Submitted by achenault on Wed, 06/03/2015 – 10:59am
When we hear words like capacity building and infrastructure building, what do they mean? For UHCAN Ohio, it means supporting organizations in communities with high concentrations of people of color, people in poverty and other at-risk populations, to strengthen their ability to serve their communities. This includes creating or strengthening access to resources that provide the outreach, enrollment, and health literacy/consumer activation services needed in their community.
The Reality of Working in Communities of Color: Often, organizations in communities of color lack the financial and personnel resources to add new services, particularly in urban cities where there are higher numbers of people living below the poverty line. Yet often these organizations are the best way to reach those living in communities of color to spread the word about or provide a new service, because they have a track record in the community, have developed trust among community residents, and are the places community members turn to when they need help.
We’ve Made Strides But There’s Still Work To Do: We have completed our second enrollment period for the Affordable Care Act, and 235,000 Ohioans have taken advantage of coverage on the Marketplace. As a result of the Medicaid expansion over 510,000 new Ohioans are have signed up for Medicaid. However, in spite of our efforts to cover the uninsured, African Americans and Hispanics still experience some of the highest uninsured rates. This makes it particularly important that our efforts reach the uninsured from these communities.
This is where capacity and infrastructure come in. If we want these trusted organizations in African-American and Hispanic communities to be part of our outreach and enrollment strategies, we have to build capacity for them to participate. As more of these trusted programs understand new coverage opportunities and participate in outreach and enrollment, we build infrastructure.
What Does This Look Like?
If we are successful, there will be faith and community-based organizations in many of our urban and rural communities that are able to:
· provide regular information on how to get covered;
· provide enrollment assistance; and
· follow up with those they enrolled to make sure they get covered, learn to use their insurance, and get connected to primary care.
How Do We Build Infrastructure?
1. The first step is to identify organizations that are central to the community you want to reach and have an interest in covering the uninsured. For our work, we engaged faith and community-based social service organizations in communities of color.
2. Next, think about how they want to be engaged and what support they will need. For our project, we encouraged organizations to become enrollment sites using Certified Application Counselors who provided outreach, enrollment assistance, follow-up, and now health literacy education.
3. Host information sessions, build relationships, and educate. We invited churches and community organizations working in African-American, Hispanic, Asian, and African communities to community meetings where we educated them on the Marketplace and Medicaid expansion, the role of a Certified Application Counselor (CAC), and how to become an enrollment site. We also provided information on other ways they could participate in outreach and enrollment.
4. Finally, provide supports that build their capacity to participate. We provided financial support, which allowed organizations to give small stipends to CACs and conduct outreach. We also provided training and ongoing technical assistance to the CACs.
The organizations we are working with, their CACs, and those they assist are becoming the infrastructure in their communities who understand coverage under the ACA and can get the word out and help people enroll. This infrastructure can be used in the future to disseminate information on how to use plans, recertify Medicaid coverage, connect to care, and provide other information that will help people retain their coverage and access health care.
This month, the U.S. Supreme Court will announce its decision in King v. Burwell, a case challenging the premium tax credits provided through the Federally Facilitated Marketplace (FFM) to residents of the 34 states that do not operate their own Affordable Care Act Marketplaces. The plaintiffs (challengers) claim that 4 words in the ACA limit subsidies to people purchasing health insurance in an exchange (Marketplace) set up by a state, and that users of the federal marketplace are not entitled to subsidies.
What’s at stake if the Court rules in favor of the plaintiffs? According to the Kaiser Family Foundation, as many as 13.4 million people in 37 states could lose subsidies if the Supreme Court rules against the federal government in King. Of the 235,000 Ohioans receiving health coverage through the federal marketplace, an estimated 80% receive premium tax credits to make the coverage affordable and most will be forced to drop coverage without those tax credits.
According to a new report by the American Academy of Actuaries , a decision against the federal government in King would:
King is a challenge to the heart of the ACA and its outcome will determine the fate of millions of Americans who have been able to get quality, affordable health insurance thanks to premium tax credits.
If the court rules for the challengers, there’s no quick fix. The current Congress is not likely to pass an amendment to the ACA to clarify that subsidies are available to people using the federal Marketplace. Proposals being floated by Republicans in Congress extend subsidies only through the next election. It’s also hard to imagine that states such as Ohio will suddenly decide to establish a state exchange. And setting up an exchange takes a long time.
Does the challenge to the ACA have legal merit? When Congress wrote and passed the ACA, everybody – Republicans, Democrats, and the Congressional Budget Office alike – agreed that the tax credits would be available in all states.
Everyone involved in the health care system, including hospitals, providers, and insurance companies, strongly disagree with the challengers’ position.
Insurance companies and the health care industry have adapted their business models to work with the ACA, and have done so successfully for nearly five years. A diverse array of more than 30 amicus (friend of the court) briefs filed in support of the ACA underscore the depth and breadth of backing for the government’s position, while challengers are primarily backed by conservative ideologues seeking to destroy the law.
The lawsuit is yet another political tactic from opponents of the ACA to dismantle the law. In fact, Republican leaders in Congress have openly admitted that they are counting on the Supreme Court to “take down” the ACA by dealing it a “body blow” that will cause it to “unravel” “pretty darn quickly.”
For now, we’re focused on making sure that consumers understand the facts: right now, and until the decision is announced, absolutely nothing has changed, and consumers who enrolled in health insurance still have health care and financial help from their tax credits. The bottom line is that no matter how much political jockeying continues to happen around the Affordable Care Act, people still need and want access to affordable, quality health care. Now that 11.7 million people have found coverage through the Marketplace, it’s time to move past these divisive arguments to make the law work for all Americans.
Submitted by achenault on Tue, 04/07/2015 – 5:21pm
UHCAN Ohio has been building outreach and enrollment capacity in communities of color by working with churches and community organizations to strengthen their ability to navigate the uninsured from their congregations and communities to coverage. We would like to highlight two of these programs: Horn of Africa Voluntary Youth Committee (HAVOYOCO), in Columbus, and University Settlement, Cleveland. HAVOYOCO primarily serves Africans, including the Somali population. University Settlement serves primarily African Americans and, through its partners, also serves Hispanic populations.
With funding from UHCAN Ohio’s Robert Wood Johnson Foundation Consumer Voices for Coverage grant, these two programs operated multiple enrollment sites and were able to hire and provide stipends to Certified Application Counselors (CACs) from their communities to provide outreach, enrollment, and post-enrollment activities for the communities they serve. The stipends allowed the programs to recruit people who had a passion for working in their own community. “We tried to do this work last year with volunteers. We had some volunteers, but did not have the quality of people who provided regular hours we could count on. We had much more success using stipends. Our CACs’ enrollment hours were more consistent, they conducted regular outreach and enrollment, and they came up with innovative places to conduct outreach and enrollment,” said Belinda Harris, CTSOC Lead Parent Advocate at University Settlement.
HAVOYOCO operated two community sites and funded two African enrollment assistors. University Settlement operated four community sites and funded three African American assistors. During the months of November through January, HAVOYOCO and University Settlement CACs provided face-to-face enrollment assistance to over 300 persons, many of whom spoke English as a second language, and conducted outreach to more than 500. More important than the numbers is the fact that there are now five trained CACs who are providing continuing enrollment assistance, following up with those they assist to make sure they got the coverage they need and understand how to use it, and who are prepared to steer people from their communities to coverage during the current special enrollment period and the next open enrollment period.
If you or someone you know needs coverage, contact us at 614 456-0060 ext. 233 or click here.
Submitted by achenault on Tue, 07/07/2015 – 11:24am
The Affordable Care Act has led to historically low rates of uninsured. Over 750,000 Ohioans have enrolled since it went into effect. However, in Ohio, health care still looks different for people with low to moderate incomes (and especially for people of color) than it does for those with more money to pay for services. This is the first in a series of articles written by UHCAN Ohio’s Health Equity Director, Nita Carter, to help us understand how our current system of health care helps to create disparities in health care that lead to disparities in health outcomes.
As a health care advocate, an African American woman, and a member of the middle class, I want to begin by sharing my own story about my recent trip to my primary care doctor for my free annual exam, to illustrate continuing barriers to health care based on income and race.
In March, I went to the doctor for my annual exam, which included a pap exam and a colonoscopy. When I arrived, my doctor, who I have been seeing for years, starts to talk about what has been going on with me since my last visit and over the year. I talk about the fact that I gained some weight this year and share other things about what I think has changed. She does her exam and orders a number of tests – the usual things, like checking my cholesterol levels and my “sugar” levels (in my community, we say “sugar,” not technical terms like “A1C”). She includes a test to check my thyroid to make sure I am having no thyroid problems, as thyroid problems run in my family and weight gain is an indicator. She also checks my vitamin levels as mine have been low in the past. She gives me a pap exam, and on another day in March I have a colonoscopy – one of the free preventive screenings under the ACA. From these 2 visits, my free colonoscopy, and my free annual exam, I received bills totaling over $500.00.
When I called to ask my provider and the insurance company about these bills, I was told that the test for my thyroid and the Vitamin D were not covered. In addition, the biopsy on the polyp (to rule out cancer) removed during the colonoscopy and some of the tests on the tissue taken during the pap exam were not covered.
Here is where money counts. If I have money none of this is a problem. I might try and appeal, but ultimately, I’m going to pay for the tests if the appeal does not work. Of course I want my thyroid checked, and I want my polyp tested to make sure it is not cancer, and I want to know if there is anything abnormal about my pap exam. But if I have no money for these extra costs, I am most likely only going to do the things that are free, even though the doctors recommends the tests that cost money. And if I am not told these tests will bear significant costs ahead of time and I get bills for them – as happened to me – I am going to be more than upset. If I have to pay these bills, I may have to skip some other important expense, like a utility bill or a prescription, or set up a payment plan using money I do not have, because I only budgeted for my monthly premium. This one visit teaches me I can’t afford “free” preventive and routine care from my primary care doctor. Next year and the years after, I am going to think twice about scheduling an annual exam, the pap exam, or any other free preventive screening that might cost me money. I may avoid routine care until I have a problem I can’t ignore – and that’s why we see big inequities in health, based on income, which disproportionately impacts people in my community.
Affordability is the main reason many currently uninsured people cite for not enrolling in coverage under the ACA. And we know that many of the uninsured are from some of our most at-risk populations, living in communities where health disparities are high. So how do we change this and create access to more affordable, quality health care? We have our work cut out for us. There is more than one answer to this question. For example, we could:
Most of all, we need to understand the problems people are having getting and paying for health care. Then we need to figure out what policy changes we should advocate for so that health insurance makes needed health care more affordable. These are the questions UHCAN Ohio struggles with every day and the questions I am going to explore in the next articles in this series on creating health equity in our health care system.
