Every American needs health insurance.  As the glitches on Healthcare.gov are repaired, it appears that all those who are eligible for new insurance options will be able to enroll.

But when that happens, what will happen to the health of Philadelphians?  The Affordable Care Act (ACA) creates a structure not only to improve access, but it also strives to create a way to improve health as a way to reduce the costs of healthcare in America.  These pieces are outlined in Title IV of the Act.

The Act authorizes a strong new investment aimed at preventing chronic illnesses as a way of saving billions of health care dollars.  Part of cost reduction is derived from improving Americans' access to preventive services by removing all copayments.

Additional savings, though, are created through investment in the nation's public health infrastructure.  This includes

  • funds to improve how we monitor and understand the occurrence of conditions like asthma, hypertension, obesity, diabetes, and others;

  • support for long-term investments in interventions to prevent or delay chronic illnesses and assure that those with chronic illnesses are identified early and linked to good care;

  • dollars for research  into health disparities and on the delivery of public health services;

  • support for training more primary care providers who will be needed to help patients use the ACA and its "medical homes."

In addition, broad preventive interventions are endorsed, like more school-based health centers, support for healthier corner stores and bodegas, smoking cessation resources and media campaigns, and labeling chain restaurant menus to provide people with information about calorie contents of food items.

All of these interventions and innovations were to have been funded by a large pool of dollars called the Prevention and Public Health Fund.

What we have seen, instead, is the persistent whittling away at the Fund by Congress as it seeks to fill gaps in other parts of the ACA:  dollars from the Fund have been used to stop cuts in physician payments mandated by the ACA (more than one-third of the fund); dollars have been used to fund the development of the on-line federal Exchange (reportedly nearly half of the Fund for this year).  What remains is a small fund that is not going to be able to launch the prevention work that is needed to promote the health of Americans.

Yes, health insurance is critical to improving American's health, and yes, healthcare is expensive.  It is critical to realize, though, that healthy people consume fewer health care dollars.  Adequate support for healthier lives is key to making a healthier nation at an affordable cost.

From Obamacare to Medicare to managed care, read more of The Field Clinic here »