Obamacare will result in wider public health benefits because of a greater emphasis on preventive medicine, according to research by the Centers for Disease Control and Prevention.
The Patient Protection and Affordable Care Act, which was brought into force by President Obama in 2010, will advance health not only by greater emphasis on prevention, but also by "reversing the historic division between public health and private health care services," according to the authors publishing in The Lancet.
The report has been produced as part of the journal's series "The health of Americans" by health experts from the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, and the Centers for Medicare & Medicaid Services in Baltimore, MD.
Dr Frederic Shaw of the CDC is one of the study authors. He concludes:
"While the central achievement of the Patient Protection and Affordable Care Act is to bring the security of health insurance to millions of people, it also has the potential to improve population health over the long term."
The US ranks first in the Organisation for Economic Co-operation and Development (OECD) for health care expenditure, but last for coverage.
The authors say they have shown that structural and financing reforms introduced by the new laws have helped move America's "sick care system" from one "largely focused on treatment of illness" to one that has "prevention, health promotion, early detection, and public health as integral components."
They cite this benefit in addition to that of raising the proportion of Americans covered by medical insurance.
'Historic opportunity for prevention'
Andrew Rein, also one of the study authors, says: "The new law represents a historic opportunity for prevention and public health by establishing the first national prevention strategy, adding substantial new funding for prevention and public health programs, and promoting the use of proven clinical preventive services by removing barriers."
The new provisions of Obamacare mean that people do not have to make co-payments for a range of evidence-based preventive services for health, the authors say.
The law also "provides impetus for greater collaboration between the US health care and public health systems, which have traditionally operated separately with little interaction," says Mr Rein, adding:
"Aligning, coordinating, and integrating the best of both systems has the potential to be a game-changer that improves the health of the US population."
Financial, organizational and clinical links between public health and health care systems are improved by the new focus on population health, the report claims.
Examples of measures that are "likely to lead to greater integration and better-quality services" include:
- Public health entities beginning to bill insurers for covered individuals' services such as immunisation
- Hospitals and public health practitioners collaborating to identify community needs.
Specialists from the CDC have added a commentary on the research in The Lancet. Tom Frieden, director, and Harold Jaffe, associate director for science, say:
"Combining public health and clinical care approaches is the best way to address some chronic illnesses.
The authors cite an example of public health measures to decrease smoking - the CDC's "tips from former smokers" campaign.
The Million Hearts initiative mentioned by the CDC directors is one example of a new payment and service delivery model being tested by the team. Focused on prevention and population health, this national scheme was launched by the authors with the Department of Health and Human Services in September 2011.
The initiative aims to prevent 1 million heart attacks and strokes by 2017, through specific objectives:
- Improved access to effective health care
- Better quality of care for the ABCS:
- Aspirin for those at risk for heart attack and stroke
- Blood pressure control
- Cholesterol management
- Smoking cessation
- Clinical attention focused on prevention
- Activating the public to lead a heart-healthy lifestyle
- Better prescription and adherence to appropriate medications for the ABCS.
The Million Hearts initiative also sets out goals for individuals:
- Prevent heart disease and stroke in your family by understanding the risks
- Exercise for 30 minutes on most days of the week
- Know your ABCS (see above)
- "Stay strong" by eating a heart-healthy diet high in fresh fruits and vegetables and low in sodium, saturated and trans fats, and cholesterol
- "Take control" of your heart health by following medication instructions.
The authors of the analysis in The Lancet say: "By the end of March 2014, the [Affordable Care Act] had brought more than 8 million more people on to the insurance rolls and helped 4.8 million more to obtain Medicaid coverage."
They add: "As a result of the law, by 2016 the number of people in the US without health insurance is expected to fall by 25 million."
In another analysis of Obamacare, according to the Medicare Rights Center, a non-profit that fights for access to affordable health care, the Affordable Care Act seems to have reduced federal government health costs. Meanwhile, emergency doctors publishing research in October 2013 claimed the long trend of uncompensated care in ERs could be reversed by Obamacare.