1. ACA Opportunities to Address Health Disparities A State Perspective

2. Michigan Stats 2 nd in the nation in unemployment at 13% In 2009, estimated 14% were uninsured In 2009, estimated 14% living at or below FPL Current budget deficit estimated between $1-1.6 billion Nearly ¼ of all Michiganders have at least 1 pre- existing condition; 23% of the states residents are minorities Michigan ranks 31st in the country for availability of the community-based primary and preventive care centers that provide safety net care to low-income adults and children.

3. Recognition of Immediate Benefits Bans lifetime coverage limits for the life of the policy Temporarily creates national high-risk pool for previously uninsurable adults Bans pre-existing condition exclusion for children Permits parents to continue coverage for young adults to 26 y.o. unless coverage through employer

4. Recognition of Immediate Benefits Tax credits for small businesses (<26 employees) Data collection and reporting requirement by 2012 Community Health Centers $11 billion appropriated for 5 years School-Based Health Centers $50million appropriated for 3 years Bricks and mortar; HIT/EMR; equipment

5. Michigan On the Ground… Michigan Department of Community Health and Wayne Co. Health Department have developed strategic plans to address social determinants in order to impact disparities using grant opportunities Coalition of safety-net providers has formed to promote inclusion within the Accountable Care Organization and Patient- Centered Medical Home discussion Increased partnership between minority health advocates, faith-based community, and current state heath administrators

6. Michigan On the Ground… Efforts to have more centers designated as Community Health Centers through ACA grant funding is underway Applications submitted by sbhcs to renovate, increase capacity and acquire HIT/EMR Collaborative outreach project being discussed to implement Public Act 653 of 2006, Michigans Health Disparity Reduction Act, through prevention and wellness grant funding

7. Michigan Consumers for Healthcare Advancement (MCHA): Working Together To Make Affordable, Quality Healthcare a Reality for All of Michigan Mission Statement: The mission of Michigan Consumers for Healthcare Advancement (MCHA) is to work collaboratively with a diverse alliance of consumers, partners and policymakers to attain affordable, accessible, quality healthcare for everyone in Michigan through education, outreach, advocacy and stakeholder engagement. Vision: MCHA works to build a healthy future in which: Healthcare is fundamental and is accessible for everyone Healthcare and health insurance coverage options are affordable for all people Healthcare and health insurance coverage options provide access to quality care that is effective, efficient, patient-centered, equitable and culturally appropriate for our diverse population Consumers are actively involved in every level of healthcare decision making Consumers and their champions shape healthcare policy and regulations to advance and improve our healthcare system Areas of Work: Education Outreach Policy and Advocacy www.healthcareadvancement.org

8. Unfinished Business… Many provisions were authorized without an appropriation of funding: Community transformation grants Establishment of school-based health centers Grants to support community health workers A national diabetes prevention program established by the CDC to provide community-based model grants Community-based health team grants to support primary care medical home – hospital collaboration Health professions training and continuing education to improve public health and prevention proficiency, cultural competence, and to reduce health disparities

9. Unfinished Business… Safety-Net Authorized establishment of school based health centers without appropriation Without federal funding, subject to unstable funding streams of private, public, and community donors Free clinics received no recognition or funding Newly uninsured may prefer to remain in the medical home that cared for them when in need; trust factor Without access to grant funding for service or renovation, greater health inequity to continue If traditional providers are rewarded at the exclusion of those serving on the frontline, further marginalization occurs and the threat of health disparities and inequities increases.

10. The national political climate… Sen. Mitch McConnell (R-KY) Would make his primary post-election goal to repeal and replace the health spending bill. GOP has publicly announced intention to deny any additional appropriation funding State Attorneys General Committed to taking the constitutional challenge to the Supreme Court Post-census redistricting to occur

11. Michigans political climate… Governor-elect Rick Snyder (R) "Do not walk in my office and ask for funding…You should walk in and say, 'Here's an outcome or result that's important to achieve,' and then we should have a discussion about how that gets measured, why it's important, where it's a priority and then to the degree it's appropriate, we'll have a discussion about funding and resources." Senate majority (R)/House majority (R) Attorney General (R) Current A.G. has joined the lawsuit against reform, over objections by the current governor Majority on the State Supreme Court

12. Likely outcome Federally Attempts to highjack appropriations and delay implementation pending judicial decision which impedes momentum Efforts to undermine regulatory process Strategy to continue debate into 2012 election Stateside Incoming administration and legislature determined to balance budget by limiting government Medicaid expansion to additional classes is unlikely State appropriations for social services and programs need business model ROI for continued funding

13. Major Take-Aways ACA is work in progress Greater public outreach must occur to provide accurate information on benefits Grant opportunities available Congressional pressure needed to secure appropriation funding Current numbers preclude repeal Obstructionist tactics must be openly rejected

14. Major Take-Aways Continued engagement of health systems and providers Funding elimination increases financial burden on existing system Utilization of grassroots engagement and social networking to keep issue current Development of strategy to educate on the process and importance of civic engagement and voting responsibility

15. Major Take-Aways Collaborative advocacy needed now more than ever before… Active engagement of pro-reform constituencies Outreach needed to educate and enlist business community Publication of best practices/alternative care models producing outcomes Active and meaningful youth engagement is needed for generational sustainability of the movement

16. THANK YOU! Deborah Riddick JD, RN Director of Policy and Planning School Community Health Alliance of Michigan driddick@scha-mi.org 517 908-0847, ext. 227