How the ACA Affects Your Public Health Career

Is it a penalty or is it a tax? Or is it both? We’ve all heard that question being asked at least once. And if you watch TV for more than 2 hours a day, you’ve probably heard it multiple times. If you’re a patient (and if you haven’t been, you will eventually), this law comes with certain benefits and rights that I covered here (and also covered extensively by the media). If you’re a clinician, the law opens up new opportunities to form Accountable Care Organizations (ACOs) that reward doctors when their patients are healthy. However, little has been discussed about the ACAs impact on the public health realm (with no surprise since we only invest $251/person in public health dollars compared to $8,086/person in health care dollars link). So what’s at stake for us public health practitioners?

Called the Prevention and Public Health Fund, this initiative brings forth an unprecedented investment in the public health mission: assuring conditions in which people can be healthy. This fund is put to work in partnership with states and communities, helping control the obesity epidemic, fight health disparities and respond to health threats. Since the Affordable Care Act was passed in 2010, the Department of Health and Human Services has awarded $1.25bil in Prevention Fund grants country-wide.

Here in California, DHHS has awarded more than $90mil to the state government and local organizations, focusing on community prevention, clinical prevention, public health infrastructure and training, as well as research and data collection.

The big winner in California is the Public Health Infrastructure and Training category, receiving a whopping $38mil to support training of public health practitioners, determine new resources to prevent, detect and respond to outbreaks, as well as improve the public health system by analyzing and communicating health data.

Another big winner is the Community Prevention category, receiving almost $35mil to support prevention activities proven to reduce health care costs and improve healthy behaviors. Surprisingly, obesity prevention and fitness (part of the community prevention category) only received $657,000, which is puzzling since the obesity epidemic is always on everyone’s minds as the biggest epidemic in the US right now.

It’s important to note that the ACA is not the only major source of funding for public health programs. The President’s Childhood Obesity Task Force and the First Lady’s Lets Move! initiative both work toward combating childhood obesity, ARRA (American Recovery and Reinvestment Act) provides $1bil to public health efforts (and is also the source of your Public Health Traineeships), and the Million Hearts initiative works to prevent heart attacks and strokes.

Perhaps the biggest impact that ACA will have on your public health service is it’s focus on prevention versus treatment. Through the development of specific organizations like ACOs to keep patients healthy, to investing in preventive care, to increasing $$$ available for education and awareness, public health efforts and the idea of starting healthy is finally being recognized and given importance.

Maybe once our health care costs get under control, we can start focusing on making a bigger investment in our public health infrastructure.

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