Amid all the rancor leading up to passage of the new health care law, Congress with little fanfare approved a set of wide-ranging public initiatives to prevent disease and encourage healthy behavior.
The initiatives provide a big dose of prevention in an effort to counter the powerful forces that encourage people to engage in sedentary lifestyles, to smoke and to eat fatty, high-calorie foods.
The emphasis on disease prevention comes nine months after President Obama signed a law that gave sweeping authority to the Food and Drug Administration to regulate tobacco products. It reflects a sea change in federal health programs and policy, said Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee.
Republicans supported many of the health promotion initiatives and objected to a few, but had much bigger concerns about the overall law. The proposals largely escaped public notice as lawmakers fought over abortion, taxes and a government-run “public option.”
Health insurance companies will soon have to cover all recommended screenings, preventive care and vaccines, without charging co-payments or deductibles.
Medicare beneficiaries will get free annual physicals. Medicaid will cover drugs and counseling to help pregnant women stop smoking. And a new federal trust fund will pay for more bicycle paths, playgrounds, sidewalks and hiking trails.
Those are some of the provisions Congress tucked into the legislation in an effort to reduce the huge toll of preventable diseases — regardless of whether the initiatives also save money for the government, as some lawmakers expect.
“When people have insurance,” Dr. Seffrin said, “they are much more likely to receive screenings and treatment. And they are more likely to seek screenings when they do not have to pay co-payments or deductibles.” As a result of such screenings, he added, cancers are more likely to be detected at an early stage, when they are treatable.
Under the law, insurers must provide coverage for all services recommended by an independent panel of experts, the United States Preventive Services Task Force, and cannot impose “any cost-sharing requirements.”
In addition, each Medicare beneficiary will be entitled to an “annual wellness visit,” in which a doctor can assess the patient’s condition, check for signs of Alzheimer’s disease and draw up a “personalized prevention plan” with a screening schedule for the next five or 10 years.
Senator Tom Harkin, Democrat of Iowa and chairman of the Senate health committee, said: “We don’t have a health care system in America. We have a sick care system. If you get sick, you get care. But precious little is spent to keep people healthy in the first place.”
Kathleen Sebelius, the secretary of health and human services, said the measures, taken together, had immense potential to “save lives and to save money.”
Under the health care law, chain restaurants with 20 or more locations will have to provide a calorie count for each standard menu item. The data must be displayed on the menu “in a clear and conspicuous manner.” Salad bars and buffets can satisfy the requirement by placing signs next to food items.
Margo G. Wootan, director of nutrition policy at the Center for Science in the Public Interest, a research and advocacy group, said consumers appeared to be choosing lower-calorie foods as a result of calorie-posting laws and regulations adopted in New York City and several other places. Equally important, she said, some restaurants have changed their menu offerings, shrinking portion sizes, reducing the fat in pastries or substituting low-fat milk for cream.
Cathy Nonas, director of physical activity and nutrition at the New York City Health Department, said consumers experienced “tremendous sticker shock” when they saw how many calories were in the food they were eating. “About 15 percent of people who come in to chain restaurants say the calorie information makes a difference in their purchasing decisions,” Ms. Nonas said.
The new law also allows employers to give stronger incentives to employees who participate in programs to lose weight, stop smoking or improve their health in other ways.
Employers can offer rewards equal to 30 percent of the cost of coverage — up from 20 percent under prior law — to employees who participate in such programs.
“This is exciting,” said Helen Darling, president of the National Business Group on Health, which represents 300 large employers. “It puts the emphasis on health improvement, not just paying for illness and injuries.”
Many of the public health initiatives — but not all — had bipartisan support.
The law provides $5 billion over five years for a “prevention and public health fund,” which will provide money to state and local governments and community organizations.
Senator Harkin said the money could be used to create “healthier communities,” where people would have safe places to engage in physical activities.
But Republicans derided the money as pork barrel spending for jungle gyms.