Advancing Healthcare Reform

The American Heart Association (AHA) is the nation’s oldest and largest voluntary healthcare organization dedicated to reducing death and disability from cardiovascular disease (CVD). With the evolving scientific evidence that efforts to improve cardiovascular health are even more beneficial in the prevention of the development of other diseases than previously thought, the AHA has revised its mission to a new statement: to be a relentless force for a world of longer healthier lives. A healthy population is essential for economic prosperity; for a strong, productive, globally competitive workforce; and for ensuring all individuals can achieve their full potential. To that end, continuous improvement is needed in the delivery of health care and in the creation of equitable policy that ensures that health care is adequate, accessible, and affordable for everyone. The term healthcare reform has become synonymous with these efforts around delivery system improvement and policy change, which we now recognize must go even farther in affecting upstream issues that influence health outcomes Advancing Healthcare Reform.

The AHA has consistently prioritized the needs and perspective of the patient in taking positions on healthcare reform while recognizing the importance of biomedical research, providers, and healthcare delivery systems in advancing the quality care of patients and the prevention of disease. Therefore, these updated principles are offered in recognition that efforts to prevent CVD can have synergistic benefit in improving overall well-being, with acknowledgment that the health system overall must remain sustainable and effective at delivering optimal patient care.

In response to the ongoing national debate on healthcare reform, previous iterations of AHA’s Principles for Health Care Reform were published in 1993 and in 2008, just before one of the most transformative periods in US health care. Since its adoption in 2010, the Affordable Care Act (ACA) has extended access to comprehensive health coverage to millions of previously uninsured Americans through the expansion of Medicaid, the establishment of the Health Insurance Marketplace, and the creation of a number of consumer protections designed to mitigate discrimination from providers and healthcare systems and to limit insurers’ ability to deny, limit, or cancel coverage.

Initial results from the ACA lowered the number of the uninsured, now estimated at 30.4 million, or 9.4% by the Centers for Disease Control and Prevention (CDC), down 18.2 million people since the passage of the ACA in 2010. Recently, concerns have arisen about the sustainability of these results, including several actions, regulations, and proposals that have the potential to threaten both the availability and the adequacy of plans in the insurance marketplace. Millions of Americans remain uninsured or underinsured, with half of uninsured adults reporting the cost of coverage as the primary factor. Moreover, the progress made across the previous 5 decades in reducing cardiovascular death and disability has stalled, and increasingly, we are learning that striking differences in cardiovascular mortality remain across sex, gender identity, race, and ethnicity, driven largely by geographic locations, income levels, level of education, and other social determinants of health

This article presents the AHA’s principles for health care that is adequate, accessible, and affordable to all, placed in the context of the existing burden of CVD in the United States, advances in coverage and care that have occurred over the past 12 years, the rapidly changing landscape of healthcare delivery systems, and our evolving understanding of each individual’s risk for CVD and stroke, particularly the most vulnerable and those who continue to receive the least attention and resources to advance their own health and well-being Advancing Healthcare Reform.