ACA Implementation Opportunities and impacts on Public Health Departments
Study Design: Methods include an environmental scan, case studies using site visits and telephone interviews, and ongoing consultation with a Technical Advisory Group (TAG). Qualitative data were collected via interviews with staff from five state health departments (SHDs) and select local health departments (LHDs) in case study states. Researchers held discussions with the state health officer, program staff, Medicaid staff, and LHD staff.
Population Studied: We conducted five case studies with state health departments (SHDs) and select local health departments (LHDs). Case study states were selected using diverse selection criteria, including governance structure, geography, rurality, and Medicaid expansion (i.e., expanding or not expanding).
Principal Findings: 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 the ACA. While all case study states are expanding their capacity to bill for services, they report that billing is unlikely to 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, participants acknowledged that many of the changes that will result from the ACA are still unknown.
Conclusions: Health department leaders expressed concern that reduced utilization of key public health services may make it difficult to sustain programs seen as important to maintaining the public’s health. Further, they note that the resulting loss of revenue could have additional impacts on health department functions and response capacity. NORC will continue to explore these themes and key findings by conducting an additional set of five case studies.
Learning Areas:Clinical medicine applied in public health
Provision of health care to the public
Identify the effect of ACA reforms on where individuals seek clinical preventive services, where services are delivered, how health departments are responding and plan to respond to ACA-related changes.
Keyword(s): Patient-Centered Care
Qualified on the content I am responsible for because: I have conducted studies for HHS on the topic of ACA impacts on state and local health departments, as well as other realted Public Health Systems research.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.