« January 2013 Issue

It's 2013: Ready, Set, Go!

By Robert Restuccia, Executive Director

With the start of the new year, Community Catalyst has new clarity -- and urgency -- about our work ahead.

The election removed all doubts about implementation of the Affordable Care Act (ACA). The flood gates have opened: enrollment under the ACA begins in less than nine months. It is going to be a busy year for consumer advocates focused on getting the ACA up and running.

The June Supreme Court decision that made the ACA's Medicaid expansion optional for states means roughly half of the coverage expansion envisioned is subject to state government approval. While many governors are moving forward on Medicaid expansion, there are a number in states with large numbers of uninsured who are resisting. For example, Louisiana's Governor Bobby Jindal is refusing to provide Medicaid coverage to the 400,000 uninsured Louisianans who will be eligible, even though the federal government is completely subsidizing the expansion for three years. Community Catalyst, along with other national partners, is providing support to advocates who are working to convince resistant governors and legislatures to put their constituencies ahead of politics.

One of states' biggest responsibilities in implementing the law is the development and operation of Exchanges, the online marketplaces where consumers and small businesses can learn about, compare, and purchase health insurance plans. The Exchanges will open the door to new coverage for millions of uninsured and provide subsidies to make coverage affordable. Some states are setting up their own Exchanges, while others are doing it in partnership with the federal government or relying on a federally facilitated Exchange. Across the country, coalitions of advocates with the help of Community Catalyst are working to protect the interest of consumers throughout this process. In California, Health Access has led a coalition that successfully fought for strong conflict-of-interest policies that will keep insurance companies off their Exchange Governing Board. The Colorado Consumer Health Initiative has held more than 50 community meetings to make sure the interests of real people are represented in Exchange deliberations.

Community Catalyst will continue to support this important work by state advocates through the Consumer Voices for Coverage project and the Affordable Care Act Implementation Fund, which together will provide more than $5 million in grants in 2013 to state advocacy groups for ACA implementation.

In the year ahead, another important focus of Community Catalyst is an ACA provision that relates to the obligation of non-profit hospitals to provide community benefit, including charity care. Taxpayers support these hospitals through tax breaks worth billions of dollars every year. In exchange for this support, non-profit hospitals are obligated to help their communities by working with them to identify and address the most pressing health care needs of the people they serve. The ACA institutionalizes the role of the community by requiring hospitals to do a periodic community health needs assessment. This provision will strengthen the voice of communities and change the paradigm from a sick care system to a health system.

The ACA will not be Community Catalyst's sole focus in 2013. While major cuts to Medicaid and Medicare were avoided in the recent "fiscal cliff" negotiations, these programs are still at risk. Protecting these vital programs in the next stage of negotiations will be an important job for Community Catalyst and our partners. But given the real challenge of rising health care costs and budget deficits, we will not be successful in "just saying no" to budget cuts. Instead, much of our work will center on improving the system and making it more cost effective. This means looking for alternatives to harmful cuts, which would hurt beneficiaries. For example, promoting better ways to care for people with chronic illnesses, developing new care delivery and payment models, lowering the cost of pharmaceuticals, and expanding public health and prevention efforts would cut costs and improve care. Toward that end, I am excited to report a $3 million dollar grant from the Atlantic Philanthropies to fund our work to improve the quality and efficiency of care for so called "dual eligibles" (people on both Medicaid and Medicare), who have complex health care needs. This work entails advancing policies that require coordinated, patient-centered care that allows dually eligible older adults to have a better quality of life and ensuring that these individuals and their caregivers have a voice in shaping these policies.  

Underlying all of our work is our view that everyone should have a say in the important policy decisions that affect their health, with the goal of ensuring everyone has access to high-quality, affordable health care. By the end of the year, we will be much closer to realizing that goal.