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Welcome to the blog for Health & Medicine. We're a 33-year old 501c3 nonprofit that operates as an independent, freestanding center driven by a singular mission: formulating health policy, advocacy and health systems to enhance the health of the public.


Dec 23, 2015 Written By: Maggie Litgen

Chicago-Area Film Screenings Advance Conversation on Childhood Trauma

In early November, the Illinois ACE Response Collaborative – a diverse group of organizations and agencies committed to expanding and deepening the understanding of the impact of childhood trauma and adverse childhood experiences (ACEs) on the health and wellbeing of Illinois residents and their communities—welcomed over 500 community members for five local screenings of the documentary Paper Tigers.

From Director James Redford and Executive Producer Karen Pritzker, Paper Tigers follows a year in the life of an alternative high school in Walla Walla, WA, that used the science and framework of ACEs to radically change its approach to student relationships and discipline, and in the process has become a promising model for how to break the cycles of poverty, violence and disease that affect families. (Learn more about the film here.)

As part of our mission to expand dialogue around of the impact of ACEs, the Collaborative’s screening targeted different audiences and sectors from restorative justice practitioners, to educators and administrators, lawyers, law enforcement professionals, healthcare providers, and employers as well as civic and community leaders. All told, over 500 people attended the screenings—many of which drew a standing room only crowd—at venues across the area including Loyola University Chicago School of Law, UIC School of Public Health, Chicago State University, and Ann & Robert H. Lurie Children’s Hospital of Chicago.

Screenings were followed by discussions from panels of experts who addressed the power of utilizing trauma-informed approaches within the education, justice, and health fields.  Jim Sporleder, the principal highlighted in the film, spoke about his approach during the panel discussion at Loyola Law. At the Chicago State discussion, moderator Dr. Kim Mann led a lively and heartfelt audience conversation as attendees noted that although the setting for Paper Tigers seems much different from our community, the challenges facing Chicago students and schools are very similar to in the film—particularly the prevalence of violence in the community as well as the impact of experiencing racial discrimination as a major ACE.

An immense interest in ACEs-related work was cultivated at the screenings and inquiries to build collaboration across sectors to address ACEs and build resiliency were a direct outcome. An evaluation of participants indicated that 73% of respondents have already made changes to their professional practice based on the findings of the ACE Study. Additionally, 89% of respondents indicated that this film made them feel more willing to contribute time to help ensure that the troubled children and youth in their community are treated from a trauma-informed model.

Over 100 people gave specific examples of how they would improve their response to people impacted by trauma in light of the film, including screening for ACEs in multiple service settings, advocating for expanded trauma-informed approaches, adjusting discipline policies, integrating behavioral health into more settings. One respondent noted that she will now “strive to work from a place of unconditional love and compassion when engaging with my students.”

Based on the robust interest in the screenings and the productive conversations they yielded, the Collaborative plans to host additional community events in the months ahead. Those interested in learning more about the Collaborative and upcoming activities are invited to contact Maggie Litgen at

Thank you to our film screening Co-Sponsors:
CBA Young Lawyers Section - Health & Hospital Law Committee
Chicago Department of Public Health
Chicago Lawyers’ Committee for Civil Rights Under Law
Chicago Body Mind Trauma Study Group
Chicago State University
Civitas ChildLaw Center, Loyola University Law School
CPS Office of Social and Emotional Learning
Health & Medicine Policy Research Group
Illinois Collaboration on Youth
Illinois Education Association
Ann & Robert H. Lurie Children’s Hospital of Chicago
Prevent Child Abuse America
Prevent School Violence Illinois
PROTECT, an initiative of ICAAP
UIC School of Public Health
UIC SPH Center of Excellence in Maternal and Child Health
UIC College of Education Youth Development Program

Dec 10, 2015 Written By: Health & Medicine Policy Research Group (HMPRG)

Health & Medicine at APHA in Chicago

In November, members of the Health & Medicine staff and board joined health professionals from across the nation for the American Public Health Association’s (APHA) Annual Meeting & Exposition. This year’s conference was held in Chicago and centered on the theme Generation Public Health. The conference was an invaluable opportunity for our staff and other public health professionals convene, learn, network and engage with peers.

Each year, after the conference, the Health & Medicine community comes together to reflect on what they’ve learned. We’d like to share some of those reflections from our staff so you can see some of the thoughts and ideas we found to be most memorable.

Health & Medicine staffers Christine Head, Erica Martinez, and Renae Alvarez at the APHA Health Advocates dinner.

Margie Schaps, Executive Director
I learned so much this year at the APHA conference.  I usually don’t like it when the conference is in Chicago because I am pulled between the conference and “stopping by” the office.  But this year I promised myself I would focus entirely on the conference, and I’m glad I did.  Rather than focus on a particular session of interest to me, I’d like to point out some salient messages I came away with that will infuse the work I do and plan for at Health & Medicine:
  1. CDC is funding 18 states, including Illinois, to do Climate Change Adaptation planning (i.e. understanding that climate change is happening and states must ready themselves for inevitable impacts).  CDC is promoting developing Trauma -Informed Community Building including expansion of solar energy, storm water efficiency, urban gardens, and neighborhood design.  Climate change will have significant impact on health, e.g. rising pediatric asthma cases which are already increasing, and data modeling is showing thousands of excess deaths and instances of disease.  We need to be looking at the impact of climate change on the need for diversification and expansion of the healthcare workforce.
  2. Health and community development are inextricably linked: improvements in child health are most closely correlated with neighborhood support and cohesion and divesting in communities has a direct impact on the safety of those communities.
  3. Community organizers are deeply interested in health but often don’t have the knowledge base needed to act.  Public health leaders need to support and inform the work of community organizers and be informed by organizers as we look for tools to make health policy change.
  4. Increasing data availability to do health disparities geo coding and other mapping is a critical tool in our efforts to mitigate the impacts of inequities.
  5. As we look to address Adverse Childhood Experiences (ACEs), we must have an upstream—poverty and racism—and downstream—addressing immediate present threats—approach.
Renae Alvarez, Policy Analyst
As stated in the “Role of Public Health Data in Advancing Health Equity in All Policies,” by Dr. Mary Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, we must use data to create political urgency around health equity and build coalitions across sectors by making injustice visible.

I attended a couple of sessions on Primary and Mental Health Integration in both pediatric care and adult health systems, and for adults, specifically those who use substances. What I took away from the nuanced view of integrated delivery systems was how pervasive the problem really is with regards to mental health, stigma, and culture.  From pediatrics, we all know that early identification is extremely beneficial and can determine one’s health trajectory. A study of child development and mental health services found that 50% of mental health disorders can be identified by 14 years of age, and 75% can be identified by 24 years of age.

According to Ali, Teich, & Mutters from SAMSHA, the vast majority of all people who were insured, 83% with substance use disorders are not getting treatment. Furthermore, 97.4% of people with and without substance use disorders, regardless of insurance status, did not feel that they needed treatment. The presentation concluded with the need for outreach efforts to raise awareness about the effectives of substance abuse treatment and they are currently looking into reasons why people do not seek treatment (i.e., lack of readiness, treatment not seen as helpful, stigma, access).

Our westernized culture almost champions and endorses the use of alcohol in all major entertainment and media outlets, whereas it stigmatizes those who use other substances such as opioids, and even more so for those who cannot afford prescription opioids, but are stuck in addiction and revert to using substances that they can afford—street drugs. Click here to read more.

Wesley Epplin, Director of Health Equity
During one of the Spirit of 1848 sessions, Dr. Nancy Krieger, a leading social epidemiologist located at Harvard’s T.H. Chan School of Public Health, shared that she had recently had an article accepted for publication that focuses on the idea of health departments and the public health system collecting data related to deaths due to use of force by police, as a matter of public accountability.  This article has since published in PLOS Medicine here.  I had seen Dr. Krieger and others discuss this issue on two panels held at Harvard (view them here and here) that I had viewed online in my preparation for an APHA presentation which focused in part on racist state-sanctioned violence. 

Locally, this is related to the recent release of the dash cam video of Chicago police officer, Jason Van Dyke’s brutal and unjust killing of Laquan McDonald, in which the officer shot McDonald, who was walking away from the officer, 16 times.  The charge of murder in the first degree to the officer and the release of the video happened approximately 400 days after the killing and after a legal battle in which the City of Chicago and Chicago Police Department (CPD) attempted to keep the video out of the public’s eye. The video shows details that conflict with the previously released statements by the CPD about the shooting. 

This instance has again brought to the fore in Chicago the longstanding issues of police violence, racial discrimination in policing, death due to use of police force, and lack of accountability from how police interact with and treat communities of color. Local activists have been active on these issues for decades, and in recent years, with the Black Lives Matter movement growing in Chicago as it has across the U.S.  Structural racism remains a major barrier to health equity, as it disadvantages people of color on the one hand, while privileging whites on the other.  Since achieving health equity and eliminating disparities is one of the overarching national health goals outlined in Healthy People 2020, the field of public health needs to find roles that it can play in helping eliminate structural racism. As health departments are part of government responsible for reducing health hazards, they ought to directly engage with other parts of government whose actions perpetuate racial injustice. Click here to read more.

Christine Head, Community Healthcare Initiative Coordinator and AHEC Administrative Assistant
This year marked my first time attending the annual APHA meeting. Overall, my experience was amazing: I had the opportunity to meet experts from across the United States as well as get a glimpse at groundbreaking research. Most exciting was having the opportunity to see a number of public health professional address racial and ethnic disparities and criminal justice. To read through the conference book and see the subject even brought up was a refreshing step in the right direction. We have a rare opportunity to create some radial change in the criminal justice system, and to see advocates across sector sense the opportunity is sign that we will see victories soon. I was feeling optimistic and proud to be able to even bear witness to what seemed like a turning of tides. But as I attended sessions and connected to other advocates focused on the criminal justice system, a pattern began to emerge.

Though we had all began to use similar language it appeared to me and some of my colleagues that we may not be using the same definition.

When presenters were declaring that “Black lives mattered” in securing health equity and creating a truly just system, it seems that we had different thresholds of success. For Black live to matter, we must move beyond simply asking to be alive. The WHO defines health as “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” By the vey principles that guide public health, to not address all of the social determinates of health that institutionalized the health gap between Blacks and other groups in the United States, we have passively declared that Black lives only matter sometimes and in some ways. For Black lives to truly matter, we must be prepared to advocate for not just reducing the number of Black bodies in morgues and in the prison system. We must do more than rattle off stats around obesity and gun violence, as if the experiences of Black people can be narrowed down to those two ailments. We must address the wider system that reduces the options for people to choose a path to thrive. Part of that is being self-reflective and intentional as advocates in how we choose to do our work.

For me, APHA was not just a conference, but affirmation of my rules of engagement in how and why I do the work that I do. It reminded me of the areas I could do better and the areas I should be proud of. It showed the path of where we need to go in order to continue to not only move the needle, but to prevent a retreat down the path of our past failures. But more importantly, it was the fire I needed to take the road towards self-aware advocacy that I hope to continue to build up for years to come.

Erica Martinez, Senior Policy Analyst
Attending this year’s APHA in Chicago made me think about the different approaches policy and research based organizations take when working toward system changes.  One approach presented at APHA is that of community engagement and partnerships on policy. Policy and research based organizations’ activities should be informed by the people who are going to be directly impacted by their work. However many times these organizations do not have the relationships and trust of the community being affected. In order to develop better informed policy proposals, organizations need to create and foster community based partnerships. In one of the sessions, a speaker emphasized how much moving policy and advocacy forward was based on relationships and trust of the partners you are working with. Equally important was while having research and data to support a policy proposal is important, without consideration of the community partners, the effort may not be well received. A couple of thoughts to create and foster better community based partnerships are for organizations to be: 1) intentional about whom they approach; 2) clear about expectations and how each organization will be credited; 3) transparent to some extent about funding and deliverables; 4) have good communication; and 5) set up an evaluation mechanism for the partnership.

Ray Wang, Program Director, Chicago Area Schweitzer Fellows Program
This year’s APHA annual meeting helped to deepen my awareness and knowledge about the social determinants of health and current work that is being done on many fronts to address them.  I was enriched and inspired by the wide ranging presentations about the built environment, climate change, community-based participatory research, progressive pedagogy, and advocacy.

One of the presentations that made the strongest impression upon me was a panel that looked back on the history of Medicare and Social Justice.  I had not realized that the enactment of the Medicare program in 1964 paved the way for the desegregation of hospitals in this country, and quite dramatically.  One of the panelists explained that in the early 1960s – more than 100 years after the introduction  of anesthesia for surgical procedures – African American physicians in the south could not get privileges at hospitals, and patients were systematically and cruelly denied access to many hospitals.  The enactment of Medicare compelled hospitals to desegregate or lose federal funding, and within two years, nearly 6,000 of them did comply by the July 1966 deadline.  The panel really brought home for me how health policy matters, and can be a powerful instrument to bring about change.

Oct 23, 2015 Written By: Wesley Epplin

Expanding the Bounds of Public Health: A Learning List for Chicago and Illinois

Health & Medicine Policy Research Group is pleased to share Expanding the Bounds of Public Health: A Learning List for Chicago and Illinois (Version 1), which includes books, films, audio recordings, and articles that focus on topics that are relevant to public health in Chicago and/or Illinois.

What do these resources have to do with public health?
Health & Medicine developed this list with the help of outside partners to promote understanding of the historical, political, economic, social, and ecological contexts of Chicago and Illinois. These resources have been valuable to our work, and we hope they will also prove useful for others working in public health and other health professions. In particular, we hope this list will be useful for those attending the 2015 American Public Health Association’s Annual (APHA) Meeting and Exposition, especially health professionals who work in Chicago and Illinois.
Many of the listed resources document and discuss examples of how money, power, and resources have been inequitably distributed by a variety of forms of systemic, structural, institutional, and physical discrimination, oppression, and violence via racism, classism, and genderism.  Some of these resources discuss efforts to redress such injustice.

Working toward health equity
Exploring the themes and topics this list touches upon is an application of eco-social theory and of the World Health Organization’s Conceptual Framework for Addressing the Social Determinants of Health, both of which point to the importance of understanding these contexts as a basis of analyzing levels and pathways of causation and distributions of power, which can help guide efforts to redress health inequities.i,ii To achieve health equity, eliminate disparities, and improve the health of all groups—one of the national priorities set forth in Healthy People 2020—public health needs to expand the bounds of the field’s interventions and research to take into account and address these various overlapping contexts. We view this list as one tool to support this work.
Using this list
In approaching this list, we suggest that readers might begin by choosing one or two items and planning to work through some additional items of interest in the months and years ahead.  Discussion and dialogue has proven an important tool for us in collecting these resources so we encourage you to consider assembling a discussion group of faculty, students, and practitioners to help process the material and understand its relevance to current health inequities.  Some of these resources could also be integrated into public health coursework.

Contribute to this list
This list is not exhaustive, but rather a curated selection of learning materials that we have found to be useful and believe hold value for others in the field. It is a work in progress and we welcome submissions of potential additions to with “Expanding the Bounds of Public Health” in the subject line.  Also, we hope that this Expanding the Bounds of Public Health learning list might be a useful model for public health practitioners in other parts of the country to promote learning and understanding of the overlapping contexts that are important to our work.

Thank you to those who have submitted recommendations for this list thus far, which includes a handful of individuals who have worked with Health & Medicine in planning APHA activities, as well as some of our staff and board members. 

i Krieger, N. (2008). Proximal, Distal, and the Politics of Causation: What’s Level Got to Do With It? American Journal of Public Health, 98(2), 221–230.
ii Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva, World Health Organization, 2010.

Oct 20, 2015 Written By: Health & Medicine Policy Research Group (HMPRG)

APHA Chicago Events

Health & Medicine is pleased to share a rundown of some of the events taking place during this year’s APHA in Chicago. We will continue to update this list with events and activities around the conference, and please feel free to share any information with us by emailing Erica Martinez at While we are happy to share this information, we have not been involved in the planning or content of the many of the events and will not be able to answer any questions unless specified under the event. Thank you.

Radical History Tours
Health & Medicine is pleased to offer five Radical History Tours at this year’s APHA meeting in Chicago. The tours are being co-sponsored by: the Spirit of 1848 Caucus, the Nursing Section, and the Occupational Health and Safety Section of APHA. In addition to four scheduled tours, a self-guided tour (with a printable PDF guide) will be made available. You can read more about the tours here and per-registration is required.
  • Little Village Community Tour - Saturday, October 31, 2015 • Time: 1:00 – 3:00
  • Haymarket Square Tour and Reenactment - Saturday, October 31, 2015 • Time: 5:00 – 6:30 p.m. (w/ option to have dinner/drinks w/ others at Haymarket Brewery)
  • Jane Addams Hull-House Museum and UIC African-American Cultural Center - Sunday, November 1, 2015 • Time: 3:00 – 6:00 p.m.
  • Old Cook County Hospital, John H. Stroger Cook County Hospital, and Community Nursing History - Sunday, November 1, 2015 • Time: 3:00 – 6:00 p.m.
  • A City of Neighborhoods: On the Green Line, a Self-Guided Tour from Bronzeville to Oak Park - Self-Guided Tour (Download here)
Tickets are required. You can check if tickets are still available for the tour you are interested in here. Please email Health & Medicine Policy Research Group at

Expanding the Bounds of Public Health: A Learning List for Chicago and Illinois
Health & Medicine Policy Research Group is pleased to share Expanding the Bounds of Public Health: A Learning List for Chicago and Illinois (Version 1), which includes books, films, audio recordings, and articles that focus on topics that are relevant to public health in Chicago and/or Illinois. Click here to read more.

Region V Community Health Worker Summit

October 30 – 31, 2015 | Chicago, IL
This Summit will take place in two locations:

October 30, 2015
US Department of Health and Human Services Region V –
Chicago Regional Office
233 North Michigan Ave, 13th Floor

October 31, 2015
National Louis University
122 S Michigan Ave, 2nd Floor Atrium

To register, please visit:
For more information, contact Venoncia Baté-Ambrus at or Judy Dixon at

Community Health Worker Site Tour and Reception
Calling all CHWs and stakeholders…Take a break from the APHA and come hang with your Peers from across the nation. Join us for a Chicago CHW site tour and reception. Expect, fun, food, drinks and dancing!

Sunday, November 1, 2015
Site Tour: 5 pm—6 pm
Enlace/Universidad Popular
2801 S. Hamlin, Chgo.IL
Reception: 6:30 pm—9:30 pm
1647 S. Blue Island
Click here to view the flier.

Wandy Hernandez:  312-878-7018,
Leticia Boughton Price: 312-878-7015,

Health and Safety Action
Saturday 10/31/15 – 3 PM – 5 PM   Location - TBD
Health and Safety Screening/Reception
Saturday 10/31/15 – 6 PM – 8:30 PM - Location – UIC SPH 1603 W. Taylor Street, Chicago, IL 60612. The main event would be a screening of the new film on the perils of Temp work - A Days Work

For a decade, National COSH and APHA OHS Section have collaborated on Joint events on the Saturday before the annual meeting. The first Health and Safety Summit was organized in Philadelphia [2005] and the last event was in Boston [2013] [Temp Worker Forum]

Chicago is the home of the First COSH group [1972] and the base for many legendary union health and safety programs, clinics and activist groups. National COSH and its allies are working to organize two events on the Saturday of the upcoming APHA meeting to highlight, engage and accelerate the movement for worker health and safety rights. This intends to take advantage of APHA OHS members and others coming to Chicago and the rich local activist movement currently engaged in H&S activity.

For more information you can visit  or

APHA Food and Environment Working Group Events
Thanks to support from the W.K. Kellogg Foundation, the Food and Environment Working Group will be hosting two events during the APHA Annual Meeting.
  1. Annual reception (Tuesday, Nov. 3, 6:00-8:00 p.m.). This is a delicious and fun opportunity to network with APHA colleagues and Chicago residents working toward a healthier, just and sustainable food system. Chicago Illuminating Company, 2110 S. Wabash Avenue, Chicago, IL. RSVP at
  2. Chicago Food System Tour (Oct. 31, 2015, 10:00 a.m. to 4:30 p.m.). Come a day early to join fellow APHA attendees and others committed to food system change for an exciting tour in Chicago, where community groups, businesses, academics and advocates are working towards creating a more just, healthy food system. For additional details and to sign up, visit:
APHA-CHPPD Day of Action
APHA-Community Health Planning and Policy Development “Day of Action:
Community Summit on Violence: Best Practice to Reducing Violence in Chicago and Beyond


2015 Health Activist Dinner
Sunday, November 1, 2015 from 6:00 PM to 9:00 PM (CST)
Chicago, IL

At this annual dinner of health activists, at the time of the American Public Health Association Annual Meeting, there will be opportunities to renew acquaintances and meet other health activists and listen to presentations by the recipients of the Paul Cornely and Edward Barsky Awards. A family-style dinner will be served. There will be a cash bar. View the event flier here.

Latino Caucus for Public Health
13,000 health professionals will be visiting Chicago for the Annuals Meetings of the American Public Health Association (APHA). The APHA Latino Caucus has organized scientific sessions and social Events. One of the them is the Pre-Conference Panel Discussion:

Impact of Latino Political Power in Chicago on Public Health
Saturday, October 31 at 3 to 4:30 p.m. (with refreshments)
Rudy Lozano Public Library, 1805 S Loomis Street, Chicago, IL 60608
View the flier here.

Student Visit Day
APHA and the Association of Schools and Programs of Public Health invite you to the 2015 Student Visit Day — an informative and interactive free half day event.
Wednesday, Nov. 4 | 8:30 a.m.–12:30 p.m.
McCormick Place Convention Center, Hall F, Chicago

•Engage with more than 100 CEPH-accredited schools and programs of public health in the 500 and 600 aisles.
•Explore the Expo featuring more than 600 booths covering the public health field, from technology and publishing to schools and universities and research and development.
•Meet members of APHA's Student Assembly at Booth 1428.
•Network with some of the 12,000 public health professionals attending the Annual Meeting.
•Attend Exhibitor Theatre presentations on applying to CEPH-accredited schools and programs of public health.

For more information and to register, click here.

Racism and Public Health

Monday, November 2

8:30-10:00 a.m.

McCormick Place, Room W178b


Speakers include Linda Rae Murray, David Williams, Cheryl Easley, and Philip Tegeler. Session moderators: Carol Allen and Barry Levy.

Jul 15, 2015 Written By: Guest Author

Lessons Learned from Nursing Home Funding Reforms

We are pleased to share a guest blog post from Health & Medicine intern Jacob Ginsburg.

On June 1st 2015 the Federal Register published the Medicaid managed care proposed rules, which included a change in the Medicaid rule for (Institutes for Mental Disease) IMDs.  This particular revision would loosen the ban on federal reimbursement for people requiring mental health treatment between the ages of 18-64 staying in IMDs, allowing for monthly capitated payments to managed care entities for people requiring inpatient stays in a mental health facility as long as admissions lasted less than 15 days.

When Medicaid was introduced, the IMD exclusion aimed at preventing states from shifting the cost of the historically state-run mental health institutions to the federal government. Additionally, by stipulating strict guidelines on what constitutes an IMD, the IMD exclusion attempted to incentivize the formation of smaller community based facilities.  Pressured by restricted federal funding, and combined with a general support of patients’ rights, these large asylums began to close and patients moved into smaller facilities.   This gained support because of the idea that smaller institutions offered a less restrictive environment to receive care.  

Unfortunately the effects of this trans-institutionalization of people with mental illness into nursing homes gave these new facilities an incentive to find loopholes in the IMD exclusion to receive federal Medicaid money.  At the same time nursing homes lobbied to protect their State funding. As nursing homes gained a greater financial stake in the institutionalization of individuals with behavioral health conditions, concerns arose about the quality of care patients received in these facilities. The closing of large, state-operated psychiatric institutions, aided by the IMD exclusion, had unintentionally given rise to a market for nursing homes that continued to segregate people with mental illness.

As that market expanded and the nursing home industry gained power, advocacy groups continued to push back against the profit driven nursing facilities, attempting to eliminate these IMDs/nursing homes and demanding more resources for community-based alternatives to institutionalization.

The demands of advocates culminated in a series of reforms starting in 2009. The presence of large numbers of nursing home residents with behavioral health conditions had caught the attention of the Chicago Tribune, which published a series of investigative articles about poor care at these facilities. The Illinois General Assembly responded with nursing home reform legislation and a new Medicaid payment system.  In a legal push, the Williams consent decree attempted to strengthen patients’ rights and reduce utilization of institutions by requiring that people in mental health facilities be offered options to leave and receive community care.  In response, the nursing homes and mental health facilities managed to include the creation of a new type of nursing facility—Specialized Mental Health Rehabilitation Facilities (SMHRFs)—in SB 26, the Medicaid expansion bill. 
The push back against the Williams consent decree and other reforms, represented by the formation of the SMHRFs, attempts to preserve the business model of the IMDs and keep patients in these facilities.If passed, the revision to the IMD exclusion would solidify the existence of these SMHRF institutions by granting them federal Medicaid reimbursement. However, while on paper these facilities offer transitional care to help people move into the community—and while this seems more appealing— limited information exists on if these new facilities can deliver the short term care they claim to provide.

There will always be unintended consequences which materialize as the push and pull between provider interest, and consumer interest; yet, policy should anticipate and attempt to mitigate this conflict. Any advocated policy should take into account, as best as possible, the reactions of profit-seeking entities in their desire to support a successful business. Moving forward we must not just examine the theoretical benefit of a policy but evaluate the practical effects and the logical fallout of any changes in policy and funding. 

Jun 26, 2015 Written By: Health & Medicine Policy Research Group (HMPRG)

What We're Reading - June 26, 2015

A rundown of the articles and stories that caught our eye this month:

Comptroller's View: No budget deal, no checks for those who can least afford to miss them
“As the state's chief financial officer, I manage the state's checkbook. This can be quite a challenge in Illinois, where we are nearly $6 billion behind in paying the state's bills. It will get much worse if the General Assembly and the governor don't reach a budget agreement the next 2½ weeks.”
Rockford Register Star, June 13, 2015

Illinois Providers Prepare Shutdown Plans for 26,000 Mentally Ill Adults, Kids
“The failure of Illinois state leaders to adopt a new budget has prompted service shutdown planning for nearly 26,000 mentally ill adults and children.

‘Without a budget or clear direction from state agencies, the consequences will be severe,” Illinois Association of Rehabilitation Facilities (IARF) President and CEO Janet Stover said on Tuesday. “Tens of thousands will lose service, and thousands more will be sent to the unemployment line as these predominately not-for-profit organizations struggle to stay afloat.’”
The Illinois Observer, June 24, 2015

OP-ED: Justice Foiled by Ignorance of Trauma
“In the parking lot, I sat in my pickup for several minutes thinking about this woman who had the outward appearance of a meth addict. I wondered how she came to be the person I just saw and what I might have done differently to improve her outcome.

My thoughts turned to remarks delivered by Abigail Baird, a developmental neuroscientist studying brain development and decision-making by teenagers. She was addressing a symposium sponsored by the National Center for State Courts and the MacArthur Foundation’s Models for Change initiative.

A few days later, I was in the audience for a presentation by Anne Studzinski, managing director of the Illinois Childhood Trauma Coalition. Both experts referred to the effects of trauma on the intersecting development of the individual. These two discussions had a link that stirred up my own memories of Kera’s visits to my courtroom.”
Juvenile Justice Information Exchange, June 10, 2015

What Poverty Does to the Young Brain
“Over the past decade, the scientific consensus has become clear: poverty perpetuates poverty, generation after generation, by acting on the brain. The National Scientific Council has been working directly with policymakers to support measures that break this cycle, including better prenatal and pediatric care and more accessible preschool education. Levitt and his colleagues have also been advocating for changing laws that criminalize drug abuse during pregnancy, since, as they pointed out in a review paper, arrest and incarceration can also trigger the ‘maternal stress response system.’ The story that science is now telling rearranges the morality of parenting and poverty, making it harder to blame problem children on problem parents. Building a healthy brain, it seems, is an act of barn raising.”
The New Yorker, June 4, 2015

At Home, Many Seniors Are Imprisoned by Their Independence
“Almost two million people over age 65, or nearly 6 percent of those Americans (excluding nursing home residents), rarely or never leave their homes, researchers recently reported in JAMA Internal Medicine. The homebound far outnumber the 1.4 million residents of nursing homes.

Who are the homebound? Compared with other aging adults, ‘they’re older,’ said Katherine Ornstein, an epidemiologist at the Icahn School of Medicine at Mount Sinai Hospital in New York and the study’s lead author. ‘They’re more likely to be female and less likely to be white; they’re lower income. They’re more likely to be non-English speakers and to be Medicaid beneficiaries.’”
The New York Times, June 19, 2015

Why the Healthcare Industry Must Take the Lead on Climate Change
“The effects of climate change threaten decades of healthcare progress, and health leaders have a responsibility to help reduce energy consumption and frame the crisis as a health issue instead of a scientific or political one, according to a report published by the Lancet/UCL Commission on Health and Climate Change.”
FierceHealthcare, June 23, 2015

May 25, 2015 Written By: Guest Author

Schweitzer Fellow’s “Noble Nine” Project Cultivates Leadership and Idealism in Englewood

This article originally appeared in the Chicago Area Schweitzer Fellows Program Spring 2015 Newsletter - click here to read the full newsletter. The Program also recently announced its 20th class of Fellows. Click here to learn more about the Fellows and proposed their service projects.

2014-15 Schweitzer Fellow Josh Taylor recently completed his service project, “the Noble Nine”, at Johnson College Prep (JCP) high school in Englewood, where Josh also taught science. The Noble Nine aimed to empower young men to pursue leadership roles, use their strengths to support their school and neighborhoods, develop an interest in service, and cultivate passion for the long-term health and wellness of their communities. One of the Noble Nine members, Troy Olive, recently wrote this reflection on participating in the program:

My name is Troy Olive and I’m a sophomore at Johnson College Prep. I participate in sports, Noble Nine, and other school activities. In Noble Nine I’ve learned a lot. I learned to be a better scholar, athlete, and person overall. In Noble Nine there are nine great young men who all have bright futures. These young men are very intelligent, funny, smart and great guys to hang around with. I’ve learned that these scholars are very trust worthy, this is one reason why they’re in Noble Nine.

In Noble Nine we work very hard to come up with ideas to change the community and our school. We want to bring the community together so young kids can have fun instead of being outside where it’s dangerous. In December, a JCP student Demario Bailey was killed when walking to basketball with his twin brother. In Noble Nine, I’ve been able to show respect to Demario’s family by selling wrist bands that we made to raise money to buy textbooks for students in Demario’s honor. On the wrist band it says a quote Demario’s mother said when he passed away. On one side it says, “I will live and not die.” On the other side it says, “twin.”

To bring the community together, this spring we are holding a basketball camp in our gym for kids in the neighborhood. This event will have kids smiling and having fun, but most importantly they’ll be in a safe environment. This camp will hopefully remind kids to stay off the streets and away from violence.

Another thing I’ve done is run a 5k run in Englewood. This was a really cool experience! I met a lot of new people from around the city. I was one of the youngest contestants and finished in the top 10!

In Noble Nine I’ve learned a lot about Englewood. I’ve learned that Englewood has the highest poverty rate in children and in the general population in the city of Chicago. I’ve learned that Englewood has more people over the age of 65 than the Chicago average. I also learned that hospitals collect information about communities like this, and we discussed why that might be. We thought hospitals might want to know this information because they want to provide solutions for their patients, they want to determine where to put clinics, and they want to figure out what kind of doctors to hire for the community. The most interesting fact to me is the leading causes of death in Chicago. Two of the leading causes of death in the city are obesity and violence/homicide. Starting a program to keep kids busy could really cut the violence rates because there would be fewer kids in the streets with nothing to do.

In Noble Nine we use this information to make better health choices, create programs for kids, and learn about our community. The information we saw was horrible; we noticed that there are not many healthy food stores around. This may be why kids eat junk food every day; this may be why they’re out of shape. Another reason may be that kids don’t work out like they need to; the closest they may get to working out is at school or through an organized sport. Unfortunately, not everyone plays a sport. Not everyone works out on his or her own time. If kids work out or jog and stop eating so much junk food, Englewood could be a healthier place. To make a difference, the community would need to change the convenience stores to healthier food stores and have food kids are interested in. A healthy food I see my classmates eat is green apples. Most students love green apples! Many students would also eat oranges or pineapples. Having access to healthier foods and regular exercise would be a great start to making Englewood healthier; kids just need access to good fruit they like to eat and fun games they like to play.

Apr 27, 2015 Written By: Robyn Golden and Bonnie Ewald

Promising Models in Transitional Care

Health & Medicine is pleased to share this post from Board Member Robyn Golden and Program Coordinator Bonnie Ewald on our work developing the Bridge Model of transitional care and other interventions to improve health for older adults. In addition to serving on our board, Robyn is director of Health and Aging at Rush University Medical Center in Chicago. Bonnie divides her time between our Center for Long-Term Care Reform and the Chicago Area Schweitzer Fellows Program. This article originally appeared in Aging Todaya publication of the American Society on Aging.

The older adult healthcare system faces complex challenges—among them are spiraling costs at the end of life, bridging fragmented services, ageism, attracting the necessary workforce and supporting family caregivers. The dominant medical model, based on discrete episodes of illness and curative care, largely ignores the big picture of individuals’ lives. As Dr. Atul Gawande recently wrote in Being Mortal (New York: Metropolitan Books, 2014), “Our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer.”

As an alternative to the current system, Gawande envisions one that works with individuals over time, taking into account a person’s self-identified goals, co-occurring medical conditions and the social determinants that affect their health and well-being. In this “refashioned” model, providers and organizations offer coordinated chronic care, and talk openly with patients and their families about goals, values and preferences. Thanks to the Affordable Care Act’s funding for initiatives such as accountable care organizations, Medicaid Health Homes, and Aging and Disability Resource Networks, many states and organizations are shifting toward such models. 

The Rush Model
At Rush University Medical Center, a large academic medical center in Chicago, health-related challenges facing older adults are not abstract policy issues, but are dealt with as stark realities demanding coordinated medical-psychosocial interventions. When individuals are discharged from the hospital they face many non-medical issues, such as who will make sure they connect with a primary care provider and appropriate home- and community-based services (HCBS)? How will care plans incorporate their values and preferences? Who will support them as they adapt to mobility changes and who will provide other psychosocial supports? Who will monitor caregivers to ensure their needs are being met? 

Rush’s Health and Aging department responds by employing a social work team that supports aging individuals as they transition between settings or manage multiple conditions. By evolving our work into standardized models of care, developing an evidence base and disseminating the models to other organizations, we seek to increase our impact and support others in changing their practice to meet the complex needs of their patients, too. We have successfully standardized our social work–centered approaches into the Bridge Model of transitional care and the Ambulatory Integration of the Medical and Social (AIMS) Model of integrating social work services into primary care, each with an evidence base showing reductions in hospitalizations and in emergency department usage.

One key contributor to our success in these efforts—and a strategy that could be employed by other advocates—is developing strong working partnerships between hospitals, community-based providers and advocacy organizations. Working closely with Chicago-area organizations such as Aging Care Connections and Health & Medicine Policy Research Group (a Chicago-based policy center working to support the needs of older adults) has enhanced the development and dissemination of best practices and the evaluation of our model. Together, we have shown that outcomes—such as hospital readmission rates—are significantly improved when social workers are an integral part of the care team, providing behavioral health support and building strong working partnerships between hospitals and HCBS organizations.

Developing such best practices for using social workers is critical because emerging care coordination models emphasize approaches that maximize the contributions of all team members, such as ensuring that all providers can effectively work at the top of their licenses.

New Approaches Work, but Difficulties Exist
Despite our approach’s great potential, working inside a flawed healthcare system has presented a number of difficulties, such as securing data-sharing agreements between hospitals and various HCBS organizations to ensure that medical and social service providers can easily access and share pertinent information. New models’ financial sustainability has also been a problem; while a social work team’s involvement may improve hospitals’ quality metrics (such as 30-day readmission rates or patient satisfaction scores), those outcomes do not always correlate with a clear business case. Furthermore, community partners’ financial stability remains a problem, and organizations across the spectrum struggle to adapt their practice culture by adopting and embracing new approaches to care.

Also, at the macro level, without a payment system that recognizes the value of psychosocial supports and community-based services, the resources older adults need often are missing. Finally, we lack validated metrics to evaluate the quality of various HCBS, making improvements in processes and outcomes difficult. How effective can a care coordinator be if affordable transportation options or quality, timely in-home services are not available?

It is imperative that older adults, their families, and we who work directly with them participate in the development of these new models. Repeatedly, in our work, we see patterns in how healthcare practice affects people’s lives.

Whether the client is a full-time family caregiver struggling to understand medical lingo or a 90-year-old adapting to mobility changes, we see that many health-related needs could be addressed by comprehensive, psychosocial services focusing on increasing health literacy and supporting individuals to live safely at home and in community. Health & Medicine organizes these lessons from on-the-ground partners to make policy recommendations that promote comprehensive health systems and address inequities in health and healthcare. In Illinois, for example, our input has affected the quality metrics by which Medicaid managed care organizations are measured, and has created the blueprint for a new ombudsman program for HCBS recipients.

Together, Rush and Health & Medicine are working toward a state and national system that bolsters HCBS providers, focuses on preventive care, reduces disparities, supports the economic security of older adults and their caregivers, and allows individuals to have a say in their care.

In our two-pronged approach of using innovative care models more responsive to the complex needs of older adults, and advocating for systemic change to improve future service delivery, we aim to create a health environment that truly allows patients’ voices to help guide healthcare practice.

Apr 03, 2015 Written By: Sharon Post

Monitoring and Improving the Medicare-Medicaid Financial Alignment Initiative

Health & Medicine’s Center for Long-Term Care Reform has been working with Community Catalyst to monitor and improve the Medicare-Medicaid Financial Alignment Initiative. Illinois’ Medicare-Medicaid Alignment Initiative is part of this program, established by the ACA and overseen by the federal Medicare-Medicaid Coordination Office (MMCO). Community Catalyst has convened meetings with state advocates and the MMCO, and based on those conversations they produced a letter to MMCO describing the systemic issues confronting states and offering recommendations to improve the program. Health & Medicine contributed to the letter and remains actively involved in Community Catalyst’s efforts to protect consumers and improve the performance of the Initiative. You can see the full letter below or click here to download. You can learn more about this issue here on Community Catalyst's website.

Mar 27, 2015 Written By: Wesley Epplin

Health & Medicine Resolution Opposing Governor Rauner’s Medicaid Cuts

Since Illinois’ new Governor, Bruce Rauner, gave his budget address on February 18, Health & Medicine has been working closely with other health advocates to fight back against the proposed cuts to Medicaid and other health and social safety net programs.  

1. We would like to share a brief update on some of our advocacy regarding Medicaid:Today, we are sharing Health & Medicine’s Resolution to OPPOSE Governor Rauner’s Cuts to Medicaid.  It begins:

Health & Medicine Policy Research Group encourages the Illinois General Assembly to reject the approximately $1.5 billion in cuts in Governor Bruce Rauner’s budget proposal.  Our government has the responsibility to improve the lives of people of State of Illinois, particularly poor and underserved communities.  

You can read the entire statement below or by clicking here.

2. Also, if you missed it, Health & Medicine had a recent opinion piece in Crain’s focused on the Medicaid cuts: First, do no harm? Rauner's Medicaid budget an economic drain.

The governor campaigned on a promise of “shaking up Springfield” and making Illinois “compassionate and competitive.” However, his proposed cuts to the safety net are akin to bloodletting: disproven and harmful to people's health, and a drain on Illinois' economy and budget. 

Read more.

3. You can follow along and join the conversation against Medicaid cuts via Twitter, using the following hashtags (and remember to follow @HMPRG): 
  • #KeepILHealthy (to follow the Medicaid conversation)
  • #TWILL (to connect the conversation with other Illinois issues)
  • #NoCuts (to connect with the broader fight against austerity)

Wesley Epplin is a Health & Medicine Policy Analyst focused on the health safety net, health reform, health workforce, and public health.  You can follow him on Twitter here.
Mar 16, 2015 Written By: David Fischer

Tamms is Not the Answer: Advocates Should Work to Keep Tamms Supermax Closed

“I Am a Man”

These words, borrowed from the placards of striking sanitation workers in 1968, were a rallying cry in the fight to close Tamms Supermax Correctional Facility. A fight that advocates thought was won in January of 2013.  Yet, just two years later State Representative Terri Bryant has filed House Bill 233 to re-open Tamms.  Her main argument?  That the prisoners who were sent to Tamms are dangerous criminals and that in order to avoid being “soft on crime,” these prisoners deserve the inhumane treatment of Segregation Solitary Confinement—a treatment which has been called torture by both Human Rights Watch and Amnesty International. 

Tamms Supermax was built for the sole purpose of keeping prisoners in utter isolation. With no cafeteria, recreation yard, classroom, or other social gathering space, prisoners were kept in their cells 23 hours a day, and allowed only one hour of recreation time in isolated concrete boxes. Some inmates were held in isolation for decades. The detrimental impact of solitary confinement is well documented and has been found to lead to deteriorating mental health, suicidality, and self-injury. In fact, solitary confinement can cause severe social entropy and social anxiety, meaning that prisoners who have been in solitary confinement have a more difficult time re-entering society.  

Why then, is Representative Bryant advocating that Tamms should re-open? 

One of her arguments is prison overcrowding. Overcrowding is a real issue in Illinois. A system built to house 31,000 inmates housed 48,653 people in 2012. Prison overcrowding leads to unsafe and unhealthy conditions for both the people who are incarcerated and the people who work there.  However, prison overcrowding is not a justification for re-opening Tamms for several reasons: 
  1. Illinois prisons were still experiencing overcrowding when Tamms was operating. Yet, the prison, which was built to hold 500 in its supermax facility and an additional 200 in its minimum security facility, generally ran at half capacity or less.  Because of the extreme treatment of prisoners, judges were reluctant to send people to Tamms.  
  2. Due to deteriorating mental health associated with solitary confinement, people held at Tamms faced even more difficulties obtaining parole than others in the system, meaning that more people were held in the facility for longer sentences than if they had not been placed in a solitary confinement facility to begin with.
  3. Overcrowding is a systemic issue in Illinois (and nationally) where minimum sentencing laws, policies that funnel black and brown men into prisons, and the over-reliance on prison sentences for low-level drug offenses lead to overcrowded prisons.
Representative Bryant also claims that closing Tamms led to increased gang activity in other prisons. While ang activity is undeniably an issue within Illinois prisons, there is little support for this point either. Gangs were an issue when Tamms was open, just as they are an issue now.  Where is the evidence that closing Tamms has increased gang activity?

There is no argument that Representative Bryant has given, or that she could give, that would necessitate re-opening Tamms. Tamms was a facility that used torture as a means to control—a facility that ran at three times the cost of other Illinois prisons, that stripped away the basic human rights of the people it held, and that did nothing to increase public safety, combat overcrowding, or tackle the myriad other issues facing our corrections system. 

If Bryant is truly interested in improving the system, perhaps she should consider advocating that Gov. Rauner re-fund CeaseFire, an organization that interrupts and addresses gang violence. Maybe she should encourage her county, and the rest of her district, to host Adult Redeploy sites. Maybe she should question the minimum sentencing laws that force low-level offenders into prison sentences. Maybe she should address the stark racial disparities that lead to more black men being charged for the same or similar crimes as white men who are not charged. There are many options Representative Bryant could endorse that would impact the issues of overcrowding, public safety, and gang violence she claims motivated this bill, but none of those options include re-opening Tamms.  

Feb 27, 2015 Written By: Health & Medicine Policy Research Group (HMPRG)

What We're Reading - February 27, 2015

A rundown of the articles and stories that caught our eye this month:

#BlackLivesMatter — A Challenge to the Medical and Public Health Communities
“Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism — both institutional and interpersonal — that contributes to poor health in the first place? Should we work harder to ensure that black lives matter?

As New York City's health commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on issues of racism and health.”
From Mary T. Bassett, M.D., M.P.H. in the New England Journal of Medicine, February 18, 2015

Lurie Children's CEO Calls on Rauner to Keep Coordinated Care for Kids
“As CEO of the state's largest children's hospital, Patrick Magoon said he will lead the effort to prevent any proposed cuts to specialized programs that help care for some of the country's sickest kids.

Funding for coordinated care entities, as such programs are known, is a small part of a proposed $1.47 billion cut to the state's Medicaid program, unveiled last week by Gov. Bruce Rauner. The Ann and Robert H. Lurie Children's Hospital runs a three-year pilot program to help families manage care of children with complex medical issues. Lurie has 1,700 patients but can enroll up to 5,000.”
Chicago Tribune, February 26, 2015

Oliver Sacks on Learning He Has Terminal Cancer
“Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.

On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.”
The New York Times, February 19, 2015

A Call to Action for End-of-Life Care of Older Adults in Nursing Homes
“End-of-life care for nursing home residents has long been associated with poor symptom control and low family satisfaction. With more than one in four older Americans dying in a nursing home -- including 70 percent of Americans with advanced dementia -- an editorial published in the Journal of the American Medical Directors Association calls for bold action to improve the care and support provided to dying nursing home patients and their families.”
Indiana University, February 19, 2015

Dr. Nadine Burke Harris Gets to the Heart of Children’s Stress
“As Dr. Nadine Burke Harris treated child after child, something told her she wasn’t getting the full picture. Most of her young patients at the Bayview Child Health Center were from the surrounding, predominantly African American neighborhood in southeastern San Francisco. Their home lives were largely plagued by poverty, domestic abuse and chaos, and later in life, many of them developed chronic illnesses. But were the two related?...

In 2011, Burke Harris left to become founder and CEO of the Center for Youth Wellness in the Bayview, a clinic that also researches the effects of stressful situations on children’s health. Her work has earned her statewide and national recognition, which includes an appointment as an expert adviser on Hillary Rodham Clinton’s project to improve young children’s lives, the “Too Small to Fail” initiative.”
San Francisco Chronicle, February 15, 2015

Learn more: Click here to listen to Dr. Harris’s TEDMED talk, “How childhood stress affects health across a lifetime.”

Chicago Children At Risk of Going Hungry
The Social IMPACT Research Center, along with the Greater Chicago Food Depository, recently released new research on breakfasts in schools. Their report shows that only 36.3 percent of possible federally funded school breakfasts are served to eligible schoolchildren in school, meaning hundreds of thousands of children are at risk of going hungry in the classroom. Experts view school breakfast as a vital program for addressing food insecurity; however, Illinois leaves $90.4 million in federal funding on the table because schools do not serve breakfast.

Feb 18, 2015 Written By: Wesley Epplin

Austerity Bites: Defending Medicaid Against Budget Cuts

Illinois’ Medicaid program and budget have been in the news a lot lately.  Most notably, Illinois’ new Governor, Bruce Rauner, proposed an approximately $1.5 billion in cuts to Medicaid in his budget proposal, including reinstituting parts of the 2012 “SMART” Act.  As many advocates and lawmakers have stated, cuts to Medicaid will hurt some of Illinois’ most vulnerable residents by limiting access to lifesaving healthcare, and in many cases actually end up raising health care expenditures. 

Prior to Rauner’s budget release, the Chicago Tribune published a front page story, Medicaid Expansion Cost Soars, on February 3, and an editorial, The state of this state? Critical. 

A number of advocates and stakeholders submitted letters to the editor in response to these stories, with the following being published by the Tribune.  These are useful perspectives for advocates to remember as we gear up once more to protect Medicaid from harmful cuts.
Health & Medicine likewise submitted an op-ed, which, while it was not published, we would like to share with our readers:

In response to the Tribune’s February 3, 2015 cover story, Medicaid Expansion Cost Soars, the fact that Medicaid expansion in Illinois has extended coverage to hundreds of thousands of previously uninsured residents is a great benefit to our state. Before the Affordable Care Act, many of those who have gained coverage waited until there was a health emergency before seeking care—this was more expensive for them, healthcare systems, and the State. Lack of coverage is not only a hardship to individuals and families (resulting in unnecessary illness, pain, loss of productivity, financial costs, stress, and tragically unjust and avoidable loss of life), but also for the hospitals and the public and private funders who bore the burden of paying for charity care. Hundreds of thousands of Illinoisans have gained health insurance and healthcare access, and we now have a far better way to pay for it; the Federal Government pays the vast majority of Medicaid expansion costs, currently at 100%, and to be reduced to 90% by 2020. Further, as more people seek primary and preventive care, we will see improvements in health and slowed growth of healthcare costs. Therefore, it is in everyone’s best interest for Illinois to figure out a way to continue to fund its portion of Medicaid. Elected officials interested in reducing Medicaid costs should also continue with other important reforms: ensuring that there are adequate reimbursement levels to provide high-quality care and services; implementing health reform and public health promotion efforts; committing to the elimination of poverty in Illinois; and facilitating healthcare access to the hundreds of thousands of Illinoisans who remain uninsured. Commitment to these reforms will ultimately save public dollars and lives.

Margie Schaps, MPH, Executive Director
Wesley Epplin, MPH, Policy Analyst
Health & Medicine Policy Research Group

As always, Health & Medicine remains committed to assuring access to the human right to healthcare.  Medicaid is a crucial part of our State’s health safety net and improving delivery systems—not cuts to the system—will make Medicaid more efficient and improve the public’s health.  As we stated in our letter, politicians who are concerned with reducing the number of people who need Medicaid should focus resources on eliminating poverty, not limiting healthcare.

Also, elected leaders must put forth plans that provide adequate revenue for the State.  There are several policy options that can be employed to gain the revenue the State needs to provide for the healthcare, social services, education, and infrastructure needs of its residents.  Illinois cannot cut its way to a balanced budget.

Advocates who are interested in being involved in advocacy to help protect Medicaid can register for an upcoming Medicaid and Budget Advocacy Summit, coming up on Friday, March 6, by clicking here. Additionally, a “Medicaid – No Cuts” resolution was introduced by Representative Mary Flowers in the Illinois House of Representatives today.


Jan 29, 2015 Written By: Health & Medicine Policy Research Group (HMPRG)

What We’re Reading - January 29, 2015

A rundown of some of the articles and stories that caught our eye this month:

Dilemma Over Deductibles: Costs Crippling Middle Class
Physician Praveen Arla is witnessing a reversal of health care fortunes: The poor are getting care and others with high-deductible plans are putting it off.
USA Today

Bernie Sanders Got Republicans To Make His Argument For Universal Health Care
“.. to Sen. Bernie Sanders (I-Vt.), who has long supported the creation of a universal health care system, battling over that particular point began to seem absurd, and he opened his remarks by noting that in every other developed country, such a debate would make no sense at all.

‘The argument of whether you provide health insurance to people who work 30 hours a week or whether they work 40 hours a week -- whoa,’ Sanders said. ‘In every major country on Earth, health care is a right of all people.’"
The Huffington Post, January, 23, 2015

To Extend or Not to Extend the Primary Care ‘‘Fee Bump’’ in Medicaid?
"While fee increases have not been shown to dramatically increase physician participation in Medicaid, efforts to reduce payment delays, administrative burdens, or the risks of beneficiaries churning off Medicaid may affect PCP participation in Medicaid as much or more. It may also be possible to achieve improvements in access through a more selective application of reimbursement-based incentives, directing those incentives to types of care providers more likely to respond to them. Moreover, efforts focusing on other determinants of patient access to care (e.g., provider network restrictions, transportation, language barriers) have significant potential to improve Medicaid beneficiaries? access to care."
Journal of Health Politics, Policy and Law

The Uninsured: A Primer - Key Facts About Health Insurance and the Uninsured in America
“The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. The access barriers facing uninsured people mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact also can be severe. Uninsured families struggle financially to meet basic needs, and medical bills can quickly lead to medical debt.”
The Kaiser Family Foundation, January 12, 2015

The Economic Benefits of Paid Parental Leave
If President Obama has his way, paid leave for new parents and people caring for ailing relatives will become national policy. Last month, he gave federal employees the right to take six weeks of paid leave when they become parents. And in his State of the Union address, Mr. Obama framed paid leave as a crucial economic matter.
The Upshot via The New York Times, January 30, 2015

Obamacare 2.0: the White House's Radical New Plan to Change how Doctors Get Paid
The idea is to move away from the broken and expensive "fee-for-service" system, which pays doctors a flat amount for every surgery and physical they perform — even if they do nothing to actually help a patient. If this works, the White House hopes it will do two things. The first is improve the quality of health care in the United States, by paying doctors the most when they provide the best care possible.
Vox, January 26, 2015

Jan 21, 2015 Written By: Guest Author

Disability Rights and Worker Rights in the New Home Care Rule: A Social Justice Perspective

Recent regulatory changes from the Department of Labor and litigation challenging them have sparked increased discussion on the role of home care workers and personal assistants, an important workforce that helps meet the needs of many older and disabled Americans. These decisions have implications for compensation of workers, access to services, and the independence of people with disabilities and older adults and have led to passionate debate among workers groups, disability rights advocates and those working in health policy.

As part of this ongoing discussion, Health & Medicine is pleased to share a guest blog post from Board Member Tom Wilson. In addition to his work with Health & Medicine, Wilson serves as a health care community organizer at Access Living, a Chicago-based organization committed to the independence and inclusion of people with disabilities.

On December 22, 2014 U.S. District Court Judge Richard Leon vacated the third party regulations amended by the Home Care Final Rule. On January 14, 2015 the District Court vacated the Final Rule’s narrowed definition of “companionship services” that are exempt from overtime compensation  in a new opinion in Home Care Association of America v. Weil.

Our society has seen several decades of attacks on unions and working people. The percentage of the private sector workforce in unions has shrunk to 6.7% in the U.S.  Many of the new jobs including home care jobs being created in this country tend toward very low wages. There is a need in our service sector for jobs that pay enough to support a family, as many of these workers are raising children and caring for families.

The court order vacating the Department of Labor regulations mandating overtime wages and minimum wages for home care workers falls into the ongoing attacks on the living standards of workers and contributes to our growing economic inequality. The judge ruled that these rules could not be done administratively but must be done legislatively. The Department of Labor obviously disagrees and may appeal.

Home Care has been a growing area of employment for several decades. It has been shaped by social and demographic changes and the disability rights movement.
The responsibility for caring for incapacitated seniors and people with disabilities that prevent self-care, has traditionally been a family responsibility. For the majority of care this is still true and many families work hard to take care of disabled family members.  As families have had to change and it has become common for a family to depend on multiple wage earners, there has been an impact on family caregiving. For the last 50 years when families were unable to provide this essential care, the solution often involved institutionalization including placement in nursing homes.

The disability rights movement understood that this way of “caring” for people had been a disaster for people with disabilities.  Many of the institutions had a record of serious abuse and neglect. People not only got bad care, but they were isolated from society, had their rights infringed upon and were reduced to dependents without choices and opportunities.

The disability community has fought for the right to be assisted in their own homes with caregivers chosen by them and for programs to pay for this valuable work that keeps them independent and active members of the community.  These services have been seen as a civil right by people with disabilities. These rights were expressed in the Americans with Disabilities Act and upheld in the Supreme Court’s Olmstead decision.

The disability community has fought for funding so people can live full lives outside institutions, with the support of paid home care workers. In a period of austerity it has been a struggle to sustain adequate funding. In some states, the home care workers have organized and are represented by unions, often SEIU, as they are here in Illinois.

These workers were excluded from typical worker rights under what are archaic federal laws about home care.  SEIU and other allies were able to get the U.S. Department of Labor to update those rules.

However some people opposed these changes. Some of the opposition came from Home Care agencies that make money by keeping wages low.  Some people in the disability community also opposed these rules because they feared cuts in hours of service for people with disabilities and seniors due to the difficulty in increasing state budgets for home care.  They thought higher wages meant fewer hours. They saw a likely scenario that some states would ban overtime hours, requiring some people with disabilities to replace their trusted worker for hours over the cap. This could mean even less wages for some workers, but the other concern was that people with disabilities want caregivers that they trust and they know well.  It is difficult to find and hire other workers that you trust.

My view as a supporter of social justice is that disability rights and worker rights are both important. It is crucial that people who use home care services and people who do home care need to unite to fight for worker rights like overtime pay, sick days and health benefits, at least until we can win universal single payer health care.  Worker rights need to be defended by all of us. We need to make sure that states respect disability rights and that they treat the workers who care for people with disabilities as valuable workers. We need to make our politicians see that people with disabilities deserve well paid workers, that people with disabilities deserve quality home services and that people with disabilities deserve to be treated as valuable members of society.

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