By Ed McField - http://llusphhealthmgmt.wordpress.com
A few weeks ago I was introduced to Breaking Bad, an intriguing television series that depicts the life of Walter White (a.k.a. Heisenberg), a chemistry school teacher turned drug manufacturer (mind you, not drug dealer). One of the various twists in the plot is that Heisenberg discovers that he has lung cancer and has no way of paying for treatment. I am apprehensive about referring to a television program that seems to exalt fringe behaviors but as I watched an early installment, it immediately became clear that this series also indirectly dealt with an issue that has been at the core of American political and policy debate for many decades and continues to cause the most heated arguments despite (and because) of the passage of the Affordable Care Act (ACA), today lovingly known as ObamaCare.
This brings me to the second part of this reflection.
Yesterday, Oct 1, 2013 was Opening Day! The Health Exchanges that were conceived as part of the ACA are now officially open and taking enrollment. The Robert Wood Johnson Foundation estimates that about 44 million people under age 65 would be covered through health insurance exchanges. In California, it is projected that by 2017, an estimated 2.3 million Californians will be newly enrolled in a health plan through Covered California (the state’s health exchange) and will have access to care. But there is a key word: access. Yes, lack of health insurance constitutes a significant barrier to healthcare but we should be reminded that access does not equal utilization. A recent survey by the Commonwealth Fund found that two-thirds of the uninsured are not aware of the health exchanges.
Although the ACA provides some solutions to the problem of securing our nation’s health, we still have questions and problems left unanswered. For example, we are yet to understand
- What is the role of incentives (and penalties), values, ideology, culture, and other psycho-social factors in influencing whether people obtain health insurance, even when eligible?
- What factors determine whether young or healthy individuals sign up for health insurance, a necessary feature of the ACA, designed to offset the risks and avoid adverse selection?
- What will be the role of safety-net (e.g. community clinics) in the context of the ACA?
These are just some of the questions that the Loma Linda University School of Public Health will continue to explore. We recognize that many of the health problems require multi-disciplinary approach and solutions. For example, we can design solutions that incorporate principles of social and behavioral sciences (i.e. health education and promotion) AND policy and systems change to improve prevention strategies, promote help-seeking behaviors, and healthy lifestyles. As a School of Public Health, we can take an active role in promoting and sharing information about the ACA. For starters, here’s the CA health exchange: https://www.coveredca.com/
Today, some are saddened that Breaking Bad has ended but there is reason to celebrate. Although the Affordable Care Act is an “imperfect policy” (show me one that is perfect), perhaps we can celebrate that millions of our fellow men and women will now have access to health insurance. But our work has only now begun.
P.s. You may wish to contribute a response or simply reflect on a few questions: 1) How would you improve the ACA, 2) what other health care needs will need to be focused on that are not addressed by the ACA, and 3) what opportunities or questions does the ACA present?