The phrase “health care reform” has perhaps never been more maligned as now in this pessimistic holiday season of high unemployment and economic inequality. By large poll margins, Americans hold unfavorable views of President Obama’s signature Affordable Care and Protection Act of 2010. The act’s keystone individual mandate for health insurance coverage will soon be the subject of a U.S. Supreme Court case, and given the court’s conservative leanings, there is a not unlikely chance that this crucial centerpiece of health care reform will be struck down.
But would a negative Supreme Court outcome be the death of Obama’s foray into health care? Don’t count on it. The president is not down-and-out in terms of health reform credibility, not compared to his rivals.
For one, as the Kaiser Family Foundation has documented, the spiraling costs of health care in the U.S. and the ever-deepening public health crisis of obesity-related chronic disease will continue to place an extraordinary burden upon local, state, and federal resources. And secondly, many of the Obama administration’s already-implemented and proposed health reform initiatives are in fact popular, cost-effective, and proving to be solid drivers of job creation in key swing states like Pennsylvania, Florida, and Nevada.
On the stump, Obama is defending these initiatives with newfound vigor. In Hawaii in mid-November, Obama declared, “change is health care reform” and singled out the 1 million young Americans receiving health insurance “because they can now stay on their parent’s insurance until they’re 26 years old.” He also played up the impending repeal of health insurance coverage denials due to pre-existing conditions: “if you get sick, if you have a preexisting condition, you can still afford to get health insurance – you’ll still have access to quality care.”
The pre-existing condition repeal will take full effect in 2014, and until then the Affordable Care Act has authorized the federal government to provide millions to the states to set up “pre-existing condition insurance plans,” which as of this month have enrolled over 30,000 uninsured Americans. On the campaign trail in Pennsylvania and North Carolina, the president can play up the particular success of these states in enrolling thousands of residents ineligible for coverage through traditional public and private insurance programs.
The president can also spotlight other smaller, popular health reform initiatives already funded through the Affordable Care Act or the stimulus American Recovery and Reinvestment Act of 2009, or that have been piloted at the state-level and are poised to go national. These include:
-Community Health Centers, which offer comprehensive primary care services to low-income patients in medically underserved areas regardless of ability to pay, received $11 billion in Affordable Care Act funds and $2 billion in stimulus funds. Community health centers provided primary care to 1 in 20 Americans in all 50 states in 2010, including over one million patients in the swing state of Florida alone.
The centers bring jobs as well. A recent health policy analysis estimates the community health centers expansion could create as many as 284,000 jobs in low-income communities by 2015. As David Frum writes in a piercing recent article, Obama has been hitting new polling lows in his working-class white support in states like Florida, Pennsylvania, and Ohio. In response, the president could hold a press event at the Central Florida Family Health Center in Seminole County, which received over $1.2 million in federal funds to renovate its clinic and expand medical and dental services to thousands of clients this year. Or the president might attend the planned groundbreaking ceremony in August 2012 for the Hamilton Health Center’s new 67,000 square foot clinic in Harrisburg, Pennsylvania, which has benefited from over $250,000 in stimulus funds to provide primary care to more than 19,000 patients in 2010.
In staging campaign events at these centers, Obama could credibly say his administration has been looking out for working-class Americans struggling to make health ends meet in tough economic times.
-Communities Putting Prevention to Work, a $650 million federal initiative funded through stimulus money, has empowered local organizations like health departments, schools, health plans, and businesses to work together to “increase levels of physical activity, improve nutrition, decrease obesity rates, and decrease smoking prevalence.”
Swing states like Nevada and Pennsylvania have been particularly enriched by these grants, receiving millions to enact programs. In Nevada, a battleground state in 2012, Obama can point to a $14.6 million anti-smoking campaign in Clark County targeting residents across age groups in schools, churches, and workplaces. The county, which has a high 22% adult smoking rate, has used the money to provide on-site smoking-cessation services, limit tobacco advertising on the campus of the University of Nevada, Las Vegas, and conduct a media campaign to educate residents on the dangers of secondhand smoke. In Pennsylvania, Obama can highlight the $25.4 million grant to the Philadelphia Department of Public Health for goals like ensuring 1,000 corner stores in the city sell fresh produce and water, completing a citywide pedestrian and bike plan, and enacting anti-smoking public education campaigns.
The president in 2012 can also tout this initiative’s economic benefits. The mayor of Boston reported in September that the city created or saved over 100 jobs and 100 part-time youth jobs thanks to Communities Putting Prevention to Work funds. There is also considerable evidence that obesity-reduction and smoking-cessation programs could have powerful long-term economic effects in stimulating jobs and reducing employer health costs. The Republican mayor of Hernando, Mississippi for instance announced this fall the city was able to raise city employee wages by 2 percent due to a 15 percent drop in health costs after city employees enrolled in a health plan wellness program similar to programs financed by Communities Putting Prevention to Work.
-Healthy Food Financing Initiative, which the state of Pennsylvania has successfully used to bring grocery stores and healthy food retailers to underserved urban and rural communities, is poised to go national with $400 million in federal funding proposed by President Obama. The president might consider a 2012 campaign stop at Brown’s ShopRite of Island Avenue in Philadelphia, the first store to receive financing under Pennsylvania’s public-private Fresh Food Financing Initiative. This 57,000 foot supermarket in the low-income Eastwick neighborhood has reportedly created 258 local jobs in this former “food desert” area.
Pennsylvania’s program has not just benefited communities in the traditional Democratic strongholds of Philadelphia and Pittsburgh, but has also financed stores in rural counties and perennial swing areas of the state like Lehigh and Bucks counties. Given Pennsylvania’s key swing state status, it’s perhaps no surprise the president would seek to promote and expand upon this local success story. The White House is also positioning healthy food financing as a signature component of Michelle Obama’s popular Let’s Move! campaign to end childhood obesity.
While important, these initiatives alone will not put an end to the nation’s health troubles. Without government action, millions of Americans in need of health care will remain uninsured and health costs will continue to be more than double those of higher-performing European, Australian, and Japanese health systems. For these reasons, policymakers must continue to advocate for universal or near-universal health coverage whether through the Affordable Care Act’s public-private insurance expansion, or through other robust regulatory and market mechanisms.
In the meantime, expect to see President Obama talking a lot more on the campaign trail about smaller programs like community health centers and healthy food financing. They differentiate the president from his main Republican rival Mitt Romney, who is unlikely to defend his experience with health reform as Massachusetts governor. They also sound a whole lot friendlier than the Affordable Care Act’s “individual mandate” and play up an attractive election year image of the president doing his part in economic hard times to support local community health and development.