And Many Happy Returns: The Affordable Care Act Turns Three

The Affordable Care Act (ACA) is a historic law and its third birthday should be celebrated.
The law, each day, helps move the country from a 'sick care' system to a real health care system. Some of the lesser known but most important provisions of the ACA focus on preventing disease instead of treating people only after they become ill. Millions of Americans are already healthier because of the prevention portions of the law, including Community Transformation Grants (CTG), expanded coverage of preventive services and other measures focused on improving health in the ACA.

The law has also ensured that:

• Every new health plan, beginning in 2010, must include coverage of evidence-based, effective preventive services, such as screenings for type 2 diabetes, immunizations and mammograms, without co-pays;
• Seniors on Medicare receive many preventive services, starting January 1, 2011, with no co-payments - these services include annual wellness visits, cervical cancer screening, diabetes screening, mammograms and important immunizations such as for the flu and pneumonia; and
• The Prevention and Public Health Fund will invest $12.5 billion over 10 years (FY2013-FY2022) in locally-determined, evidence-based community prevention programs and will support public health job creation and training programs. The Fund will provide a coordinated, comprehensive, sustainable and accountable approach to improving the nation's health outcomes through the most effective prevention and public health programs.

One of the law's great prevention successes is the CTGs program -- one of the hallmark initiatives of the Prevention and Public Health Fund. CTGs provide communities with resources to focus on their top health priorities, including smoking cessation and obesity prevention.

In just three short years, the law has been an enormous benefit to Americans. In 2011, the Centers for Disease Control and Prevention (CDC) awarded $103 million in CTGs to 61 state and local public health or related organizations, and, in 2012, CDC funded CTG programs with $226 million, including approximately $70 million in CTG funding to 40 additional communities.

To commemorate the third anniversary of the Affordable Care Act, we at the Trust for America's Health (TFAH) released a story bank featuring stories of successful prevention initiatives in action from around the country. Many of the stories focus on CTG awardees and show how this new program, made possible by the ACA, is already helping to improve the health of Americans. TFAH's Prevention and Public Health Stories in the States story bank includes more than 50 profiles in 28 states, including:

• The launch of the first Accountable Care Community (ACC) in Akron, Ohio, which builds on the idea of an Accountable Care Organization. In 2011, the nonprofit organization Austen BioInnovation Institute (ABIA) brought together a wide range of 70 different groups to coordinate health care inside and outside the doctor's office for patients with type 2 diabetes, and received500,000 per year for 5 years for a capacity building CTG. The ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month over 18 months with an estimated program savings of3,185 per person per year. This initiative has also led to a decrease in diabetes-related emergency department visits.
• Oklahoma is using a CTG to work with a range of sectors to make healthier choices easier in the state. Nearly 70 percent of Oklahoma County's premature deaths are largely preventable, and the county spends about920 million every year to treat chronic disease. In September 2011, Oklahoma City was awarded a3.5 million CTG. Using a portion of those funds, along with additional outside resources, the Oklahoma City-County Health Department (OCCHD) created the "My Heart, My Health, My Family" program to provide prevention programs and services, specifically focused on cardiovascular disease. The CTG money will also support expanded walking and biking trails, a push to help schools offer healthy menu options and a physical education coordinator for city schools.
• Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) in Kentucky received a capacity-building CTG to help support this program which has delivered important results for a holistic, community-based approach to address substance abuse. UNITE was created a decade ago, however the CTG will help expand its work to support public health efforts aimed at reducing chronic diseases, promoting healthier lifestyles, reducing health disparities and controlling health care spending, and will serve 119 of the state's 120 counties. UNITE works to rid communities of illegal drug use and misuse of prescription drugs by coordinating treatment, providing support to families and friends and educating the public about the dangers of drug abuse.
• The West Virginia Department of Health is using CTG support to help local health departments in every county in the state implement targeted initiatives including: safe places in communities to work and play, Farm-to-School Initiatives to improve nutrition in school settings, Child and Day Care Center Nutrition Programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

The ACA began a new era for public health. The law paves the way toward ensuring public health is no longer separated from the rest of the health care system. The ACA supports common-sense community approaches focused on connecting the care people receive in the doctor's office with opportunities to stay healthier beyond the doctor's office, where we all live, learn, work and play.

As the Affordable Care Act continues to benefit the country, in another year, we'll have an abundance of stories to share of communities turning their health around by focusing on preventing illness and thereby creating happy, healthy and thriving neighborhoods.

Jeffrey Levi, PhD

Associate professor of health policy, George Washington University

Executive Director, Trust for America's Health

(This article was originally posted in the Huffington Post blog here.)