This post concludes the Year-In-Review Series, which has looked at the ten most significant public health moments of 2014. Last week we examined the increased use of e-cigarettes and major advances in HIV prevention. We close our list by looking at the implementation of the Affordable Care Act and the rampant Ebola outbreak.

9. Healthcare is a Right, Not a Privilege

2014 was the year of discovery for Americans and ObamaCare, formally known as The Affordable Care Act. Three major developments unfolded in regards to the ACA:

  • National standards came into effect regarding the sale of private insurance plans, as well as the provisions found in the plans. Denials for pre-existing conditions are now a thing of the past, alongside increased plan prices for older adults. Coverage must now be comprehensive and offered at 4 levels: Bronze, Silver, Gold and Platinum.
  • For the first time ever, childless adults that met poverty level criteria were able to get Medicaid coverage under ACA extended Medicaid eligibility.
  • U.S. citizens that chose to remain uninsured were to expect a $95 fine levied through the IRS.

The Affordable Care Act has been met with some doubts regarding its efficacy, especially where it concerns patient comprehension. A 2014 study of 3,490 Americans found that 42% were unable to correctly describe a deductible and 62% did not know that a health maintenance organization (HMO) plan carries more provider restrictions than a preferred provider organization (PPO). Among those that live under the poverty line, which most might consider a target population for the ACA, approximately 58% had not heard of the exchanges and subsidies, while another 44% either did not know or were misinformed about the relationship between deductibles and premiums.

This confusion can lead to uninformed decision-making and financial harm for many Americans. Take an older individual, on a fixed income, purchasing a bronze plan so they can have affordable monthly payments. Being unaware of the substantial deductible, this individual would be shocked to see a bill totaling $5,000 for a hospitalization and would be left with unanticipated, substantial medical debt. It takes more than health insurance to improve the health and welfare of our nation. It takes effective communication about the fundamentals of these health insurance policies.

Sure, the ACA has done its job in insuring more Americans. But is the information about deductibles, premiums, co-pays, HMOs and PPOs clearly reaching the general public? Not likely.

The study on ACA preparedness found that the least knowledgeable demographic were young women with a low level of education. The data indicates a need for health officials to target this segment of the population, and other at-risk groups, in their ACA awareness and information campaigns. Mastering the basics of insurance can dramatically change the outcome of health crises for many uninformed citizens.

Ultimately, the implementation of the ACA was the biggest breakthrough in health insurance coverage for Americans in 2014. In 2015, we of course hope to see more insurance information, terms and plan details communicated effectively to those seeking coverage.

10. Ebola Panic and Preparedness

2014 saw many Americans become familiar with, and terrified of, the Ebola virus. Much of the scare stemmed from the harrowing realization that the virus, which has killed thousands in West Africa, has no known cure. The panic, however, spread much faster than the virus.

It all began when Thomas Eric Duncan became the first known case of Ebola in the U.S. after he contracted the virus in Liberia and traveled to the states to visit family. Upon showing symptoms, Duncan was admitted to Texas Health Presbyterian Hospital where he died of the illness two weeks later. Due to a breach in protocol, two nurses involved in his treatment fell ill with the virus. Through excellent care, both nurses survived. A media frenzy severely exacerbated the threat of the illness, criticized CDC’s handling of the virus and threw the nation into an unnecessary panic..

From H1N1 (swine flu) to West Nile Virus, U.S. health officials are always the first to be attacked anytime an outbreak occurs. After the initial incident, the CDC confidently reaffirmed their ability to contain the virus. Though they faced harsh criticism, they were ultimately correct in their assertions. The fact is, contracting Ebola is very difficult as the virus is transmitted through the fluids of the infected party only after they displayed symptoms. Which is why the two nurses were the only ones infected by Duncan. Dozens of other hospital staff, family and community members that were in contact with Duncan were, and remain, healthy.

The Ebola scare left many to question the nation’s level of preparation for future viral outbreaks. The CDC championed changes in its procedure for protective gear protocol and the handling of medical negligence. They also developed a response team that can be positioned to any affected hospital. If the Ebola scare of 2014 taught us anything, it’s to tune out the media hype and embrace a stronger outlook of preparedness.

The year-in-review series has documented the following ten public health issues/moments:

  1. General Practitioner Shortage
  2. Electronic Health Records
  3. National Health Disparities
  4. Aging Baby Boomers
  5. Transforming Health for Transgendered Populations
  6. Curtailing the Carbon Footprint
  7. The Rise of E-cigarettes & Marijuana Legalization
  8. HIV Prevention & Blood Donation Bans Lifted
  9. Affordable Care Act
  10. Ebola Virus Panic & Preparedness

One honorable mention to round out this series is the attention, awareness and viral fundraising campaign for Amyotrophic Lateral Sclerosis. ALS, or Lou Gehrig’s Disease, may not be the most prevalent disease, but it is particularly brutal and was selected as the flagship disease for social media-based fundraising. It all started with the “Ice Bucket Challenge.” The idea was that friends would challenge one another to dump a bucket of ice water on themselves and then donate a sum of money towards ALS; those that refused were challenged to pay a higher donation fee to an ALS foundation.

The fun videos became a viral sensation, garnering the attention and subsequent ice bucket challenge videos of many celebrities, including Mark Zuckerberg and Bill Gates. In the short time the challenge took place, nearly $80 million was raised towards a cure for the disease.