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What Does the Affordable Care Act Mean For Preventive Health?

What Does the Affordable Care Act Mean For Preventive Health?

Picture of Sarah Kliff

Chronic diseases are the most common, costly and preventable American health issue. Half of American adults live with a chronic condition, which also are responsible for just under three-quarters of American deaths, according to the Center for Disease Control. Chronic conditions disproportionately effect underserved and minority populations; heart disease deaths, for example, are higher among African Americans than whites, while Hispanic populations have a diabetes rate twice that of the general population.

The health reform law makes an unprecedented investment into preventive health. Most significantly, it establishes a $15 billion Preventive Heath Fund, launching a host of new programs to prevent some of our country's most pressing health issues before they begin. The impetus to improve health is as much a budgetary issue as it as a public health concern. The United States' health expenditures now average approximately $7,000 per person-more than twice the average of 29 other developed countries-and chronic conditions account for 75 percent of that spending.

Not everyone, however, sees health reform's approach to preventive medicine as the right one. The Preventive Health Fund has quickly emerged as one of the most politically contentious and vulnerable Affordable Care Act provisions, one of Republicans' top repeal targets. Republicans deride many of the new programs as egregious in a time of fiscal crisis. Congress has already voted twice on defunding the nascent fund-the vote passed the House but failed in the Senate-and Sen. Mike Enzi, a Republican from Wyoming, has famously derided as "a slush fund for jungle gyms."

As the health reform law nears its two-year anniversary, I will be using my Dennis A. Hunt Fund award to report a three-part series on the challenges and opportunities of reform law's preventive programs, examining whether new approaches and bolstered funding are paying dividends at the ground level. My goal is to explain how policies crafted in Congress are playing out for under-served communities and what a new influx of grant money means for community health. I want to address the political arguments, too: what role does this fund have in improving community health? What outcomes should we expect from a $15 billion federal investment - and what, so far, are we getting?

I'm still in the initial phases of determining which programs and communities I'd like to include. As a reporter for the Washington Post, I'd like to make the story a national one that brings in geographically, economically and socially diverse communities, ranging from urban to rural and stretching across the country.

What excites me most about this project is the opportunity to write about health policy in a real world context. I have covered health care for just about five years now, first for Newsweek and, most recently, for Politico. I will start next month at the Washington Post, still on the same beat.

The stories I love to write most are those that tie together a health policy with its eventual outcomes. Those have ranged from a profile of a late term abortion doctor, and how reproductive health policy in Nebraska shaped his practice, to a data-intensive investigation of how major health interests were spending their lobbying dollars after the passage of the Affordable Care Act.

Pouring over new regulations can be dry. The stories they contain, however, are anything but. What drives my health policy reporting is the belief that decisions made in Washington effect millions of Americans, the health care they receive and the insurers, hospitals and doctors who provide it. Tracing the connection between a federal policy decision in Washington and a health outcome halfway across the country isn't an easy reporting task - but with this grant, I hope to make that, and many more, connections over the coming months and in my forthcoming stories.


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