Category Archives: Affordable Care Act

Public Health Policy: What to Watch in 2018

NACCHO’s government affairs team has provided a forecast of what to expect in public health policy in 2018. The decisions made in Washington this year will have a major impact on local health departments and on the public’s health. As always, NACCHO members and staff will work together this year to be the voice of local health departments. Below is a short list of the top things to watch this year. For the full list, go to Continue reading

Six Years Later: The Affordable Care Act and Public Health Transformation

By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

This month marks the sixth anniversary of the passage of the Patient Protection and Affordable Care Act (ACA). The law has brought about significant change to the healthcare and public health landscape, fundamentally shifting how we as a nation think about the meaning and value of health.

The Department of Health and Human Services estimates that an impressive 17 million uninsured people have gained health insurance under the law. In addition to expanding access to care, the ACA encourages a more holistic approach to care by rewarding clinical care providers for value instead of volume. As a result, we’re seeing a greater focus on quality and outcomes in the clinical setting. Continue reading

Supreme Court Ruling on Affordable Care Act Will Benefit Millions

lamar-hasbrouck-headshot-2015By LaMar Hasbrouck, MD, MPH, NACCHO Executive Director

The recent U.S. Supreme Court decision allowing federal subsidies to continue for people buying health insurance on federal exchanges under the Affordable Care Act (ACA) is a historic one that will enable millions of Americans to live longer, healthier and more productive lives.

The National Association of County and City Health Officials (NACCHO) supports implementation of the ACA because of the strong commitment of our members to protecting and improving the health and safety of the American people. The ACA puts the highest priority on promoting good health and preventing people from getting sick in the first place. Continue reading

CDC’s Dr. Judy Monroe Explains How OSTLTS Supports Local Health Departments

judy-monroeBy Ian Goldstein, Web and New Media Specialist, NACCHO

Judy Monroe, MD, FAAFP, is the deputy director for state, tribal, local and territorial support efforts at CDC and director of the Office for State, Tribal, Local and Territorial Support (OSTLTS). In her role, Dr. Monroe provides critical leadership for supporting and revitalizing the public health system. Her efforts focus on establishing a systems approach that supports integration and collaboration among public health professionals and translating science to practice to increase the capacity and performance of public health agencies. The following is an excerpt from a recent podcast interview with Dr. Monroe.

NACCHO: How are you able to translate science into practice in order to increase the capacity and performance of governmental public health departments?

JM: Great question. We’ve actually used a logic model framework where you have to be aware of the science, accept it, adopt it, implement it, and then evaluate and sustain it. With each one of those steps, from awareness to adoption, we’ve got things—for example, CDC puts out Vital Signs every month, which talks about really timely topics using the best and latest science. We make sure that we’re using those to raise awareness of the latest science. We have some tools called “Did You Know?” that is a weekly publication that goes out to the field. We try to make it user-friendly. We have health officer orientation and welcomes. Partners like NACCHO help raise awareness. Meetings like the NACCHO Annual meeting help raise that awareness.

To me, that’s sort of the “what,” the science. But the “how” is where the nitty gritty comes from. How do you actually put this into practice? To me, the way to really make that happen is through conversation with folks in the field. We have something once a month called a Vital Signs Town Hall Meeting where we get folks that are in practice talking with the scientists at CDC and then folks in the field who get examples of how they’ve translated that [science] so others can learn from them. It’s a great way to cross-fertilize.

NACCHO: How do you bring these folks together?

JM: [The town hall meeting] is actually a phone call. It is a national town hall conference call. Anyone is welcome to join and there is information on our website about that. If you go to the OSTLTS webpage on the CDC website, there is lots of information there for health departments.

NACCHO: Much of the Affordable Care Act (ACA) is already in effect and many important provisions are set to take effect in January 2014. How is OSTLTS supporting local health departments with the ACA implementation?

JM: [OSTLTS is doing so] in a number of ways. It started with a workgroup that we have that is led by David Fleming, who is a NACCHO member, which looks at the health department of the future. We’ve been focusing on workforce, electronic health records, public health and healthcare integration, shared services, and so forth.

Listen to the rest of Dr. Monroe’s response at

CDC Director Dr. Tom Frieden Discusses the ACA, Winnable Battles, and the Future of Public Health

By Ian Goldstein, Digital Media Specialist, NACCHO

Since 2009, CDC Director Dr. Tom Frieden has controlled both infectious and chronic diseases in this country and globally. Previously, Dr. Frieden led programs that reduced illness and death and increase life expectancy substantially as commissioner of the New York City Health Department from 2002 to 2009. As CDC director, Dr. Frieden has intensified CDC’s 24/7 work to save lives and protect people through effective response to outbreaks and other health threats at the local, state, national, and global level. The following is an excerpt from a recent podcast.

NACCHO: We’re heading into a critical period for the implementation of the Affordable Care Act (ACA). How are you coordinating implementation activities across the CDC, given that there are many moving parts?

Dr. Frieden: We have create a unit and a committee and through both of those parts, we’re getting all parts of CDC to figure out what we can do to help and what the ACA can do to help public health. I think it’s important to recognize that expanding access, waiving preventative service fees, and many other aspects of the Affordable Care Act can dramatically improve public health in this country. In addition, public health departments around the country can do a lot to increase access to healthcare by encouraging and facilitating enrollment in both marketplaces and Medicaid.

NACCHO: How is CDC thinking about the role of local health departments?

Dr. Frieden: This is a very important issue. There is a misconception out there that public health is healthcare for poor people and since that’s now taken care of with the Affordable Care Act, that public health is no longer necessary. That is completely wrong on basically every count. It is something that gets some credence in some circles. For one, we need to adapt. There are changes in how the healthcare system is structured. Taking into account those changes, we need to figure out everything from, for example, services that we will continue to provide, which may in some jurisdictions include immunizations, tuberculosis control, STD control—[health departments] may need to learn to bill for those services.

In addition, we need identify areas where we in public health can collaborate with healthcare providers on things like diabetes prevention program where providers may refer and insurers may pay for community-based services. And third, we need to engage with healthcare to improve the quality so we can improve the prevention value of the services provided—most importantly, the Million Hearts agenda but also very important areas ranging from teen pregnancy prevention, opioid overdose prevention, immunization, and more.

To hear Dr. Frieden’s thoughts on the CDC Winnable Battles and the future of public health under sequestration, listen to NACCHO’s podcast.

Bridging Clinical Medicine and Public Health

terry-allanThis post was originally published on the Public Health Newswire as part of a series on the impact of the Affordable Care Act written by contributing authors with varying public health perspectives. This piece is from NACCHO President Terry Allan, RS, MPH, Health Commissioner of the Cuyahoga County (OH) Board of Health. Allan says the health reform law is a catalyst for innovation in the way clinical medicine integrates with public health. He shares examples of ways this partnership transforming health delivery and generating real results in the Buckeye State.

Now that the Affordable Care Act (ACA) stands as the law of the land, the focus on elevating the quality of care, improving patient outcomes, and taming runaway costs for treatment have now become a national imperative. This will be no easy task. The reverberations from this profound transformation will impact all sectors of our health system, which currently accounts for approximately 18 percent of the gross domestic product. Providers, payers, and consumers must abandon business as usual and public health practitioners must find their way in this evolving landscape.

As a local public health officer serving 850,000 greater Clevelanders in Cuyahoga County and president of the National Association of County and City Health Officials, I have had the opportunity to share health reform experiences with colleagues from across the nation. It is clear that state and local health departments must define their new role and demonstrate our distinct value proposition among the many players in this complex delivery system.

In this context, it makes sense to concentrate first on what public health does best. Local health departments have long been identified as ideal conveners of community partners. They are uniquely qualified to marshal the substantial resources of nonprofits, academia, private businesses, community hospitals, and other governmental agencies, all working together to solve complex health problems. Preventing hospital readmissions necessitates meaningful community dialogue on linking medical providers with local prevention programs that work to increase access to healthy food choices, increase opportunities for physical activity, and connect patients to smoking cessation programs. This collaborative approach has proven successful in the past in greater Cleveland, where a partnership to reduce tobacco use in Cuyahoga County decreased adult smoking rates from 26.5 percent in 2003 to 18.8 percent in 2007, lower than the state of Ohio (23.1%) and the nation (19.7%) in 2007. A similar collaborative effort reduced childhood lead poisoning rates in Cuyahoga County by over 50 percent between 2004 and 2010.

Sustaining these gains can be a real challenge to communities, given the inconsistency of public health resources and the lack of historical emphasis on funding for prevention. The Prevention and Public Health Fund established under the ACA represents a genuine opportunity to change this dynamic. We can demonstrate how local health departments can be the eyes and ears of the healthcare system, outside the walls of hospitals and community heath centers, working as extenders in the neighborhoods and homes of their patients. We can work with primary care practices and specialists to support accountable care organizations to reduce environmental triggers in the homes of asthmatics and reduce emergency department admissions. We can employ and train outreach workers and health coaches to navigate the community health and social service system, advocating for patients to reduce costs and improve outcomes. We understand the dynamics of how the actual causes of morbidity and mortality often have more to do with unhealthy neighborhood conditions and the compounding disadvantages that many low-income minority communities face.

All of these examples represent real value to the system and are consistent with the tenants of the National Prevention Strategy.

A former state health director in Ohio called public health “the greatest story never told.”  It’s time to tell it.

A Vision for Implementing Health Reform in Oregon

lillian-shirleyThis post was originally published on the Public Health Newswire as part of a series on the impact of the Affordable Care Act written by contributing authors with varying public health perspectives. This piece is from Lillian Shirley, MPA, MPH, Director of the Multnomah County Health Department and NACCHO’s immediate past president. She shares how Oregon has been working with community stakeholders and local health leaders to meet the needs of an entire population. It is this vision, Shirley says, that will guide them through full and successful implementation of the health reform law.

The Affordable Care Act (ACA) has revolutionized key relationships in the Pacific Northwest, erasing state lines, county boundaries, and hospital market shares to create an unprecedented partnership for the public good.

Beginning in 2010, public health leaders from four counties around metropolitan Portland began working with local hospital directors to respond to the ACA and public health accreditation.

We realized the only way to effectively assess the community health needs in real time was to bring everyone to the table. That meant convening staff from 14 different hospitals and health systems in Oregon and Washington—professionals who compete fiercely against one another. These historic rivals would need to work together and with public employees from four county health departments to assess the needs of more than two million people in the Portland region.

County health department staff were quickly identified as critical to this evaluation, both as the prevention experts and for our ability to plan in the interest of the entire population. Local public health leaders also bring an equity lens and cultural competence to community involvement and strategic planning.

Multnomah County Health Department was selected to serve as the legal convener. The Oregon Association of Hospitals and Health Systems provided critical startup assistance and the work group was formed. Together, we chose the name Healthy Columbia Willamette, for the two mighty rivers whose confluence defines the Portland region.

Our goal is to prioritize the community health needs, enable joint efforts to implement and track improvement activities, and improve the health of the population. We are using a modified version of NACCHO’s Mobilizing for Action through Planning and Partnerships (MAPP) assessment model.

Using this model allows Healthy Columbia Willamette to tap community wisdom and experience, including interviews with more than 100 stakeholders such as ambulance companies, 911 dispatchers, social services, and housing providers. Plans call for listening sessions and a strength assessment with other community members.

We are committed to monitoring how we’re doing. Transparency is a local public health value, and Healthy Columbia Willamette is now building an online data dashboard to help engage and inform the community. Our website went live April 1.

This collaboration has strengthened Oregon’s own health reform efforts, as county health departments partner with these same hospitals, and with area health plans, in new coordinated care organizations. We truly are working together. Balancing financial realities with the public good is not easy. But we are seeing old problems with new eyes.

Won’t it be powerful if we can apply this same unified momentum, energy, and creativity to a single confounding issue like childhood obesity? Imagine how we could help a community of children growing up at the confluence of this time, and these efforts, thrive. This is our vision for implementing the Affordable Care Act here in Oregon.