25th Anniversary Supplement of the Journal of Health Care for the Poor and Underserved

This Supplemental Issue of the Journal of Health Care for the Poor and Underserved (JHCPU) celebrates the 25th year of the journal’s publication. The theme for this issue is the “Patient Protection and Affordable Care Act” (PPACA), the landmark health reform legislation that was signed into law by President Obama in March of 2010, and in the broadest of terms upheld by the Supreme Court in the Spring of 2013.¹ This theme is timely and relevant given the original and current focus for this scholarly publication on the medically underserved and the intent of the legislation, among other areas, to provide health insurance for millions of uninsured and underinsured in the Nation.

History of the Journal

The Journal of Health Care for the Poor and Underserved (JHCPU) is an academic journal that originally formed part of the Institute on Health Care for the Poor and Underserved, founded by David Satcher MD, PhD, in 1988. Dr. Satcher is the Director of the Satcher Health Leadership Institute at Morehouse School of Medicine and served as the 16th U.S. Surgeon General from 1998 to 2002. The JHCPU, affiliated with the Association of Clinicians for the Underserved (ACU), is the premier journal addressing medically underserved populations in North and Central America, the Caribbean, and sub-Saharan Africa. The JHCPU is a leading health policy journal (Kaiser) and an essential core journal in public health practice (Medical Library Association’s Core Public Health Journals Project).

Overview of the PPACA

Signed into law in March of 2010, the PPACA is the most sweeping reform program to offer health insurance for the uninsured and underinsured in the almost 50 years since President Lyndon Johnson signed Medicare and Medicaid into law.² Key provisions of the Law include expansion of health care access, an emphasis on prevention and primary care, health care cost containment, and enhancement of the health care delivery system.³ This legislation includes a number of components that were implemented early such as elimination of limitation or denial of coverage for pre-existing conditions for children under age 19 and expansion of dependent coverage to age 26.^4,5,6 In 2014, the pre existing condition prohibition will apply broadly. According to the National Health Interview Survey, there was an 8.3% increase in young adults with health insurance from September 2010 to June 2011, approximately 2.5 million adults.⁷ The Congressional Budget Office (CBO) estimated that the PPACA will cover an estimated nine million in Medicaid and another seven million will purchase insurance through the exchanges.^8,9 The Commonwealth Fund estimates that more than 80% of the estimated 16 million will be covered.¹⁰

Selected features of this landmark legislation are available in a variety of sources including the Kaiser Family Foundation health reform website, which has a wealth of data on the content and progress of the Law’s implementation. Examples of some other provisions of the Law are:^11,12

• • Expansion of preventive services, based on evidence-based guidelines from the United States Preventive Services Task Force. This includes cancer preventive services such as screening mammography and colonoscopy and genetic testing for hereditary breast and ovarian cancer syndrome.¹³

• • Creation of state-based Health Benefits Marketplaces (formerly Exchanges) through which families/individuals at 133%-400% of federal poverty level can purchase insurance.

• • Expansion of public programs including expansion of Medicaid to all non-Medicare eligible under age 65 with incomes up to 133% poverty level (including pregnant women, children, and adults without children). The Law provides for extension of funding for the Children’s Health Insurance Program (CHIP) through FY 2015, and continues the authority for the program through 2019.¹⁴

• • Creation of Essential Health Benefits (EHB) package of comprehensive services, which must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; and rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric...