Better known simply as "health care reform," the Patient Protection and Affordable Care Act (ACA), became law in March 2010 and it affects almost everyone. Parts of the ACA start at different times between now and January 2014. Did you know that some new consumer protections are already in place? For example:

* Your insurance cannot be canceled unless you lie to your insurance company or commit fraud.

* If you have health problems and can't get insurance, you may now buy it from the new pre-existing condition insurance plan. See www.pcip.gov and choose your state.

* Children cannot be denied insurance because they have a health problem.

* Your insurance cannot have lifetime limits for essential health benefits - the basic services everyone needs. Essential health benefits include emergency services, maternal care, prescription drugs, and preventive services.

The Health Foundation of Greater Cincinnati is an independent nonprofit organization dedicated to improving community health through grants, evaluation, and education. The Foundation works in Cincinnati and 20 surrounding counties in Indiana, Kentucky, and Ohio. You can ask us questions about the ACA and find copies of our materials at: http://reform.healthfoundation.org.

Healthcare reform is truly exciting for mental health. Finally, mental health is recognized as a health condition and is to be included in basic healthcare benefit packages.

Now that mental health is on the inside, what happens next? What healthcare reform means for mental health can be very difficult to decipher. I have found a couple of sources for excellent information - information about mental health and healthcare reform that is explained clearly and simply:

• The College for Behavioral Health Leadership offers free monthly webinars over the next year. The webinars are archived in case you miss one.
• The National Council of Community Behavioral Healthcare sponsors a regular blog on mental health and healthcare reform. The previous blogs are archived in case you want to go back and look at blogs you may have missed.

Let me know if you find other helpful sources of information about mental health and healthcare reform.

This week has been a real test of the Health Foundation's belief in sharing openly all of the public opinion polling data collected by our Health Issues Polls . I have received many calls from people on both sides of the issue, but especially calls from the smoking and liquor lobby thanking me for my groundbreaking work. They are also asking for more specifics about our poll that shows that Ohioans want the smoking ban in bars lifted.

First, let me set the record straight: our data show that Ohioans are split on support for the ban on smoking in bars. There is no great call to arms to repeal the ban based on our findings: 51% said they want to repeal the ban, 47% said they wanted to keep it in place. But the calls I've gotten from the public give me serious pause: How can I, a staff member of The Health Foundation of Greater Cincinnati, an organization that has given over $14 million in grants to reduce alcohol, tobacco, and other drug use in our region, be providing data to groups who want to encourage increased consumption of cigarettes?

My answer is transparency and reliability. The Health Foundation believes that we must provide high-quality, reliable, local public opinion data so people can make data-driven decisions. We know we cannot control public opinion, but understanding what people think is critical to the work that we do.

In order for the Health Foundation to be a legitimate source of high-quality, reliable data, we cannot just release the data we like best. This means that when we ask tough public opinion questions, we are not always going to get the answers that we hope for. But it is our responsibility to provide the data to the community.

One very important distinction that was not made in the media is the difference between public opinion data and research data. We used good polling techniques to obtain the opinions regarding smoking in bars, but that doesn't change the research data that shows that first- and second-hand smoke cause cancer of the lungs, mouth, throat, and other cancers in people who smoke in a bar (or anywhere for that matter) and, because of the prolonged exposure, people who work in bars. The poll data show that the public is divided on whether or not people should be permitted to smoke in bars. The research data show clearly that smoking causes cancer, emphysema, and many other unpleasant or fatal illnesses.

Unfortunately, while the media chose to spin the spilt on support for the smoking ban in bars into a cry for repeal of the law they have missed other stories that I think are much more interesting:

• The majority of smokers support continued ban on smoking in restaurants and workplaces
• A third of Kentuckians are uninsured
• Most Ohioans and Kentuckians support mental health and substance abuse treatment over incarceration for non-violent offenders
• Most of Ohioans and Kentuckians support healthcare reform

Now that healthcare reform has been signed into law, its provisions will phase-in over four years. The law creates a number of amazing opportunities. As a healthcare access grantmaker and supporter of high-quality patient care programs in our community, we believe that some of the provisions can help improve access for many previously uninsured people and sustain many struggling programs that provide care for the uninsured. Healthcare reform also treats mental illnesses and substance use disorders the same as other illnesses.

We recently abstracted some key provisions affecting consumers and providers from some Kaiser reports. Our document is on our healthcare reform web site at: http://reform.healthfoundation.org/happening/What%20Changes%20as%20a%20Result%20of%20Healthcare%20Reform.pdf. There is also a 13-page summary with more technical details available at: http://www.kff.org/healthreform/upload/8061.pdf.

One of the things I noticed is how many quality of care and cost containment components are included in the law. There is a partial list on page 5 of the Health Foundation's document. Several things are interesting about this:

• The programs provide for a lot of experimentation that could unfreeze our healthcare system, and which are likely to generate better services and lower costs. Examples include: several programs that help keep people out of institutions and in their own homes; bundled payment demonstrations; and sharing of cost savings with accountable care organizations that maintain quality.

• Quality and cost are linked. A number of efforts are targeted to find the sweet spots between quality and cost. High quality and low cost is the ideal, but in the real world, we are too often closer to low quality and high cost. Examples of what may generate higher quality at lower cost include: establishing a Patient-Centered Outcomes Research Institute; creating a national health quality improvement strategy; establishing an Innovation Center to study payment reforms that maintain or improve quality; and improving patient outcomes reporting.

• There is more funding of and payment for, evidence-based wellness

• Better care coordination is a goal affecting both quality and cost, with provisions to coordinate care between CHIP, Medicare and Medicaid, and to establish a Community–Based Collaborative Care Network.

• States will be given permission in Medicaid to develop medical homes for patients with chronic conditions, certain risks, or serious and persistent mental illness.

My question for you is: How might the Health Foundation best help its grantees and communities to prepare for a lot of change in four years, and to seize some of these interesting opportunities?

According to a recent New York Times article, patients are asking their healthcare providers questions about the healthcare reform laws, not just about their personal health. The healthcare providers don't always know how to answer.

It's not surprising. At over 1,200 pages each, the healthcare reform laws are not a light read. They are written in legalese, not plain English. Certain provisions don't take effect for months or even years. It's hard to keep it all straight.

That's what we're trying to help with at our healthcare reform site. While the bills were going through Congress, we followed the conversations and provided summaries and updates. We answered questions people were asking. We waded through all the information--and misinformation--and presented the facts of reform and how it would affect our region.

Now that the bills are law, we're starting to do the same thing. We've posted a summary of the laws and when the changes take effect . In the coming weeks and months, we'll include more summaries and analysis, as well as links to other sources of information.

So what do you want to know about the laws? What questions do you have or are you getting? How can we help you explain healthcare reform to your clients and patients?

Last week I was in Erie, Pennsylvania, presenting at a community forum. One of the speakers reminisced about his youth and how his family doctor practiced in a house in the neighborhood. That doctor was an integral part of the community and the speaker's childhood. In most places, that type of access to a family physician no longer exists. However, 2,000 communities across the nation have access to another provider that also plays an integral part in a community and in the lives of children and families: the school-based health center (SBHC). SBHCs are as local- and community-driven as healthcare can get these days. The school community--school staff, parents, students, supporters, and neighborhood representatives--helps define the SBHC and the services it will provide. One of the identified concerns about healthcare reform is the limited access to primary care services. At this point, it is estimated that once everyone has health insurance and begins seeking regular, on-going primary care services, these services will be hard to get because there won't be enough providers. This is where the SBHCs can play a role. SBHCs are mostly located in communities that have high numbers of uninsured adults, in addition to high numbers of children with Medicaid or no insurance. Structuring the SBHCs to be open to the community--and not just school children--will allow more access points in communities where they will be needed the most. One of the hidden gems in the healthcare reform bill is support for expanding SBHCs. The bill makes $200 million beginning this year available to provide capital improvements, equipment, and other supports for SBHCs. Those funds could be used to remodel existing facilities to make them available to the community while keeping the kids safe and sound in the school building. Doesn't that seem like a great way to bring the local doc back into the community and create an important relationship and childhood memory for today's children?

I have always known that I learn more from having conversations with people than I do from reading a text book or a newspaper. This came home to me this past week at a meeting of people who like me are interested in health grantmaking.

On Thursday night of the Grantmaker's in Health Issue Dialogue, we were privileged to hear a panel of health policy analysts talk about the political debate on healthcare reform. It was interesting to hear the different points of view on various aspects of reform from people who knew what they were talking about and who treated each other with respect. I came away from hearing the panel discussion with a sense that no one has all the right answers in this debate. The two most divergent views were those of Jonathan Cohn of The New Republic and Michael Cannon of The Cato Institute. To get a sense of the thinking of these two men, you might look at these two articles: The House Bill is a Great Idea and Yes, Mr. President: A Free Market Can Fix Health Care.

The discussion made me think and made me wonder what others think. Can we get relief from rising healthcare costs and provide security for people related to healthcare while still protecting the rights of individuals to make decisions on their own?

I have learned more about the "sausage making" that goes on in making laws during this healthcare reform debate than in any previous political debate that I have observed. I don't like all that I am learning about the process of lawmaking but I believe we have a chance at "better sausage" because we are watching the process and having discussions. It saddens me that our lawmakers do not seem to be listening to each other or to us, their constituents. What do you think? Are we going in the right direction? Can we stand up for the less fortunate and protect individual rights? Can we have quality, affordable healthcare for all?

Apparently, a public insurance option is very scary to our political representatives, but you know what? Public opinion polls in Ohio and across the nation continue to show strong public support for an affordable public health insurance plan.

The Health Foundation just finished a special Ohio Health Issues Poll focused exclusively on healthcare reform. I think the opinions of Ohioans would surprise anyone watching the news or reading newspapers lately: 69% of Ohio adults said that the option of an affordable public health insurance plan that any American can opt into would improve our current healthcare system. Not surprisingly, 88% of Ohio Democrats support the public option, but 40% of Ohio Republicans also think that the public option would improve the current healthcare system.

Similarly reputable national polls show that the majority of Americans also support the public option, support in September ranged from 73% support from the NBC/Wall Street Journal poll http://online.wsj.com/public/resources/documents/WSJ-NBC_Poll090922.pdf to 57% from the Kaiser Health Tracking Poll http://www.kff.org/kaiserpolls/upload/7988.pdf. With this level of support, it is unclear to me why the public option hit the cutting room floor so quickly in the Senate. The public option has been presented as something very polarizing, but the Health Foundation and other public opinion polls seem to suggest otherwise.

You might also be surprised what Ohioans think about other healthcare reform issues. You can learn more at http://www.healthfoundation.org/ohip.html or take a look at the Health Foundation's healthcare reform site at http://www.healthfoundation.org/reform. This is a nonpartisan source for information on the current debate in Washington and how it could affect our region.

So if you're going for scary this Halloween in Ohio, you'll have to cross the public option off your list. Ohioans support it, as do many people across the country.