The United States spends twice what most other industrialized nations spend on health care, yet ranks 24th out of 30 such nations in terms of life expectancy. America spends 3 percent of health care dollars on preventing diseases (as opposed to treating them), when 75 percent of costs are associated with preventable conditions. To adequately meet prevention needs, and to control unsustainable growth in health care costs, a 2012 Institute of Medicine (IOM) report recommended that the U.S. increase federal funding for public health and prevention by $12 billion annually. According to a report recently published by the American Public Health Association, a key first step toward meeting this need is the Prevention and Public Health Fund, a mandatory fund for prevention and public health programs created by the Affordable Care Act (ACA). The purpose of the Fund is to provide a stable and increased investment in activities that will enable communities to stay healthy in the first place, and it was designed to gradually build from $500 million in FY 2010 to $2 billion per year by FY 2015. Despite a recent legislative reduction of $6.25 billion over nine years to help postpone a cut in Medicare physician payments, and some use of the Fund to replace existing appropriations, the Fund still represents a crucial investment in the health of communities and in the nation’s long term fiscal health.

The Commonwealth Fund recently published a paper in Medscape Public Health regarding preventive health services under the Affordable Care Act (ACA). The law has already extended coverage to dependents through age 26. By 2014, Medicaid will expand to cover most low-income adults and the exchanges will extend insurance to many small business and individuals. This eminent expansion of health insurance coverage will greatly increase in the use of preventive services in the United States. ACA provisions also eliminate cost sharing associated with the provision of preventive services, which will also likely impact use. Finally, the movement toward medical homes will also augment the use of preventive services. The paper discusses these relationships in the context of delivery system reforms.