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Affordable Care Act

The protests and violence in the U.S. these past few weeks have left many of us unsettled. As if we weren't before.

So I'm not sure what to write about. I have opinions about what I think is right and wrong in this country, but that's not what this blog is about.

And yet politics and socioeconomic issues have always influenced healthcare facility planning and design in modern America, starting with the Hill-Burton Act of 1946.

Hill-Burton Act

Hill-Burton was born from President Truman's five-part plan to improve the health and healthcare of Americans. It called for the construction of hospitals and related healthcare facilities -- providing federal grants and guaranteed loans to improve America’s hospital system.

Did it work?

More facilities probably improved access to healthcare for many across the country, especially in rural areas. But the design of most of those original Hill-Burton hospitals largely ignored the human side of healthcare.

It took Planetree in the 1970s to wake us up to that.

And, if you look at the data on the rise of chronic conditions over the past 60 years you can't say that the construction of new healthcare facilities improved our health either.

Medicare & Medicaid

The next big legislation that affected the health and healthcare of Americans was when Congress created Medicare and Medicaid in 1965. This national insurance program was actually part of Truman's plan, but it took 20 years for it to happen.

On the facilities side, this landmark social program helped finance the creation of low-budget, state-run “nursing homes” that increasingly warehoused America's sick, often poor, frail elders.

Did that work?

Sort of. But many people, especially those with resources, didn't want to go to those grim nursing homes.

So, developers began building assisted living, memory care, and rehabilitation facilities -- often in continuing care retirement communities (CCRC) that housed all three. Today healthy Baby Boomers are rejecting traditional CCRC models, searching for senior housing and communities that offer them meaning and purpose.

And we all know what's happened at nursing homes during this pandemic. While I'm not sure there's any data to support this, my guess is that many of the nursing home Covid-19 deaths have been at state run facilities.

Affordable Care Act

Hard to believe it took 45 years to pass the next significant piece of healthcare legislation that would affect U.S. healthcare facility planning and design.

The main goal of the Affordable Care Act (ACA) in 2010 was to slow the rising cost of healthcare by taking steps to make health insurance more available and more affordable to those who need it the most. Many of its provisions were aimed at shifting from a system of treating sick people to a system where the goal is to keep them healthy.

And as we all know, this resulted in an increase in retail clinics a well as the design and construction of a lot of new outpatient facilities and micro-hospitals.

Did it work?

Well, more people did get insurance, but many fell by the wayside after the Trump administration got rid of the insurance mandate in 2017.

Where people get healthcare has changed, as more of us are getting flu shots at our local drug stores instead of our doctor's office. Or using telemedicine to talk to our doctors.

And I expect the hospital to continue to shrink as the need for inpatient beds decreases, but that's more because of advances in medicine and medical technology than legislation.  We also have been successful in reducing healthcare acquired infections, mostly due to initiatives that were funded as part of the ACA.

What's Next?

I've been asking that question ever since the pandemic swept across this country and laid bare all the flaws and inequalities of the U.S. healthcare system. Does our government have a role to play in improving our healthcare and residential care facilities so that they better support the health and well-being of all Americans?

Many of the design changes and technology we've been talking about to address surge capacity and infection control are going to cost money. Lots of money. Maybe some more federal grants and loans would help make that easier.

And our government should take the lead in reforming our system of housing and long-term care of our poorest, frail elders. Because clearly that's not working.

Just throwing money at the problem won't work, though.

It's going to take careful, thoughtful collaboration to come up with new strategies and resources to tackle the facility challenges facing our healthcare system. If we can learn from the past, it just might help us to create a different future.

What do you think?  Share your comments below in the comment box or contact me.

Want More of What's Next?

Check out my recent presentations on what's next for healthcare facility planning and design and senior living and residential care design in the wake of Covid-19.

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Bill Coble

4 years ago

The Kaiser model is the way forward in my opinion.. This pandemic has ripped the facade away - Americans are tired of paying more and getting less and on top of it not knowing if they can afford Cobra or a higher out of pocket costs. The model was broken and now we know how broken it is. What healthcare systems had to endure with PPE costs, etc.. This has been a wake up call.

Sara Marberry_013-Retouched-New copy

What's my story? I'm a healthcare and senior living design knowledge expert who writes and speaks frequently about trends and issues affecting these two industries. I'm also a strategic marketing consultant and content creator, working with companies and organizations who want to improve the quality of healthcare and senior living through the design of the physical environment. You can reach me at .

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