View From Washington

How Might the Affordable Care Act Address Prematurity?

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP     

For the past seven years our colleagues at the March of Dimes have led a Prematurity Awareness Campaign with the twin goals to 1) raise public awareness of the problems of prematurity and (2) to decrease the rate of preterm birth in the United States. Finding common cause during the health reform debate, AMCHP joined with March of Dimes and other partners to advocate for provisions that address these goals by improving access and quality of healthcare for women of childbearing age, with emphasis on investing in preventive strategies. As we mark Prematurity Awareness Day this November we have a timely opportunity to consider the provisions of the Affordable Care Act (ACA) and how they might help address this ongoing public health challenge.

The main highlight of course is that the ACA will extend affordable health insurance to the estimated one in five women of childbearing age who are currently uninsured and the practice of gender rating insurance premiums is prohibited. That means roughly 13 million women who would have a much better chance of receiving regular preventive services and early access to prenatal care if they were to become pregnant.

Additional ACA provisions ensure that maternity care services have to be included in any Exchange plan benefits package. An additional provision calls for the development of “Bright Futures” preventive health guidelines for women. The U.S. Department of Health and Human Services recently contracted with the prestigious Institute of Medicine to begin formulating these recommendations with the panel’s first meeting slated for Nov. 16. Finally, the law requires all state Medicaid programs to cover smoking cessation services for pregnant women. Each of these provisions will help prevent prematurity. 

But one thing we know from public health science is that health insurance – while fundamental and essential – is insufficient to improve population health outcomes and that many of the causes of prematurity are still unknown. The preconception care movement also tells us that focusing on prenatal care by itself might simply be too late. As highlighted in the landmark Institute of Medicine study Preterm Birth: Causes, Consequences, and Prevention, “Preterm birth is a complex cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, neighborhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors and genetics.”

Our best opportunities to improve birth outcomes and prevent prematurity will therefore likely come from focusing on upstream interventions across the lifespan that prevent or mitigate the chronic disease and other risk factors that might cause poor health and poor birth outcomes. Hence AMCHP’s advocacy mantra on Capitol Hill – healthy kids start with healthy moms and healthy families. 

Fortunately, the Affordable Care Act includes several additional provisions that could move preconception health recommendations into practice and have an impact on reducing infant mortality. Here are the highlights:

The creation of a National Prevention and Wellness Strategy and the Public Health Investment Fund will help reorient our health system toward prevention of disease and injuries.  

  • National Prevention and Wellness Strategy: The federal government does not currently have any mechanisms or plans that coordinate health policy across government to assess our public health status, establish national priorities, and identify health goals and objectives. The law calls for creation of a national strategy to accomplish these goals. AMCHP will advocate that improving our nation’s current ranking of 30 in the industrialized world in infant mortality rates has to be a national priority.

  • The Public Health Investment Fund: Is a dedicated funding stream for public health and prevention that is needed to meet the many health threats we must face, including infant mortality and its contributing factors. The Fund will build upon what we know already works and to test new approaches. It will prioritize prevention and health, not just treatment. It will support core public health infrastructure to help state, local and tribal health departments meet their responsibilities and ensure adequate levels of accountability. The Fund also boosts public health research and will provide public health practitioners and policymakers with the information we need to make the best decisions about preventive health.

  • Finally, the creation of the new $1.5 billion Maternal, Infant and Early Childhood Home Visiting Program offers states and communities the most direct opportunity to provide at-risk communities with the services and systems needed to move the needle on maternal and infant health indicators. For additional background information, see the June 2010 Pulse issue on home visiting. 

None of these provisions are a silver bullet solution to the persistent and complex problem of prematurity, but taken together they will go a long way to providing the commitment, leadership and resources we need to accelerate progress.