ll Americans have a huge stake in provisions of the Affordable Care Act that have largely gone unnoticed by the media. Beyond the mandate for insurance coverage, the ACA holds the promise of a healthier nation through potent policies for disease prevention and public health. We should all be aware of these provisions — and Congress should not compromise them.
Health insurance is prominent in the public discourse about the ACA. That should come as no surprise, given the immediacy of this issue for each of us. This is well demonstrated by Jonathan Gruber’s masterful account, “Health Care Reform: What It Is, Why It’s Necessary, How It Works.”
His story focuses on “four typical Americans … Anthony, Betty, Carlos and Dinah … each of whom is about to have a heart attack” (this alone should give us pause). Atypically, all four survive in Gruber’s story. But with differing health insurance — or none — they experience vastly different financial consequences.
Gruber concludes: “The major accomplishment of the Affordable Care Act is to provide true security to the insured in the U.S.” Perhaps. But insurance against the costs of sickness doesn’t in itself make us well, or prevent heart attacks. Does the ACA affect health?
The act’s offer of hope of better health for all Americans lies chiefly in Title IV of the act, “Prevention of Chronic Disease and Improving Public Health” (Sec 4002). Here are just three examples:
- The Prevention and Public Health Fund uniquely supports a broad range of prevention, wellness, and public health activities. It provides more than 12 percent of the operating budget of the Centers for Disease Control and Prevention, the nation’s prevention agency.
- The Preventive Health and Health Services Block Grant provides all 50 states, the District of Columbia, two American Indian tribes, and eight US territories with flexible funding to address their unique public health issues at the state and community level.
- The Million Hearts Initiative leverages several of the unprecedented opportunities under the ACA to prevent 1 million heart attacks and strokes over 5 years. This initiative could spare Anthony, Betty, Carlos, and Dinah their heart attacks altogether — not by insuring them against catastrophic health care costs but by assuring the delivery of effective clinical preventive services and community interventions to reduce risk and improve the nation’s cardiovascular health.
Others, too, have seen broad implications of the ACA for the health of Americans:
- Senator Tom Harkin: “This bill … recognizes that where Americans live and work and go to school also has a profound impact on our health. This is the very first opportunity in a generation — one that may never return — to invest in modernizing the public health system.” (Congressional Record)
- Howard K. Koh, then-assistant secretary for Health and Human Services, and Kathleen G. Sebelius, then-secretary of HHS: “… we believe that the Act will reinvigorate public health on behalf of individuals, worksites, communities, and the nation at large … and will usher in a revitalized era for prevention at every level of society.” (New England Journal of Medicine)
- Health and hospital experts Nicholas W. Stine and Dave A. Chokshi: “The opportunity to reinforce a common agenda for medicine and public health is perhaps the greatest promise of health care reform … [and] may herald a new era of collaboration toward improving the health of all Americans.” (New England Journal of Medicine)
We all have a stake in being healthy. No one is immune to accident or illness — insured or not. The current prevention and public health provisions of the ACA constitute major commitments to protect and improve the health of all Americans. Beyond health care costs alone, the ACA is achieving greater security for our health. It is in the national interest to assure that these provisions are preserved.
Darwin R. Labarthe, MD, is professor of preventive medicine at the Northwestern University Feinberg School of Medicine. Donald M. Lloyd-Jones, MD, is senior associate dean for clinical and translational research and chair of Northwestern’s Department of Preventive Medicine.