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.