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Final Paper: National Health Care – For or Against?

NGR5638 Health Promotion

Dr. Marchina Jones

Katrina General, RN, BSN

Spring 2015

Abstract

There are many benefits to health promotion and disease prevention. Although it seems more logical and cost efficient to prevent disease as oppose to treating it, many Americans suffer from chronic diseases. The United States (US) spends more on health care than any other nation (Woolf et al., 2008). Because of this, it was identified as a need to reform healthcare in the United States; hence, the passage of the Affordable Care Act (ACA). The law is aimed to address the core issues within the United States healthcare system, including: the rising cost of care; insufficient access; quality and efficiency of care; and limited value on disease prevention. It was concluded that the Affordable Care Act have shifted the focus from disease treatment to disease prevention by offering several provisions which promote health and prevention. The purpose of this paper is for me to take a stance, either ‘for’ or ‘against’ ACA as it pertains to a means to prevent disease and promote health. After carefully analyzing the provisions of the Affordable Care Act, it is my position that I am ‘for’ ACA as it pertains to a means to prevent disease and promote health.

Final Paper: National Health Care – For or Against?

Introduction

According to Woolf, Jonas & Kaplan-Liss (2008), health promotion is defined as “any combination of educational, organizational, economic, and environmental supports for behavior and conditions of living conducive to health.” Disease prevention includes primary, secondary, and tertiary preventive measures. Primary prevention includes interventions which prevent the onset of a target disease or illness, such as the administration of vaccines to healthy individuals. Secondary prevention involves identifying and treating people who have developed risk factors, but not the disease itself. Tertiary preventive measures are usually performed as part of the management of individuals with clinical illnesses (Wolf et al., 2008).

There are many benefits to health promotion and disease prevention. For example, those who are vaccinated are likely to avoid a variety of life threatening diseases. Those who undergo cancer screenings are more likely to receive a more timely diagnosis, which leads to better outcomes. Also, early detection of diabetes and other chronic diseases can lead to the adoption of a healthier lifestyle and better management (McMorrow, Kenney & Goin, 2014). Although it seems more logical and cost efficient to prevent disease as oppose to treating it, many Americans suffer from chronic diseases. According to Wolf et al. (2008), “almost half of Americans have one or more chronic illnesses, and the number is expected to grow by 29% from 133 million in 2005 to 171 million in 2030.” The United States (US) spends more on health care than any other nation (Woolf et al., 2008). Because of this, it was identified as a need to reform healthcare in the United States; hence, the passage of the Affordable Care Act.

Overview

The Patient Protection and Affordable Care Act (PPACA), also known as Obamacare and Affordable Care Act (ACA) was signed by US President, Barack Obama on March 23, 2010 (Shaw, Asomugha, Conway & Rein, 2014). The law is aimed to address the core issues within the United States healthcare system, including: the rising cost of care; insufficient access; quality and efficiency of care; and limited value on disease prevention. According to the article by Shaw et al. (2014), “The central purpose of the law is to bring the security of health insurance to uninsured Americans, but the law also aims to increase the quality of care, restrain the growth of costs, and advance population health.” With the implementation of the Affordable Care Act, it is expected that the number of uninsured will decrease by 25 million by year 2016 (Shaw et al., 2014).

As previously stated, the Affordable Care Act was implemented with the intent to reform the United States healthcare system by making health insurance accessible to more Americans, as well as making key improvements to the quality of care and healthcare spending. Despite the intent, ACA is not popular with most Americans. According to Wilensky (2015), a gallop poll taken in November 2014 indicated that only 37% of the United States public approved of the legislation. There are several factors which are contributing to the high rate of disapproval, some of which are: cancellation of existing policies; being mandated to purchase comprehensive policies which are of little use; having to switch doctors; being fined for not obtaining coverage, etc. (Wilensky, 2015).

As you can see, there are pros and cons associated with the legislation. There are Americans who are ‘for’ the Affordable Care Act and there are also many Americans who are ‘against’ it.

Purpose Statement

The purpose of this paper is for me to take a stance, either ‘for’ or ‘against’ ACA as it pertains to a means to prevent disease and promote health.

Position

After carefully analyzing the provisions of the Affordable Care Act, I am ‘for’ ACA as it pertains to a means to prevent disease and promote health. Prior to the implementation of the Affordable Care Act, the US healthcare system had been described as a “sick care system” because of the focus on treatment rather than prevention (Shaw et al., 2014). “The Affordable Care Act aims to better emphasise prevention and public health in the US health system through establishment of national prevention priorities, catalysis of prevention initiatives, reduction of barriers to preventive services, provision of substantial new funding for public health interventions and infrastructure, and fostering of collaboration between public health and health care” (Shaw et al., 2014).

In an article by Lau, Adams, Park, Boscardin & Irwin (2014), it is discussed how the Affordable Care Act has a provision which extends dependent coverage. Therefore, ACA provides an expansion of health insurance coverage to young adults. This expansion resulted in a decrease from 42% uninsured young adults in 2010 to 36% in 2011. According to Lau et al. (2014), most morbidity and mortality during young adulthood are preventable. However, there was a decreased likelihood that young adults would obtain preventive care because historically they accounted for the group with the lowest rate of health insurance of any age group (Lau et al., 2014).

In a study performed by Lau et al. (2014), findings revealed an increase in the amount of young adults receiving preventive care after the enactment of ACA. There were an increase in routine examinations, blood pressure and cholesterol screenings, and annual dental visits. These findings suggested that young adults will access preventive care in the absence of financial burden. This was accomplished by the Affordable Care Act which allows dependents to remain on their parents’ private policy up to age 26, as well as by offering these services with no copayment (Lau et al., 2014).

In an article by McMorrow et al. (2014), it is discussed how insured Americans use more preventive care. It is also stated that the “ACA includes several components that expand coverage and reduce cost-sharing and thus have the potential to increase the receipt of recommended preventive care.” One component is an optional expansion of Medicaid for low-income Americans. In the study performed by McMorrow et al. (2014), it was confirmed that insurance coverage does indeed play a significant role in the use of preventive services. It was suggested that if low-income Americans had coverage similar to those of higher income, their rates of preventive care would increase. Overall, the findings revealed that ACA will likely increase the utilization of preventive care (McMorrow et al., 2014).

The Affordable Care Act also offers several other beneficial provisions, such as the coverage of pre-existing conditions. Health insurance companies will no longer be able to deny coverage or charge more because a person has a pre-existing medical condition (HealthCare, 2015). This provision will promote health by allowing Americans to receive the needed care and not allow the sick to become sicker. In an article by Cawley (2014), it is discussed how the Affordable Care Act also increased the maximum rewards that health insurance plans may offer in wellness programs. The goal is to promote healthy behaviors such as weight loss and smoking cessation. With that, many plans now offer smoking cessation and weight loss programs, along with gym membership discounts and/or on-site gyms (Cawley, 2014).

Conclusion

In conclusion, the growing prevalence of chronic diseases, rising healthcare costs, and the number of uninsured all led to the implementation of the Affordable Care Act. Conversations leading up to the passage of ACA placed a great deal of emphasis on preventive care. Expanding coverage to the uninsured and requiring insurers to cover preventive care with no copayment were provisioned by ACA to promote health and wellness, as well as increase access and utilization of preventive care services. Other provisions such as mandating coverage for pre-existing conditions and offering incentives for wellness programs are also other ways ACA is promoting health.

Historically, the US healthcare system has been known to focus on treatment as oppose to prevention. It is my belief that ACA is shifting that focus by implementing several provisions which are aimed to promote health and prevent disease. Because of that, I am “for” the Affordable Care Act as it pertains to a means to prevent disease and promote health.

References

Cawley, J. (2014). The Affordable Care Act permits greater financial rewards for weight loss: a

good idea in principle, but many practical concerns remain. Journal of Policy Analysis

and Management, 33(3), 810-820.

HealthCare. (2015). Health coverage rights and protections: Coverage for pre-existing

conditions. U.S. Centers for Medicare & Medicaid Services. Retrieved from



Lau, J. S., Adams, S. H., Park, M. J., Boscardin, W. J., & Irwin, C. J. (2014). Improvement in

preventive care of young adults after the affordable care act: the affordable care act is

helping. JAMA Pediatrics, 168(12), 1101-1106. doi:10.1001/jamapediatrics.2014.1691

McMorrow, S., Kenney, G. M., & Goin, D. (2014). Determinants of receipt of recommended

preventive services: implications for the Affordable Care Act. American Journal of Public Health, 104(12), 2392-2399. doi:10.2105/AJPH.2013.301569

Shaw, F. E., Asomugha, C. N., Conway, P. H., & Rein, A. S. (2014). The Patient Protection and

Affordable Care Act: opportunities for prevention and public health. Lancet, 384(9937),

75-82. doi:10.1016/S0140-6736(14)60259-2

Wilensky, G. (2015). Why does the Affordable Care Act remain so unpopular?. Jama, 313(10),

1002-1003. doi:10.1001/jama.2015.0542

Woolf, S. H., Jonas, S, & Kaplan-Liss, E. (2008). Health promotion and disease prevention in

clinical practice (2nd Ed.). Philadelphia, PA: Wolters Kluwer Lippincott Williams & Wilkins.

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