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Crisis as Catalyst: The Affordable Care Act and Public Health in Philadelphia September 24, 2010

Crisis as Catalyst: The Affordable Care Act and Public Health in Philadelphia September 24, 2010. Nan Feyler, JD., MPH Chief of Staff Philadelphia Department of Public Health Nan.feyler@phila.gov. The Patient Protection and Affordable Care Act. Invests in Public Health and Prevention.

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Crisis as Catalyst: The Affordable Care Act and Public Health in Philadelphia September 24, 2010

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  1. Crisis as Catalyst:The Affordable Care Act and Public Health in PhiladelphiaSeptember 24, 2010 Nan Feyler, JD., MPH Chief of Staff Philadelphia Department of Public Health Nan.feyler@phila.gov

  2. The Patient Protection and Affordable Care Act

  3. Invests in Public Health and Prevention • Creating national spotlight on prevention and public health as essential to health care • Clinical prevention • Requires in health plans and no cost-sharing • Requirements in Medicare and Medicaid • Includes tobacco cessation for pregnant women • Oral health care prevention • Promote prevention and wellness to seniors

  4. Invests in Public Health and Prevention • Community Based Prevention • Prevention and health promotion outreach and public education campaign • Community Transformation Grants • Reasonable Break Time for Nursing Mothers • Menu labeling • Employer based wellness programs study and recommendations

  5. Invests in Public Health and Prevention • National Prevention, Health Promotion & Public Health Council and National Prevention and Health Promotion Strategy • “Historic opportunity to bring prevention and wellness to forefront of the nation’s effort to improve health” • Community health approach to prevention and wellness

  6. Invests in Public Health and Prevention • Prevention and Public Health Fund • To provide for an expanded and sustained national investment in prevention and public health programs • For prevention wellness and public health activities including prevention research and health screenings. • Funding levels • FY2010 $500 million up to $2 billion FY2016

  7. Expands Access to Coverage • Most people will be required to have insurance by 2o14 • Some employer requirements depending on employer size • Creation of American Health Benefit Exchanges • Expansion of Public Programs

  8. Expands Access to Coverage • Requires comprehensive coverage with a minimum set of services • Young adults stay on parent’s plan until age 26 • Caps annual out-of pocket spending • Cannot deny coverage or charge more to people with pre-existing conditions • Cannot put lifetime limits on benefits • Cannot cancel a policy without showing fraud

  9. Community Health Center and National Health Services Corp • $11 billion for CHCs over next 5 years: • $1.5 billion – construction and renovations • $9.5 billion - create new health centers an expand preventive and primary care • $1.5 billion for National Health Services Corp

  10. Reduces Health Disparities • Data Collection and reporting by race, ethnicity and language • Cultural Competence Training and Organizational Support • Workforce Diversity • Health disparities research • Increasing prevention, access to coverage, and support of community health centers

  11. Impact on Philadelphia • Expanded access to clinical and population based services • Increased funds for existing and newly-authorized public health programs through Prevention and Public Health Fund • Potential for increased workforce development • Opportunity to address health disparities

  12. Significant poverty Red areas = census tracts with >20% poverty Red areas = census tracts with >40% poverty

  13. Uninsurance Over Time in Philadelphia 174,000 165,000 157,000 154,000 136,000 102,000 Source: PHMC Household Health Survey (2009 data is estimated from Families USA); Behavioral Risk Factor Surveillance System, CDC

  14. Philadelphia Health Status Of 10 largest US Cities highest prevalence of • obesity (35.1%) • diabetes (11.9%) • hypertension (33.4%) • over 5 percentage points above the county that ranks second worst (Cook County, 28.1%).

  15. Adult Smoking 10 Largest U.S. Cities, 2007 Source: Behavioral Risk Factor Surveillance System, 2007; City-specific public health data sources

  16. Tobacco use: Racial disparities *PHMC Household Health Survey

  17. Infant mortality rates US, PA, Philadelphia 2000-2008

  18. Strengths • A Chance for Transformation • Works to integrate prevention • Recognizes importance public health and prevention • Removes risk or pre-existing condition and other barriers • Provides potential funding

  19. Opportunities • Philadelphia Department of Health recently awarded $1,118,493 in Affordable Care Act funding for Capacity Building Assistance to Strengthen Public Health Infrastructure and Performance

  20. Concerns • Continued need for safety net • Excludes many immigrants • City Health Centers ineligible (FQHC Look Alikes not included) • Prohibits funds for abortion

  21. Biggest Concern • Backlash – for political and or fiscal reasons all or some of the law may be repealed. • prevention and public health may be first to go • no coherent plan

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