calorie
information on menus of chain restaurants:

Improved nutrition standards across the armed services

For the first time in 20 years, the Department of Defense (DoD) updated their
nutritional standards to include more fresh fruits, vegetables, whole grains,
lean meats, and low-fat dairy products at the 1,100 service member dining
facilities. Healthier foods were also made available at DoD schools and other
areas where food is purchased on military bases, such as snack bars and vending

Reauthorized the Supplemental Nutrition Assistance Program (SNAP) to include
important investments that help participants move to self-sufficiency,
strengthen program integrity, modernize technology, and emphasize good

The Agricultural Act of 2014 was enacted February 7, 2014. The law reauthorizes
the Supplemental Nutrition Assistance Program (SNAP), the largest program in
the domestic hunger safety net. It offers nutrition assistance to millions of
eligible, low-income individuals and families and provides economic benefits to
communities. The reauthorization of SNAP preserved the fundamental structure of
the Program, and made a number of new investments such as providing $200
million for SNAP Employment and Training pilots to help participants find jobs
and increase earnings, testing on-line grocery purchases, enhancing retailer
standards, and helping participants stretch their dollars to purchase more
fruits and vegetables.

Expanded access to healthy foods in underserved communities while increasing
farmers and ranchers customer base by making Electronic Benefits Transfer
available at farmers markets

Farmers markets and farm stands can now accept government benefits such as SNAP
and coupons from participants in the Women, Infants and Children program from
an electronic system.

Initiated a Summer Electronic Benefits Transfer demonstration project to reduce
food insecurity among children during the summer

During the school year, millions of children receive nutritious free and
reduced price school meals through the USDA. However, less than a fifth of
these children receive meals through USDAs summer meals programs when school is
out of session. As a result, low-income children are at higher risk of food
insecurity and poor nutrition during the summer. The Summer EBT demonstration
project is meant to help bridge that gap. It has showed a significant reduction
in food insecurity among participating families and led to positive changes in
childrens nutrition.

Increased access to healthy food choices for families participating in SNAP

     Increased access to healthy food choices for SNAP participants by setting
new standards for SNAP retailers

     Created a two-year, nationwide pilot to enable SNAP participants to
purchase their groceries online

     Created a purchase and delivery pilot to improve access to groceries for
homebound elderly and disabled SNAP participants

     Helped families avoid food insecurity and hunger during the Great Recession
with higher monthly SNAP benefits

     Incentivized participants in SNAP to purchase more healthy fruits and
vegetables through the Food Insecurity Nutrition Incentive Program

Launched a multi-year, multi-agency Healthy Food Financing Initiative to
leverage private funds to increase the availability of affordable, healthy
foods in underserved urban and rural communities across the country

The Healthy Food Financing Initiative (HFFI) has brought grocery stores and
other healthy food retailers to low-income, low-access communities in urban and
rural communities across America. Without alternatives, residents of these
communities often have to travel long distances to shop or rely on fast food
restaurants and convenience stores that offer little or no fresh food. With
technical assistance, improved access to capital, and financial support for
retailers and other businesses in the food supply chain, HFFI is expanding
access to nutritious food in these communities.

The Work Ahead

President Obama asked each member of his Cabinet to write an Exit Memo on the
progress weve made, their vision for the countrys future, and the work that
remains in order to achieve that vision. Here are their key points on the work
ahead to improve health for all Americans.

Building on the Progress of the ACA

Repealing the ACA, as some have suggested, risks rolling back consumer
protections  like making it illegal to discriminate against those with
pre-existing conditions and improving benefits  for Americans who get health
insurance through the Marketplace, Medicare, Medicaid, or on the job.  A recent
study shows nearly 30 million Americans would lose their coverage under one
version of repeal as well.  We can work together to make the system even
better, but we should build on the progress weve made, not go backwards.
Secretary Burwell

Reforming the Health Care Delivery System

Building on the successful models developed during this Administration, while
seeking out opportunities to extend value-based payment to an even broader
range of providers and health care services, including high-cost drugs, not
only benefits patients but allows clinicians the flexibility to practice
medicine in the way that best meets the needs of their patients. The passage of
MACRA was a monumental step forward in the effort to reward quality and value
in physician payments; however, additional federal legislation should be
considered that would use payment incentives to drive the delivery of
value-based health care throughout the entire health care system, improve the
interoperability of data, and integrate care.
Secretary Burwell

Developing Precision Medicine

The next great revolution in medicine will emerge from an ability to use
genomic, lifestyle, behavioral, environmental, imaging, and clinical data to
understand health and disease, and to use those insights to develop tailored
prevention approaches and medical treatments.
Director Holdren

Continuing the Fight against Opioids

In late 2015, President Obama appointed me to lead an interagency federal
effort focused on the rural heroin and prescription opioid crisis. In 2014
alone, we lost 28,648 lives too soon and according to NIH, the epidemic incurs
$72 billion in health costs each year. The opioid crisis disproportionately
affects rural communities in part due to the lack of outreach and treatment
resources available in remote areas. After hearing from mothers and fathers
who've lost their children to opioid misuse, and listening to mayors and
medical personnel appeal for greater treatment resources, it's clear that rural
communities need our help.
Secretary Vilsack

Combating the Global Threat of Infectious Diseases

Continued high level U.S. leadership will be critical to maintain momentum and
further institutionalize the gains that have been made, including through
support to WHO and partners for external evaluations and country planning.
U.S. leadership should include working with partners to follow through on their
commitments, emphasizing the importance of country preparedness as a national
priority, and highlighting the need for sectors beyond health, including the
animal health, development, security, technology, and foreign affairs sectors,
to support this work. Strengthening the multi-sectoral approach will benefit
long-term health systems and the ability to respond effectively to outbreaks.
Secretary Burwell


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