Health Care Safety Net Center

For more information about this program, please contact:
Wesley Epplin, Policy Director, wepplin@hmprg.org

Overview

The Health Care Safety Net Center at Health & Medicine works to strengthen the safety net of policies and systems that help provide health care for people who would otherwise go without it. At the heart of this Center’s work is the longstanding belief of Health & Medicine that health care is a human right and must be honored and upheld as such. As health reforms are enacted locally and nationally, our health systems reform leadership is central to developing thoughtful implementation strategies to expand care for all Illinois residents while also assuring that stakeholder voices are heard and integrated into new policies.

Our approach

How do we advance health care as a human right? Our multi-pronged approach includes policy research, health planning, narrative change, policy advocacy, consulting, and more. We engage partners and provide education around policy and politics that shape what’s possible to achieve. We center human rights as core to health equity, which is a long-term goal that takes building a movement. We grow the base of individuals, organizations, elected and appointed officials, and government institutions that are committed to health equity, equity more broadly, and social justice.

Our work includes: 

  • Activating and participating in coalitions and collaborations
  • Consulting and planning with public agencies
  • Policy research
  • Policy advocacy
  • Hosting educational events
  • Narrative change
  • Intersectoral collaboration
  • Interdisciplinary engagement
  • Intersectional solidarity

Some of the frameworks that influence our work are listed here:

  • Social epidemiology
  • Eco-social theory
  • Social determinants of health framework
  • Health in all policies
  • Human rights
Our work

Health & Medicine’s Health Care Safety Net Center works to move society toward upholding health care as a human right.

In the last several years, Health & Medicine’s health policy and health systems reform leadership has contributed to Affordable Care Act (ACA) implementation and state health reform initiatives in Illinois. Health & Medicine’s greatest strength is our reputation among government, private and non-profit partners as an “honest broker” and trusted authority on all aspects of health policy, with expertise in health care safety net issues. We build coalitions across all sectors to align efforts and maximize the potential of reform. We interpret federal and state policy for local systems by researching best practices, convening stakeholders and building consensus to facilitate successful policy implementation and achieve the essential goal of health reform: the human right to health care for all.

Health & Medicine serves as the leading health policy resource in Chicago and Cook County—advising elected officials at the local and national level, health systems, providers, academics, and more. We conduct research to examine how the ACA and state health reform has enabled the healthcare safety net to enhance services and address the social determinants of health, as well as unintended consequences of reform. Health & Medicine continues to serve as a resource for health systems leaders at the county level (including the Cook County Board and Health System Board) testifying at County Board meetings and advising other groups on how to best work with the public sector. We advise Cook County Board President Toni Preckwinkle on new appointments to the Cook County Health and Hospitals System (CCHHS) Independent Board, which Health & Medicine helped to create in 2007 and continues to serve on the nominating committee. 

Important engagements include:

Healthy Illinois Campaign: Health & Medicine is a charter member of this campaign, which is focused on making quality, affordable healthcare coverage accessible to all people in Illinois, regardless of immigration status.

Nominating Committee for the Cook County Health and Hospital System Independent Board: Health & Medicine is a longstanding member of and currently chairs the Nominating Committee for the Cook County Health and Hospital System Independent Board.

Budget engagement: Health & Medicine regularly weighs in on the Cook County Government budget, speaking with the President of the County Board, other commissioners, and Cook County Health leadership regarding the need for robust funding for the health system. 

Protect Our Care Illinois: Although this coalition is currently inactive, Health & Medicine remains committed to this collective effort to protect health care coverage in Illinois, especially to respond to new threats to this coverage.

Research and Writing

Two current Health & Medicine’s Health Care Safety Net Center research and writing projects:

  • Certificate of Need: Health & Medicine is researching the development, effectiveness, and potential reforms related to the certificate of need process in Illinois.
  • Cook County Health Governance: Our staff have interviewed past members of the Cook County Health & Hospitals System Board for insights on how this board could more effectively support Cook County Health. 

Recent media engagements

Past research

Strengthening the Safety Net in Illinois After Health Reform

Creating Healthy Communities: Helping the Safety Net Navigate the Challenges and Opportunity of Health Reform In 2017 Health & Medicine conducted a research project examining how the ACA and state level health reforms can support the move toward health equity and stronger communities in the Chicago area with a specific focus on the Western Suburbs. This research led to two papers:

  • Beyond the Clinic: A National Health Equity Review Implications for our local safety net (March 2018) This policy and practice review of national work examines how the safety net can use this time of health reform opportunity to address social determinants of health, structural determinants of health inequities, and ultimately health equity. Ample studies and papers detail clinical care interventions and programs to provide more services to meet unaddressed needs. However, these studies rarely focus on the need for large safety net institutions to utilize their individual and collective political power to change the structural inequities that drive the inequitable distribution of social determinants of health. To make a valuable new contribution to the trajectory of healthcare’s interest in advancing health equity, this paper does not focus on social determinants of health. Rather, it gives examples of this work to orient readers to research and national efforts. The paper also addresses how the power of the health sector—which represents roughly 18% of the U.S. economy—could be better used to influence structural drivers of inequities.
  • A Qualitative Review of Chicago’s West Suburban Safety Net: Consequences, Adaptation, and Recommendations for Future Reform (March 2018) This study extends previous research examining the impact of the Affordable Care Act and state Medicaid expansion on the safety net. The paper analyzes how the current political context impacts the safety net sector while also examining overall adaptations to health reform, understanding its consequences, and identifying safety net stakeholders’ policy and philanthropy recommendations for future reform. This research focused specifically on the safety net in western Cook County and eastern DuPage County, Illinois (the western suburbs of Chicago). Researchers conducted key informant interviews with executive leadership and focus groups with staff from thirteen area federally qualified health centers (FQHCs), hospitals, free and charitable clinics, insurers, and community-based organizations using semi-structured focus group and interview guides. In addition to qualitative analysis, our report offers policy and practice recommendations to address the challenges of reform at the institutional, state, and federal level.

Strengthening the Safety Net After Health Reform: An Examination of the Cook County Safety Net (June 2016) In 2016, Health & Medicine completed new research on the Cook County Safety Net in partnership with Loyola and others to capture how state and federal health reform efforts have impacted Federally Qualified Health Centers (FQHCs), free and charitable clinics (FCCs), and hospitals in Cook County. This study was unique from others that examine the safety net in that it intentionally asked participants to discuss both the anticipated effects and the unintended consequences of health reform implementation. Key themes include:

  • The challenge of navigating the changing insurance and provider landscape
  • Continued barriers to access as services remained unaffordable even with reform
  • The need for greater support for quality improvement activities as well as enhanced capacity to respond to the demand for patient-centered care that addresses social determinants of health

These anticipated and unintended consequences have required FCCs, FQHCs, and hospitals to constantly adapt to the reformed environment and have revealed the depth of each of the systems’ organizational capacity and assets. Our report is designed to deepen understanding of the Cook County safety net while providing recommendations for policymakers and philanthropy, as well as identifying areas for further research to guide health reform and policy.

History of Leadership

Below are some examples of work from the past decade by Health & Medicine’s Health Care Safety Net Center. Our organization’s work and commitment to health care as a human right stretches back to the very beginnings of our organization. As our founder, Dr. Quentin Young would say, “Everybody in, nobody out!”

Public Health Woke: This project was pursued alongside our colleagues at the Collaborative for Health Equity Cook County and as part of the Reimagine Health team. The group took action on the recommendations from Public Health Awakened titled, A Short Guide to Protecting Undocumented Residents and Their Families for the Benefit of Public Health and All Society. In particular, our efforts focused mainly on Cook County Health improving its signage, referrals process, training for staff, and internal policies regarding making facilities safer and more resourceful for immigrants and other groups facing harsh and increased vitriol as well as increased actions by government agencies against immigrants.

Governor’s Office of Health Innovation and Transformation: In 2015, during the implementation of the Affordable Care Act, Illinois’ Governor’s Office called on Health & Medicine to serve as a lead coordinator for the Governor’s Office of Health Innovation and Transformation (GOHIT) and its efforts to develop a health reform implementation plan for Illinois. Over the approximately six-month project, Health & Medicine worked with 900+ stakeholders, participating in and overseeing 30+ committees and ensuring stakeholder voices informed the initiative. The results of thousands of hours of work by healthcare stakeholders from across the state, the GOHIT process yielded numerous policy recommendations that can contribute to the improved provision of healthcare in Illinois and ensured stakeholder voices informed the initiative. The results of thousands of hours of work by healthcare stakeholders from across the state, the GOHIT process yielded numerous policy recommendations that can contribute to the improved provision of healthcare in Illinois.

As leaders in the GOHIT process, Health & Medicine volunteered to host the archive of the reports and resources that came out of the initiative as resource for those working to advance health policy reform in Illinois. Click here to view all GOHIT materials via Dropbox. 

Medicaid 1115 waiver application support: In 2014, Health & Medicine was asked by the Governor’s Office to engage stakeholders regarding the Medicaid 1115 waiver being sought by the administration. The 1115 waiver application, titled Path to Transformation, sought a range of improvements related to improving how Medicaid would support patients, including overhauling existing waivers, supporting people with behavioral health problems, providing supportive housing, workforce initiatives, and providing support for other social determinants of health. Health & Medicine collected, sorted, categorized, and summarized comments such that they could be responded to appropriately to improve the state’s 1115 waiver application.

Our Other Initiatives and Programs