To protect and serve

Friday afternoon's session on Protecting Impacted Public Health Programs at APHA’s 2011 Midyear Meeting was both encouraging and frustrating...which is not surprising. In the field of public health, those two words probably go together just as well as peanut butter and jelly.

When it comes to vaccines, Alexandra Stewart, assistant research professor at the George Washington University School of Public Health and Health Services, said the health reform law could go far in promoting vaccination. For example, health insurance plans offered via the new state health insurance exchanges will be required to cover — with no cost sharing — all vaccines recommended by the national Advisory Committee on Immunization Practices. Also, states that decide to offer such recommended vaccines via their Medicaid programs will be eligible for a boost in federal Medicaid matching funds, Stewart said.

The health reform-related vaccine provisions could help fill woeful (and frankly, short-sighted) state funding gaps. For instance, Stewart noted, Alaska has eliminated funds for adult vaccines; California cut $18 million from its vaccine program; North Carolina withdrew all funding from its universal childhood vaccine program; and in Indiana, county health departments are prohibited from administering government-purchased vaccines to children who have insurance. But with the promise of health reform far from a sure thing, the gains and successes the U.S. has achieved in vaccination rates could be in trouble.

In the field of HIV/AIDS prevention and care, health reform presents the same kind of nervous hope. The law has the potential to reduce barriers to HIV screening, will expand access to health care and treatments, and eliminate discriminatory insurance practices against people living with HIV, said Christopher Brown, assistant commissioner of the STI/HIV Division with the Chicago Department of Public Health. However, health reform should not be viewed as a replacement for the national Ryan White program, which provides assistance to people with HIV who don't have sufficient insurance or financial resources. Ryan White offers a number of needed services that health reform will not, such as medical transportation, emergency financial assistance and housing, psychosocial support and early intervention services, Brown said. Luckily, Brown said he is "seeing support from the highest level of government" that the Ryan White program isn't going away.

Unfortunately, it's unclear what health reform will do for the "silent epidemic" of sexually transmitted diseases, said Gail Bolan, director of CDC's Division of Sexually Transmitted Disease Prevention. Bolan first gave a little background: the annual cost of STDs in the nation is $17 billion (whoa!) and rates of some STDs are actually on the rise, such as chlamydia and syphilis. The provisions of health reform could boost the work against STD infection via expansion of Medicaid eligibility, new technologies and investments in community health centers, which often serve as primary care providers for populations at particular risk for STDs, Bolan said. But having insurance doesn't always mean access and safety net services will still be needed to reach all those at risk, she noted, adding that in 2008–2009, 69 percent of state and local STD programs experienced funding cuts. Bolan called on public health folks to remain committed to assessing the quality and effectiveness of STD programs going forward, Bolan said.

"We have to be able to answer the 'so what' questions," she told session attendees, as in, if this program goes away, then so what?

What do you think, readers? Are you worried that health reform will threaten the survival of important public health programs? Let us know in the comments section!