Crisis as Catalyst:The Affordable Care Act and Public Health in

PhiladelphiaSeptember 24, 2010

Nan Feyler, JD., MPHChief of Staff

Philadelphia Department of Public HealthNan.feyler@phila.gov

The Patient Protection and Affordable Care Act

Invests in Public Health and Prevention

Expands Access to Coverage

Reduces Disparities in Health Care

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

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

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

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

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

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

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

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

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

Significant poverty

Red areas = census tracts with >20% poverty

Red areas = census tracts with >40% poverty

Uninsurance Over Time in Philadelphia

Source: PHMC Household Health Survey (2009 data is estimated from Families USA); Behavioral Risk Factor Surveillance System, CDC

Uninsurance by Age Group and Data SourcePhiladelphia, 2000-2009

0%

5%

10%

15%

20%

25%

2000 2002 2004 2006 2008 2009*

Total Population (PHMCHHS)

Adults, 18-64 (PHMCHHS)

Adults, 18-64 (BRFSS)

102,000

136,000

157,000

154,000

165,000

174,000

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%).

Philadelphia Health Status

Source: Behavioral Risk Factor Surveillance System, 2007; City-specific public health data sources

Adult Smoking10 Largest U.S. Cities, 2007

Adult Smoking Prevalence10 Largest U.S. Cities, 2007

0%

5%

10%

15%

20%

25%

30%

Adult smoking

PhiladelphiaChicagoPhoenixSan AntonioNYCHoustonDallasSan DiegoLASan Jose

City of PhiladelphiaDepartment of Public Health

Tobacco use: Racial disparities

*PHMC Household Health Survey

Tobacco use among adults: Philadelphia, 2008

27.3%

26.6%26.1%

28.5%

24.5%25.0%25.5%26.0%26.5%27.0%27.5%28.0%28.5%29.0%

Philadelphia White Black Latino

Pece

ntag

e

Infant mortality rates US, PA, Philadelphia 2000-2008

• 0

2

4

6

8

10

12

14

16

18

2000 2001 2002 2003 2004 2005 2006

HP 2010 Target US Philadelphia- AllPhiladelphia- White Philadelphia- Black

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

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

Concerns•Continued need for safety net

▫Excludes many immigrants

•City Health Centers ineligible (FQHC Look Alikes not included)

•Prohibits funds for abortion

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