In 1979, Surgeon General Julius Richmond launched a health promotion and disease prevention initiative to improve the health of the nation's population. Thus Healthy People 1990 began in 1980. We are now entering the fifth iteration of these 10-year agendas with Healthy People 2030 (HP2030), focusing on health and well-being. Healthy People 2020 (HP2020) was a successful initiative: of 1,318 objectives-1,111 that were measurable and 985 that were trackable-33.9% met or exceeded their targets, 20.8% improved, 31.0% had little or no detectable change, and 14.3% got worse.
Two objectives related to access to healthcare demonstrated statistically significant improvement: persons (under age 65) with medical insurance achieved 89.0% in 2018 of a 100% target and persons with a usual primary care provider was 76.4% in 2016 for a target of 83.9%.1 For HP2030, new targets for these objectives are persons with medical insurance at 92.1% and persons with a usual primary care provider at 84%. These new targets represent a reduction in expected outcomes compared with HP2020 targets.
Access to insurance
The increase in numbers insured from 2012 to 2016 can be attributed to the opportunities provided through the Patient Protection and Affordable Care Act (ACA) of 2010. The provision to allow young adults below age 26 to stay on their parents' plans and early Medicaid expansion opened coverage for many. Additionally, the ACA full coverage provisions in 2014 triggered a dramatic drop in the number of uninsured and the uninsured rate to an historic low in 2016, providing 20 million previously uninsured Americans with insurance. Assaults on the ACA and select legislated changes resulted in loss of insurance for many. Beginning in 2017, "the number of uninsured nonelderly Americans increased for three straight years, growing by 2.2 million from 26.7 million in 2016 to 28.9 million in 2019, and the uninsured rate increased from 10.0% in 2016 to 10.9% in 2019."2
People of color, low-income families, and the working poor are more likely to be uninsured. Adults (under age 65) in states where public coverage (Medicaid) was not expanded are more likely to be uninsured than children who have protections under the federal Children's Health Insurance Program. These facts and statistics are troubling, and improving these numbers requires a commitment to the belief that healthcare is a right and not a privilege.
Healthy People 2030
Doubly concerning is the reduction in target goals for access to healthcare in HP2030 objectives. HP2030 has removed duplicate objectives, ending with only 355 core or measurable objectives. The reduction from 100% having access to medical insurance to 92.1% is not acceptable. The HP2030 agenda is less prescriptive than past agendas with a shift in responsibility to local communities, making them the drivers of success in meeting national goals. HP2030 will address public health priorities by setting national objectives and tracking them over the next 10 years through a framework that directs local communities to follow four steps: identify needs and priority populations, set your own targets, find inspiration and practical tools, and monitor national progress using our data as a benchmark.3 It is thus even more important that NPs work with other healthcare providers to ensure that HP2030 goals are exceeded. It is time to lead the way.
Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN
EDITOR-IN-CHIEF [email protected]
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