EDITORIAL The 2010 Health Care Act and Barriers to Effective Health Promotion Among Men Who Have Sex With Men David A. Fessler, MD, MPH,*† Jennifer Mitty, MD, MPH,* Kenneth H. Mayer, MD,*‡ and Harvey J. Makadon, MD‡ The 2010 Patient Protection and Affordable Care Act (PPACA) contains many provisions aimed at improving reimbursement for health promotion and disease prevention, which are not necessarily covered under many traditional health insurance plans. In particular, Title IV, Prevention of Chronic Diseases and Improving Public Health, provides for new funding and several prevention-based initiatives. 1 The Act mandates that new private health plans and insurance policies beginning on or after September 23, 2010 cover an array of preventive services without expecting recipients to share costs. These covered services are to include those rated as “A” (strongly recommended) or “B” (recommended) by the US Preventive Services Task Force (USPSTF) and vaccinations recom- mended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC). Similarly, since January 1, 2011, Medicare now covers an annual wellness visit with customized prevention plan, including coverage of many USPSTF recommended preventive ser- vices without cost-sharing. Starting in 2013, state Medicaid programs that eliminate cost-sharing for USPSTF-recommended preventive services may receive enhanced matching federal funds to sup- port these services. Other ways in which the PPACA may well improve preventive health include increased access to health insurance without concern for lack of coverage for preexisting conditions, mental health, or substance abuse treatment. The focus on integrated care and support for commu- nity health centers will also likely benefit underserved populations substantially. Nevertheless, as these welcome changes are phased in, it is important to be aware of the gaps, which may emerge or be exacerbated in specific subpopulations whose preventive care needs are not fully addressed by the USPSTF and ACIP recommendations. One such group is men who have sex with men (MSM). The Department of Health and Human Services identified MSM in their Healthy People 2010 document as an underserved population group experiencing significant health dispar- ities. 2 MSM have several unique health risks compared with demographically matched heterosexual men, including increased prevalence and incidence of HIV and other sexually transmitted diseases (STDs), including human papillomavirus (HPV)-related anal cancer. 3 As highlighted in a recent report by the Institute of Medicine, 4 the underserved and stigmatized nature of the MSM population can also make it difficult to conduct studies that provide the evidentiary criteria required for USPSTF grade A and B recommendations, which focus on broader representative primary care populations, generally with larger sample sizes. The recently updated STD treatment guidelines published by the CDC provide evidence-based screening recommendations specific to the MSM population, which vary significantly from those of the USPSTF and ACIP, generally in the direction of more proactive screening for MSM. 5 The most striking differences between these organizations’ recommended practices for MSM occur in routine screening for gonorrhea, chlamydia, and hepatitis C, although important differences exist as well in recommendations for screening for HIV, syphilis, and anal dysplasia. The included Table 1 summarizes differences in recommended screening practices between the USPSTF/ACIP and the CDC. Given the increased incidence of STDs in this population and overlapping transmission dynamics of many of these diseases among MSM, more proactive screening is warranted, but several appropriate and important screening measures will not have mandated coverage under the auspices of the PPACA. According to recent data, MSM continue to be one of the few major at-risk groups in the United States in which the rate of new HIV infections continues to rise, particularly among younger From the Divisions of *Infectious Diseases and †General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA; and ‡The Fenway Institute, Boston, MA No authors have any financial disclosures. There are no sources of support that require acknowledgement. Correspondence: David A. Fessler, MD, MPH, 330 Brookline Ave, Shapiro Building, 6th Floor, Boston, MA 02215. E-mail: dfessler@bidmc. harvard.edu. Received for publication September 18, 2011, and accepted January 24, 2012. DOI: 10.1097/OLQ.0b013e31824fc62a Copyright © 2012 American Sexually Transmitted Diseases Association All rights reserved. Sexually Transmitted Diseases ● Volume 39, Number 6, June 2012 449