The 18th biannual Institute of Politics survey is out. It reports that Millenials (18-29 year olds) are significantly less enthusiastic about the electoral process now than they were just nine months ago. Only 35 percent of students report that they will definitely express themselves when 100 percent of the nation’s congressmen and women, at least 36 of our senators, and 37 of our governors are up for reelection.

I am not sure I understand the reasons behind the lowered interest by Millenials in the electoral process. Some of my political-pundit friends tell me that mid-term elections are always like this. They have neither the same glitz and excitement nor the same glamorous national conventions as elections during presidential years. But in many ways the decisions that are made are as crucial as those made in the past, and this year the concerns in front of us as an educated electorate could not be more compelling.

There are big stakes at hand with the economy in its weakened condition, the country’s armed services engaged on two foreign fronts, and our states suffering some of the tightest budgetary crunches they have experienced in years. Everything that happens in state houses, Capitol Hill, governors’ mansions, and the White House has implications for the type of job opportunities, housing choices, healthcare, and long term benefits that members of the classes of 2011-2014 can count on in both the near and the distant future.

As many students know, as president of the American Academy of Pediatrics this past year, I was deeply ensconced in the healthcare reform debate. Through it, I learned two lessons. The first is that, despite what you see on television and read in the blogs, members of Congress on both sides of the aisle were dead serious about producing the very best health-reform legislation they could. They all knew that this was a big commitment and a once-in-a-generation opportunity and they wanted to get it as right as they possibly could. The other thing is that change through legislation and regulation does not happen overnight. The Affordable Care Act of 2010 was passed on Mar. 23, 2010 and its first provisions just became active on Sept. 23, 2010. The full bill’s provisions won’t roll out until 2014. They can’t. It will take that long to make the kind of major transformation that the bill calls for.

When the new Congress comes to work after the elections, it will have some serious work on their agenda. Depending on the outcome of the election, there may be a challenge to the ACA—a call for its repeal. Also, the House will again take up the Child Nutrition Act. As a pediatrician, I see these two issues as crucial for our nation’s children and for all of our country.

The ACA was crafted with major benefits. For the first time in our history we have universal health insurance coverage. We have a heavy emphasis on preventive services including seriously needed behavioral and mental-health services. Women’s health care is strengthened in the bill. There is a great provision that allows people up to age 26 to stay on their family health insurance so that they can pursue graduate studies and other career opportunities. The ACA was debated and the debates strengthened it. The ACA was analyzed and reconfigured financially and the Congressional Budget Office reported that it lessened the deficit. The ACA was passed and is now moving into the regulatory process where there is still ample opportunity for refinement.

Repealing the Affordable Care Act would waste all the hard work that both parties have put into this major reform. It might be another decade or two before we would have legislation that would tackle the current healthcare system. Without reform, the $2.7 trillion we now spend per year on health care would have spiraled to $4 trillion per year. The United States cannot afford that.

And what about the Child Nutrition Act? Again, as many of you know, with the American Academy of Pediatrics, I have been working with the First Lady on the “Let’s Move!” initiative targeted at childhood obesity. One of the major contributors to obesity is the poor quality of the food that is offered to children in our public schools: Remember those great cafeteria school lunches of Agriculture Department leftover commodities?

The Nutrition Act has been passed by the Senate and awaits a House vote. It would greatly improve the quality of food served to children—good, fresh food for our kids. If we are going to take the obesity epidemic seriously and conquer it in this generation, we need to stop feeding children the wrong things on the taxpayer’s dollar and need to start wisely offering school students healthy lunches every day.

So, I hope the IOP is wrong. In my field, there are crucial questions on the line. There are in other fields, too. At Harvard, students study all about these questions. At the ballot box, students can do something about them.

Judith S. Palfrey ’67 is a Master of Adam’s House and the Immediate Past President of the American Academy of Pediatrics.

This post was originally published at The Harvard Crimson.