The Work Experiences of Community Health Professionals: Implications for the Continued Rollout of the Affordable Care Act.

OBJECTIVE State health reform (Patient Protection and Affordable Care Act [ACA]) policies may impact the work experiences of community health professionals. We examine the extent to which community health professional work experiences differ depending on state Medicaid expansion and health insurance exchange policies. DESIGN Public Health Workforce Interests and Needs Survey (PH WINS) (2014) responses from public health nurses, community health workers, health educators, and other public health professionals were merged with state ACA Medicaid expansion and health insurance exchange operations data. We used multivariate regression to examine the extent to which community health professionals in states without Medicaid expansion, or expansion states without a state-run health insurance exchange, reported lower-quality work experiences and less leadership support than did community health professionals working in Medicaid expansion states with state-run health insurance exchanges, controlling for worker characteristics. SETTING Local and state health departments (SHD) in 37 states. PARTICIPANTS 10,246 state health department and 6450 local health department (LHD) workers. MAIN OUTCOMES Work satisfaction (job, organization, pay, and job security), quality of work experiences, leadership support, and impact of the ACA on work. RESULTS In adjusted analyses, LHD community health professionals in states without Medicaid expansion reported worse experiences of leadership support (β = -9.83; P < .05). LHD community health professionals in Medicaid expansion states without state-run health insurance exchange operations reported lower-quality work experiences (β = -13.06; P < .01), less leadership support (β = -11.52; P < .001), and perceived greater impacts of the ACA on their work (β = 9.18; P < .001) than did LHD community health professionals in expansion states with state-run health insurance exchanges. CONCLUSIONS Less state control over health insurance exchange operations or state inaction with respect to Medicaid expansion may negatively impact LHD community health professional work experiences and perceptions of leadership support.