1. 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

3. Invests in Public Health and Prevention Expands Access to Coverage Reduces Disparities in Health Care

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Significant poverty Red areas = census tracts with >20% poverty Red areas = census tracts with >40% poverty

14. Uninsurance Over Time in Philadelphia Source: PHMC Household Health Survey (2009 data is estimated from Families USA); Behavioral Risk Factor Surveillance System, CDC 102,00 0 136,00 0 157,00 0 154,00 0 165,00 0 174,00 0

15. 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

16. Source: Behavioral Risk Factor Surveillance System, 2007; City-specific public health data sources Adult Smoking 10 Largest U.S. Cities, 2007

17. City of PhiladelphiaDepartment of Public Health Tobacco use: Racial disparities *PHMC Household Health Survey

18. Infant mortality rates US, PA, Philadelphia 2000-2008

19. 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

20. 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

21. Concerns Continued need for safety net ▫Excludes many immigrants City Health Centers ineligible (FQHC Look Alikes not included) Prohibits funds for abortion

22. 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