From the Dean: What Does the ACA Mean for Our Region?

By Howard Frumkin

In the year since the last issue of Northwest Public Health appeared, the US health care system marked a historic transition: implementation of the Affordable Care Act (ACA). This issue is devoted to that transition and what it means.

Our state did well. By the end of the enrollment period on March 31, Washington Healthplanfinder reported that 146,497 state residents had signed up for private health insurance through the state’s health insurance exchange, 268,367 newly eligible people had enrolled in Medicaid, and 135,485 people previously eligible for Medicaid but not enrolled had signed up. An additional 408,086 people had re-enrolled in Medicaid. This totals over 950,000 enrollees, of whom over 550,000—8 percent of the state’s population—were newly insured. We should celebrate this achievement.

The ACA centers on health care delivery, but it is highly relevant to public health as well. It encourages the integration of public health with clinical care—an opportunity recognized and seized by many public health leaders (such as Washington’s Secretary of Health, Dr. John Wiesman). Federal funds have been allocated to prevention. Hospitals are required to provide community benefit, which often entails working “upstream” from the point of care. Insurance plans are required to cover preventive services. Again, we should celebrate these and similar provisions.

I am proud that the UW School of Public Health has fully engaged these opportunities, through our teaching, research, and service. You can read about some of these efforts in this issue. In brief:

• Professor Doug Conrad is leading a team, including students Jeremy Snider, Megan Shepherd-Banigan and Ian Randall, in collaboration with Public Health - Seattle & King County, that is monitoring the impact of the ACA on the health of King County.

• Professor Anirban Basu is leading UW-SHARE, a mail survey of 40,000 randomly selected Washington State households that aims to understand how the ACA affects Washington residents.

• Aaron Katz, Patricia Lichiello, and John Hall are conducting a qualitative state-level field network study of ACA implementation.

UW students have also played an important role in ACA implementation. Associate Dean Mark Oberle led an effort, across the Health Science schools, to facilitate this student activity. Read “The Invincibles” on page 22 of this issue for more about how UW students have contributed to ACA implementation in our state.

Finally, UW SPH faculty have served in various capacities related to ACA and health reform: Doug Conrad on the Washington Health Benefits Exchange, Jack Thompson and Tao Sheng Kwan-Gett on the state Public Health - Health Care Delivery System Partnership workgroup, Mark Oberle on King County’s Health Reform Leadership Circle Executive Committee.

And as this issue of Northwest Public Health went to press, Ron Sims, former King County Executive and Chair of the UW SPH Dean’s Council, was named chair of the Health Benefits Exchange Board by Governor Inslee.

We will be drawing lessons from the first year of the ACA for years to come. For now, several conclusions suggest themselves:

• Bold, transformative public policy is possible, even in an era of political paralysis. And this policy can improve life for millions of people. Courage and perseverance are essential.

• While thoroughgoing reform, such as a single-payer system, might secure universal, affordable, high quality health care, partial reform that is politically more feasible can still yield important benefits. Compromise is sometimes necessary.

• In our nation, faith in collective solutions—in government—is fragile, and can be badly shaken by poor performance, such as the botched rollout of Healthcare.gov. Government must deliver services efficiently and well.

I hope you enjoy the fascinating mix of articles in this issue, and I hope they provide useful information as you work to advance the health of the public.