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The Hidden Benefits Of The Affordable Care Act — And How They Could Change The Modern Face Of Health Care


President Barack Obama’s health care reform law will spend more than $1 trillion over the next decade to extend health coverage to millions of people — and about $20 billion actually trying to make us healthier.

The money supporting these initiatives is tucked inside the Affordable Care Act in the form of the Prevention and Public Health Fund. Created by the 2010 health care law, the fund is the nation’s first mandatory funding stream dedicated to public health and prevention activities. In addition to supporting new and existing community prevention and research activities, money from the fund is being used to strengthen state and local public health infrastructure, bolster data collection for community- and clinical-based prevention activities and expand and improve training for the public health workforce.

By law, the fund must be used “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs.”

The importance of the preventive initiatives included in the health care law cannot be overstated. The enactment of the Affordable Care Act is a watershed in U.S. public health policy, marking a shift in our health system from one that focuses on treating the sick to one that focuses on keeping people healthy.

Changing The Face Of Health Care

Americans have access tOunce Of Prevention Quote 2o some of the best diagnostic technologies and cutting edge treatments — but we don’t have much to show for it. The U.S. spends twice as much on health care as other developed countries, yet has worse health outcomes. The question is why. In many ways, the United States has a “sick care” system and not a “health care” system. What this means is that very few resources are invested in preventing death and disease before they actually happen.

Today, seven in ten deaths in the U.S. are related to preventable diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer. And according to a 2010 report from the Robert Wood Johnson Foundation, medical treatments for the half of the population with these chronic health conditions account for 84 percent of health care spending. However, a mere 3 percent of U.S. health-care spending is invested in preventing these health problems. Much more money is spent on treating illness after it occurs. For too long, prevention and wellness have been neglected.

Improving the health of Americans and reducing preventable deaths won’t just benefit those individuals. Better health will be key to reversing decades of skyrocketing health care spending. And the prevention fund is the Affordable Care Act’s primary means of making inroads on these problems, one community at a time.

“If we removed the barriers to healthy living, we would bend the cost curve in health care spending. In order to do that, we had to target communities,” Sen. Tom Harkin (D-Iowa), who created the fund, said in a written statement.

The Affordable Care Act called for the prevention fund to receive $18.8 billion from 2010 to 2022, then $2 billion annually in future years. But despite the fund’s many success stories, public health leaders agree that it will remain a political hot potato. Republican policymakers have repeatedly targeted the fund for cuts or elimination, asserting that it is wasteful or that it would accomplish little beyond existing federally funded disease prevention and health promotion programs. Congressional Republicans have already taken more than $6 billion out of the fund since 2012, against the recommendations of medical and public health groups like the American Public Health Association (APHA) and the Institute of Medicine (IOM). Furthermore, the main source of dollars for local initiatives — the Community Transformation Grants program — is ending Sept. 30, two years early, because Congress reallocated the funding to other programs.

Such attacks are likely to continue, according to Laura Hanen, MPP, chief of government and public affairs at the National Association of County and City Health Officials.

“The Prevention and Public Health Fund is a target first and foremost because it is part of the Affordable Care Act,” Hanen told The Nation’s Health. “It is also a large chunk of money that is hanging out there that is very desirable when wanting to find an offset for other spending priorities. The fund was mischaracterized as jungle gyms and bike paths when it was being marked up in the Senate…so it’s had its critics from before the time the Affordable Care Act became law, but it has continued henceforth.”

To protect the fund from further attacks, Hanen urges public health leaders and advocates to continue to educate Congress, their staff and the public about the fund’s importance to creating a healthier world.

“For public health, for people who support prevention, the fund is a critical investment to really change our health care system to a health system, so that the focus is not just on making people who are sick better,” Hanen said. “It’s about preventing them from getting sick in the first place or creating conditions that prevent them from getting sick in the first place.”

Research suggests efforts like those facilitated by the Prevention Fund could yield substantial returns. A study conducted by a pair of University of Arkansas professors and published in the August 2011 edition of Health Affairs concluded that a 10 percent increase in public health spending by cities and counties would reduce deaths due to preventable causes by 1 to 7 percent. A 2009 report by Trust for America’s Health, an independent advocacy group, estimated that a $2.9 billion investment in preventive health initiatives could lead to more than $16 billion in annual savings within five years.

“In creating the fund, the federal government made a historic investment in the future by focusing on keeping soaring health care costs under control while at the same time helping those who want to be healthy, get or stay healthy,” Jeffrey Levi, PhD, executive director of Trust for America’s Health, told The Nation’s Health.

Taking Action on Prevention

Prevention Fund dollars are already being used in a variety of ways, including supporting the work of the Centers for Disease Control and Prevention and the Health Resources and Services Administration:

  • Community prevention:Funds are being used to enhance community-based preventive health programs at the local level including tobacco cessation, obesity prevention, and disease-specific efforts.
  • Clinical prevention: Funds are being used to expand awareness of clinical preventive services and benefits.
  • Public health infrastructure and training: Funds are being used to bolster public health infrastructure at the state and local level, increase training capacity for the health care workforce, and expand public health officials’ ability to prevent and respond to infectious disease outbreaks.
  • Research and tracking: Funds are being used to increase and expand data collection on public health services nationwide.

Examples of funded activities include:

  • Through the National Public Health Improvement Initiative, Virginia has achieved information technology savings of $1.2 million, seen a 32 percent increase in enrollment in the state’s Medicaid Family Planning Program, and realized an overall increase in efficiency.
  • Through the Community Transformation Grant program, Iowa is expanding access to blood pressure and tobacco use screenings at dental practices to over 300,000 patients, increasing the number of referrals to the state’s tobacco quitline service, and targeting health interventions at the region of the state with the highest stroke mortality rates.
  •  In Hennepin County, Minn., a new system is linking patients with clinical and community programs. And in Wisconsin, advocates are working to implement smoke-free policies in low-income housing.

Perhaps the highest-profile use of the prevention fund is the CDC’s $162 million anti-tobacco advertising campaign called “Tips From Former Smokers.”   Just 12 weeks after the launch of the federal ad campaign, calls to tobacco cessation quit lines around the country increased by 200,000, and visits to www.smokefree.gov, a federal website designed to help people quit smoking, were up by more than 400,000. Even more importantly, the medical journal The Lancet credits these ads with prompting 1.6 million people to attempt to quit smoking and 100,000 people actually to do so in 2012.

The spots feature graphic accounts from individuals with serious tobacco-related ailments, such as a cancer patient from North Carolina who had her larynx removed:

Most of the projects financed by the prevention fund are smaller in scale and cost and based in individual communities, however. These aim to address the underlying cultural and behavioral factors that lead to poor nutrition, inactivity, obesity and tobacco use, and they have the potential to make measurable improvements in health, said Georges Benjamin, executive director of the American Public Health Association in Washington.

“We think that there’s evidence that communities have begun talking about those problems, identifying the root causes, trying to use these monies to leverage other funding and other things that they’re already doing to begin to make a difference,” Benjamin said.

In San Diego County, California, the local government and the Chula Vista Elementary School District used federal grants to make an immediate impact on students’ weight, said Nick Macchione, the director of the county Health and Human Services Agency.

Live Well San Diego recently announced a new partnership with Vons Grocery Stores. The collaboration will focus on helping shoppers make healthy choices and inspire community members to take action for their health.

Live Well San Diego recently announced a new partnership with Vons Grocery Stores. The collaboration will focus on helping shoppers make healthy choices and inspire community members to take action for their health.

School administrators approached county officials in 2010, concerned that unhealthy weight was holding back their students, Macchione said. In partnership with the county’s Live Well San Diego initiative, they conducted voluntary body mass index screenings of 25,000 kids in 44 schools. The findings confirmed the leaders’ fears: Almost 40 percent of the children were either overweight or obese. “This was shockingly alarming,” Macchione said.

Using some of the $8.2 million the county received from the prevention fund, the health agency and the school started making changes, Macchione said. The cafeteria started offering healthier food and local farmers visited to talk about agriculture and provide fresh produce. Math teachers incorporated physical activity into counting lessons. And students and parents received information about nutrition and exercise.

Two years later, Chula Vista schools already could boast gains: a 3.2 percent reduction in the share of students who were obese or overweight. The county has since started spreading this program to 300 schools serving 650,000 children, Macchione said.

Programs in Indiana also focused on children brought home the challenges faced by those working to address health in

Residents of Clinton County, IN, take part in a 'Get Fit Challenge' sponsored by the Community Partnership.

Residents of Clinton County, IN, take part in a ‘Get Fit Challenge’ sponsored by the Community Partnership.

their communities, said Andrea Hays, the project director overseeing the $3 million in Community Transformation Grants managed by the Healthy Communities Partnership of Southwest Indiana in Evansville.

As in San Diego County, they worked with local schools to incorporate healthier food and physical activity in students’ daily routines. Under one pilot program, Healthy Communities Partnership of Southwest Indiana joined with a local hospital to deliver fresh fruits and vegetables to a school, where Hays saw firsthand how deeply rooted the problem was.

“We had kids that had never tried a banana before,” Hays said. “It’s culture shock for these kids.”

In Iowa, the Department of Public Health tapped into $8.2 million in prevention funding to link patients to more medical providers. As part of the Iowa Community Referral Project, a partnership with local health boards and the Urbandale-based Iowa Primary Care Association, dentists received training to take blood pressure measurements and ask patients about tobacco use.

Four of the dental clinics participating in this program provided blood pressure tests to more than 4,000 people and discovered that 6 percent had hypertension, more than 70 percent of whom visited a medical doctor for further care, said Kala Shipley, the executive officer for health promotion at the Des Moines-based department.

Results like these won’t immediately reverse years of rising obesity rates and worsening health, but they’re a good place to start, Macchione said.

“Culture change takes time,” he said. “If we just look back 30 years ago on smoking, can you imagine in our first year and we started our campaign and we showed probably little-to-no impact, if we would’ve given up?”

America could be—should be—a nation committed to the health of its people, not solely to the treatment and management of its sick. We want children and parents to take for granted that the places they live, work, play, and learn are going to support them in healthy eating, physical activity and living smoke-free—not make it harder.

Prevention is making that possible today.


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