Local health departments will be affected

At the center of much of the implementation effort will be the local health departments, which often are responsible for providing services to many uninsured that the bill targets for new coverage. In addition, health departments will be involved in one of the primary initiatives of the new law, the expansion of community health centers.

Pestronk says that the bill could substantially improve how health departments operate. "It devotes resources toward the health of the people," he says. "It addresses unsustainable costs, erratic quality and unequal access to medical care. We can assume a strong focus on the prevention of bad outcomes, not as much on fixing people once broken."

One aspect of the legislation that particularly pleases Pestronk is its focus on the development of the public health system, through funding for training and education, loan repayment programs and placement programs. "People think of public health as only the doctors, nurses and dentists," he says. "But there's a broader range of skills, like epidemiologists, health information systems and lab specialists, who are invisible. This will help develop the next generation of health care workers."

Pestronk looks forward to the new funding for community health centers, which he says will expand access to areas that are currently not served. "There aren't enough centers in places where they are needed," he says. "There's a need for additional ones to provide care where regular physicians are not available to provide services."

In general, Pestronk and other local government professionals support the changes in the health care system, even if the program remains controversial in the political realm. While the law provoked a national debate from start to finish, the professionals view the legislation as an opportunity to forge a path to better health care for a system that was badly in need of reform. "It's a very positive step in the U.S.," Pestronk says. "It shows that we can design a community health system that makes it likely that good health will be the result. It's the virtue of designing a system where preventive health is the default. Good health is not just good for the person themselves; it's good for the whole country."

Despite the improvements, Pestronk believes even more can be done. "No piece of legislation is perfect the first time around," he says. "It will help to discover what works best and what misses. We'll bring that to the policy makers."

Beddoe adds that the health care reform legislation remains a work in progress. "If history is a guide, there will be changes," he says. "Medicare, Social Security were updated and tweaked and reformed over the years. I'm not expecting anything less in this process."

Robert Barkin is a Bethesda, Md.-based freelance writer.

• Read the "Key provisions in the healthcare bill for cities and counties" sidebar to learn about some implications.