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The New Spring of the ACA

February 17, 2014
by Ron Manderscheid
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What progress is being made? What are our new responsibilities?

The New Year is progressing rapidly toward spring. Simultaneously, the Affordable Care Act (ACA) is gaining significant momentum in several key areas: enrollment in health insurance; integration of care; and application of public health principles. What progress is being made? What are our new responsibilities?

As of the end of January, about 3.3 million persons have enrolled in health insurance through the state Health Insurance Marketplaces and 3.2 million have enrolled in the state Medicaid Expansions. At the same time, more than 3 million young adults under age 26 are continuing their health insurance coverage through family policies. More than one-quarter of the new Marketplace enrollees are under age 35, thus helping to assure necessary balance in the newly covered population. Approximately six weeks remain before the Marketplaces will close; they will not re-open again until mid November. If you or someone you know needs health insurance coverage, please take note that you must enroll before March 31, the date on which the Marketplaces will close. (Enrollment in the Medicaid Expansions will continue throughout the year.)

Dramatic progress is equally evident in county and community efforts to integrate mental health, substance use, and primary care services. Counties and communities now recognize that they will need to provide the organizational framework in which health homes can develop and operate. Where resources are more limited, counties are working with local federally-qualified health centers (FQHCs) and local mental health and substance use providers to implement initial organizational arrangements. Such structures can become the basis for developing more encompassing county or community collaboratives at a later date that also include public health and public welfare initiatives. In support of this work, NACo and NACBHDD are collaborating to promote Accountable Communities, with counties leading these local efforts.

Recognition continues to grow rapidly that public health approaches and programs will be an essential feature of county and community health collaboratives. Included are population-based disease prevention and health promotion programs, as well as county and community efforts to improve the social and physical health determinants that play such an important role in subsequent health status and disease onset for local populations.

On balance, we can (and should) be quite optimistic about the progress being made in ACA implementation. As these developments accelerate, it will be critical for counties, communities, and behavioral health entities to take several actions to keep pace with these developments. These actions include:



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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