Expanding Medicaid

For public health officials, the Medicaid controversy is only one of many changes ushered in by the ACA and the economic downturn that they are addressing. While other sectors are working to develop plans for handling the uninsured, many local health departments are reassessing their role of providing clinical services to patients, says Dr. Peter Beilenson, commissioner of health in Howard County, Md. “We’re moving more to public health specialty services for that population,” he says.

In addition, public health is acting as a resource for those entering the healthcare system, as a “navigator” that helps people understand where to go for services. A third area of concentration, he says, is educating the public on “community wellness,” how people can improve their health and live better and longer lives through better health behavior. Public health departments also continue their traditional, and less controversial, role of enforcing health laws, he says, and are also leading the effort “to break down the silos” among service providers.

Terry Allan, commissioner of health for Cuyahoga County, Ohio, adds that the ACA looks to local public health departments to take a more critical role in preventive healthcare, offering flu shots, vaccines and family planning. That may involve more proactive programs that seek to reduce costs through the system by offering preventive services. As an example, he says that nurses may begin making home visits to asthma patients to help find and eliminate factors that may be causing asthma attacks, rather than waiting to treat an asthma attack in the emergency room.

With those responsibilities outlined in the new legislation, public health departments must decide whether to wait until the scene is more settled or move ahead to take full advantage of the new opportunities that may not materialize if the political landscape changes significantly. “Some departments are putting their toe in the water,” he says. “We’re diving in deep.”

He points to the decision of his own health board to hire a clerk who will spend the entire workday looking for opportunities to draw more resources from the system, a position that may not cover its own cost immediately but has significant potential in the near future. “The world is evolving so quickly,” he says. “We want to be sure that we take advantage of the law.”

Local health departments are not paralyzed as a result of the unsettled political scene and continue to perform their traditional roles as well as explore new opportunities that are emerging in the roiling healthcare waters, Pestronk says. “The force at work continues to be at work,” he says. “This has added another dimension, another complexity that has to be discussed. But they are not on hold.”

For public health officials, the uncertainty creates challenges and new opportunities. “There are a lot of unknowns,” Allan says. “We have to take a breath and see where we all fit in. The world is changing.”

Robert Barkin is a Bethesda, Md.-based freelance writer.