ACA Implementation Opportunities and impacts on Public Health Departments

Research Objective: The Patient Protection and Affordable Care Act (ACA) includes reforms that expand insurance coverage and enhance access to clinical preventive services. To explore the impacts of the ACA on state and local health departments, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with NORC at the University of Chicago to conduct the study, “Implications of the Affordable Care Act for HHS Public Health Programs.” 

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.