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Health Reform Implementation: Where Things Stand
 

Health Reform Implementation: Where Things Stand

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    Health Reform Implementation: Where Things Stand Health Reform Implementation: Where Things Stand Presentation Transcript

    • Health ReformImplementation: Where Things Stand Mary-Beth Harty and Naomi Seiler Department of Health PolicyGeorge Washington University School of Public Health and Health Services August 16, 2011 The Department of Health Policy
    • Major Threats to Public Health Funding• State and local budget cuts• Federal-level threats to health programs: – Proposals to scale back Medicaid – Demands for sharp cuts in discretionary programs – Added pressure of debt limit debate – Bipartisan global spending proposals
    • Concern That Policymakers Will Think WeNo Longer Need The Public Health System • Many observers think health reform has solved all our problems • “Why do we still need HIV testing and prevention programs?” • Particularly challenging for “public health” programs that do provide direct services, like HIV testing
    • Opportunities for Expanded Coverage• 2014: Medicaid expansions – Up to 133% FPL – Childless adults, a key population for HIV programs• 2014: Health Insurance Exchanges – Subsidies for people between 133-400% FPL• Other key insurance reforms that go into effect in 2014 (incl. no pre-ex condition exclusion)• Already in place: Pre-existing condition insurance plans• Young adults up to age 26 remaining on parents’ insurance – Another key population for NCHHSTP
    • Opportunities for Better Coverage of Key Services• Better coverage of preventive services – “new” plans have to cover USPSTF recs, ACIP recs, HRSA re children’s health and re women’s health – IOM recommendation re HIV testing• Essential Health Benefits – Sets floor for services in exchange plans and Medicaid expansion plans – Includes category of preventive services – Based on “typical employer coverage”
    • Opportunities for Integration into Primary Care System• Essential community providers – Exchange plans will have to network with providers that serve medically underserved populations• Medicaid health homes - can include HIV• Community health centers – Expansion – Ongoing safety net role
    • Opportunities Specific to Public Health• Prevention and Public Health Fund – Dedicated mandatory funding stream for public health – Survived Congressional challenges so far• Community Transformation Grants – NCHHSTP partners should identify primary applicants and work with them to supplement primary goals – One major component is increasing access to key clinical services• National Prevention Strategy – Includes sexual health as a targeted priority area
    • Start Building Relationships Now• Important to have relationships in place before changes roll out: – Other components within health department – Other state agencies (education, etc) – State Medicaid programs – Provider organizations – Community health centers – State insurance commissions – Exchange implementing agency and planning councils – CTG grantees (if not already part of the consortium)
    • Important Tools for ACA Implementation• HIT• Billing capacity• Communications capacity• Referral systems• Policy tracking (federal and state)• Safety net capacity• Best practices• Strategic planning
    • Key Sources of Information For Health Departments– CDC– State director groups (NASTAD, NCSD, etc)– Disease-specific advocacy groups– Kaiser– NACCHO/ASTHO– TFAH– Others?
    • Uncertainty About ACA’s Fate Doesn’t Justify Inaction• The goal for today is to adapt to a changing system – even if we don’t know the precise trajectory.• The steps that HDs should take – building relationships, assessing strengths and weaknesses, integrating into primary care – can and should happen anyway.• HDs have to experiment with new ways of partnering and working to meet public health goals.
    • Thank you.mary-beth.harty@gwumc.edu nseiler@gwu.edu