Millions of Americans will now have access to affordable, quality health insurance, thanks to the historic health reform legislation President Barack Obama signed into law in March.
The long-awaited law is, in part, the culmination of decades of work by health and public health advocates, such as APHA, who celebrated the law as a significant step forward in fixing the nation’s broken health system.
“For nearly a century, providing quality, affordable care to all Americans has eluded our grasp,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). “This measure will strengthen our public health system, invest in prevention, improve the health of the American people and move us closer to providing comprehensive and affordable health coverage for all Americans.”
Beyond the insurance reforms, the landmark law, known as the Patient Protection and Affordable Care Act, is also a momentous victory for public health and prevention.
The law creates a dedicated Prevention and Public Health Fund that will provide $15 billion over 10 years to support community prevention and research activities as well as strengthen state and local public health capacity. In addition to the new funds, which represent the largest commitment to prevention and wellness in U.S. history, the health reform law establishes a National Prevention, Health Promotion and Public Health Council, which will be chaired by the U.S. surgeon general and tasked with coordinating the development and implementation of a national prevention strategy.
To help direct the country’s newly funded prevention efforts, the law relies on the expertise of the U.S. Preventive Services Task Force and Task Force on Community Preventive Services — two independent bodies commonly hailed by public health workers for a tradition of focusing exclusively on the evidence.
“This is a historic opportunity to use this (money) in a strategic way to change our culture and change our health care system,” said APHA member Rob Gould, president and CEO of the Partnership for Prevention. “This is the start of a much bigger national movement to change our whole culture toward preventing illness and optimizing health and that is the great hope. Public health can really use this as a long, teachable moment.”
Among a long list of prevention measures, the reform law creates grants to support state and local efforts aimed at reducing chronic disease rates, eliminating health disparities, curbing childhood obesity and promoting evidence-based prevention strategies. In a coup for nutrition advocates, the law requires certain chain restaurants to display calorie information on menus and menu boards. On the insurance side, the bill eliminates co-pays or deductibles for preventive services that receive a grade of “A” or “B” from the U.S. Preventive Services Task Force. It also directs Medicaid programs to provide tobacco cessation services for pregnant women at no cost to the patient, but does not require Medicaid to offer other services highly recommended by the U.S. Preventive Services Task Force — a gap Gould described as a missed opportunity.
“The task ahead of us is to convince state policy-makers to include more preventive services,” he told The Nation’s Health. “We need to make the case that it’s the right thing to do…and that this will deliver high-value returns.”
In the short-term, the law makes $500 million of the new Prevention and Public Health Fund, which will be administered through the U.S. Department of Health and Human Services, available for work in the current federal fiscal year. Gould called on decision-makers to direct some of the initial funds to the Task Force on Community Preventive Services, whose “vital work” develops the “Guide to Community Preventive Services” — a resource used by public health workers nationwide to develop effective interventions.
“It’s the Community Guide that will provide guidance on how to spend money in an effective way to really have an impact on prevention,” Gould said.
Insurance reform to benefit millions
The nation’s new health reform law is expected to expand coverage by more than 30 million people, crack down on what many described as abusive insurance practices, and create insurance exchanges in a fashion that promotes access and affordability.
“This is historic for consumers in America because we finally have a guarantee that regardless of our health status, our employment status, our income status, we’ll have an option available to us that we can afford and that will be quality health care,” said DeAnne Friedholm, director of health reform at Consumers Union.
While the law sets a timeline through 2015, a number of benefits will kick in this year, among them: uninsured people with pre-existing conditions will have immediate access to insurance; insurance companies are barred from refusing children with pre-existing conditions; parents can keep their children on their insurance plans until they turn 26; insurance companies cannot rescind policies after a person becomes sick; and the Medicare prescription drug program will shrink the gap in which beneficiaries begin paying out of pocket — a gap often referred to as the “doughnut hole.”
By 2014, state-based insurance exchanges will have opened that offer both individual and small group plans, and the individual mandate will have kicked in. The mandate will require most people to purchase insurance or pay a penalty and will offer subsidies to help those in certain income groups. The launch of the mandate will also coincide with an expansion in Medicaid eligibility.
“It’s a quantum leap forward for both Americans who are currently uninsured and for Americans who now have insurance,” said Kathleen Stoll, deputy executive director of Families USA, a health care consumer advocacy group. “We’ll now have a floor that will force many states to improve how they regulate the insurance industry, and we hope some states will go above that floor.”
While many health advocates backed proposals that included a public option — an insurance plan offered directly by the government — and a national insurance exchange, most advocates agree that, with assistance, the state-based exchanges can also promote affordability and access.
“There will be standards for minimum standard benefit packages that insurance companies will have to meet,” Friedholm told The Nation’s Health. “It will come down to each state having the resources and expertise to set up the exchanges.”
Unfortunately, the reform law is not all good news, according to some critics. Even with the expansion, some people may still be uninsured, such as those who are not legally in the United States or those who opt instead to pay the penalty. Also, many single-payer advocates remain disappointed with the legislation.
In addition, the law restored $50 million annually in abstinence-only education funds for the next five years. Also, one day after signing the law, Obama issued an executive order reinforcing current rules prohibiting the use of federal funds for abortions. The order also requires insurance companies that cover abortion services and which participate in state exchanges to take complicated steps to ensure no federal money pays for abortions: customers will have to make two separate payments, one for abortion coverage and another for everything else. According to reproductive health advocates, the burdensome rule could persuade insurers to drop abortion coverage altogether.
“It’s a crushing spectacle to see that the price of moving forward such an important bill…was bought at such a high price in terms of women’s reproductive health,” said Laura MacCleery, director of communications and government relations at the Center for Reproductive Rights.
For more information on the health reform law, visit www.healthreform.gov. For information on APHA’s many advocacy activities related to health reform passage, including a new issue brief on the history of health reform, visit www.apha.org/advocacy/healthiestnation/legislation or www.apha.org/advocacy/reports/reports.
- Copyright The Nation’s Health, American Public Health Association