Public Hearing on Post-ACA Challenges


Mar 17


Officials met at Chicago’s City Hall to discuss the impacts of a possible GOP health care law. Photo by John J. Kim

With legislation for an ACA replacement currently in the works, the City of Chicago and Cook County are preparing for potential changes to our nation’s health care laws. A joint public hearing was held at City Hall on February 15th, 2017 to discuss possible impacts to local hospitals and patient access. Chaired by Cook County Commissioner Bridget Gainer and Aldermen Pat O’Connor and Ameya Pawar, the hearing included testimony from Cook County Health and Hospitals System CEO Jay Shannon, Chicago Department of Public Health Commissioner Julie Morita, and CommunityHealth’s Executive Director Judith Haasis.

To distinguish CommunityHealth from other federally qualified health centers and the CCHHS, Judith Haasis began by clarifying, “We do not serve individuals with Medicaid or other forms of insurance. Our mission is to deliver essential health care to those who are uninsured and “uninsurable.” For 24 years, we have been a safe place for those who are often forgotten — prompting many to refer to us as Cook County’s “safety net under the safety net.””

CommunityHealth’s delivery model is also distinct in two other ways: our workforce of physicians and other health care professionals are all volunteers, and our services are free — from the medical and dental appointments to the medications dispensed out of our on-site licensed pharmacy, economic barriers that can impact access to care are eliminated.

Despite the estimated 22 million who gained coverage under the ACA, there are still over 240,000 Chicago residents who are uninsured — and many are in desperate need of our care. “I am here today to speak on their behalf,” Judith explained, “and say that the repeal or reduction in benefits afforded under the ACA will carry devastating consequences. This is not hyperbole — this is fact.”

If Medicaid expansion is reversed and other ACA advancements are halted, the number of uninsured will once again rise, and Chicago’s safety net providers will each face different challenges. For CommunityHealth’s model of care, the impact of these changes can be framed within three imperatives: economic, public health, and moral.

Judith stated, “First, we must recognize the economic imperative that drives up the cost of delivering care. For every uninsured person who seeks care at a hospital emergency department (ED), the cost to that hospital in real dollars impacts not just the hospital but all of us.” A 2016 Northwestern study showed that ED utilization declines when uninsured patients choose CommunityHealth as their medical home — saving hospitals an estimated $7-$15 million annually.

A typical visit to CommunityHealth costs $520 less than a visit to a local ED. And now 7 months into a formalized referral program with Rush University Medical Center through which low-income, uninsured patients in need of a medical home are now being seen at CommunityHealth, there have been zero ED follow-up visits or hospital readmissions. “Having access to care matters…and makes good business sense,” Judith noted.

“Second, we must also recognize the public health imperative that plays out in the headlines when there is an outbreak of influenza…or worse,” said Judith. Our communities are only as healthy as the residents we sit next to on the bus, in the workplace, or at a restaurant. Having access to care enables us to build a healthier Chicago and Cook County.

Finally, we must recognize the moral imperative that challenges us to embrace the belief that health care is a basic human right. “The ACA has provided life-enhancing and life-saving benefits to tens of thousands of people living right here in Cook County. Having access to care matters….and saves lives,” Judith stated.

Martin Luther King once remarked, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” More than 50 years after these words were spoken, it is incumbent upon all of us to stand up and speak out on behalf of the progress that has been made under the ACA. Judith concluded by saying, “The number of uninsured Cook County residents remains much too high even now — 3 years into the ACA. We simply cannot turn back.”