Key provisions in the healthcare bill for cities and counties

The massive legislative overhaul has implications for large sections of the economy, and the public sector is no exception. Here are some key provisions that affect local governments:

• Expanded coverage — County hospitals often care for people who do not have health insurance. Extending coverage to 31 million more Americans is expected to reduce the cost to counties.
• Community Health Centers — Additional funding for outpatient clinics, especially important in rural areas, is considered by public health officials as one of the bill's most significant achievements.
• Cost control — Local government is one of the nation's largest employers, and the excise tax on costly plans will force a change in coverage, but not until 2018.
• Pooling coverage — Cities are still able to pool their coverage, so that many smaller cities and towns can share risk and reduce costs.
• Preventive health — Public health officials are pleased that a new emphasis on preventive care is matched with additional funding.
• Cost-shifting — Local governments, which often are tasked with implementing health care, have protection against the temptation of state governments to push health costs to them.
• Medicaid for prisoners — County governments made some progress on Medicaid coverage for prisoners in county facilities who have not yet been convicted, but continue to push for full coverage.
• Funding for hospitals — Big-city hospitals are concerned about payments for their facilities that treat a disproportionate share of Medicaid patients.