Category Archives: Affordable Care Act
Implementation of the Affordable Care Act—and keeping future generations of Americans healthy or even healthy enough—will rely on an adequate supply of primary care physicians. That includes family physicians, pediatricians and internists who can help steer patients toward healthier lifestyles and effective treatments for chronic illnesses to help avoid both unnecessary complications and costs. However, the Association of American Medical Colleges predicts a shortfall of about 45,000 primary care doctors in the next decade, according to The Wall Street Journal. Many medical students have traditionally avoided primary care training in favor of specializing in fields such as dermatology and radiology because the pay is generally far higher. That matters especially these days, when many medical students leave school owing more than $150,000 for their training.
According to the article, in an effort to increase the number of doctors specializing in primary care, a number of medical schools have strengthened their primary care programs and at least 17 new medical schools have opened since 2005—some that have only primary care training programs. And some of the schools have been able to recruit effectively by building loan repayment programs into the program, especially if students commit to practicing in underserved areas following their training.
Colleen Christmas, director of the internal residency program at Johns Hopkins Bayview Medical Center, who is interviewed in the article, points out that a strategy of increasing the number of primary care doctors makes economic as well as population health sense. According to Christmas, a recent study by Johns Hopkins researchers showed that with each 1 percent increase in the proportion of primary-care physicians, an average city will have 503 fewer hospital admissions, almost 3,000 fewer emergency-room visits and 512 fewer surgeries annually.
Read the full story in The Wall Street Journal.
>>Bonus Link: Four months after Surgeon General Regina Benjamin left her post to return to academia and a medical practice, the White House has nominated Vivek Hallegere Murthy, co-founder and president of Doctors for America and a Boston-area physician, to take up that post.
White House Announces Modification to Affordable Care Act Aimed at Letting Many Keep their Current Health Insurance Coverage
The White House announced on Thursday that health insurance companies will now be permitted to renew many previously cancelled health insurance plans for the upcoming coverage year. The plans had been cancelled by insurers in the last few weeks because they did not include a menu of preventive services—for example, some immunizations provided without a patient co-pay—that are required under the Affordable Care Act (ACA) for health plans that cover people in the United States beginning January 1, 2014. Insurers are allowed, but not required, to reinstate the cancelled plans and will not have to include free preventive services in the renewed plans for 2014.
The roll out of health insurance under the ACA has seen numerous glitches, including difficulty even logging into the health insurance marketplace website. On Thursday, Kaiser Health News posted a very informative FAQ aimed at answering some of the many questions consumers and health experts have right now about signing up for health insurance for 2014.
>>Bonus Link: Read about the Affordable Care Act on RWJF.org.
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
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?
While immunizations are a ubiquitous symbol of public health, in the last decade or so many public health departments have shied away from using the icon on their home pages or even adding it to a top ten list of what they do in the hopes of making both citizens and policymakers realize that public health extends far beyond infectious disease. Yet as public health departments integrate their work with the private sector, who will do the vaccinating, how immunization records will be kept and who gets paid for the work are pivotal issues that local health officials are grappling with.
A well-attended session at the NACCHO Annual conference yesterday provided a few more questions than answers, but armed attendees with new information as implementation of the Affordable Care Act (ACA) begins and both public health and private providers see their roles change and merge. Significantly, the ACA is expected to enroll millions of children, and under new rules the Vaccines for Children program will no longer cover the cost for vaccines for children who can receive immunizations under their own insurance. That will reduce funding for some health departments.
Other changes ahead for vaccination coordination include the role of accountable care organizations (ACOs) in coordinating care under the ACA, electronic registries and billing for public health services, said Paul Etkind, MPH, DrPH, head of infectious diseases at NACCHO.
“Much of this has yet to play out, so there are many unknowns,” said Etkind, who added that vaccines are a good example of the need for up front conversations with providers about what public health has to offer and a good way for health departments to become part of ACOs. “Going forward there will be a greater emphasis on coordinating care between the public and private sectors, than in delivering the care in many cases and public health needs to be active players in this process.”
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.
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.