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Supreme Court Ruling on Affordable Care Act

Last week, the Supreme Court of the United States issued a 5-4 ruling that largely upheld the Affordable Care Act.

Notwithstanding the ruling, the health care crisis in America will not be solved until Americans begin living healthier, more physically active lifestyles. Bipartisan support of cost-effective legislation and public policies that support exercise and primary prevention remains critical to our country's future.

In this edition of Capitol Report, IHRSA will take a look at the parts of the law that impact health clubs, what happens next and what other organizations are saying about the decision.

The following is an update of the analysis published by IHRSA when the Affordable Care Act passed Congress in March 2010.

Health Reforms That Impact Health Clubs

Greater Emphasis on Healthy Lifestyle Solutions

1. Premium discounts for employee participation in wellness programs. The law provides for an increase in premium discounts for employees who participate in workplace wellness programs that require participants satisfy certain conditions, such as body mass index (BMI), cholesterol, or blood pressure. Current law allows for a discount equal to 20% of the cost of employer-sponsored coverage. Beginning in 2014, the Affordable Care Act will allow employers up to a 30 percent premium discount for meeting certain health targets and gives HHS the option to increase the discount to 50 percent. This could increase employer and employee interest in wellness programs that have assessments and health tracking; it could also increase frequency of visits to health clubs since people will have to satisfy certain health requirements.

2. Unlimited reimbursement for health club memberships allowed. The law allows employers and insurance providers to offer employees unlimited reimbursement amounts for fitness center memberships.

3. Annual wellness visits. Medicare now covers the full cost of an “annual wellness visit” to include, among other requirements, a body mass index (BMI) measurement, personalized health advice, and, where appropriate, a referral to a local program for counseling on healthy living, including weight loss, physical activity, smoking cessation, fall prevention, and nutrition.

According to the Centers for Medicare and Medicaid Services, over 1 million eligible seniors have received a free wellness visit during 2012.

4. Greater coverage of preventive services, including obesity counseling. Health insurers will now be required to fully cover certain preventative services as outlined by the U.S. Preventive Services Task Force (USPSTF). This includes clinical obesity screening for all adult patients and offering intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. 

Tax on Tanning Services

A ten percent tax on tanning services took effect on July 1, 2010. Read more on the tax and exemption criteria at

Health Reforms that Impact All Businesses

1. Insurance Exchanges. Small businesses with fewer than 100 employees will be able to pool together to purchase insurance in state-based insurance exchanges by no later than 2014.

2. Tax Credits. Until the insurance exchanges are set up in in 2014, businesses with fewer than 25 full time equivalent employees earning on average less than $50,000 annually, will be eligible for a tax credit of 35 percent of health insurance costs.  The tax credit will increase to 50% in 2014. More info here.

3. Beginning in 2014, employers with at least 50 full-time equivalent employees will be subject to penalties if the employer:

  • Does not offer insurance and at least one employee received a government subsidy to afford insurance; or
  • Offers qualifying insurance that requires an employee to pay more than 9.5% of household income.

Health Reforms to Promote Healthy Living in American Communities

Employee Wellness

1. Community transformation grants through the CDC will be available for the development of evidence-based development of worksite wellness programs.

2. The CDC will provide employers with consultation and tools in evaluating worksite wellness programs and build evaluation capacity among workplace staff. The legislation directs the CDC to study and evaluate employer-based wellness practices. 

3. Grants for small businesses to provide comprehensive workplace wellness programs will be available from HHS to help small businesses to provide employees with access to comprehensive workplace wellness programs.

Education and Outreach

1. $500 million is provided to the Center for Disease Control and Prevention (CDC) for the development and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness through a science-based media campaign of health improvement across the lifespan. Obesity screening and counseling are specifically cited.

2. The law created a Prevention and Public Health Fund to be administered through HHS that would expand and sustain a national investment in prevention and public health programs. The fund supports programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings.

3. The law created a National Prevention, Health Promotion & Public Health Council within HHS to provide coordination and leadership at the federal level, and among federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care. The council  developed the National Prevention Strategy in 2011. 

4. The U.S. Department of Health and Human Services (HHS) awards grants to states to carryout initiatives to provide incentives to Medicaid recipients that successfully participate in healthy lifestyle programs and demonstrate changes in health risks and outcomes, including controlling or reducing weight.

What Happens Next?

The law is still on track to be fully implemented by 2014. The Department of Health and Human Services is providing in-depth information on the implementation process both at the national and state levels. From grants to new services and programs, find out how health care reform is taking shape where you live:

The Health Care Law and You

Meanwhile, IHRSA continues to lobby for legislation that promotes and protects health clubs, encourages advocacy, and report to you on major developments that could impact your business.

If you have any questions or concerns, please do not hesitate to contact us at

Hear From Other Voices on the Court’s Decision

If you’d like to see what other organizations fighting for primary prevention are saying, visit Trust for America’s Health website for a compilation of statements, including those from the American Cancer Society, American Diabetes Association, American Heart Association and more. Read statements…

Also, here are statements from the National Federation of Independent Business and the US Chamber of Commerce.

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