Tuberculosis Elimination Efforts in the United States in the Era of Insurance Expansion and the Affordable Care Act.
The Patient Protection and Affordable Care Act can enhance ongoing efforts to control tuberculosis (TB) in the United States by bringing millions of currently uninsured Americans into the health-care system. However, much of the legislative and financial framework that provides essential public health services necessary for effective TB control is outside the scope of the law. We identified three key issues that will still need to be addressed after full implementation of the Affordable Care Act: (1) essential TB-related public health functions will still be needed and will remain the responsibility of federal, state, and local health departments; (2) testing and treatment for latent TB infection (LTBI) is not covered explicitly as a recommended preventive service without cost sharing or copayment; and (3) remaining uninsured populations will disproportionately include groups at high risk for TB. To improve and continue TB control efforts, it is important that all populations at risk be tested and treated for LTBI and TB; that testing and treatment services be accessible and affordable; that essential federal, state, and local public health functions be maintained; that private-sector medical/public health linkages for diagnosis and treatment be developed; and that health-care providers be trained in conducting appropriate LTBI and TB clinical care.
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Victor
V
Balaban
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Suzanne M
SM
Marks
Massachusetts Department of Public Health, Jamaica Plain, MA.
Sue C
SC
Etkind
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Dolly J
DJ
Katz
San Francisco General Hospital, San Francisco Department of Public Health, TB Control Section, San Francisco, CA.
Julie
J
Higashi
California Department of Public Health, Center for Infectious Diseases, Division of Communicable Diseases Control, TB Control Branch, Richmond, CA.
Jennifer
J
Flood
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Ann
A
Cronin
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Christine S
CS
Ho
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Awal
A
Khan
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Division of Tuberculosis Elimination, Atlanta, GA.
Terence
T
Chorba
D054242:Emigrants and Immigrants; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy; D017057:Medically Uninsured / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D011634:Public Health; D015980:Public Health Practice; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*; D014481:United States