Obamacare. The Affordable Care Act (ACA). Whatever you choose to call it, President Obama’s key legislative victory of his presidency introduces major changes in the way Americans manage their healthcare. Along with this legislation has been an avalanche of questions and, to my chagrin, politics. So. Many. Politics.
What I would like to do right now is to strip down the ACA to more understandable bits and how this fits into the public health world.
Understatement. If there’s one thing everyone agrees on concerning the ACA, it’s this. There’s no way to overhaul the healthcare-insurance system without complication. It was complicated before the ACA, and it’s still complicated. If we could somehow blow up the whole system and build it again from scratch, my guess is that it would look nothing like it does now. Other countries offer free health care to its citizens, and there are many reasons why the US does not and why this was not included in the ACA. I’ll give you $$$ guesses why.
So we all know it’s complicated. That’s about where everyone begins to diverge on their beliefs. For some people, it truly is an ideological divide. Do you believe health care is a privilege or a right? The answer you give may go a long way into explaining why people are so divided on this issue.
Some people are upset because they believe it is wrong for the government to require people to purchase anything, let alone healthcare. Others are upset because they don’t believe the ACA went far enough to insure that every American had health care. Should all healthcare be free? Should insurance companies be involved at all? How can people without a lot of money afford to buy health insurance when they can barely afford to feed themselves? Now we expect them to pay a penalty?
I have my opinions, along with everyone else, on what this system would look like in my ideal world. However, for the purposes of this blog post, I will stick to the facts to try to explain how the ACA, in its current form, will impact and has impacted the world of public health.
Let’s start with the need for the ACA in the first place.
We’ve all been there. Sick. At the doctor’s office or at home. Miserable. It’s not fun. But what if we were REALLY sick? What if we had a debilitating disease that left us unable to work? The way the health care system was set up in America, if you became ill, there was a good chance you would not have the means to take care of yourself. In fact, medical bills are the number one cause of bankruptcy.
The stated aim of the ACA is to improve health care for individuals/ whole populations and to reduce overall health care costs. For this to work, not only do we need to inform the insurance system*, but the health care system as well. Right now, our health care system works as more of a sickness management system that helps to treat symptoms and sickness after they’ve already begun. By switching to a preventive system, which I’ll talk about in a bit, we can save not only lives, but money as well.
*For the sake of our brains and my ability to be as succinct as I can, I’ll just focus on the public health and health care portion of the ACA as opposed to the insurance piece. I would like for our blog readers to come back, not scare them away with all. the. words. If you find yourself looking for more non-partisan information about the insurance side of things, check out the Kaiser Family Foundation’s website.
What did the ACA do for Public Health? Public Health is Already Super Awesome.
You are so right, all-knowing headline! Public health IS awesome. But Obamacare has helped fill in some gaps that exist in the public health field.
According to the American Public Health Association, the following were created through the ACA:
- Prevention and Public Health Fund
- Community Transformation Grants (focuses on comprehensive chronic disease prevention)
- Public education campaigns
- Community Health needs assessments
- Nutrition/menu labeling
- Public health workforce development
- Public health research
Let’s talk about a few of these a little more in-depth.
One thing that public health has always championed is how important prevention is to individual health. Not only is preventing disease and bad health outcomes important for health, but also saves billions of dollars. It is much cheaper to prevent someone’s heart attack than to perform surgery and treat with medication after a heart attack.
Before the ACA, many health insurance companies did not cover preventive measures such as vaccines and routine check-ups. In fact, if you went to a doctor for a routine check-up and the doctor did not find anything wrong with you, the insurance company would treat that visit as not necessary and would not pay for it. Again, not every insurance company did this, but many did. It was almost as if they were punishing the healthier people for doing the right thing.
Because of the ACA, most health insurance plans now must cover a set of preventive services, such as vaccines and screening tests. These screening tests include blood pressure, cholesterol, obesity, tobacco use, and many more. A full set of the covered screening tests can be found on the Healthcare.gov website. With the ACA, this is the U.S.’s first mandatory funding for public health.
Prevention works. Prevention saves me money. Prevention saves YOU money. Making sure prevention is covered is a huge return on a very small investment. This is an obvious benefit from the ACA.
Community Transformation Grants
The CDC awarded some communities in the U.S., including my current hometown of Oklahoma City, these grants that will focus on chronic disease prevention. Chronic diseases are things like heart disease and diabetes, for example. Specifically, these grants will focus on:
- Helping people be tobacco-free
- Active living and healthy eating
- Quality clinical and other preventive services
- Creation of healthy and safe physical environments
Basically, this will help communities with these types of grant put certain infrastructure in place to help people better manage their preventable chronic diseases. More importantly, it will also help people by preventing these chronic diseases from developing in the first place.
One particular thing I’m personally excited about is the physical environment piece. Here in Oklahoma City, this is something that is desperately needed. Oklahoma City was first populated right after the land run in 1889, but the vast growth and development of the city was in lockstep with the mass production of cars. Therefore, Oklahoma City was mostly designed as a very car-friendly place to live. The goal of transit was to get as many people from one place to another as quickly as possible.
Well, it turns out that, for multiple reasons, Oklahoma City is not a very healthy place to live. One of these factors is the lack of walkable places. However, there is a very bright future ahead for the health of this city, and one reason for that is the collaboration between the city planners and public health officials. With the help of this grant, money will be available to make Oklahoma City and other communities a healthier place to live.
Community Health Needs Assessments
The term “community health needs assessment” is just a long way of saying “a scientific way to find out what a community needs to make it healthier.” Conducting these needs assessments are extremely important in moving forward — no needs assessment results are the same as another since each community is unique with unique needs. The needs assessment will tell you what you need to focus on, what to evaluate, and which intervention to choose.
Public Health Workforce Development
I’ve talked about the move from managing chronic diseases after they happen to more of a preventive role for public health. This means it is extremely important for the public health workforce to make this transition as well. While public health is trying to make this transition, it has also faced a substantial decrease in funding, staff, and resources in the past few years. This is where the ACA comes in.
The ACA helps existing and new programs that help with loan repayment, scholarships, and other ways of support to health care workers. It also helps with support for the hiring of public health workers, especially during emergencies. With the implementation of some of the above-mentioned items, training for these programs will also be needed.
Just skip to the part where you tell me how all this is going to help me.
Yeah, yeah…I do have a tendency to get into the weeds sometimes. Let me bring this on home.
A lot of the things I talked about basically try to prevent people from developing chronic diseases like heart disease and diabetes. By training the public health workforce and fully funding these initiatives, we can really make a difference in our nation’s health. I’ve already witnessed a sea change in my community, as entities are working together for the first time to make these changes happen. It’s a very exciting time to be in the public health field.
However, I must mention that the only way this will work is if this is fully funded. We’ve seen in Washington recently exactly how “easy” it is to fully fund Obamacare. Again, I’m not going to make this a political post. But let me just say that no matter your political affiliation, the ACA is the current law of the land. All of these provisions, if fully funded, will make a difference.