A tipping point day for the American people

History will long record the first day of October 2013 as a day deserving to be remembered. On that Tuesday, the United States reached a tipping point: We joined all other developed countries by taking a necessary step toward universal health insurance coverage. President Franklin Roosevelt dreamed of this day in 1933; President Lyndon Johnson advanced toward it in 1964; President Bill Clinton tried to achieve it in 1993; and now it finally has arrived.

After three and a half years of useful discourse and debate over the Affordable Care Act, and after unnecessary distress, dissension, and discord, social justice has prevailed. More than 39 million poor and near-poor people now will be able to purchase health insurance just like you and me. Truly, an amazing tipping point.

A quarter century hence, we should see a vastly changed health landscape. We will see a reduction in the glaring health disparities experienced by people who are poor or near-poor. We also will see much greater access to needed care, and many fewer people with active illnesses who receive no care at all.

As we look forward from October 1^st, we have special hopes for people who experience mental health and substance use conditions:

• We hope that all persons with these conditions will enroll in health insurance and that they will have access to the care they need and want.
• We hope that all mental health and substance use care services will become fully integrated with primary care and that these new systems will reduce early mortality and promote positive wellness.
• We hope that new prevention and promotion efforts will reduce the onset of mental and substance use conditions and have a salutary effect on personal health status.

To fulfill our vision and our hopes, we have a very full agenda that began on October 1^st:

• We must help people with mental and substance use conditions enroll in health insurance. Prior experience in Massachusetts suggests that this will not be an easy task.
• We must reach out to entities that are forming Accountable Care Organizations (ACOs), including Federally-Qualified Health Centers (FQHCs). These entities will provide much of the organizational structure necessary to make health homes a reality. This is not a time to sit back to wait and see what will happen.
• We must develop new prevention and promotion interventions, and we must learn about public health. In the future, we will need to work at the community as well as the clinical level.

October 1, 2013 was an historic day. It not only fulfilled a long-term national dream; it also opened up a whole new set of possibilities and challenges for each of us.

I can see Franklin Roosevelt smiling in the hazy distance.