The Journal of Extension -

August 2015 // Volume 53 // Number 4 // Tools of the Trade // v53-4tt1

Issues in Health Reform: Using a Blog to Inform Professionals and the Public

This article describes a blog designed to be a source of unbiased information about the ACA for the general public and as a tool for Extension educators to help them understand the intricacies of the ACA so that they could be more conversant about ACA's opportunities and challenges in their communities. Some current blog posts, including the recent Supreme Court decision, Medicaid Expansions decisions, and a reflection on the first 5 years of the ACA, are noted to showcase how the blog is being used to inform about ongoing policy issues.

Roberta Riportella
Kansas Health Professor of Community Health
School of Family Studies and Human Services
College of Human Ecology
Kansas State Research and Extension
Kansas State University
Manhattan, KS 66506
Professor Emerita
University of Wisconsin-Madison

Isn't the ACA Only about Insurance?

In a social ecological context, the health of the public is related to 1) individual lifestyle choices (mixed with genetic dispositions); 2) opportunities communities make available to their residents to make healthy choices, including all of the social determinants of health such as affordable quality food and housing, stable well paying jobs, etc.; and 3) access to quality and affordable health care. Even as it concerns access to affordable health care as a primary focus, the Affordable Care Act (ACA) affects many of those domains. It includes provisions to improve health at the individual and at the community level.

The ACA has 10 sections, and only Title 1 details "Quality and Affordable Health Care for All Americans." There are sections about the health care workforce, innovative medical therapies, revenue provisions, and public health roles and responsibilities. While most Americans understand that all health insurance plans must now cover preventive services free at the point of service, it is less well understood that the ACA offered outreach grant dollars for communities to create healthy environments—prevention, from a community perspective. Safety net providers were given additional funds to expand their health care services and to recruit and retain additional health care providers. That is, a major retooling of the health care delivery system is underway.

Why a Blog on ACA for Extension?

Thus the ACA will continue to have a major impact on the lives of those Extension educators work with and for in rural and urban communities, in farms and in factories, in schools and at home. As the ACA rolled out, it became apparent that consumers and professionals needed accurate, factual information, trying to sort the wheat from the chaff, especially against the backdrop of strong opposition that has oft times confused and presented barriers to people being in compliance with the law. My blog was designed to be both a source of unbiased information about the ACA for the general public and as a tool for Extension educators to help them understand the intricacies of the ACA so that they could be more conversant about ACA's opportunities and challenges in their communities. An early blog covered Extension's potential roles in helping communities adapt to the ACA (May 2013), noting Braun's (2012) commentary on the topic, as well as directing folks to a webinar on the same topic (Covering Kids and Families, 2012).

This article describes that blog with the expectations that more educators will avail themselves of its content, feel knowledgeable as they engage in ACA community conversations, and assist its author in determining future topics.

The Issues in Health Reform Blog

The blog, Issues in Health Reform, resides at:, each posting categorized by topic. The range of topics has been broad, covering ACA's insurance elements (individual and employer mandates, enrollment in the markets, tax subsidies, the small business tax credit options) and issues for special need populations: immigrants and the continuing uninsured.

As access to affordable care is likely a topic of concern in all U.S. communities, how states are making this a reality for their residents is likely an important topic of local conversation. I try to keep current, but, as policy and its implications are moving targets, sometimes this works better than others. As this article was being written, the King v Burwell Supreme Court of the United States (SCOTUS) decision was handed down in favor of allowing all who are receiving tax subsidies to continue to do so. The blog had dealt with this topic several times when: the SCOTUS agreed to hear the case (July 2014); the arguments were being heard (Feb 2015); the decision was pending (June 16, 2015); and it was handed down (June 29, 2015).

Another SCOTUS decision, this one about state's discretion to expand or not their Medicaid programs, has been a frequent topic on the blog (several summer 2013 blogs, the July one talks of this in a national context). That decision left many people in the "gap," ineligible to receive tax subsidies and too poor to purchase insurance on their own. The March 2015 blog details the implications when states have not yet participated in the Medicaid Expansion. It was specific to Kansas, though the issues noted are relevant as well for the other 20 states that have not yet expanded their Medicaid programs either. (See which states have or have not expanded at Families USA, 2015.) There is no time limit on when a state may expand its Medicaid program to include all with incomes below 138% of the FPL ($16,242 for an individual, 2015), though there is a change overtime in how much federal financial support the state can obtain. Therefore those discussions may happen at anytime in the future, and Extension faculty may be called upon to facilitate these as public issues educational moments. Information presented in the blog may assist in those discussions.

While the blog mostly covers issues related to the ACA, it does also cover broader issues affecting our communities and the health of their residents. For instance, the May 2013 blog was on using data to help communities plan, and there has also been a blog on the role of Critical Access hospitals (Oct 2013). It also has covered broader issues about how the health care insurance market might change because of mandates (Aug 2013).

Most blog posts are a synthesis of published works, news articles, included embedded links to the original reports, with some interpretation of the significance of the specific issue. For instance, a recent blog (March 2015) summarized the Affordable Care Act's (ACA) first five years.


Many times these blogs have also served as the basis for press releases in my home state. I encourage your use of this blog for similar or other purposes within your own states and welcome input on topic areas of national interest. I also welcome a diversity of opinion that may expand the blog's reach and usefulness.


Braun, B. (2012). Responding to health care reform: Mobilizing Extension. Journal of Extension [On-line], 50(5) Article 5COM1. Available at:

Covering Kids and Families (2012). The election is over: What's next for Health Care Reform?" Webinar. Retrieved from:

Families USA. (2015). A 50-state look at Medicaid expansion. Retrieved from:

Kaiser Family Foundation. (2015a). New Kaiser survey finds eleven million newly insured adults. Retrieved from:

Kaiser Family Foundation. (2015b). Premium changes in the Affordable Care Act's Health Insurance Marketplaces, 2014-2015, JAMA, 313(6):557. Doi:10.1001/jama.2015.121 Retrieved from: