NACo Deputy Legislative Director of Health Paul Beddoe discusses what public policy leaders should know and do about the Affordable Care Act during a North Carolina Association of County Commissioners seminar held Oct. 15, 2013, in Orange County, N.C.

1. County Commissioners and Managers: What
Public Policy Leaders Should Know & Do
NCACC Affordable Care Act Seminar
Orange County/Chapel Hill
October 15, 2013

2. Presentation Overview
About NACo
The Context – Why health reform? How did we end
up with the ACA?
County policy options under the ACA
Coverage expansion
Medicaid & the Safety Net
Public Health: Disease Prevention & Health Promotion
Jail Health
WWW.NACO.ORG | MAY 2013

3. About NACo
The National Association of Counties (NACo) assists America's counties in
pursuing excellence in public service by advancing sound public policies,
promoting county solutions and innovations, fostering intergovernmental and publicprivate collaboration and providing value-added services to save counties and
taxpayers money
Founded in 1935, NACo provides the elected and appointed leaders from the
nation's 3,069 counties with the knowledge, skills and tools necessary to
provide fiscally-responsible, quality-driven, and results-oriented policies and services
for healthy, vibrant, safe and resilient counties
WWW.NACO.ORG | MAY 2013

4. The Context
Counties: “Where the Rubber Meets the Road”
Unique Role of Counties: Providers, Payers, Purchasers
Highly polarized political debate
WWW.NACO.ORG | MAY 2013

5. The Context
WWW.NACO.ORG | May 2013

6. The Context
WWW.NACO.ORG | May 2013

7. The Context
WWW.NACO.ORG | May 2013

8. The Context
WWW.NACO.ORG | May 2013

9. The Context
WWW.NACO.ORG | May 2013

10. NACo and Health Reform
2008 – NACo President appoints Health System Reform
Working Group
Working Group holds three hearings around the country
Working Group drafts a White Paper proposing NACo
priorities in health reform
The White Paper is debated, amended and approved by
the NACo Health Steering Committee, NACo Board and
NACo Membership
WWW.NACO.ORG | May 2013

11. County Policy Options
Coverage expansion
Individual mandate
Define role for county agencies
Community leadership role
Employer mandate
Set county employee health benefit policy
If continuing to offer coverage, design
benefit to comply with ACA
Consider workplace wellness incentives
WWW.NACO.ORG | May 2013

12. County Policy Options
Medicaid & the Safety Net
Medicaid for all up to 133% FPL – state option
Pass through for counties required to contribute to nonfederal share
$14.1 billion cuts to DSH 2014-2019, cuts extended into
out years
New requirements for NFP hospitals
WWW.NACO.ORG | May 2013

13. County Policy Options
Public Health: Disease Prevention & Health Promotion
Prevention & Public Health Fund: “… to provide for expanded and sustained
national investment in prevention and public health programs to improve health
and help restrain the rate of growth in private and public sector health care
costs”
Source: Sarah Kliff
Workblog.washingtonpost
WWW.NACO.ORG | May 2013

14. County Policy Options
Public Health: Disease Prevention & Health Promotion,
cont’d.
Community Transformation Grants (CTG)
Public Health Workforce
Public Health Improvement Initiative (PHII)
Section 317 Immunization Program
Epidemiology and Lab Capacity (ELC) Grant Program
WWW.NACO.ORG | May 2013

15. County Policy Options
Jail Health
Persons in custody pending disposition of charges retain
eligibility for QHP coverage on the exchanges
Screen inmates for eligibility? Enroll?
Pursue billing for services?
Medicaid? We’re working on it …
WWW.NACO.ORG | May 2013

16. Questions?
Contact Us!
For questions or more information, feel free to contact us
Matthew Chase, NACo Executive Director
mchase@naco.org
Deborah Cox: Legislative Director
dcox@naco.org or 202.942.4286
Arlandis Rush: Justice and Public Safety
arush@naco.org or 202.942.4236
Paul Beddoe: Deputy Legislative Director/Health
pbeddoe@naco.org or 202.942.4234
Arthur Scott : Agriculture and Rural Affairs
ascott@naco.org or 202.942.4230
Michael Belarmino: Finance & Intergovernmental Affairs
mbelarmino@naco.org or 202.942.4254
Ryan Yates: Public Lands
ryates@naco.org or 202.942.4207
Daria Daniel: Community and Economic Development
ddaniel@naco.org or 202.942.4212
Julie Ufner: Environment, Energy & Land Use
jufner@naco.org or 202.942.4269
Bob Fogel: Transportation
bfogel@naco.org or 202.942.4217
Yejin Jang: Telecommunications and Technology
yjang@naco.org or 202.942.4239
NACo was named one of nine remarkable associations in the United States after a four-year study conducted by the American Society of Association
Executives and The Center for Association Leadership because of its commitment to members and purpose