Running head: SUPPORT OF THE ACA

The 2010 Affordable Care Act Can Improve the Health of Americans
Brittany N. Reynolds
University of Central Florida

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Abstract

Americans are not meeting their potential for disease promoting behaviors. Studies show that
tobacco use, diabetes, obesity, and physical inactivity are plaguing the nation. These diseases
lead to increased morbidity and mortality and are responsible for an alarming number or deaths
each year. Healthcare costs due to the treatment of these often preventable diseases are
exorbitant. The 2010 Affordable Care Act (ACA) addresses these diseases with provisions
focused on improving access to health care and disease prevention across the country. Sectors of
the ACA aim to improve the health of the nation by implementing programs and grants
nationally, state-wide, in workplaces, and individually. In regards to health promotion and
disease prevention, the ACA is a progressive effort to eliminate the burdens caused by these
diseases.

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Introduction

Promoting health through disease prevention is essential to maintaining good overall

health. On average, Americans receive only half of their recommended preventative services
each year (Koh & Sebelius, 2010). According to Health People 2020 (2015), Americans are
falling short on meeting 42% of the health initiatives aimed at improving the public health of the
nation. Deaths from heart disease, stroke, diabetes, cancer and obesity are among the most
common chronic diseases, costing billions of dollars in care (Centers for Disease Control and
Prevention, 2015). Many of these diseases have risk factors that place a person at a much higher
risk for obtaining them. Some health risk behaviors include the following: inadequate physical
activity, smoking, poor nutrition, and consumption of too much alcohol (Centers for Disease
Control and Prevention, 2015). Lack of access to healthcare increases health disparities which
leads to unhealthy behaviors and poorer health. As of 2011, 17 states had greater than 18% of
residents living without health insurance (Zamosky, 2013); emphasizing a need for healthcare
reform. The 2010 Affordable Care Act (ACA) was designed to improve the health of American
citizens by not only making healthcare more affordable, but also by promoting disease
prevention through individuals, workplaces, communities, states and nation-wide. There has
been much debate over the ACA, often referred to as Obamacare, with many people not
understanding what is incorporated into the act. The ability of the ACA to empower people
across the nation regarding health initiatives makes this act a positive step in the direction toward
health promotion- for this reason, Americans should support it.
Tobacco
According to the Centers for Disease Control and Prevention (CDC), cigarette smoking is
responsible for around 480,000 deaths each year, or one death out of every five deaths. Smoking

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adversely affects your general health, and especially your respiratory health- predisposing
smokers to cancer, chronic obstructive pulmonary disease, high blood pressure and diabetes (US
Department of Health and Human Services, 2015). Around 29% of people who live below
poverty level are smokers, and in total, one in every five Americans smokes tobacco (Center for
Disease Control and Prevention, 2015). Unfortunately, each day around 2,100 youth and young
adults will become daily smokers (US Department of Health and Human Services, 2015). Efforts
to decrease the incidence of smokers across the country are necessary to improve public health.
The ACA addresses the need to promote smoking cessation. For example, section 2502
Medicaid and Tobacco Pharmaceutical Coverage, aims at prohibiting states from not allowing
coverage for smoking-cessation drugs (Koh & Sebelius, 2010). Medicaid beneficiaries have a
high percentage of smokers and research has shown that provisions such as these will increase
the number of people who attempt to quit, and successfully quit smoking (McAfee, Babb,
McNabb, and Fiore, 2015). The article, Promoting Prevention through the Affordable Care Act
(2010), acknowledges the efforts of the ACA in regards to tobacco cessation in other ways as
well. Sections of the ACA increase access to tobacco-use counseling and evidence-based
cessation programs. Decreasing barriers to tobacco cessation medications and programs can help
to improve the number of people affected by this highly addictive habit- reiterating the benefits
of the ACA.
Diabetes
Since 1980, the number of Americans diagnosed with diabetes has tripled with nearly 21
million people affected by this disease in 2011 (Centers for Disease Control and Prevention,
2015). Diabetes is linked to many complications including: heart disease, stroke, kidney disease,
visual complications, neuropathy and other serious health problems (American Diabetes

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Association, 2015). The 7th leading cause of death in the United States is diabetes, and studies
have shown the number of deaths attributed to diabetes may be underreported (American
Diabetes Association, 2015). This growing problem is especially noted amongst the older
population. In 2007, older adults aged 65 and older, accounted for nearly $65 billion in direct
diabetes care cost (Caspersen, Thomas, Boseman, Beckles, and Albright, 2012). This
demographic of people suffers from diabetes complications disproportionately compared to
people less than 65 years of age. The article Aging, Diabetes, and the Public Health System in
the United States (2012), highlights the increased societal burden due to the morbidity and
mortality in the older population diagnosed with diabetes. With the prevalence of this disease
increasing across the United States, and the profound financial impact on healthcare costs related
to diabetes treatment and care, more interventions are needed to derail this epidemic.
A person can limit their risk for developing diabetes if they are able to maintain a
healthy weight, refrain from smoking, eat healthy and stay physically active (American Diabetes
Association, 2015). The ACA has implemented several interventions for improving health
promotion which directly affect diabetes prevention. Section 10501 National Diabetes
Prevention Program, funds efforts to reduce preventable diabetes in at-risk populations. This
program, created by the CDC, encompasses four components. These components are: 1) train a
workforce to deliver the structured lifestyle program cost-effectively, 2) implement a recognition
program to ensure quality, and establish a registry of program sites, 3) prepare sites to deliver the
lifestyle program, and 4) market the program (Caspersen, Thomas, Boseman, Beckles, &
Albright, 2012). A number of sections include grants for increasing access to preventative health
services as well, which are paramount to diagnosing diabetes and borderline diabetes early on.

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Earlier diagnosis leads to earlier intervention and treatment- decreasing comorbidities related to
diabetes.
Obesity
Obesity is a complex disorder involving an excess of fat (Mayo Clinic, 2015). According
to the CDC, more than one-third of Americans are classified as obese. Obesity is linked to other
diseases, such as heart disease, stroke, diabetes and certain cancers (Centers for Disease Control
and Prevention, 2015). An alarming 33% of adolescents are considered to be overweight or obese
(US Department of Health and Human Services, 2015). According to the article The Role of
Weight, Race, and Health Care Experiences in Care Use Among Young Men and Women (2014),
some studies have reported the increased use of primary care providers for sick visits among
people who are overweight or obese. This article also reports the disproportionate number of
ethnic minorities affected by obesity, which attributes to over $190 billion in medical spending.
Causes of obesity can be related to some genetic predispositions, but are more often attributed to
lack of energy balance and an inactive lifestyle (National Institute of Health, 2015). The CDCs
high ranking of deaths related to obesity should encourage more efforts being placed in
prevention of this disease.
As previously stated, lack of energy balance is a main contributor to obesity. Excess
calorie consumption with inadequate calorie expenditures leads to this imbalance (National
Institute of Health, 2015). The ACA is responsible for the nutritional information seen at chain
restaurants across the country. Section 4205 Nutritional Labeling of Standard Menu Items at
Chain Restaurants requires that certain nutritional information be disclosed at chain restaurants
and some vending machines. This disclosure can help Americans make healthier choices when
eating at these restaurants. It is recognized that communities play a vital role in health promotion

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and disease prevention. The ACA has implemented several policies that strengthen partnerships
between communities and local governments. An example of this is section 4201 Community
Transformation Grant. Included in this grant is a promise to improve nutrition and increase
physical activity (Koh & Sebelius, 2010). If these sections of the ACA are successful, obesity
rates should decline. A decline in obesity will lead to a healthier America.
Physical Activity & Workplace Wellness
A Gallup survey completed in August 2014 reported the average working American now
works around 47 hours a week (Saad, 2014). Americas technology-driven society has more
people working desk jobs which decreases their amount of physical activity. Regular physical
activity is one of the most effective disease prevention behaviors, reducing the risk for obesity
and cardiovascular disease (Centers for Disease Control and Prevention, 2015). Although
Workplace Wellness Programs can positively impact productivity and decrease health
expenditures by improving employee health, they have been underutilized (Centers for Disease
Control and Prevention, 2015).
Women in the workplace have also increased with nearly 73 million women in the
United States working in 2013. Of these employed women, around 70% had children less than
18 years of age (United States Department of Labor, 2013). In an article by Brenner and
Buescher (2011), breastfeeding is reported to positively impact not only babies, but mothers as
well- by decreasing the mothers risk of developing hypertension, high cholesterol, breast cancer,
ovarian cancer and diabetes. Despite that 75% of mothers start out breastfeeding their babies,
only 13% continue to breastfeed throughout the babys first birthday. According to the article by
Brenner and Buescher (2011), more than half of mothers have already returned to work by this

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time, and workplace barriers are one reason these mothers are unsuccessful at maintaining their
breastfeeding.
With the ACA, even small businesses have access to grants for implementing workplace
wellness programs. With technical help from the CDC, formerly established wellness programs
will be monitored for effectiveness and quality (Koh & Sebelius, 2010). Workplace wellness
programs can lead to not only individual improvements, but organizational improvements as
well. Employers can benefit from enhanced employee productivity, decreased employee
absenteeism, and lower insurance compensation costs (Centers for Disease Control and
Prevention, 2015). The ACAs emphasis on promoting workplace wellness is another example of
how this act will help prevention become mainstream healthcare in the nation.
The ACA has the potential to improve the health of future generations too. Section 4207
Reasonable Break Time For Nursing Mothers requires employers to allow sufficient time for
breastfeeding mothers to do so. Employers will also be required to have appropriate facilities for
nursing mothers as well. This could lead to an increased number of nursing mothers who have
returned to work- promoting the health of mothers and babies alike.
Summary
Collectively, these provisions have the potential to greatly impact the nation. Efforts of
the ACA to increase access to these health promoting behaviors and programs will undoubtedly
improve the health of the United States of America. These provisions are supported by evidencebased studies which emphasize how health promotion leads to disease prevention. Eliminating
certain health disparities with these efforts could potentially be the gateway to a healthier society.
The ACA reaches out to the nation from an individual level to a national level and addresses
specific goals for each sector. Healthcare providers have a responsibility to educate patients on

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the opportunities provided by the ACA and should embrace these provisions for their ability to
positively impact the nation.

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References

American Diabetes Association. (2015). Complications. Retrieved from

http://www.diabetes.org/living-with-diabetes/complications/
Brenner, M. G., & Buescher, E. S. (2011). Breastfeeding: A Clinical Imperative. Journal Of
Women's Health (15409996), 20(12), 1767-1773. doi:10.1089/jwh.2010.2616
Caspersen, C. J., Thomas, G. D., Boseman, L. A., Beckles, G. A., & Albright, A. L. (2012).
Aging, diabetes, and the public health system in the United States. American Journal Of
Public Health, 102(8), 1482-1497. doi:10.2105/AJPH.2011.300616
Centers for Disease Control and Prevention. (2015). Retrieved from http://www.cdc.gov
Koh, H., & Sebelius, K. (2010). Promoting prevention through the aca. New England Journal of
Medicine, 363, 1296-1299. doi: 10.1056/NEJMp1008560
Healthy People 2020. (2015). Healthy people 2020 leading health indicators: Progress update.
Retrieved from http://www.healthypeople.gov/2020/leading-health-indicators/HealthyPeople-2020-Leading-Health-Indicators%3A-Progress-Update
Mayo Clinic. (2015). Diseases and conditions: Obesity. Retrieved from
http://www.mayoclinic.org/diseases-conditions/obesity/basics/definition/con-20014834
McAfee, T., Babb, S., McNabb, S., & Fiore, M. C. (2015). Perspective: Helping Smokers Quit
Opportunities Created by the Affordable Care Act. The New England Journal Of
Medicine, 3725-7. doi:10.1056/NEJMp1411437
National Institute of Health. (2015). What causes overweight and obesity. Retrieved from
http://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes

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Saad, L. (2014). The 40 hour work week is actually longer- by seven hours. Gallup. Retrieved
from http://www.gallup.com/poll/175286/hour-workweek-actually-longer-sevenhours.aspx
US Department of Health and Human Services. (2015). Overweight and obesity statistics.
Retrieved from http://www.niddk.nih.gov/health-information/healthstatistics/Pages/overweight-obesity-statistics.aspx
US Department of Health and Human Services. (2015). Tobacco facts and figures. Retrieved
from http://betobaccofree.hhs.gov/about-tobacco/facts-figures/
United States Department of Labor. (2013). Women of working age. Retrieved from
http://www.dol.gov/wb/stats/recentfacts.htm

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