By Scott Presson:

APHA held its first Midyear Meeting June 23-25, 2011 in Chicago. I attended to represent the Oral Health Section through support APHA made available so that each Section could participate. The theme of the meeting was “Implementing Health Reform, a Public Health Approach.” There were many outstanding presenters that gave us a robust picture of many of the current issues in implementing the Affordable Care Act.

Many provisions of the ACA are being implemented or on schedule to be implemented by 2014. This includes some of the oral health provisions that are authorized by the ACA, and either don’t require appropriations or actually received appropriations within the ACA. Many of the important oral public health provisions, however, are authorized but do not have appropriations to fund them. As is apparent if you are watching the political dialogue, finding funding for these new oral health provisions will be quite unlikely in the short-term. Many public health officials are concerned that new funding already provided in ACA, such as the Prevention and Public Health Fund, will be eroded by reductions in funding for other discretionary public health programs. This will potentially decrease their effect. A larger assault on public health and other health programs is taking place that may restrict and limit how much of this historic law can be implemented. Now that ARRA stimulus money is running out and state budgets are not improving, many state and local health departments are under even more budget pressures. Many health departments are losing even more staff and programs. 

In planning for implementation of ACA in 2014, when many important provisions, such as the health exchanges, are implemented, states are using a wide range of approaches. Some states are refusing federal funding to do planning, while others see this as an opportunity to modernize and improve competition. Several speakers noted that some state and local health departments are using this time of change as an opportunity to restructure along the lines of the Public Health Accreditation Board and/or to better align with provisions in the ACA. 

Jennifer Granholm, former governor of Michigan, encouraged the audience to make their views known to policymakers, turn up the volume, contact them personally or visit them, and be creative in individualizing your letters or visits. Form letters should be individualized to increase their impact. Larry Wallack, a renowned expert in media advocacy, gave the audience advice about framing the issues around ACA. “If they can get you asking the wrong questions, they don’t have to worry about your answers.”  The role of government is the core issue; who we are as a country and why this matters. The opponents are arguing that this is about freedom, while many proponents are arguing that this is about controlling costs. He advises that this is about fairness; that if we are a country that cares about our fellow citizens and believes in an equal opportunity for success, that the first rung on the ladder of opportunity is health. Make no mistake, the 2012 election will have great impact on the future of ACA.

As far as the oral health provisions in ACA, the meeting did not go into this level of detail, but I will briefly summarize. The requirement that children have dental insurance will be implemented when the health exchanges begin in 2014. There is funding already available for expansion of community health centers and school-based health centers, including potential for dental facilities. Important provisions to strengthen oral public health and training programs at HRSA and CDC have not received appropriations. I did have the opportunity to ask Caya Lewis, a high CMS official, to continue to work with states to improve implementation of Medicaid dental benefits so that more children actually receive care.

Oral Health provisions and their status have been summarized by the Children’s Dental Health Project.  See:

http://cdhp.org/cdhp_healthcare_reform_center

http://cdhp.org/system/files/Moving%20on%20the%20Dental%20Care%20Provisions%20in%20Health%20Reform.pdf

http://www.cdhp.org/system/files/Moving%20on%20the%20Oral%20Health%20Provisions%20in%20Health%20Reform.pdf

http://www.cdhp.org.php5-4.websitetestlink.com/system/files/Health%20Care%20Reform%20Toolbox.pdf

Following the meeting, the Section representatives met to discuss the conference and give APHA feedback on the meeting.  The meeting was worthwhile in focusing on the status of this historic legislation. Whether its potential is realized depends on the will of the people and leadership from the public health community. Please make an effort to stay current with this issue and to engage in efforts to implement the law as robustly as possible as economic conditions improve. We must make appropriations for oral health programs a visible priority.