More than 600 public health officials gathered in Chicago in late June to seize the opportunities and tackle the thorny issues surrounding implementation of the Affordable Care Act. The now 16-month-old health reform law looms large for public health and the goal of assuring a healthy nation. But its future also remains uncertain.
Attendees of APHA’s Midyear Meeting, which convened under the theme “Implementing Health Reform: A Public Health Approach,” heard from top leaders in the field and shared lessons for improving health outcomes in communities across the country.
Former Michigan Gov. Jennifer Granholm (watch video), who was instrumental in promoting health and wellness as a core principle of her state’s health reform efforts, welcomed attendees and set the tone for the three-day meeting. She questioned why we tolerate the “absurd outcomes” we see in U.S. health care, with low returns on our high investment, as compared to other countries. But she quickly pointed out that public health can change that.
Critical to the solution are initiatives that prevent disease and injury and promote health, and the Affordable Care Act takes important steps to reorient the U.S. health system to support prevention and wellness. The good news, delivered by national pollster and political adviser Celinda Lake (watch video) from her recent public opinion research on prevention, is that “the public is strongly supportive of prevention and believes it should be a much higher priority.”
Despite the support, health reform faces many hurdles. In addition to legal challenges, some in Congress have tried to repeal the law entirely as well as eliminate specific public health provisions. The law’s Prevention and Public Health Fund, for instance, which has already begun to direct some of its $15 billion in funding over 10 years to communities to reduce obesity, curb tobacco use and increase access to preventive care services, has been a continuing target.
The fund, the nation’s first mandatory funding stream dedicated to public health programs, was intended to expand ongoing investments in public health and prevention. Instead, its monies could be eliminated, reduced or used instead to supplant existing funding at a time when resources are already shrinking.
“The public health infrastructure in this country is at risk and in some places crumbling,” said Paul Jarris, MD, MBA, executive director of the Association of State and Territorial Health Officials, at the meeting. “(The fund) is an incredible opportunity for us, but it can slip through our fingers.”
In meeting sessions, attendees discussed opportunities to leverage the law to improve community health and to protect threatened public health programs. They were also called upon to continue to advocate on behalf of health reform and work to educate their communities, partners and policy-makers about the importance of this law and its critical investments in health.
Closing Session speaker Lawrence Wallack (watch video), dean of the College of Urban and Public Affairs at Portland State University, opined about some of the obstacles that lie ahead and about the path forward. He observed that while health reformers may focus on data and facts and statistics to make the case for robust changes in our health system, that’s not what matters. The debate, for many opponents of the law, is about the role of government in assuring a healthy nation and the values that guide our country.
That’s a fundamental argument, he said, we must win.
In concert with its meeting, APHA released a report that assessed the work force provisions of the Affordable Care Act. The issue brief showed that the law has thus far failed to adequately invest in the public health work force, which could jeopardize the law’s disease prevention and health promotion goals.