Every health professional and every LGBT advocate I know was holding their breath this morning, waiting for the Supreme Court decision on the constitutionality of the Affordable Care Act. A little after 10, the cheering could be heard across the land; ACA was upheld!
The ACA is the foundation of long-needed health equality for LGBT people. It includes historic nondiscrimination provisions and is the mechanism under which new LGBT data collection is being rolled out, and the leading implementation plan, the National Prevention Strategy, explicitly names LGBT people as a class needing equal opportunity for health.
Beyond the historic LGBT inclusion - our health disparities just underscore how much we need this expanded coverage. Under ACA, people who are not covered by their partners' health insurance can obtain it at a fair price, and so can the most stigmatized and thus poorest among us. Transgender people cannot be denied coverage for being transgender (like I was last year). People with pre-existing conditions will no longer be excluded or have unreasonable premiums. People with HIV can obtain drugs less expensively and can qualify for Medicaid more easily.
The Centers for Disease Control and Prevention has recently been running a series of reports on the top 10 public health accomplishments of the last century. In my opinion, ACA created a change that is bigger than even that inclusion and coverage expansion, a fundamental shift that is no less than the first top public health accomplishment of this century: the spotlight on how helping us be healthier is the real solution to our health care crisis.
Analysts estimate a whopping 75% of our health care costs come from avoidable chronic diseases. Most of these diseases can be avoided by addressing three issues: eating better, exercising more, and not smoking. Everyone agrees our health care costs are spiraling upward. Government analysts project they will only continue to double, even triple in the coming years. Everyone agrees that reform is needed in health care; luckily, ACA attempts to address those problems directly.
What's news to many is that the biggest solution to our health care crisis might be as easy to understand as: help Americans eat better, exercise more, and stop smoking.
Even better, evidence shows we want to be healthier. Public health officials now understand how structural barriers, often barriers the government can affect, really impact our ability to be healthier. If bike lanes are built, biking goes up so much major cities are now dealing with driver backlash. If greens are cheaper than fast food, people eat many more vegetables. If smoking is not allowed indoors, more people quit than by any other single intervention. Whatever the Supreme Court had ruled today, we know this: government policies have a big impact on our ability to be healthy.
In my role as the director for the Fenway Institute's Network for LGBT Health Equity, I travel the country working with states and groups running projects to make local policies more health-friendly. Maybe others don't know this, but I love seeing the handiwork of the ACA's National Prevention Fund everywhere: banks in Minnesota running a wellness campaign; new farmers' markets in South Carolina; new bike lanes in Atlanta; an LGBT wellness project in DC; the LGBT pride ads from the CDC's smoking cessation campaign. That's a long-needed first! Yes, we smoke more than others. (Got stigma?)
All of this work adds to the wave of health already moving across the land. For example: citywide bike sharing in Minneapolis, D.C., Boston, and next up, New York City. Do you know the White House even has a bike-sharing station inside its visitor gate? Or last year's commitment by the secretary of Transportation to prioritize biking and walking as much as driving. (Got sidewalks? I don't yet.) The other day, one of my favorite food shows, Chopped, was highlighting public school lunch ladies and grading their dishes on how fresh and healthy they were. How often have the words "fresh and healthy" even been in the same sentence as "school lunches"?
Everywhere you turn, while young and old, even while sick, people are making daily decisions to be healthier. Behind the scenes, ACA is helping state and local governments make policy decisions to take down the barriers so we can be healthier.
Not only is being healthier the single most important step to curbing health care costs - it affects each of us on such a profound daily level. I sweated through a morning bike ride to the train yesterday, and it was hard to ignore how unexpectedly happy I was for the whole rest of the commute.
Yes, today we all rightly cheer the Supreme Court decision. As a public health professional I also cheer the bigger verdict, one the Supreme Court could not ever take away from us. Now we know we need to be healthier, we want to be healthier, and government policies can help us achieve that goal as quickly as possible.
SCOUT, Ph.D., is the director of The Fenway Institute's Network for LGBT Health Equity.