And Many Happy Returns: The Affordable Care Act Turns Three

The Affordable Care Act (ACA) is a historic law and its third birthday should be celebrated.
The law, each day, helps move the country from a 'sick care' system to a real health care system. Some of the lesser known but most important provisions of the ACA focus on preventing disease instead of treating people only after they become ill. Millions of Americans are already healthier because of the prevention portions of the law, including Community Transformation Grants (CTG), expanded coverage of preventive services and other measures focused on improving health in the ACA.

The law has also ensured that:

• Every new health plan, beginning in 2010, must include coverage of evidence-based, effective preventive services, such as screenings for type 2 diabetes, immunizations and mammograms, without co-pays;
• Seniors on Medicare receive many preventive services, starting January 1, 2011, with no co-payments - these services include annual wellness visits, cervical cancer screening, diabetes screening, mammograms and important immunizations such as for the flu and pneumonia; and
• The Prevention and Public Health Fund will invest $12.5 billion over 10 years (FY2013-FY2022) in locally-determined, evidence-based community prevention programs and will support public health job creation and training programs. The Fund will provide a coordinated, comprehensive, sustainable and accountable approach to improving the nation's health outcomes through the most effective prevention and public health programs.

One of the law's great prevention successes is the CTGs program -- one of the hallmark initiatives of the Prevention and Public Health Fund. CTGs provide communities with resources to focus on their top health priorities, including smoking cessation and obesity prevention.

In just three short years, the law has been an enormous benefit to Americans. In 2011, the Centers for Disease Control and Prevention (CDC) awarded $103 million in CTGs to 61 state and local public health or related organizations, and, in 2012, CDC funded CTG programs with $226 million, including approximately $70 million in CTG funding to 40 additional communities.

To commemorate the third anniversary of the Affordable Care Act, we at the Trust for America's Health (TFAH) released a story bank featuring stories of successful prevention initiatives in action from around the country. Many of the stories focus on CTG awardees and show how this new program, made possible by the ACA, is already helping to improve the health of Americans. TFAH's Prevention and Public Health Stories in the States story bank includes more than 50 profiles in 28 states, including:

• The launch of the first Accountable Care Community (ACC) in Akron, Ohio, which builds on the idea of an Accountable Care Organization. In 2011, the nonprofit organization Austen BioInnovation Institute (ABIA) brought together a wide range of 70 different groups to coordinate health care inside and outside the doctor's office for patients with type 2 diabetes, and received500,000 per year for 5 years for a capacity building CTG. The ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month over 18 months with an estimated program savings of3,185 per person per year. This initiative has also led to a decrease in diabetes-related emergency department visits.
• Oklahoma is using a CTG to work with a range of sectors to make healthier choices easier in the state. Nearly 70 percent of Oklahoma County's premature deaths are largely preventable, and the county spends about920 million every year to treat chronic disease. In September 2011, Oklahoma City was awarded a3.5 million CTG. Using a portion of those funds, along with additional outside resources, the Oklahoma City-County Health Department (OCCHD) created the "My Heart, My Health, My Family" program to provide prevention programs and services, specifically focused on cardiovascular disease. The CTG money will also support expanded walking and biking trails, a push to help schools offer healthy menu options and a physical education coordinator for city schools.
• Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) in Kentucky received a capacity-building CTG to help support this program which has delivered important results for a holistic, community-based approach to address substance abuse. UNITE was created a decade ago, however the CTG will help expand its work to support public health efforts aimed at reducing chronic diseases, promoting healthier lifestyles, reducing health disparities and controlling health care spending, and will serve 119 of the state's 120 counties. UNITE works to rid communities of illegal drug use and misuse of prescription drugs by coordinating treatment, providing support to families and friends and educating the public about the dangers of drug abuse.
• The West Virginia Department of Health is using CTG support to help local health departments in every county in the state implement targeted initiatives including: safe places in communities to work and play, Farm-to-School Initiatives to improve nutrition in school settings, Child and Day Care Center Nutrition Programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

The ACA began a new era for public health. The law paves the way toward ensuring public health is no longer separated from the rest of the health care system. The ACA supports common-sense community approaches focused on connecting the care people receive in the doctor's office with opportunities to stay healthier beyond the doctor's office, where we all live, learn, work and play.

As the Affordable Care Act continues to benefit the country, in another year, we'll have an abundance of stories to share of communities turning their health around by focusing on preventing illness and thereby creating happy, healthy and thriving neighborhoods.

Jeffrey Levi, PhD

Associate professor of health policy, George Washington University

Executive Director, Trust for America's Health

(This article was originally posted in the Huffington Post blog here.)

Schools: The Missing Link in Promoting Healthy Children

On May 9^th, 2012, Healthy Schools Campaign and Trust for America’s Health, along with a group of partner organizations (including Health & Disability Advocates), released policy recommendations to Secretary of EducationArne Duncan and Secretary of Health and Human Services Kathleen Sebelius. The recommendations called on the departments to “further support the critical connection between health and learning, and build this priority into the Department’s infrastructure and leadership.”

A strong connection exists between children’s health and education. A child who is healthy is more likely to attend school and engage in learning. However, many schools lack things necessary to promoting health, such as access to clean air and water, nutritious food and school nurses; and do not provide an opportunity for students to be active throughout the day.  

School’s lack of emphasis on health comes at a time when promoting health is of the utmost importance. Rates of chronic diseases, such as asthma, diabetes or obesity, have doubled among kids in the last several decades. Students with a chronic condition often need extra care to manage their condition, and school—a place where many kids spend most of their time—could play an important role in their health.

Our nation faces a growing achievement gap in our nation’s students—which recent studies have shown to be linked to health issues. Low-income minority students are more likely to suffer from health issues, as well as more likely to attend a school without a healthy environment.

Healthy Schools Campaign, Trust for America’s Health and their partner organizations crafted their recommendations with these strong connections between health and learning in mind. The recommendations focus on actions that are within the government’s role to make and can have an immediate impact on the health of students and the achievement gap:

Recommendations to the Department of Education:

1. Expanding the mandate of the Office of Safe and Healthy Students (OSHS) and appointing a Deputy Assistant Secretary to the office in order to build up the office’s capacity for leadership.
2. Support pre-service and professional development programs for teachers and principals by making health a priority in grants and other training programs.
3. Make health an important factor of the standard of excellence for the Blue Ribbon Program.
4. Developing and disseminating best practices for colleges and universities to support teachers’ and school leaders’ abilities to address student health needs
5. Support the development of resources for schools to effectively engage parents around school health and wellness issues.
6. Support the development of educational data systems and school accountability programs that incorporate student health.

Recommendation to the Department of Health and Human Services:

1. Reduce barriers schools face in providing health care to students: Currently, restrictive regulations limit the reimbursements schools can receive from Medicaid. Removing these restrictions, which HHS itself deemed “unenforceable,” would allow schools to expand the health care schools can afford to provide to students.
2.   Include Schools in the National Prevention Strategy: The strategy emphasized the importance of making good health a priority in all areas of life, not just within a health care setting. It is important for HHS to acknowledge how important schools are to an effective prevention strategy, and to fully investigate the role schools may be able to play in promoting health.

At the event, Secretary of Health and Human Services Kathleen Sebelius announced a $75 million investment in the establishment of school health centers, as a part of the School-Based Health Center Capital (SBHCC) Program, created by the Affordable Care Act. These health centers offer disease prevention and health screenings to students. This announcement marks one of many necessary steps in the right direction towards the integration of health and education.

Stephanie Altman

Health & Disability Advocates; Program and Policy Director

Check back with Illinois Health Matters for more info on how the Department of Education and the Department of Health and Human Services integrate health into the nation’s schools. 

Let’s Hear it for Prevention

Prevention is not only the best medicine, it’s the cornerstone of the Affordable Care Act (ACA). To ensure that prevention is integrated into our nation's health care systems, the ACA created the National Prevention, Health Promotion, and Public Health Council, composed of the heads of 17 Federal agencies and chaired by the U.S. Surgeon General.

Earlier this year, the Surgeon General announced the National Prevention Strategy,  which is a comprehensive plan to increase the number of Americans who are healthy at every stage of life by moving health care away from a system focused on sickness and disease, to one focused on wellness and prevention.

So how do we turn this plan into reality? The answer is that everyone has a role to play in a healthier community, state and nation.

The Surgeon General, Dr. Regina M. Benjamin, is visiting regions around the country to launch this vision. She believes everyone – businesses, educators, health care institutions, government, communities and every single American – has a role to play.

Thursday December 8, 2011, Dr. Benjamin stopped in Chicago, and urged Illinois community leaders and public officials to take a pledge, committing themselves to do what they can to make healthier choices easier choices for themselves and the people in the communities they serve.

“I will be a leader to make healthier choices easier choices where I live, learn, work, play and pray.”

This is an unprecedented call to action is for individuals, communities, schools, faith institutions and employers to all take part. The pledge, and more information about the National Prevention Strategy is hosted by Community Commons and managed by Health & Disability Advocates and the Trust for America’s Health.

So what are you waiting for? Ask not what your country can do for your waistline. Ask what you can do to make your country healthier.

Take the prevention pledge today.