Now that the Affordable Care Act (ACA) has finally been fully implemented, millions of Americans will now have access to health care coverage and to health care services. As a country, we are now able to begin the transformation from a “sick care” system into one that centers on prevention and health promotion. People that were once denied coverage, those who did not have employee health benefits, or those who were too financially insecure to afford premiums are now able to seek care, and the medical and public health workforces must adapt to accommodate these increasing numbers by increasing their own. As of today, despite the growing national awareness of the importance of the public health system in sustaining a healthy population, the public health workforce is being crippled by substantial decreases in funding, reductions of resources and staff, inadequate training, and an inequitable distribution of health care practitioners in areas of the greatest need. According to the American Public Health Association (APHA), 44,000 governmental public health jobs at the state and local level were lost between 2008 and 2010. Numbers compiled by the National Association of County and City Health Officials (NACCHO) show that 41 percent of local health departments (LHD) experienced some level of reduction in workforce capacity. The NACCHO reports that all LHDs are experiencing a 13 percent diminished capacity in staff operations, with reductions in hours worked and mandated furloughs. Because of these budget cuts and workforce shortages, agencies must now do more with less. This not only puts a strain on agencies; it also detracts from worker recruitment and retention. Given the estimate provided by the Association of Schools of Public Health (ASPH), we are expecting a workforce shortage of 250,000 workers by 2020.
The ACA allocates new funding for the public health system, mainly through Title IV’s Prevention and Public Health Fund (sections 4002, 10401), which supports public health activities, new prevention and public health programs, and invests in public health infrastructure. The ACA also included a set of provisions that were designed to “enhance” the training of the health care and public health workforces. The Public Health Workforce Loan Repayment Program (Section 5204), which is funded by the Department of Health and Human Services, provides up to $35,000 in loan repayment to public health and allied health professionals who agree to work for at least three years at a federal, state, local or tribal public health agency or fellowship following their graduation. Our policy proposal is twofold: first, we are proposing that loan repayments be made available to individuals who graduated from accredited schools of public health within the last five years (to compensate for time since the initial inception of the ACA provisions and its implementation) and are currently working for federal, state, local...