Revamped ObamaCare threatens to throw out baby with the bathwater

Greg Nash

There’s a lot of talk about dismantling ObamaCare. Pundits and prognosticators attempt to predict the fate and timeline of the law, and the required bridge legislation that will be required for a realistic transition from what is to what will be. Given partisan politics, the default position is usually to throw out the baby with the bathwater. The latest offering from the GOP, the American Health Care Act, appears to have split the baby.

Seemingly lost in the debate was the original intent of the law. The Patient Protection and Affordable Care Act, PPACA, ObamaCare by its original name, is more descriptive of the purpose of the law, namely to provide patient-centered, health protection that won’t break the bank. By expanding federal Medicaid, creating insurance exchanges, implementing payment and insurance reforms, and encouraging innovation, PPACA has effectively broadened the tent of healthcare coverage for more than 20 million Americans.

{mosads}Significantly, the law also recognized the importance population health, or as I like to call it, health beyond the walls of the medical facility. In fact, improving the health of the community and population was an essential component of the Triple Aim, characterizing the overall objectives of the law. Those provisions might be some of the most significant, yet under-appreciated, parts of the law.


By promoting population health improvement, the current law emphasizes the need to prioritize the link between healthcare and population health. Most health professionals agree that health is not merely the absence of disease, but rather the state of complete physical, mental, social, and spiritual well-being.

Further, there is an appreciation for the harmonious relationship that exists when healthy individuals thrive in resilient communities supported by sustainable systems of health. Yet, despite this more holistic view of health, policy makers tend to equate health with healthcare. They ignore or minimize importance of contextual factors that influence health.

We have traditionally measured the health of populations was by calculating rates of death, morbidity, disability, hospitalization, and life expectancy. In other words, we tracked only the metrics for physical health. Increasingly, we are incorporating broader measures that in fact predict those measures: the social determinants of health.

These determinants of health are far more contextual in nature and include livable wages, housing, food security, education, transportation, presence of social service providers, language proficiency, neighborhood stability, and more. Neighborhood of residence trumps whether someone has a regular health care provider in terms of predicting health status. For example, zip codes have become the most powerful predictor of life expectancy.

With some help from the government, and a credible chief health strategist, communities can begin to collectively attack the precursors to poor health outcomes. When that occurs, the gaps in health outcomes have the potential to close. And, eventually, the health expectancy — the reasonable expectation that a person living in given community can expect to achieve and maintain health and wellness — will likely increase.

Successful strategies will undoubtedly incorporate community organizing, priority setting, and recruitment of resources; they will require access to actionable data and ongoing measurement to track progress to goals; they will employ innovative social networking and consumer interactive tools; and, will require the active participation from stakeholders in non-health sectors, including education, transportation, urban planners, business, and others.

Despite several universally welcomed features of ObamaCare, for example, coverage for dependent children until age 26, preventive services, and coverage for people with preexisting conditions, there were obviously notable design flaws. Regrettably, for too many, these flaws led to raising premiums, unaffordable co-pays, and limited physician choices, necessitating an overhaul.

However, the law’s emphasis on population health improvement by including the Prevention and Public Health Fund, the triple aim, and other provisions currently omitted from the latest reboot, incentivized healthcare providers to look beyond their examination and waiting rooms. It might serve the architects of the American Health Care Act well to recognize that these provisions are a part of the baby worth saving.

Hasbrouck is the former executive director of the National Association of County and City Health Officials (NACCHO). The former Illinois State health director, and Epidemic Intelligence Service Officer at the U.S. Centers for Disease Control and Prevention, he has public health experience at the local, state, national and international levels.

The views expressed by contributors are their own and are not the views of The Hill.

Tags Health Healthcare ObamaCare Paul Ryan

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