The National Connection for Local Public Health

Health Reform and the Affordable Care Act

Challenges and Opportunities Ahead for

Local Health Departments

THE BIG PICTURE

The Patient Protection and Affordable Care Act

(ACA) sets the stage for a comprehensive

national approach to population-based prevention.• Health in all policies through a National Prevention

Strategy

• Recognition of policy and environmental change

approaches to public health

• Mandatory appropriation (new money)

THE BIG PICTURE

The ACA includes provisions for:

• Public health workforce development

• Enhancement of the evidence base for prevention and

public health

• First dollar coverage of clinical preventive services by all

public and private insurers (for new plans)

ACA Public Health Benefits

Prevention and Public Health Fund

$15 Billion/10 years

$500 million/FY2010, ramping up to $2 billion in FY2015 and

each year thereafter

•Provides for expanded and sustained national investment in

prevention and public health programs authorized by the

Public Health Service Act for prevention, wellness, and public

health activities, including prevention research and health

screenings

The Prevention and Public Health Fund – A Groundbreaking Approach

• A “mandatory appropriation” (does not require

Congressional action for funds to be available each

year). This was a huge victory for public health.

• Congress and the Administration have concurrent

authority to allocate the Fund. If Congress does not

do so, the Administration will.

The “Reality Check” Has Already Begun

• FY10 - $500 million, of which half went to primary care

workforce development by decision of Administration.

• FY11 - $750 million – to public health and prevention

• FY12 - $1 billion – at the mercy of a new Congress.

• The first Congressional attempt to defund the Fund failed

last year and more attacks are a certainty.

• Few local health departments have received any dollars

from the Fund so far.

Prevention and Public Health Fund – Current Status

FY11 - $750 million

$145 million – Community Transformation Grants

$40 million – Natl Public Health Improvement Initiative

$40 million – Epi/Lab Capacity Grants

$52.2 million – Comprehensive Chronic Disease

$20 million – Public Health Workforce Development

The “Reality Check”

If the Prevention and Public Health Fund survives:

• Annual advocacy for allocations that benefit local health

departments will still be needed.

• The competition for new funds is intense.

• There is insufficient funding for all the new programs

authorized by the ACA. Some promises will be empty.

The Work of Implementation Has Barely Begun

The new law provides a host of essential building

blocks for improving health status through

evidence-based prevention and public health.

Sustained advocacy for funding and for sound

federal and state policies that guide

implementation will be critical.

It will take many years and a healthier economy

before that potential can be realized.

The Big Question

Question:

Is Health Reform a

Threat or an

Opportunity for Local

Health Departments?

Answer:

Yes.

The Rules of the Game Are Changing But the New Rules are Unknown

Local Health Departments Across the Country Are In the Same Boat: Threat or Opportunity?

A Conundrum for Health Departments and their Partners

On the one hand, the

Administration is

moving full speed

ahead on

implementation.

On the other hand, the

GOP, with a new

majority in the House

(but not the Senate) is

determined to gut the

law.

So What Do We Do? Two Things At Once.

1. Play offense. Assume the key aspects of the law will

remain in force and work to address the opportunities and

challenges locally.

AND

2. Play defense. Explain the law to your communities and

join NACCHO in advocating vigorously for maintenance

of the Prevention and Public Health Fund and other

aspects essential to improving the nation’s health.

Local Opportunities: New Roles and Functions to Consider

• Expanded role in Medicaid enrollment and in

outreach and enrollment for state health

insurance exchanges

• Expanded role in case management.

• Maintain and enhance role as health data and

information experts for the community.

New Roles and Functions to Consider

• Collaborate with non-profit hospitals to conduct community

health needs assessments required by IRS.

• Develop new business models to bill or contract for

services.

• Leverage the dollars flowing to FQHC’s by developing a

public entity FQHC.

New Partnerships to Consider

• Convene partnerships for population-based prevention,

including the engagement of new partners in policy

development.

• Pursue relationships with groups forming Accountable

Care Organizations.

• Establish new arrangements with FQHC’s for co-location

of services, referrals, and/or purchase of services.

Some Questions to Ask

When more health department clients have

insurance cards in hand, what will be the impact

on financing and mix of clinical and population-

based services in my community?

Should I plan to transition clinical services to other

providers and focus more resources on

population-based prevention?

Systemic Challenges That Affect LHDs’ Approaches

• Lack of community support for health system

reform.

• Lack of State willingness or capacity to implement

Affordable Care Act.

• Possible influx of new patients to health care

systems with inadequate reimbursement or

resources (particularly PCPs) to care for them.

Local Health Department Challenges

• Viability as a safety net provider.

• Inability to compete as other entities assume

greater roles in prevention and primary care.

• Future funding reductions for public health

services erroneously deemed unnecessary by

policy makers when expanded health insurance

coverage is in place.

Local Challenges

• Realigning resources for altered roles.

• Training the current public health workforce for

altered roles.

• Pursuing new opportunities after years of cuts

have weakened the public health system.

Some Views from Other Local Health Departments(from open discussion at NACCHO Annual meeting)

• “This is all very scary but also very exciting.”

• Our fear is that we will have to redefine ourselves.

We may have to give up what we are more

comfortable with.”

Some Views from Other Local Health Departments(from open discussion at NACCHO Annual meeting)

• “We need to be the data and information gurus in

the community….we look at indicators and

outcomes.”

• “We can make real health reform work in the

community. I know that we all can’t just do that

tomorrow, but if we nurture new partnerships and

collaborations, those are the keys to making this

work.”

Some Views from Other Local Health Departments(from open discussion at NACCHO Annual meeting)

• “You have to get yourself to the table to be part of

the conversation….Pay attention! Make sure you

are there!) (reference to regional discussions

among hospitals, health insurers, community

health centers)

• “We’ve got to stop saying health care reform won’t

work and rather bond together and figure out how

to make it work for our communities.”

• “

NACCHO Resources

A webpage with resources that we are populating as fast as

we can:

http://www.naccho.org/advocacy/healthreform.cfm

Tell us what you think and what you need!

Email: healthreform@naccho.org

Other Resources

White House: http://www.whitehouse.gov/HealthReform

Department of Health and Human Services:

http://www.healthcare.gov/

Kaiser Family Foundation: http://healthreform.kff.org/

Families USA: http://www.familiesusa.org