Impacts of the Affordable Care Act on State and Local Health Department Programs

NORC is conducting the study “Implications of the Affordable Care Act for HHS Public Health Programs” for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in HHS. The study examines how expanded insurance coverage and enhanced access to clinical preventive services changes how individuals seek care, shifts where preventive services are obtained, and affects the role of state and local health programs. The study seeks to identify how health departments are responding and plan to respond to ACA-related changes and the anticipated future changes to public health practice. 

Project activities include an environmental scan, case studies using both site visits and telephone interviews, and ongoing consultation with a Technical Advisory Group (TAG). Findings show that health departments are seeing reductions in client volume for some public health programs (e.g., immunizations, breast and cervical cancer screening) and respondents believe it is a result of ACA insurance expansion. While all case study states are expanding their capacity to bill for services, they report that billing is unlikely to fully replace program revenue should program funds be reduced. Many respondents discussed that some health departments may need to continue providing preventive services, especially in areas where there is an insufficient number of providers. While concerned, health departments are also looking at new, unique opportunities within the ACA, including expanding billing capabilities and partnering with accountable care organizations. NORC will continue to explore these themes and key findings by conducting an additional set of five case studies.