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Implementing the Affordable Care Act: A Historic Opportunity for Public Administrators

By Kathleen Sebelius, Secretary of U.S. Department of Health and Human Services

ACAHealth care is one of the thorniest public policy issues of our day – and one that has challenged public administrators since long before the first issue of Public Administration Review was published 73 years ago.  In fact, when President Barack Obama signed the Patient Protection and Affordable Care Act into law in March 2010, it was the kind of health care reform 100 years in the making.

The health care law confronts a problem that many of you see every day: millions of Americans effectively locked out of the private health insurance market. Years of rising costs have led many to give up on trying to find affordable, quality health coverage. Without the security of coverage, many Americans have been unable to stay healthy, provide for their family, or grow their small businesses. And we have all paid a price in the form of stretched public assistance and the burden of uncompensated care.

But after receiving my own master’s degree in public administration in 1980, I could hardly have anticipated the historic moment the country – and public administrators – face today to improve the health and well-being of millions of Americans because of the Affordable Care Act.

For the 85 percent of Americans who already have health coverage, the law is making it stronger, thanks to new benefits and protections. Children can no longer be denied coverage because of a pre-existing condition, like diabetes, asthma, or cancer. Millions of Americans with insurance can now get vital preventive services, such as flu shots, cholesterol checks, and cancer screenings, at no out-of-pocket cost.  More than 6.6 million people on Medicare with high prescription drug costs have saved an average of more than $1,000 on their medications since the health care law was enacted. And 3.1 million young adults have been able to remain on their parents’ plans up to age 26.

A critical piece of the puzzle is providing better options for the 15 percent of Americans who lack coverage or who buy their own insurance and are looking for a better deal. Because of the health care law, new coverage options are right around the corner.

In just a few weeks, there will be a whole new way to shop for affordable, quality coverage through the new Health Insurance Marketplace. The marketplace will be open for enrollment in every state starting on October 1, for coverage beginning January 1, 2014. Uninsured Americans, small business owners, and those who need better options will be able to easily compare plans and choose the coverage that best meets their needs.

All plans in a marketplace must cover an essential set of benefits, including hospital visits, prescription drugs, and mental health services. Discrimination based on gender or pre-existing conditions, such as diabetes or cancer, will be outlawed. Many individuals, families, and small business owners will qualify for a break on their monthly premiums.

The Health Insurance Marketplace will be accessible online at HealthCare.gov (in Spanish at CuidadoDeSauld.gov), which was put together with families and small businesses in mind. It is easy to use. There is a live Web chat tool, and it is where people can go right now to get information, checklists, and other materials that will help them prepare for October 1. We have also launched a 24/7 customer call center to assist people in more than 150 languages. HealthCare.gov will also help people find out whether they will be eligible for Medicaid coverage in their state.

The health care law provides states an unprecedented opportunity to expand their Medicaid programs to cover uninsured adults with incomes at or below 133 percent of the federal poverty level. That is up to $15,000 a year for an individual and $31,000 for a family of four. And the best part from the states’ perspective is that the federal government will pick up 100 percent of the bill for the first three years – and at least 90 percent of the bill from then on.  As a former governor, I know this is a deal that cannot be beat.


But we know that just making health care coverage available is not enough. We also need to make sure people know about the new options and sign up for coverage. When it comes to the health of our communities, real change happens at the local level when we all work together.

That is why we announced an initiative with America’s libraries and awarded grants to nearly 1,200 community health centers to help connect millions of people with affordable health coverage. And businesses and insurers have partnered up on education campaigns to inform their customers. The more people we can reach and enroll, the better the health outcomes will be for our cities, our counties, and our country.

As city and county managers, state program administrators, policy leaders and analysts, and other public administrators, you can play an important part in outreach and education efforts by helping to mobilize your communities. Visit HealthCare.gov and sign up for updates and share them with your family, friends, and the people you serve. Conversations about affordable private health insurance and expanded Medicaid coverage are too important for your voices not to be heard.

For 73 years, PAR has examined the challenges and opportunities facing our nation’s public administrators. It has provided a public forum on the laws and demographic shifts that have long put public administrators on the frontlines of our nation’s public policy.

You are once again at the forefront of this critical work. Together, we can meet this historic moment to help millions of Americans enjoy the security of affordable, quality health coverage they need and deserve – to the benefit of us all.


Note: This Perspective will appear in Public Administration Review’s special issue on health care reform in September 2013. It is currently available online at http://onlinelibrary.wiley.com/doi/10.1111/puar.12120/abstract

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The American Society for Public Administration is the largest and most prominent professional association for public administration. It is dedicated to advancing the art, science, teaching and practice of public and non-profit administration.

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