The Affordable Care Act (ACA) precipitated a decade of reforms and reactions that have made a distinct impact on the Cook County health care safety net. “Reform” in health care encompasses a complex interplay of changes, forces, structures, and agents—including official legislation and rulemaking as well as the responses of government agencies, health care providers, payers, patients, advocates, private funders, and others. The health care safety net exists in constantly changing relationships to all the moving pieces that comprise the amorphous topic of ‘health reform.’
Within a context of power inequities and deeply rooted systems of oppression, safety net institutions seek to provide care to mitigate their harm. When people reference a social determinant of health, whether it be housing, food, education, transportation, or jobs, there is also an imperative to explore the connection to structural inequities, based on root cause-level systemic oppression. Within safety net institutions, individual workers and patients attempt to find spaces within this broader context where services that meet basic health needs are accessible to all. Funders, advocates, and policy-makers are caught up in a similarly dynamic interplay as providers, patients, and payers. Even as people work to either personally meet their needs or to fill urgent gaps in services, many also work to nudge parts of the system to change direction while responding to ongoing change.
In 2016, Health & Medicine initiated a research project to explore the impacts, unintended consequences, and unfinished work of health reform—broadly defined—from the perspective of representatives of Cook County’s health care safety net through interviews and focus groups with people working in the sector. In late 2018, we began the process of re-interviewing participants in our original research project as well as adding the perspective of stakeholders from additional sectors. Initial findings from this qualitative research served as the basis for an October forum entitled The Chicago Forum for Justice in Health Policy: Health Reform Impacts, Challenges, and the Future. Forum participants responded to our research findings as well as adding their own feedback and experiences. This report summarizes our learnings based on both our research and the forum proceedings.