Chronic disease and healthcare costs: implications of the affordable care act and subsequent supreme court decisions

American public health has enjoyed successes in infectious disease prevention, healthcare access expansion, workplace safety, and other areas. Yet due to chronic disease, an area of public health significance, Americans face worsening health outcomes and exorbitant healthcare costs. The federal government included provisions in the Patient Protection and Affordable Care Act (PPACA) in order to improve these issues, including population based prevention, clinical prevention, and healthcare payment and organizational reforms. Each of these may have a long term impact upon chronic diseases and their associated costs by focusing on prevention and chronic disease management. Recent Supreme Court decisions, however, have had an effect on these laws. First, the Court’s Medicaid expansion decision in National Federation of Independent Business v. Sebelius limited the proliferation of clinical-based preventive based services. Second, the Burwell v. Hobby Lobby Stores, Inc. decision likely opened employer and insurer mandated preventive services to legal attack. While the PPACA did not cure the chronic disease and cost issues that the United States faces, it contains essential steps in the nation’s incremental health policy process