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Crisis as Catalyst:The Affordable Care Act and Public Health
in PhiladelphiaSeptember 24, 2010
Nan Feyler, JD., MPHChief of Staff
Philadelphia Department of Public [email protected]
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The Patient Protection and Affordable Care Act
Invests in Public Health and Prevention
Expands Access to Coverage
Reduces Disparities in Health Care
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Significant poverty
Red areas = census tracts with >20% poverty
Red areas = census tracts with >40% poverty
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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
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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
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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
Philadelphia
Chicago
Phoenix
San Antonio
NYC
Houston
Dallas
San Diego
LA
San Jose
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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
Pec
enta
ge
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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
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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
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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
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Concerns
•Continued need for safety net▫Excludes many immigrants
•City Health Centers ineligible (FQHC Look Alikes not included)
•Prohibits funds for abortion
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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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