Submitted on Wed, 2014-04-30
By Bonnie Lu

When will local health departments start to see the complete effects of Obamacare?

What’s Next for Local Health?

The Affordable Care Act open enrollment deadline for 2014 has passed, and the new program looks like it’s had a pretty large impact on the country’s uninsured. What’s not clear however is the effect of the ACA on local health departments and community health centers in both the short and long-term.

The Affordable Care Act Exceeds its Target

More than seven million people signed up for private health insurance through the Health Insurance Marketplace before the March 31st open enrollment deadline, and Medicaid saw an increase in more than 3 million users during that time too. States that adopted the expansion of Medicaid increased at rates 5x higher than states that did not. All told, the percentage of Americans without health insurance fell to its lowest rate in six years. It’s a great start that will hopefully continue chipping away at the uninsured rate for years to come.

As of now, some local health departments are reporting the Affordable Care Act has had little impact on daily operations, while others that we’re in direct communication with have noticed a decrease in traffic through their doors, though this varies from region to region. Flu shots, one of the major services local health departments supply, had peaked before open enrollment began in October. By the time the website’s hiccups were corrected, most people already had their flu shots. In 2014, local health departments should be able to collect revenue from patients with private insurances during flu clinics.

Legislation Impacting Public Health

As funding has continued to drop, states legislatures have encouraged local health departments to bill for services. In New York for instance, local health departments cannot provide state supplied vaccine to insured children, but can continue serving those patients if they have the capacity to bill insurances.

Recent Medicare rule changes are also impacting the billing process. In 2014, all providers, including local health departments, are required to individually enroll with Medicare to be reimbursed, and can no longer utilize other organizations or provider information to process claims. The importance of insurance contracting and credentialing has never been higher.

The State of Public Sector Healthcare Funding

The very familiar story of decreased funding for local health departments continues. Over the past three years, the number of employees working for local health departments has dropped by 15%, and funding for programs like emergency preparedness has dropped by almost 45% over the same period. Most concerning though is the overall financial wellbeing and the future sustainability of local health departments. Grants have become much more competitive and are tied to specific objectives, whereas almost half of all local health departments with a reserve fund experienced a decrease (46%) in their most recently completed fiscal year. Many local health departments face a challenging future, uncertain of where and how they will secure long-term funding.

Forward-thinking Solutions

It’s pretty apparent that the funding situation for public health is not going to drastically improve any time soon. Even funding sources like the Prevention and Public Health Fund that are set aside specifically for public health are constantly in a state of flux. It’s imperative for local health departments to get reimbursed for the services they provide. The most successful health departments today are tirelessly working to get credentialed and contracted with insurance companies, and also making sure every claim gets processed through with 100% accuracy more maximum reimbursement.

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