The shutdown is just one of two government stories making headlines today. The other, of course, is the opening of consumer health insurance marketplaces, also known as exchanges, in every state that will let consumers purchase coverage that takes effect as early as January 1, 2014. (Sign up after December 15, 2013 and coverage could begin after January 1.) The marketplaces are the cornerstones of the Patient Protection and Affordable Care Act (ACA) signed into law three years ago.

The exchanges will not only sell insurance, but also serve as electronic sign-up centers for public health coverage. For example, under the ACA, Medicaid has been expanded to cover many low-income adults; previously in order to qualify for Medicaid, most adults had to have children under 18 years of age as dependents. Information on the exchange websites will let people comparison shop for health insurance by price and other options, as well as find out whether they qualify for subsidies and tax breaks to help cover the cost of the insurance. In a statement released to announce the opening of the marketplaces, the American Public Health Association (APHA) underscored the fact that all Americans using the marketplace will be guaranteed access to health care and a range of preventive services, including cancer screenings; vaccinations; care for managing chronic diseases; and mental health and substance use services.

“This is a defining moment in the transformation of our U.S. health system,” said Georges Benjamin, MD, APHA’s executive director. “Thanks to the Affordable Care Act, Americans will finally have greater access to affordable, quality care and preventive health services. The marketplace gives preventive care to Americans who never had it before, especially the 44,000 who die prematurely every year because they lack health insurance.”

According to the APHA, under marketplace and Medicaid expansion provisions 25 million uninsured Americans will gain health coverage within 10 years and even more will lower their health costs. Other provisions of the ACA include the Prevention and Public Health Fund already in place to improve the health of Americans through proven community-based preventive health services and strengthening of the public health work force and infrastructure.

Experts at the Robert Wood Johnson Foundation have created and compiled resources to help individuals and health experts navigate the exchanges in their states.

>>Bonus Links: Read previous posts about the Affordable Care Act on NewPublicHealth:

• Do You Speak Affordable Care Act? — Sept. 4, 2013
• What’s the Role of Local Health Departments in Implementing the Affordable Care Act? — July 24, 2013
• Health Departments Begin Implementing the Affordable Care Act: NACCHO Annual — July 11, 2013
• How Will the Affordable Care Act Impact Public Health? — Dec. 3, 2012
• RWJF Statement on the Supreme Court's Affordable Care Act Ruling — July 28, 2012

Health Insurance Marketplaces Under the Affordable Care Act Open Today in Every State
Health insurance marketplaces, also known as health insurance exchanges, open today in every state under the Patient Protection and Affordable Care Act, which was signed into law three years ago. Coverage obtained through the exchanges gives purchasers guaranteed access to health care and a range of preventive services, including cancer screenings; vaccinations; care for managing chronic diseases; and mental health and substance use services. “Most importantly…coverage will translate into more opportunities to live longer, healthier and fuller lives,” saidRisa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which has launched a comprehensive resource site to help individuals, families and small businesses learn about coverage options available to them, and enroll. Read more on the Affordable Care Act.

2010 California Pertussis Outbreak Linked to ‘Personal Belief Exemptions’ to Vaccines
Researchers have linked the 2010 California pertussis—or “whopping cough”—outbreak to parents who refused to have their children vaccinated for other than medical reasons. During the outbreak, 9,120 people became sick and 10 infants died. The study, which was published in the journal Pediatrics, looked at both outbreaks and filed personal belief exemptions, finding that people who lived in areas with high rates of such exemptions were about 2.5 times more likely to live in an area with many cases of pertussis. Approximately 95 percent of a population must be vaccinated in order for it to maintain herd immunity. Read more on vaccines.

Study: Against Medical Advice, 14 Percent of Infants Sleep in the Same Bed as Parents, Caregivers
Despite the associated risks, many infants still sleep in the same bed as parents, other adults and or children, according to a new study in the journal JAMA Pediatrics. The rate has more than doubled since the early 1990s and now stands at about 14 percent. Such sleeping arrangements increase the risk of sudden infant death syndrome (SIDS) or death from other sleep-related causes. Study co-author Marian Willinger, special assistant for SIDS at the U.S. National Institute of Child Health and Human Development, said it is important for doctors to discuss proper sleep-time habits with new parents; the study found that parents who receive advice against sleeping in the same bed as infants are 34 percent less likely to do so. Read more on maternal and infant health.

A recent survey by the American Institute of Certified Public Accountants (AICPA) found that more than half of about 1,000 American adults polled could not correctly define common health insurance financial terms such as premium, deductible or copay. That’s concerning considering that opening day to sign up for health insurance under the Affordable Care Act is October 1. “Half of Americans would fail health insurance 101,” said Ernie Almonte, CPA, chair of the Institute’s National CPA Financial Literacy Commission. “That’s critical insight as consumers prepare to make important decisions with implications for both their physical and fiscal well-being,” says Almonte. “Americans need to take time in the coming weeks to familiarize themselves with key terms and assess their needs so they make the best decisions for their health and financial situations.”

Knowing what the terms mean can help people make informed choices when they sign up for health insurance. For example, a copay is the out of pocket cost to a patient for a health service. Choosing a plan with lower co-pays can help individuals save money, according to the Institute.

The survey found that people with high school diplomas or less education were significantly more likely than those with a college education to be unable to define financial health terms. The survey also found that 41 percent of  responders said they were not at all knowledgeable about the Affordable Care Act; just under half of responders said they thought they were somewhat knowledgeable.

The Affordable Care Act (ACA), which kicks into high gear in January, was front and center at the recent annual meeting of the National Association of County and City Health Officials (NACCHO) in Dallas. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, addressed the benefits to population health of many of the new law’s provisions and Kathleen Sebelius, Secretary of the Department of Health and Human Resources, which has overall responsibility for the law, spoke about the ACA via video.

For the most part, the role of local health departments under the ACA is still emerging and will become better known as more provisions are implemented and clarified.

To better understand what we know about that role and what will become better known down the road, NewPublicHealth spoke with Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems for NACCHO.

NewPublicHealth: Are there specific provisions under the ACA that apply to local health departments?

Michelle Zamperetti: There are no provisions specifically designated for local health departments but there are many provisions that impact local and state health departments. For example, many will be involved in the outreach and enrollment efforts for the new marketplaces and some will be designated as navigators to help people enroll for health insurance coverage in both the state-run marketplaces and the federally funded exchanges. For example, I recently learned that authorities managing a state-based health insurance exchange were not pleased with some of the navigator program applicants, so they reached out to a local public health director and asked that health department to be the navigator program leader in their region. And even in communities where health departments don’t give direct enrollment assistance—such as filling out paperwork online—we are confident that people with established relationships with their health department may use it as an entry point for finding out about health insurance, and health departments will need to know how to help them enter the system.

In addition to the insurance expansion provisions of the law, there are also important provisions to strengthen the coverage provided through insurance, particularly in the area of clinical preventive services. For health departments that provide direct services, there are opportunities to become in-network providers under the ACA.

NPH: Do you think many health departments will work together with non-profit hospitals, which now have a mandate from the Internal Revenue Service (IRS) to provide some form of community benefit in order to maintain their tax-exempt, not-for-profit status under the ACA?

With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law. 

>>Read more NewPublicHealth coverage of NACCHO Annual.

In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”

Frieden ticked off actions that local health departments can take to help support enrollment, including:

• Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
• Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
• Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.

A new commentary by Dr. Georges Benjamin, president of the American Public Health Association, looks at how the Affordable Care Act (ACA) is impacting public health and how it will create new opportunities for better health for more people across the nation.

The Affordable Care Act affects all 10 essential public health services, writes Dr. Benjamin in the commentary published by the Institute of Medicine.  Dr. Benjamin says the ACA will influence the public health system in three major ways:

• Expanded insurance coverage will impact how public health departments offer clinical services: Governmental public health agencies currently providing clinical services may transfer cases to the private sector, such as routine childhood vaccinations.
• New care delivery models offer opportunities to integrate public health principles and enhance requirement for hospitals to define and utilize beneficial community efforts: Public health practitioners will have the opportunity to share their expertise on assessing the health of populations, implementing community and broad-based solutions, and evaluating the outcomes of these solutions.
• Public health services can reach more people: Programs and services such as, home visiting and other maternal child health programs and specialized behavioral health services will be made available to the general population, in addition to programs on prevention and protection.

“There is a lot to learn as we make this transformation to achieve better health and better value for our health investment. A transformed public health system is an essential element of that change,” Dr. Benjamin comments in the report.

>>Read the commentary.

>>Bonus links:

• Read a NewPublicHealth post on a convening of local, state and national public health leaders to develop guidance for transforming public health
• Read more on how states are implementing the ACA

This morning, in a historic decision, the Supreme Court of the United States (SCOTUS) upheld the Affordable Care Act (ACA). Read the SCOTUS opinion here. In a statement released by the Robert Wood Johnson Foundation following the ruling, Foundation President and CEO Risa Lavizzo-Mourey commented on the landmark decision:

Today’s ruling by the Supreme Court allows the nation to move forward on the road to better health. The Affordable Care Act, when fully implemented, will expand the number of people with health coverage, introduce strategies for improving the quality of health care, and support plans to make our communities healthier places... Today’s ruling by the Supreme Court permits the implementation process to continue in full force, and we look forward to working with everyone who shares our goals to make meaningful improvements in the health and health care of our country.

The Foundation also posted a compiled listing of resources related to the ACA decision, including full and abbreviated analyses of the different scenarios that could have played out today.

>>Read the full statement from the Foundation.