For the past several years, many of us in health philanthropy have seen the implementation of the Affordable Care Act (ACA) as a key opportunity for attention and investment. At the New York State Health Foundation (NYSHealth), we focused resources first on supporting and sharing policy analyses and providing technical support to help our state implement the law well. In 2013 we prioritized outreach and enrollment efforts to ensure that as many New Yorkers as possible got covered.
Given the success of the new insurance program, the question for many of us leading health philanthropies is: Where should we turn our attention next?
One obvious thought is to devote more attention to keeping people healthy (and thus requiring less medical care). We at NYSHealth are devoting more of our resources to encouraging healthy communities that make it easier for residents to eat healthy and stay physically active. We are joined by many other health philanthropies that fund a broad array of initiatives focused on the prevention of health problems.
But crucial challenges remain in our medical care system; these deserve philanthropic attention and offer opportunities to help Americans get better medical care. My three favorite examples are the following:
Covering those who remain uninsured: Although we have made great progress, with approximately 20 million Americans newly insured with public or private plans since implementation of the ACA began, we still have work to do to expand coverage to those who have been left out.
One clear opportunity is to explore ways to extend coverage to undocumented immigrants, who are prohibited from purchasing health insurance through the exchanges and are ineligible for coverage using any federal Medicaid funds. President Obama’s recent executive order expanding immigration status protections for certain groups of undocumented immigrants will (if not overturned by the courts) open up some new avenues for coverage in a couple of states. In New York State, for example, we estimate that 250,000 undocumented immigrants could be covered because New York already extends state-funded Medicaid coverage to all low-income legal residents. California has a similar practice in place.
It has been estimated that nearly one-quarter of those remaining uninsured are undocumented immigrants; attention to this population could lead to substantial gains in the rate of insurance. Foundations can help support outreach and enrollment efforts to help ensure that undocumented people who are eligible can sign up for coverage. Philanthropy also has a role to play in pushing for state-level policy options to extend insurance coverage to undocumented immigrants.
A large portion of Americans also remain uninsured because of the so-called “coverage gap” in states that have not expanded Medicaid. More than 3.8 million people fall into this category, with the most residing in Texas, Florida, Utah, and Georgia. While the political climate, of course, is extremely challenging, both state and national foundations can play a role in advocating for Medicaid expansion and educating policy makers about the benefits not only to the health of residents but also to the financial health of states choosing to participate in the expansion.
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Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.
