Robert F. Wagner Graduate School of Public Service, New York University, New York, NY 10012, USA; email:
Annu Rev Public Health. 2018 Apr 1;39:507-524. doi: 10.1146/annurev-publhealth-040617-013534. Epub 2018 Jan 24.
The Affordable Care Act (ACA) of 2010 placed a substantial emphasis on public health and prevention. Subsequent research on its effects reveals some notable successes and some missteps and offers important lessons for future legislators. The ACA's Prevention and Public Health Fund, intended to give public health budgetary flexibility, provided crucial funding for public health services during the Great Recession but proved highly vulnerable to subsequent budget cuts. Several programs that aimed to increase strategic thinking and planning around public health at the state level have proven to be more enduring, suggesting that the convening authority of the federal government can be a powerful tool for progress, especially when buttressed by some funding. Most important, by expanding insurance and mandating a minimum level of coverage, the ACA both increased access to clinical preventive services and freed up local public health budgets to engage in population health activities.
2010 年平价医疗法案（ACA）非常重视公共卫生和预防。随后对其效果的研究揭示了一些显著的成功和一些失误，并为未来的立法者提供了重要的经验教训。ACA 的预防和公共卫生基金旨在赋予公共卫生预算灵活性，为大衰退期间的公共卫生服务提供了关键资金，但后来证明极易受到预算削减的影响。几项旨在提高州一级公共卫生战略思考和规划能力的计划被证明更具持久性，这表明联邦政府的召集权可以成为进步的有力工具，尤其是在获得一些资金支持的情况下。最重要的是，通过扩大保险范围并强制要求最低覆盖水平，ACA 既增加了获得临床预防服务的机会，又为地方公共卫生预算腾出资金来开展人群健康活动。
