When most Americans think of health policy, the Affordable Care Act (ACA), or Obamacare, comes to mind. The landmark 2010 law famously prohibited insurers from discriminating against the 130 million Americans with pre-existing conditions, created marketplaces where individuals could buy health insurance and allowed young adults to stay on their parents’ plan through age 26. The ACA also expanded Medicaid for low-income people, required insurers to cover 10 essential health benefits and eliminated copayments on preventive services like checkups and vaccinations.

The 2020 Presidential election ー along with Congressional ones ー may decide the fate of these reforms. When the Senate voted narrowly not to overturn the ACA, a group of 20 states, led by Texas, sued in federal district court, which deemed the ACA invalid. The U.S. Supreme Court has agreed to hear the case and decide the ACA’s fate by June 2021.

If the district court's decision upheld, there would be potentially devastating consequences for patients, health insurance markets and the health care system, as Katie Keith explains on HealthAffairs.org: "Tens of millions of people would lose coverage immediately, Medicaid expansion would be eliminated, protections for people with preexisting conditions would be disrupted and the health care system would be thrown into confusion and chaos."

Finally, some healthcare policies can also be determined at the state level. In 2006, Massachusetts expanded health insurance access long before the ACA. In a worst-case scenario, state and local elections can mitigate whatever federal changes may lie ahead.

What we eat is deeply personal, but nutrition and food access are vital public policy issues.

Lacking consistent access to quality food is associated with poorer health, including obesity, diabetes, cardiovascular disease, hypertension, depression, and eating disorders, explained Jaime Coffino, PhD, MPH, postdoctoral research fellow at NYU’s Grossman School of Medicine.

One in ten — or 14.3 million — American households experienced food insecurity in 2018. That figure reached 22.7 percent during the pandemic, according to the Brookings Institution.

People with food insecurity have higher annual health costs, Coffino said. “Therefore, addressing food insecurity is a significant public health priority.”

The federal government sets dietary guidelines (think food pyramid turned “MyPlate”), and funds the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) that serves 40 million low-income families. The proposed 2021 federal budget cuts $180 billion from SNAP. The federal government also funds the school lunch program that fed nearly 30 million children in 2018.

“The food that we provide to these students allows them the nourishment they need so they can not only perform academically, but so they can grow into healthy adults as well,” explained Siri Perlman, RD, Assistant Director of Child Nutrition Services at the Bassett Unified School District in La Puente, CA.

During the pandemic, schools operated under seamless summer feeding rules, providing food to anyone in need without verifying income. The USDA extended these more flexible rules through 2020, helping schools serve growing numbers of food-insecure families and relieving pressure on school meal programs, which rely heavily on federal funding.

Before heading to the poll, voters should assess candidates’ understanding of the issue and their plans, Perlman suggests. Ask candidates: “How do you support systems that are in place so they can be successful to meet the needs of the students in the communities that they serve?”

Environmental effects on our health can be far-reaching; some of the obvious risks include exposure to hazardous substances in air, water, soil and food. According to the World Health Organization, preventable environmental conditions cause 23 percent of worldwide deaths.

The U.S. Environmental Protection Agency is charged with protecting health, reducing environmental risks and enforcing environmental protections. Favoring less regulation, the Trump Administration has rolled back Obama-era environmental regulations, including clean air and water standards and climate change mitigation measures.

States and municipalities are also key in protecting residents from environmental risks. City officials in Flint, Michigan switched water sources to save money, for instance, causing a public health crisis when lead seeped into drinking water.

In other words: Who runs your city or town could be just as important as who is elected President.

Access to safe, quality, stable and affordable housing is associated with better health and mental health, according to a 2018 review in Health Affairs.

“Your living space affects your health in numerous ways, from the dangers of exposure to carcinogenic building materials to the safety benefits of grab bars and other fall prevention strategies to the emotional benefits of biophilia [connection to nature] and decluttering,” explained Jamie Gold, a Mayo Clinic-certified wellness coach and author of Wellness by Design: A Room-by-Room Guide to Optimizing Your Home for Health, Fitness and Happiness.

“The links between where and how we live, and how safely and healthfully, are not new.” Gold said. “Every American deserves a safe, healthy living environment and public policy can go a long way toward making that happen.”

A few federally funded organizations working toward improving home safety include: Healthy Housing Rewards, CAPABLE and Veteran’s Administration home adaptation grants. Additionally, the Low Income Home Energy Assistance Program subsidizes household expenses, and low-income housing tax credits create incentives to expand affordable housing.

At every level of government, regulations can improve access to healthy housing.

Discriminatory policies ー or policies that fail to prevent discrimination ー cause tangible harm, according to vast evidence showing people of color and LGBTQ+ people suffer worse health.

"We see more depression and anxiety among any population that is historically or currently discriminated against," says Carl Streed Jr., MPH, Assistant Professor at Boston University School of Medicine. "This is what we would describe as the Minority Stress Model ー that the extra burden placed on people from society and from the policies that maintain those inequalities lead to worse mental and physical health outcomes."

Though the Supreme Court has ruled in favor of LGBTQ+ marriage and employment rights, many anti-discrimination laws vary by state. Absent federal protections, LGBTQ+ Americans continue to face barriers to health care, parental rights, and protection from discrimination.

The overall health of the nation rests on a web of interrelated public policies. Even if you don’t lack nutritious food, housing, certain civil rights or health insurance, it's your civic duty use your vote to help shape America’s overall health and well-being.