Perceived and anticipated impacts of the Affordable Care Act on state public health practice

The Affordable Care Act is poised to significantly alter the healthcare environment, notably removing barriers to access. The ACA will also have critical impacts on public health practice, including how public health departments operate and set priorities. As more individuals are shifted into healthcare coverage and some barriers to healthcare are removed, there may be some changes into how public health agencies prioritize and budget for programs and services, especially direct, clinical services. This presentation will focus on the results of a multiple case study examining the perceived and anticipated effects of the ACA on the budget and priority setting process in state health agencies.

Forty-five qualitative, key informant telephone interviews across six state health departments were conducted in Spring 2011. Seven to eight interviews were completed at each department. Respondents are executive and division/bureau leadership. Data from the interviews were coded thematically.

Preliminary findings show diversity in anticipated effects. Emergent themes from the interviews focus on how the ACA may influence priorities and priority-setting processes, the impact on the department's mission, and implications for the day-to-day public health operations of the agency will be explored. Respondents expressed uncertainty regarding ACA impact on future flexibility in program planning, new opportunities for increased focus on traditional, population-based public health practice, and perceived limitations in resources for preventative programs. Similarities and differences across divisions, positions, and states will also be discussed.

The findings from this presentation will provide a sense of the implications of the ACA on public health practice and the priority and budget-setting processes. These findings may also assist public health administrators in preparation for the full implementation of the ACA.