The Obama Administration’s landmark health care reform legislation – the Affordable Care Act (ACA) – is again making headlines this week as the Supreme Court hears arguments challenging its constitutionality. On the agenda today – the individual mandate – one of the most contested and controversial parts of the law.
According to the Centers for Disease Control and Prevention (CDC), an estimated 59 million Americans lacked health insurance in 2009. The individual mandate, as part of the current law, will require almost every American to obtain health insurance by 2014. Those without insurance (through an employer sponsored plan or public program such as Medicare) will be required to purchase a policy through an affordable insurance exchange. Failure to obtain health insurance will result in a penalty paid by the individual.
Proponents cheer the mandate believing it will result in greater access to vital health care services and lessen the financial burden on the health care system as the federal government and taxpayers currently foot the medical bill for the uninsured. But, opponents, including 26 states, are challenging the constitutionality of the mandate citing that Congress does not have the authority to require Americans to ‘buy’ anything.
Controversy and constitutionality aside, as a self-professed public health ‘nerd,’ I welcome the notion of attainable health care for all. From a social marketing perspective, however, I ask ‘will the individual mandate and the ACA really increase use of health care services?’ True, more Americans will have access to health care, but will they actually access it? One of the administration’s key priorities with ACA is to improve public health. When people use preventive care services such as annual screenings and immunizations, the burden of disease, over their lifetime, is reduced. In theory, we become healthier people. But, increasing the use of health care services is a multi-faceted challenge, and one that requires a fundamental shift in American behavior.
As we have learned through our work as social marketers, removing barriers – such as cost – that prevent people from action or inaction is an essential first step. We also know that we need to pair that with clear, concise messaging to communicate the value of a new behavior to influence and incite action. When Congress passed it in 2009, ACA removed one of the biggest barriers to preventive care – cost – by providing first dollar coverage for critical cancer screenings, cholesterol and blood pressure tests, and vaccinations, among other services, and the individual mandate (if it stays) will ensure all Americans can access health care. But, according to the Agency for Healthcare Research and Quality (AHRQ), “roughly 60 million people – 1 in 5 Americans –have no usual source of medical care, such as a family doctor or clinic.” Instead of scheduling annual well visits, when early signs/symptoms of disease are often detected, many only seek treatment after an often preventable illness or disease onsets.
It’s too early to tell what impact the preventive services provision has had on American health, and as the drama unfolds in the Supreme Court this week, I keep thinking of ACA and the individual mandate as a social marketing challenge. If it holds and the ACA remains intact following deliberations, how can we help Americans understand, value, and seek important care that can improve their health?