The Affordable Care Act (AKA
“National Health Reform”) &
Tuberculosis Control: Atlanta,
GA
October 7,2010
MDH TB Advisory Committee
October 14, 2010
Deb Sodt
Goal of Meeting
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“to plan for optimal TB control at the state and
federal levels under a changing health
environment in the Affordable Care Act
(ACA).”
Approximately 40 Attendees
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CDC
George Washington University Health Policy Department
10 State TB Control programs
2 Local TB Control programs
National TB Controllers Association
Regional TB Training and Medical Consultation Centers
Stop TB-USA
American Thoracic Society/American Lung Association
Infectious Diseases Society of America, PH Committee
Emory University
U.S. Preventive Services
Task Force (USPSTF)
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Evaluates clinical research in order to assess the
merits of preventive measures such as screening tests,
counseling, immunizations, preventive medications
Recommendations: A, B, C, D, and “Insufficient”
Under ACA, health plans must cover preventive
services with “A” or “B” ratings
Currently, TB screening recommendation defers to
CDC recommendations
USPSTF is under the U.S. Public Health Service
Health Care Reform and TB Control
in Massachusetts
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Positive effects
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Improved (financial) access to care, especially for
low income adults
Provides added reimbursement to local TB control
programs/clinics
Incentives to connect community health centers
(primary care) with TB specialty services
But….the remaining uninsured
are mostly:
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Young, single males
Racial and ethnic minorities and non-citizens
Undocumented
English not the primary language
Lower education level
Less employed
Lower income
Live in urban areas
Access to health insurance
≠
Access to health care
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People enroll but then drop out due to cost
Patients frequently change health plans,
looking for cheaper rates
Increased co-pays
No more state “free care pool” funds
Long wait times for appointments w/PCP
52% of 2009 TB cases were seen in emergency
or urgent care departments during their course
of treatment
Possible Strategies Discussed
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Participate with other interested partners in the discussions
about what is included in “prevention and wellness services
and chronic disease management in the “essential benefits
package” “
Pursue an A/B recommendation from USPSTF for TB
preventive services (e.g., screening and treatment of LTBI) CDC has submitted a nomination
Promote TB patients’ enrollment in Medicaid or other
insurance options
Get public health clinics included in networks of specialty care
providers who can bill under ACA
Apply for federally-funded pilots and grant funding