Healthcare Gains at Risk

Federal efforts to replace the ACA risks undermining progress on health equity just as it was getting started.
May 23, 2017
Source: The Community Progress Report: Measuring the Wellbeing of Greater New Haven

The Affordable Care Act (ACA) represents a major commitment by the federal government to health equity. Its insurance coverage expansion and investments in the health care system reach millions of underserved Americans in populations that experience a disproportionate share of chronic and preventable health problems relative to the general public.

Disparities in health outcomes have long histories and complex root causes. Reducing and ultimately eliminating them requires improvements beyond expanded insurance coverage. Federal efforts to replace the ACA, however, along with a state proposal to adjust Medicaid eligibility levels, risks undermining progress on health equity just as it was getting started.

The Numbers

  • ACA Medicaid Expansion and Health Insurance Marketplace subsidies expanded health care coverage to 300,000 previously uninsured CT residents1 .
  • The percentage of Greater New Haven residents who lack health insurance dropped from 10% in 2012 to 4% in 20152. Among Black residents in Greater New Haven, uninsured rates dropped from 12% to 4%; among Latinos it dropped from 20% to 16%3.
  • 43% of Greater New Haven adults earning $30,000 or less and 28% of adults earning $30,000 - $100,000 per year postponed or did not receive the health care they needed in the past year. Cost was the top reason4.
  • From 2012 to 2014, the rate of hospital encounters for diabetes was 282 per 10,000 adults ages 20-44 in New Haven, as compared to 45 per 10,000 in Connecticut's nine wealthiest towns5.

Reaching the Underserved

At Transitions Medical Clinic, a Community Foundation grantee that provides care to formerly incarcerated men and women, Community Health Worker Jerry Smart meets with a patient and his daughter. Photo credit: Transitions Medical Clinic

The ACA has made large gains in improving access to health care by expanding Medicaid to include adults without children and offering subsidies for the Health Insurance Marketplace to qualifying income levels. It also eliminates out-of-pocket costs for preventive services for everyone and makes it possible for everyone to get coverage regardless of medical history or pre-existing conditions.

The ACA also increased funding to expand the health care workforce, and invested more than $11 Billion in Federal Community Health Centers, the primary delivery system for low income individuals and families. Connecticut-based Community Health Centers received $150 Million of this capital funding, according to the Connecticut Health Foundation. The ACA also strengthened data collection and research, along with other attempts at making system-wide improvements6.

The American Health Care Act of 2017 (AHCA), the proposed replacement of ACA, includes a cap on federal Medicaid financing and eliminates enhanced funding for Medicaid expansion. If passed, these changes would likely lead to large coverage losses among poor families and people of color.

"We know that health care coverage alone won't solve all the barriers to accessing care, but it's a critical first step," says Patricia Baker, president and CEO of the Connecticut Health Foundation. "Without coverage, it is far more challenging to focus on the other improvements that are needed in the health care system, such as addressing care quality and affordability, and other barriers to health equity."

For all its gains, the ACA puts a financial strain on individuals whose incomes are just over the threshold that would qualify them for Marketplace subsidies. As a result, the average monthly cost of health care for a family of four in Connecticut has increased 57 percent from 2007 to 2014, to an average of $5737.

Medical costs are expected to rise even further for families with limited incomes. Proposed state adjustments to Medicaid would lower income thresholds for parents with minor children from 155 percent above the poverty level to 138 percent above the poverty level. This would impact about 9,500 parents by increasing average monthly costs by an estimated $1008.

What The Community Foundation is Doing

In 2016, The Foundation distributed $3.3 million in grants, making health and wellness one of The Foundation's largest areas of grantmaking.

Recent funding includes support for New Haven Mental Health Outreach for MotherS Partnership, or MOMS, which in a pioneering partnership with Stop & Shop, makes mental health available to women in grocery store "hubs."

The Foundation is also home to New Haven Healthy Start, a national leader in work to reduce infant mortality and eliminate racial and ethnic disparities in birth outcomes. The Community Foundation is also a core partner in The Greater New Haven Community Index 2016, a comprehensive study of the health and wellbeing of Greater New Haven.

A Donor's Commitment to Health

Read about the legacy of Anne Hope Bennett, granddaughter of Oliver Winchester. Bennett's fund has supported numerous organizations devoted to preventing or curing sickness in New Haven.

Works Cited

  1. CT Dept. of Social Services and Access Health CT.
  2. The Community Progress Report: Measuring the Wellbeing of Greater New Haven. The Community Foundation for Greater New Haven and DataHaven. 2016.
  3. 2015 data from DataHaven 2015 Community Wellbeing Survey, 9. 2012 data from 2012 DataHaven Community Wellbeing Survey, 13.
  4. Abraham, Mark and Mary Buchanan. (2016). Greater New Haven Community Index. New Haven, CT: DataHaven
  5. The Community Progress Report: Measuring the Wellbeing of Greater New Haven. The Community Foundation for Greater New Haven and DataHaven. 2017.
  6. Artiga, Samantha et. al What is at Stake for Health and Health Care Disparities under ACA Repeal? Kaiser Foundation Issue Brief. March 2017; 4.
  7. Alice Report 2016: Connecticut United Ways
  8. "Impact of Reducing Eligibility for HUSKY Parents from 155% of FPL to 138% of FPL." Issue Brief. March 2017. Connecticut Health Foundation.

© The Community Foundation for Greater New Haven
May 2017