Year in Review: Renewing our Commitment to Public Health

By Dawn Fukuda May 18, 2014

As I began my tenure as chair of the National Alliance of State and Territorial AIDS Directors (NASTAD) in May 2013, I was full of energy and optimism. January 1st of 2014 was close at hand, and represented a massive new opportunity to invigorate our response to the HIV and viral hepatitis epidemics through the implementation of the Affordable Care Act (ACA).

I was confident based on our experience with state health care reform in my home state of Massachusetts that increased access to medical care through broader insurance coverage would translate into health promotion and disease prevention outcomes that would advance our progress along the HIV Care Continuum. I remain steadfast in my belief that integrating an HIV and viral hepatitis response into primary medical care and reimbursable health services is the way to sustain our efforts into the future; yet the mechanics of the ACA roll out over the past year also provide a striking reminder of the essential and non-transferrable role of public health.

In the context of planning for a radically new health care environment, state health departments began to reassess their roles in the prevention and care response—particularly for those direct care interventions historically administered by public health that were now likely to be covered for individuals under public and private health insurance. In Massachusetts, we examined opportunities to transfer AIDS Drug Assistance Program (ADAP) enrollees newly eligible for Federal subsidies to more affordable health insurance plans; we met with our state Medicaid program to review the extent of coverage for care and prevention services; we partnered with community health centers designated as enrollment assistance sites; and provided training and technical assistance to medical case managers and prevention providers to ensure eligible individuals maximized their coverage opportunities.

As states prepared to confront the implementation challenges of health reform, NASTAD played a critical role in educating HIV and viral hepatitis programs about how to navigate these shifts in the coverage landscape. NASTAD convened a series of regional meetings, with attention to the local fiscal and policy environments, to assist health department staff with transition planning for programs such as ADAP, medical case management, and HIV prevention and testing services in healthcare and non-healthcare settings. These consultations provided an opportunity to become grounded in the complexities of a rapidly evolving system, to share best practices, and to envision solutions to meet emerging challenges at the state and jurisdictional levels.

Yet perhaps the single greatest lesson of the past year has been the explicit recognition that health insurance coverage alone cannot replace the capacities of public health intervention. In fact, we are only just now beginning to test the extent to which those services we have come to define as core to the HIV and viral hepatitis response will be sufficiently reimbursed by third party insurance. Until we can guarantee these components are in place, and that our most vulnerable residents and populations will be adequately served, it is essential to maintain our HIV prevention and care efforts alongside the expanded access to medical care and treatment services made possible by under the ACA. We must continue to partner with health and social service providers, consumers, and community advisory groups to monitor new opportunities and gaps in our evolving health care system, to adapt our prevention and care approaches, and to redesign a system that can see us to the end of the HIV and viral hepatitis epidemics in the nation. I have thoroughly enjoyed embracing the challenge of serving as NASTAD chair during such a historic time in our fight to end HIV and viral hepatitis. Though much work lies ahead of us, I am more confident than ever that NASTAD’s strong leadership in the U.S. and around the world will continue to play a pivotal role in helping us achieve a generation free of AIDS and viral hepatitis.