So this week I’m taking a brief turn a little bit away from my main topic to focus more on the Affordable Care Act.  Obviously having appropriate health care can support anyone in achieving more physical activity and the basic idea behind the act is to put patient more in charge of their health (U.S. Department of Health and Human Services [HHS], 2015).  For a patient to really become physically active the patient has to take responsibility for their health.  All the walking paths and bike lanes in the world will not create healthy people.  People have to choose to use the paths and lanes.

So first the basics of what the law is supposed to do for us (from HHS website about the law).

Coverage

• Ends Pre-Existing Condition Exclusions for Children
• Keeps Young Adults Covered
• Ends Arbitrary Withdrawals of Insurance Coverage
• Guarantees Your Right to Appeal

Costs

• Ends Lifetime Limits on Coverage
• Reviews Premium Increases
• Helps You Get the Most from Your Premium Dollars

Care

• Covers Preventive Care at No Cost to You
• Protects Your Choice of Doctors
• Removes Insurance Company Barriers to Emergency Services

My family and I are currently covered by a plan that we got through the Affordable Care Act, or Obamacare.  I’m quite satisfied with it at this point.  We enrolled through Healthcare.gov on the open marketplace and found a plan that was appropriate for us at this time. The coverage is better than our previous plan and the cost is less.  For me the lack of cost for well checks and preventative care is awesome.  Previously taking my daughters to a well child check would cost a copay of $25 for each girl ($75 for just a well child check).  Now the well child checks are actually free.  I am satisfied with the care we’re getting.

I have not addressed the most controversial part of the plan referred to as minimum essential coverage (Centers for Medicare and Medicaid Services [CMS], 2015).  This is the part of the law that requires coverage for particular individuals or fines have to be paid (CMS, 2015).  The outcry against this is mostly about freedom being taken away and losses that small businesses might have because of the requirement.  I can understand both sides of the argument.  In a perfect world everyone would have health insurance and not be required to buy insurance.  This is not a perfect world.

The Affordable Care Act was signed into law in 2010 and has been slowly rolled out with the open enrollment in the Health Insurance Marketplace beginning in October 2013 (HHS, 2015).  But how did we get here. The implementation of the Affordable Care Act can be instructive for the implementation of any new law or policy.

The idea for the Affordable Care Act was actually taken from a similar reform done in Massachusetts.  David Simas, a whitehouse staff member, stated, “The state’s progressive vision of universal coverage and the conservative idea of market competition are what formed the blueprint for Obamacare: that everyone should have access to quality, affordable health care, and no one should ever go broke just because they get sick” (2013).  President Obama first began to address this kind of reform in the 2008 campaign.  He presented a plan very similar to the system in Massachusetts (The Commonwealth Fund, 2008).  With Obama’s election and democrats taking the majority in both the House and Senate the democrats could work on passing health care reform.  Both parties acknowledged that reform was necessary but of course disagreed on how it should take place.

The Obama administration felt that they had to work on healthcare reform quickly and began working in the first year of the administration (Frontline, 2010).  He quickly got major democratic senators and congressmen on board and the Finance Committee formed a bill based around the Massachusetts system already in place (Frontline, 2010).  Throughout the year the President attempted to get bipartisan support for the bill in the Senate and the House (Frontline, 2010).  In the end the bills were passed in both the House and the Senate with no Republican voting for the bill (Frontline, 2010).

So is the act working?  A recent New York Times article basically said yes.  Read the article here.

I’m probably biased on this issue.  I think that everyone should have healthcare.  I get my insurance through the Affordable Care Act and really it is in my interest to have more patients with insurance.  That’s more patients for me to be paid to see.

Passing this reform took a lot.  Pretty much everyone in America had to agree that the current healthcare system was not working well.  Then it was still impossible to get agreement on how to fix it.  In the end Obama said that the Democrats would just pass the bill without the Republicans and that’s what they did (Frontline, 2010).  Hopefully getting people to agree on supporting physical activity won’t be so hard.

References

Centers for Medicare and Medicaid Services (2015). Health insurance market reforms.  Retrieved from http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/index.html

Frontline (2010).  Obama’s deal: Chronology.  Retrieved from http://www.pbs.org/wgbh/pages/frontline/obamasdeal/etc/cron.html

U.S. Department of Health and Human Services (2015). About the law.  Retrieved from http://www.hhs.gov/healthcare/rights/

Simas, D. (30, October 2013).  Why we passed the Affordable Care Act in the first place.  Retrieved from http://www.whitehouse.gov/blog/2013/10/30/i-know-game-6-starts-soon

The Commonwealth Fund (2008).  The 2008 Presidential Candidates’ Health Reform Proposals: Choices for America.  Retrieved from http://www.commonwealthfund.org/publications/fund-reports/2008/oct/the-2008-presidential-candidates-health-reform-proposals–choices-for-america

The National Physical Activity Plan Alliance (NPAPA) has created a plan to increase physical activity throughout the whole nation (2010).  The primary area of interest to me is the Transportation, Land use and Community Design section of the plan (NPAPA, 2010).  Within that section the plan lists the following strategies…

STRATEGY 1
Increase accountability of project planning and selection to ensure infrastructure supporting active transportation and other forms of physical activity.

STRATEGY 2
Prioritize resources and provide incentives to increase active transportation and other physical activity through community design, infrastructure projects, systems, policies, and initiatives.

STRATEGY 3
Integrate land-use, transportation, community design and economic development planning with public health planning to increase active transportation and other physical activity.

STRATEGY 4
Increase connectivity and accessibility to essential community destinations to increase active transportation and other physical activity.

These strategies can be compared to Mesa 2040 and can found to greatly influence some of the goals of development within the Mesa 2040 plan.  The public sector has helped to develop these plans to increase physical activity through city planning activities.  The question is will these strategies be applied in areas of real need.

Recently the city of Mesa has been doing some work on Mesa Drive near the US 60.  Mesa Drive is not the nicest area of the city and needed some improvements.  The project widened the street, added two pedestrian crossing signals on Mesa Drive,  improved lighting, provided landscaping, bus pullouts and shelters (City of Mesa, 2014).  One of the landscaping projects was taking an old abandoned house on a large lot on Mesa Drive, tearing the house down and turning the remaining lot into a park.  The neighborhood did not have any parks in the area.  The abandoned lot was transformed from a hazard to a place the community can gather.  My wife always comments as we drive past the new park on how nice it is for the kids to have place to run around.  Before the park was created the nearest park was just a little less than a mile away but across major roadways.  The roadwork and all the improvements did end up costing over $25,000,000 (City of Mesa, 2014).  So it was not cheap.  I wonder how much it would have been just to buy the lot, tear down the house and make a little park there.

The Mesa Drive project was expensive but it did do some good in the area.  The area is a low income area and now the road is more inviting to walk down and there’s a nice park where before the lot was just full of hazards.  There are certainly other problem areas in Mesa but this is at least a good start (I could have done without all the crazy neon sign stuff though, that seems like a waste of money).

So there is a national plan out there for development that can encourage physical activity and Mesa is trying to incorporate some of that plan into continued city development.  But this is not just a local issue.  The NPAPA’s plan is a national one.  There are areas all over the country that could use further development like Mesa drive.

A recent study looked at the disparities in parks across Kansas City in relation to income and race (Vaughan, Kaczynski, Wilhelm, Besenyi, Bergstrom, & Heinrich, 2013).  The study found real disparities between the parks and play areas in higher income areas and lower income areas (Vaughan et al., 2013).  Lower income areas contained more parks but the quality of the parks was very questionable, the authors felt that the result could be that , “the children who need exercise the most may be less enticed to get it” (Vaughan et al., 2013).

But fortunately some of these problems are being recognized and the recent Shady Lane Park revitalization in Houston, TX is a good example of another project that is supporting physical activity in a neighborhood.  You can watch a video about the park here.

The Houston Chronicle had an article about the revitalization of the park.  The article addressed some of the needs of the community and how the park was really going to help.

“One of the most important needs this project addresses is the lack of resources that low-income communities have to engage their citizens in outdoor recreation activities. Shady Lane Park is located in the Eastex-Jensen Super Neighborhood, a densely populated and largely Hispanic area north of downtown Houston. Estimated population of the area is 49,908 with a median income of $26,270. The area has only 75.91 acres of parkland distributed among eight small neighborhood parks, nowhere near the recommended standard of 19 acres per 1,000 people to promote healthy lifestyles and outdoor activities” (Turner, 2013).

The park provides a place for physical activity to occur and gives the kids a safe place to play.  The great thing about the project is that it not only enables physical activity and provides an attractive area in the neighborhood but the park also serves as basin to help prevent flooding in the area (Turner, 2013).  It shows how parks and other policies to increase physical activity can work in synergy to serve other needs of the city.  Plus that playground looks awesome.

City of Mesa (2014). Mesa drive and southern avenue improvement projects.  Retrieved from http://www.mesaaz.gov/engineering/Projects/MesaDrandSouthern/MesaSouthern.aspx

National Physical Activity Plan Alliance (2010). The plan. Retrieved from http://www.physicalactivityplan.org/theplan.php

Turner, J. (2013, October 7).  The benefits of public parks. The Houston Chronicle. Retrieved from http://www.chron.com/opinion/outlook/article/The-benefits-of-public-parks-4876090.php

The policy making in Mesa that predominantly deals with city planning and physical activity took place mostly through the development of Mesa 2040.   The basic development of the plan was done through the Planning Advisory Committee (PAC) (Mesa City Council, 2014).   PAC members consisted of citizens from the Planning and Zoning Board, Economic Development Advisory Board, Transportation Advisory Board, Design Review Board, Historic Preservation Board, Housing and Community Development Advisory Board, Human Relations Board, and Parks and Recreation Board (Mesa City Council, 2014).  The PAC reviewed the previous city plan and updated where it was deemed necessary (Mesa City Council, 2014).  The board through working with various governmental departs, especially the planning department developed an outline for the plan.

Then a series of public meetings was held to discuss the plan for the city. The meetings included the PAC reporting to the various boards that made up its membership (Mesa City Council, 2014).  The PAC also set up information booths at various activities, attended civic meetings, and provided a website for citizens to give feedback (Mesa City Council, 2014).  The culmination of the planning was six community workshops where citizens were presented with the plan and offered an opportunity to give feedback on the plan (City of Mesa, 2015).

I’m assuming most of the forums went a little better than the public forums held in Pawnee, Indiana (Pawnee is a fictitious town from the TV show Parks and Recreation.  Its a pretty funny show.)

Following the public forums the plan was put up for a public vote and was approved on the November 4, 2014 balloting (City of Mesa, 2015).  So the policy was developed by a planning committee in a very public way.

The general plan consists of policies that help guide decisions that will be made for Mesa’s future.  Some of the policies that are of particular interest to me include…

• Public Spaces P1:

  The design and redesign of public buildings and facilities will include consideration of how to provide dynamic public spaces where appropriate.

• Public Spaces P2:

  Design of neighborhoods, neighborhood village centers, mixed use activity districts, downtown, and transit districts should consider and include the development of a variety of public gathering places appropriate for the scale and location of the development.

• Neighborhoods S4:

  Establish and maintain an ongoing process for improving connections and walkability in existing neighborhoods by installing sidewalks where needed and improving the amount of shade and other amenities along sidewalks.

• Neighborhood P3:

  Continue positive working relationship with local schools to provide parks, meeting locations, and support for neighborhoods

• Transit S2:

  Identify key outcomes from community outreach to guide the development of transit alternatives.

• Transit P4:

  Develop transit service to match character types.

• Transit P6:

  Integrate transit into the multi-modal transportation network.

• Transit P7:

  Create a transit system that is sustainable over the long term.

References
City of Mesa (2015). Latest news. Retrieved from http://www.thisismymesa.org/Events.aspx

City of Mesa (2015).  Mesa City Code.  Retrieved from http://www.mesaaz.gov/clerk/CodeBook/Table_of_Contents.aspx

Mesa City Council (2014). Mesa 2040. Retrieved from http://issuu.com/cityofmesa/docs/mesa2040generalplan/0

I live in Mesa, AZ and I live right in near the old downtown area of Mesa.  Currently Mesa has a plan for the development of the entire city entitled Mesa 2040.  The plan addresses several areas of public health in relation to physical activity including the use of the 2012 parks bond issue (Mesa City Council, 2014).  The bond was designed so that Mesa could improve parks across the city to encourage more active lifestyles. (Mesa City Council, 2014).  The plan goes on to talk about neighborhood development with the walkability and complete streets that should encourage physical activity (Mesa City Council, 2014). The complete streets plan include trees to enhance walkability.  There are certainly times of year in Mesa where having some shade from a tree makes a huge difference in being able to walk outside.

The plan explicitly lists several policies and strategies to increase physical activity in relation to city planning.  The fourth strategy in neighborhood development is to increase the walkability and connectivity of the neighborhoods (Mesa City Council, 2014).  Mesa also has a direct policy to include public gathering spaces in potentially shared public areas (Mesa City Council, 2014).  The plan claims that all the areas of the city will be reviewed and assessed for how they can better fit in with the current plan for the city (Mesa City Council, 2014).  They plan to address these changes through zoning, budget allocations and subdivision regulations (Mesa City Council, 2014).  The city planning office will primarily be responsible for the walkability issues (Mesa City Council, 2014).

The plan was developed by the plan advisory committee over the space of nearly two years (City of Mesa, 2015).  The public was welcome at meetings to express thoughts and concerns.  The committee included input from the city manager and the planning offices of Mesa (City of Mesa, 2015).  The actual committee consisted of members of the Planning & Zoning Board, Design Review Board, Transportation advisory board, housing advisory board and several others (City of Mesa, 2015).  The plan was approved by voters in November 2014.

Essentially the plan was developed by city officials with the input of the community.  The plan was approved by voters.  A group that voted against the plan was concerned with private property rights.  The group stated, “Government is formed by ‘We the People’ to protect life, liberty, and property. The Mesa 2040 General Plan does not protect private property. In fact, it undermines the liberty it’s supposed to protect. The protection of private property rights of the people of Mesa is not mentioned once, in a 300-page document which purports to define the vision of Mesa government for the future (Polleta, 2014).”

Honestly I think the property rights is a bit of a silly concern. I’m more concerned with the follow through of the plan.  Mesa claims to be interested in walkability and expanding parks.  I want to see it actually happen.  There are areas of Mesa that the city is working on improving.  The downtown area where I live is getting a light rail extension and they are attempting to revitalize the area.  There is an interesting neighborhood that was built in east Mesa a few years ago that seems to be a model for the neighborhoods that the city envisions in the 2040 plan.  Its called Agritopia.  This neighborhood has short white vinyl fences that do not close off spaces, porches, tree lined streets, paths that encourage walking and social areas for meeting.  The neighborhood seems to be a model for what Mesa wants to do.  I hope that Mesa actually follows through.  I think that everyone wants more walkability on streets and wants nicer parks I’m just not sure everyone wants to pay for it.

References

City of Mesa (2015). Upcoming events. Retrieved from http://www.thisismymesa.org/Events.aspx

Johnston Properties (2012).  Neighborhood/lifestyle.  Retrieved from http://agritopia.com/neighborhood-lifestyle/

Mesa City Council (2014). Mesa 2040. Retrieved from http://issuu.com/cityofmesa/docs/mesa2040generalplan/0

Polleta, M. (2014).  What mesa could look like in 20 years. The Arizona republic. Retrieved from http://www.azcentral.com/story/news/local/mesa/2014/10/02/mesa-look-like-in-future/16587431/