The Affordable Care Act and
Public Health
Andrew Rein
Associate Director for Policy
Centers for Disease Control and Prevention
February 8, 2011
PHSR IG Breakfast
National Health Policy Conference
The Affordable Care Act
 Expands insurance coverage to 32 million more
people
 Makes coverage and care more affordable
 Protects consumers and ends insurance abuses
 Bans insurance companies from:
 Denying coverage to kids with pre-existing
conditions
 Dropping or limiting coverage
 Limiting choice of doctors
 Restricting emergency room care
 Guarantees consumers right to appeal
The Affordable Care Act
Includes Cost Savings


Center for Medicare and Medicaid Innovation
develops and implements new ideas
Targeted demonstration programs, including
 Accountable Care Organizations
 Medical homes

Waste, fraud, and abuse
The Affordable Care Act
Will Increase Quality of Care
 National Quality Strategy
 Better care, affordable care, and healthy people/healthy communities
 Proposed priorities
 Make care safer
 Promote effective coordination of care
 Assure person- and family-centered care
 Promote most effective prevention and treatment practices for the
leading causes of mortality, starting with CVD
 Help communities promote better health
 Make care more affordable for individuals, families, employers, and
governments by reducing costs through continual improvement
More Than Coverage…
The Affordable Care Act
is a
Real Opportunity for
Public Health
More People Will Have Access
to Preventive Services

Preventive services now covered with no cost
sharing
 USPSTF, ACIP, Bright Futures, and women’s health guidelines
and recommendations
 Private insurance, Medicare
 Incentive for states to include in Medicaid

Medicare wellness visit
 Review medical history, current care
 Risk assessment and review of functional ability
 Routine measurements, e.g., BMI
Data and Programs Provide
Public Health Benefits

Data and monitoring
 Health disparities data

New funding for a variety of programs




Childhood Obesity Demonstration
Teen pregnancy prevention
Home visitation programs
School-based health centers
Nation-wide Menu Labeling Puts
Information in Consumers’ Hands

Calories listed on menus and menu boards
 Restaurants and retail food establishments with 20 or
more locations
 Other nutrient information (e.g., saturated fat, cholesterol,
sodium, carbohydrates, sugars, fiber, protein) available in
writing upon request

Calories listed for vending machine items
 Operators who own or operate 20 or more machines
Prevention and Public Health Fund
Provides Sustainable Funding
 Grows from $500m to $2b annually
2010
2011
2012
2013
2014
2015-19
$500m
$750m
$1b
$1.25b
$1.5b
$2b
 2010:
 $250M for primary care workforce
 $250M for prevention and public health:
•
•
•
•
$126m – Community and Clinical Prevention
$70m – Public Health Infrastructure
$31m – Research and Tracking
$23m – Public Health Training
Prevention and Public Health Fund
 Support community transformation to reduce
leading causes of death
 Strengthen federal, state, tribal, local, and
territorial public health detection and
response
 Information for action
Prevention and Public Health Fund:
CDC FY10 Investments
Investment area
Public health infrastructure
Amount
$50m
CPPW
$36.4m
HIV
$30.3m
ELC / EIP
Healthcare surveillance
$20m
$19.8m
Tobacco media
$9.5m
Public health workforce
$7.5m
Tobacco quit lines
$5m
Community Guide
$5m
ARRA evaluation
$4m
ARRA media
$4m
Total
$191m
Reduce Leading Causes of Death

Communities Putting Prevention to Work
 Mobile County, Alabama:
• Educate community and decision-makers on health benefits of
comprehensive smoke-free indoor air policies
• Work with tobacco retailers to restrict point of purchase tobacco
advertising
• Support worksites and schools to establish tobacco-free
environments and promote cessation services
 South Carolina Dept of Health and Environmental Control:
• Pilot statewide Farm-to-School program to increase consumption of
fruits and vegetables
• Potential to impact students, school staff, and surrounding
communities, with approx 11,000 public schools serving approx
733,000 meals
Reduce Leading Causes of Death

Increase tobacco cessation and reduce initiation
 Media ads to educate public about harmful effects of tobacco use and
secondhand smoke
 Maintain, enhance or augment national network of tobacco cessation
quitlines to increase quit attempts, access to effective cessation
services, and numbers of successful quitters

Curb HIV epidemic through enhanced laboratory capacity,
surveillance, testing, care and treatment, and prevention
 Annual internet-based survey on HIV risk, testing behavior, and
exposure to prevention services among MSM
 100,000 additional HIV tests in populations disproportionately
affected by HIV
Strengthen Public Health Detection and
Response

Enable states to do more with less
 Tennessee: Transition vital records to web-based system to permit interactive,
real-time information exchange, better utilization of resources, improved
linkage with states and agencies, and faster response to public health threats.
 Massachusetts: Establish Office of Local Health to increase efficiency by sharing
staff and services among districts covering at least half of state population.
Implement state-of-the-art reporting and monitoring systems linking local and
state public health entities.

Enhance epi /lab capacity for efficient, effective response
 New Jersey: Launch Communicable Disease Reporting and Surveillance System
Antimicrobial Resistance module to improve monitoring across state
 Michigan: Enhance Michigan Disease Surveillance System and Emergency
Department Surveillance System to better accommodate automated receipt,
mapping and analysis of referrals from EHRs and lab information systems
Strengthen Public Health Detection and
Response

Skilled workforce to address complex public health demands
 Supported over 225 epidemic investigations
 Support front-line service delivery and outbreak response
while training public health professionals
• 65 entry-level public health professionals
• 27 EIS officers and 5 CDC-CSTE Applied Epidemiology
Fellowship trainees
National Prevention, Health
Promotion, and Public Health Council

Opportunity to prioritize and align prevention
efforts across the federal government and the
nation

Chaired by the Surgeon General

Council members: 17 federal departments

Advisory Group: 13 non-federal members
appointed
Council Members
Bureau of Indian Affairs
Department of Labor
Corporation for National and
Community Service
Department of Transportation
Department of Agriculture
Department of Veterans Affairs
Department of Defense
Environmental Protection Agency
Department of Education
Federal Trade Commission
Department of Health and Human
Services
Office of Management and Budget
Department of Homeland Security
Office of National Drug Control Policy
Department of Housing and Urban
Development
White House Domestic Policy Council
Department of Justice
National Prevention Council: Charge
1.
Develop the National Prevention and Health
Promotion Strategy (National Prevention Strategy)
2.
Provide ongoing leadership and coordination of
federal prevention and health promotion efforts
3.
Produce an Annual Status Report
National Prevention Strategy




Identify goals, priorities, and actions for improving
health
Ground activities in evidence-based practices
Align and focus federal prevention and health
promotion activities
Align with existing national efforts, such as:
– Let’s Move!
– Healthy People 2020
– National Quality Strategy
– America’s Great Outdoor Initiative
Approach

Work across sectors

Catalyze public and private partnerships:
 Federal, state, tribal, local, and territorial
 Private, non-profit, faith, community, labor

Focus on where people live, learn, work, and play
 Community, worksite, institutions, etc.

Promote healthy development and behaviors
throughout all stages of life

Eliminate disparities
Stakeholder Engagement

National conferences

Stakeholder input sessions

Outreach calls

HHS Regional meetings

Council website:
www.healthcare.gov/nationalpreventioncouncil
Draft Framework
Vision
Goals
Strategic Directions
Recommendations
Action Items
Draft Vision
Working together to improve the health and
quality of life for individuals, families, and
communities by moving the nation from a
focus on sickness and disease to one based
on wellness and prevention.
Draft Goals
Americans Living Healthier and Longer
 Healthy Communities
 Preventive Clinical and Community Efforts
 Empowered Individuals
Draft Framework
Vision
Goals
Strategic Directions
Recommendations
Action Items
10 Strategic Directions
Cross-Cutting (4):
1. Healthy Physical, Social and Economic
Environments
2. Eliminate Health Disparities
3. Prevention and Public Health Capacity
4. Quality Clinical Preventive Services
10 Strategic Directions
Targeted (6):
5. Tobacco-Free Living
6. Reduce Alcohol and Drug Abuse
7. Healthy Eating
8. Active Living
9. Injury-Free Living
10.Mental and Emotional Wellbeing
Thank you!
For more information go to:
www.healthcare.gov