If there are two common threads running through discussions concerning the Affordable Healthcare Act (ACA), they are first that change is here, and second, no one really has a clue what that change will actually mean to Kentuckians in the long term.
“The ACA will have an impact on health departments. It is going to put a whole lot more people out there on the street on health insurance,” said Dr. Rice Leach, commissioner of health at the Lexington-Fayette County Health Department (LFCHD). “I think how [health departments] are impacted is going to look a little different depending on what part of the state they’re in. I can’t give you a specific prediction. The United States has passed a law that creates an entitlement for 30 or 40 more million people, and here in Lexington, for 10,000 or 20,000 more people to have health insurance. Now, who is going to take care of them?”
Leach, who has worked in public health since 1966 in every capacity from an intern to chief of staff to the U.S. surgeon general, said that Lexington is fortunate because it houses a third of the state’s doctors and has a large number of hospitals. He also stated that many other health departments across the state are “heavy in patients,” most of whom were affected by a downturned economy.
“We did not see an increase in patients, because we have pretty much gotten out of the patient business, and we have transferred that work. We had a lot of people who had insurance, and we encouraged them to use their insurance somewhere else. We referred those patients either to the private sector or primary care centers,” he said.
Despite the fact that LFCHD has filtered patients to other medical outlets, all state health departments could see a change, Leach said. He predicted that if the private sector steps up to serve the newly insured populace, it could have a “major negative impact on cash flow, because the volume won’t be there.” On the other hand, Leach said that if the private sector doesn’t accept the patient load, the stress goes onto the health departments, but with a twist — health departments might be expected to provide a whole continuum of care that includes doctors and laboratory services.
“What I am hoping is that other systems will step up to take care of the acute medical care part [for] people, so that we can continue to focus on trying to keep people well in the first place and eliminate the need to go to the doctor for things that can be prevented,” Leach said. “It will save money, and people will have more time to do whatever they want or need to do with their lives.”
Regardless of what the future holds for public health departments, these quasi-agencies in 120 counties of Kentucky are still doing business nearly every day — the type of business that reaches farther than clinical services.
According to Linda Sims, the Lincoln Trail District public health director and president of the Kentucky Association of Public Health Departments until Jan. 1, there are multiple factors that influence what health departments can and cannot do.
“It is getting harder for us because we have a great deal of mandates and limited ability to generate dollars,” Sims said. “We are a safety net provider and a preventive agency for the ones who don’t have any means. But we also do a lot of services that people never see.”
Leach calls the mandated services their “mission critical activities,” which include preventive health, communicable disease control, public health education, emergency response, sanitary code and restaurant inspection, and public health policy such as the recently enacted non-smoking policy, among other programs.
But again, the health departments are being asked to spin straw into gold with one major flaw — a lack of straw.
“We’ve experienced a 22 percent reduction in funding and a 22 percent reduction in staff,” Leach said. “They hired me to be commissioner here on March 1, 2011, and on March 15, I found out I was losing $2 million. A year later, I found out I was losing another $2 million, either through reduced funding or increased costs from retirement systems.”