Implementing Health Care Reform:
An Aging and Public Health Approach Preview
Lené Levy-Storms, A&PH Chair Elect
In 2011, APHA held a Midyear Meeting in Chicago on implementing health care reform. This first-ever meeting in June occurred just over a year after President Obama signed into law the Patient Protection and Affordable Care Act on Jan. 5, 2010. Thus, this timely meeting allowed in-depth insight into how federal and state governments are implementing this seminal legislation including its successes and challenges. ACA is the most significant health legislation passed since Medicare and Medicaid in 1965, so one must wonder: what have we learned about health care and health care delivery in the past 45 years that the ACA reflects? How is ACA particularly relevant to aging and older adults? This article is the first in an ongoing series that will describe how ACA reflects and supports modernized notions of healthy aging.
Before discussing the answers to these questions, I must state a couple of action points. First, the ACA is extremely long in its legislative length (almost 1,000 pages!), but it is readable. Read it. Second, its enormity is further reflected in its implementation plan, which will entail an ongoing process or series of steps over many years to come. Of course, this assumes that ACA will not be repealed and that appropriations will be made accordingly. In these political times, these are huge assumptions. Thus, ACA is legislation that will require ongoing participation by health care leaders, stakeholders, and consumers, etc., in order to ensure it is implemented as it was intended to the extent it was intended. Get involved as the ACA will surely evolve. Time is of the essence.
To address the first question above, ACA is noticeably different in its language about health and health care delivery than previous health care legislation. These differences go beyond semantics and reflect how health and health care has changed. Since the turn of the 20th century, the U.S. population has shifted from health risks associated with infectious diseases to those associated with chronic diseases. Health is less an event and more a lifestyle. Health is a state of physical, social, mental and emotional well-being and not just the absence of disease. Likewise, health care is more than medical services. If one skims ACA, one may notice such words as: prevention, community, coordination, quality and affordability, and coverage. ACA, like changes in population health, has in its principles notions of health as holistic, systemic and community-based. Public health is actually in one of its 10 Titles! Of course, these are ideals, and ACA is not perfect. It is the “best” legislation that could be passed in its time.
To address the second question above, ACA 1) Acknowledges and optimizes the role of gender in health and health care — women use health care the most and are the health care providers in their families. Aging is largely a female phenomenon, since women live longer than men on average and disproportionately represent elders; 2) Modernizes Medicare to address gaps and preventive services including medication coverage gaps and approving evidence-based preventive health care services; 3) Enhances direct care workforce efforts including improved training in geriatrics; 4) Supports coordinated care for Medicare and Medicaid dual eligible elders; 5) Values independence at home through demonstration projects; 6) Creates the voluntary community living assistance services and support (CLASS) Act. Are we excited yet?
This concludes the first “preview” article in the upcoming, ongoing series of more in-depth articles to explore and summarize ACA, especially as it was perceived by me during the APHA Midyear Meeting in 2011. You may see details about the Midyear Meeting 2011 at: http://www.apha.org/Midyear/. There you will find a link to YouTube for video-recorded opening (i.e., “The Public Health Context for Health Reform”, middle-morning and -afternoon (i.e., “Various Approaches to Improving Population Health” and “Public Health, Health Care and Quality,”) and closing (i.e., “Communicating Effectively to Build Support for Public Health”) sessions. In between these plenary sessions, I attended several repeated “breakout” sessions including: 1) Public Health and Quality Care; 2) Connecting Public Health and Clinical Prevention; 3) Developing the Public Health Workforce; and 4) Engaging Policymakers and Other Leaders. In the next article, I will summarize the above sessions that I attended in particular as they address how ACA promotes health aging.