ASTHO at 75: Celebrating the Past and Preparing for the Future

Fraser, Michael R.; Hardy, George

The passage of the Affordable Care Act (ACA) in March 2010 created new opportunities for state and territorial health agencies and for ASTHO beyond the ACA's core focus on expanding health insurance coverage to millions of uninsured Americans. The Maternal, Infant, and Early Childhood Home Visiting Program supported the scale and spread of evidencebased home visiting programs in many state and territorial health agencies' maternal and child health programs. New opportunities to prevent chronic diseases, unintentional injury, and other leading causes of morbidity and mortality were established in the nation's first ever source of dedicated funding for prevention: the Prevention and Public Health Fund. ASTHO supports several Prevention and Public Health Fund programs including the Million Hearts Initiative, tobacco use prevention, and initiatives to expand breastfeeding at the state and territorial levels. The ACA also led to new challenges for ASTHO and its members. Questions about the public health agency role as a safety net provider were raised and threatened to lead to funding reductions because state health agency efforts were perceived of as duplicative of services covered by health insurers. While concerns that state immunization, STD/STI prevention and control, breast and cervical cancer screening, infant mortality/ preterm birth prevention, hypertension, and child and youth with special health care needs programs would be eliminated by the ACA have not been realized, there are lingering questions about why public health agencies are funded to provide the delivery of clinical services when the population traditionally served by state and territorial health agencies is now Medicaid eligible or may obtain health insurance coverage through the federal health care exchange.