
{"id":27478,"date":"2012-08-23T09:54:00","date_gmt":"2012-08-23T13:54:00","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=27478"},"modified":"2012-08-23T09:54:00","modified_gmt":"2012-08-23T13:54:00","slug":"health-dept-awaits-next-steps","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2012\/08\/23\/health-dept-awaits-next-steps\/","title":{"rendered":"Health dept. awaits next steps"},"content":{"rendered":"<p><strong>By Susan Dickson<\/strong><br \/>\n<em>Staff Writer<\/em><\/p>\n<p>The Orange County Health Department exists to enhance the quality of life, promote the health and preserve the environment for all people in Orange County, and officials say certain provisions of the Patient Protection and Affordable Care Act, affirmed earlier this summer by the Supreme Court, could help facilitate that mission. <\/p>\n<p>Under the act, a vast number of uninsured Americans should obtain health coverage by 2014. In addition, the act places a focus on preventive health care \u00e2\u20ac\u201c something Orange County Health Director Colleen Bridger praises. <\/p>\n<p>\u00e2\u20ac\u0153That\u00e2\u20ac\u2122s kind of the core of public health,\u00e2\u20ac\u009d she said, \u00e2\u20ac\u0153helping people understand the importance of preventive health.\u00e2\u20ac\u009d <\/p>\n<p>\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s nice to have the big guy in the corner when it comes to talking that talk,\u00e2\u20ac\u009d she added. <\/p>\n<p>The health department provides a number of health care services, including primary care, dental services, maternal health care, immunizations and HIV\/AIDS testing and counseling. But beyond medical care, the department also takes an educational role, promoting safe and healthy lifestyles for county residents.<\/p>\n<p>One of the department\u00e2\u20ac\u2122s primary roles is that of a safety-net provider for those who can\u00e2\u20ac\u2122t afford to obtain medical care otherwise \u00e2\u20ac\u201c including many uninsured and Medicaid patients. Some have argued that once most Americans become insured in accordance with the PPACA, safety-net providers like the health department won\u00e2\u20ac\u2122t be needed \u00e2\u20ac\u201c but Bridger disagrees. <\/p>\n<p>\u00e2\u20ac\u0153When you increase the number of people who have some sort of insurance coverage without increasing the number of people who can provide it, everybody who provides that service is going to be busier than they were before,\u00e2\u20ac\u009d she said. \u00e2\u20ac\u0153With more and more people having a payer source, they\u00e2\u20ac\u2122re going to come seeking medical services more frequently, and so the private practices aren\u00e2\u20ac\u2122t going to have enough capacity to serve everybody who needs to be served anyway.\u00e2\u20ac\u009d <\/p>\n<p>In addition, safety-net providers like health departments serve a certain niche of patients, Bridger said, like those who might be late to appointments because they have to use public transportation or those who have mental as well as physical issues they need served. <\/p>\n<p>\u00e2\u20ac\u0153They really need a lot more time and attention than can happen in a private setting,\u00e2\u20ac\u009d she said. <\/p>\n<p><strong>The Medicaid question<\/strong><\/p>\n<p>Exactly how many uninsured health department patients will gain coverage under the PPACA is somewhat unclear, with the federal penalties for states opting out of the act\u00e2\u20ac\u2122s expansion of Medicaid \u00e2\u20ac\u201c the joint state-federal insurance program for low-income Americans \u00e2\u20ac\u201c struck down in the Supreme Court decision. <\/p>\n<p>North Carolina lawmakers have not yet indicated whether or not the state will participate in the act\u00e2\u20ac\u2122s Medicaid expansion provision, which would expand Medicaid eligibility to include anyone making less than 133 percent of the federal poverty level. For safety-net providers like the Orange County Health Department, that decision will seriously affect their budgets. <\/p>\n<p>\u00e2\u20ac\u0153We are of course very interested in what is going to happen with that decision,\u00e2\u20ac\u009d Bridger said. \u00e2\u20ac\u0153There\u00e2\u20ac\u2122s really nothing we can do other than just keep watching. The interesting thing about health care for the last 10 to 15 years is that if you\u00e2\u20ac\u2122re not changing, you\u00e2\u20ac\u2122re not doing it right, so being able to turn on a dime is less of a big deal for us now than it was 10 years ago.\u00e2\u20ac\u009d <\/p>\n<p>At this point, Bridger said the department will simply proceed with the assumption that Medicaid funding won\u00e2\u20ac\u2122t be lower than current levels. <\/p>\n<p>\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s always easier to operate from that assumption,\u00e2\u20ac\u009d she said. <\/p>\n<p>Should North Carolina choose to participate in the Medicaid expansion, that could free up some much-needed dollars for the health department, according to Corey Davis, a member of the Orange County Board of Health and a public health attorney with the National Health Law Program. <\/p>\n<p>\u00e2\u20ac\u0153Every dollar that safety-net hospitals, that community health centers, that health departments aren\u00e2\u20ac\u2122t paying for care out of their budgets, things that they\u00e2\u20ac\u2122re already providing out of state dollars, out of local dollars \u00e2\u20ac\u00a6 that frees up funds for other things,\u00e2\u20ac\u009d he said.<\/p>\n<p>\u00e2\u20ac\u0153The more federal dollars that come into public health departments for medical activities mean that we are likely to be able to provide more and more-comprehensive medical activities,\u00e2\u20ac\u009d Davis continued. \u00e2\u20ac\u0153That means looking at things like community gardens, like walking paths. It could mean stepped-up surveillance activities \u00e2\u20ac\u00a6 to more quickly recognize and address things like a whooping cough outbreak.\u00e2\u20ac\u009d  <\/p>\n<p>In addition, Davis said the Medicaid expansion could enable the health department to spend more dollars taking on community-wide issues like obesity.<\/p>\n<p>\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s exactly the kind of problem that is difficult to solve without a commitment at the county or state level. It\u00e2\u20ac\u2122s exactly the kind of thing that health departments should be doing,\u00e2\u20ac\u009d he said.<\/p>\n<p>However, especially during tight budget years, health department dollars are stretched and \u00e2\u20ac\u0153there is no extra money,\u00e2\u20ac\u009d Davis said, and \u00e2\u20ac\u0153if we have that $1,000 and we have kids with whooping cough, we\u00e2\u20ac\u2122re going to treat the kids with whooping cough.\u00e2\u20ac\u009d <\/p>\n<p>Regardless of the Medicaid expansion, Bridger said she does worry that some politicians want to overturn the entire bill. <\/p>\n<p>\u00e2\u20ac\u0153That is certainly on our minds,\u00e2\u20ac\u009d she said, \u00e2\u20ac\u0153and it would be unfortunate for access to care.\u00e2\u20ac\u009d <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Officials say certain provisions of the Patient Protection and Affordable Care Act can enhance the quality of life for all people in Orange County.<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-27478","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/27478","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=27478"}],"version-history":[{"count":1,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/27478\/revisions"}],"predecessor-version":[{"id":27479,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/27478\/revisions\/27479"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=27478"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=27478"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=27478"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}