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
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 newlyauthorized 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
Uninsurance by Age Group and Data Source
Philadelphia, 2000-2009
25%
20%
Total Population (PHMC
HHS)
15%
10%
5%
136,00
0
157,00
0
154,00
0
165,00
0
174,00
0
Adults, 18-64 (PHMC
HHS)
Adults, 18-64 (BRFSS)
102,00
0
0%
2000
2002
2004
2006
2008 2009*
Source: PHMC Household Health Survey (2009 data is estimated from Families
USA); Behavioral Risk Factor Surveillance System, CDC
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%).
Adult Smoking
10 Largest U.S. Cities, 2007
Adult Smoking Prevalence
10 Largest U.S. Cities, 2007
30%
Philadelphia
Chicago
Phoenix
San Antonio
NYC
Houston
Dallas
San Diego
LA
San Jose
25%
20%
15%
10%
5%
0%
Adult smoking
Source: Behavioral Risk Factor Surveillance System, 2007; City-specific public
health data sources
Tobacco use: Racial disparities
Pecentage
Tobacco use among adults: Philadelphia, 2008
29.0%
28.5%
28.0%
27.5%
27.0%
26.5%
26.0%
25.5%
25.0%
24.5%
28.5%
27.3%
26.6%
26.1%
Philadelphia
White
Black
Latino
*PHMC Household Health Survey
Department of
Public Health
City of Philadelphia
Infant mortality rates
US, PA, Philadelphia 2000-2008
18
16
14
12
10
8
6
4
•
2
0
2000
2001
HP 2010 Target
Philadelphia- White
2002
2003
US
Philadelphia- Black
2004
2005
2006
Philadelphia- All
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