Transcript Nan Feyler
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
[email protected]
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