At this historic moment, ADA and thousands of our members are actively engaged in efforts to reshape the country’s health policies, to place nutrition closer to center stage in assuring Americans will be healthier and that registered dietitians and dietetic technicians, registered are recognized as providers of the best quality nutrition care and services. These are advocacy efforts we must make on our own behalf because, in all honesty, no one else is going to do it for us.
Who will speak as clearly as we can about the importance of nutrition strategies for keeping people healthy? Who will be there to ensure RDs are included in community and clinical health teams that address health problems? Who will advocate for health information technology to include nutrition data? Who besides ADA will speak about nutrition as the foundation of health and the cornerstone of prevention?
We owe it to ourselves and to our future to demand a seat at the table where health reform is being debated. I would like to share some of the details of ADA’s work, update you on our progress and encourage you to join the cause of making nutrition a more significant strategy in everyone’s health.
ADA and Reform
Throughout 2009, we have been meeting with members of Congress across the country who sit on the key committees taking up health reform. As of this writing, it appears the House of Representatives will consider a health reform bill sometime this fall. It is not clear when the Senate will consider a bill; in fact, despite all the words and all the action, it is not a foregone conclusion that any major health reform bill will pass in 2009. Neither ADA nor anyone else really can predict how the debate will play out, or what the final product will look like.
Long before the current debate on health reform began, ADA was engaged on issues that matter to our members: successfully expanding coverage for nutrition care and services and increasing reimbursements to providers.
To prepare for this debate, which encompasses the entire U.S. health system, ADA brought together a task force to consider how reform could impact nutrition and enlarge the role we play in public health as well as clinical areas. ADA has since had a continuous dialogue with Senate and House committees that decide health matters. ADA has met with members of the House and Senate to discuss the importance of nutrition in health care legislation.
Our messages have stayed true to ADA’s mission and vision: to improve the health of Americans through nutrition strategies. From our outreach, people already better understand that nutrition is the foundation of health and it is a cornerstone of disease prevention and management.
During this summer, ADA’s Washington staff has been involved in intense discussions with Congressional committee staff, promoting the role of nutrition and nutrition services in prevention and disease management. We stay in touch with numerous members of the five key Congressional committees and the leadership of the House and Senate. ADA’s political action committee — ADAPAC — helps make it possible for ADA to be assertive on the issue of health reform, which we have made the centerpiece of our grassroots activities in 2009.
ADA intentionally has not taken a position on any of the proposals pending in House and Senate, because it would be premature to take a position on a specific piece of proposed legislation until it has been finalized and we know exactly what the bill says. In the meantime, we continue our work to get provisions included that would strengthen prevention-related portions of the legislation. If ADA does take a position on a complete bill, it likely will be when the House or Senate decides to take it up for a debate.
That being said, there are provisions in the House draft that ADA is likely to support. For example, H.R. 3200 would require all private health insurance plans, the new “public option” (if there is one) and Medicaid to cover preventive services recommended by the U.S. Preventive Services Task Force which recommends the following:
“… intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians.”
However, this is not the language ADA recommended to Congress. We prefer more precise language that is not subject to interpretation. The House chose this language because other options to expand Medical Nutrition Therapy services — including the version we favored — were judged by the Congressional Budget Office to be too expensive. Therefore, ADA would like to see amendments to Medicaid that would cover MNT for beneficiaries who are at risk of developing a chronic disease as a result of being obese. H. R. 3092, introduced by Kathy Dahlkemper (D.-Pa.) embodies that concept, and if it is offered as a floor amendment during general debate, ADA will do all we can to support it.
In the Senate, our message to the Finance Committee includes a request to include the provisions of Sen. Jeff Bingaman’s (D.-N.M.) bill, S. 1060, the Obesity Prevention, Treatment and Research Act. This bill amends the Medicare, Medicaid and State Children Health Insurance programs to cover MNT for people who are obese or are diagnosed as pre-diabetic. This is only logical now that obesity has reached a point where two-thirds of adults and one in five children are overweight or obese. Preventing and controlling obesity is central to health reform that provides better quality care at lower costs.
In both the House and Senate, ADA continues to stress that disease prevention and management must be available to Americans. We make the point that this is part of a smarter overall health system that tilts the scale toward primary care physicians and teams of professionals to care for people in their own communities. And if someone becomes sick away from home, or relies on more than one physician, electronic medical records will facilitate their care and treatment.
ADA also favors provisions that establish new restaurant labeling requirements, patient-centered medical homes in community-based settings as well as Medicaid programs, and improved reimbursement rates in Medicare.
These are exciting and important times for ADA, every member and every American. We have the ability and the duty to design responsible policies and programs that will create a healthier future for everyone.