Effort also advocates for Medicaid expansion under federal law
By JULIE MINDA
U.S. health care is changing quickly as the country implements the Affordable Care Act, but many people are confused about or unaware of how the act impacts them.
An advocacy program funded in part by Mercy educates Mississippians about the benefits of health reform and helps people access the assistance the act provides.
"Many people don't know (what benefits) exist because of the misinformation that is out there, and some don't even realize that the law has passed," said Roy Mitchell, executive director of the Jackson, Miss.-based Mississippi Health Advocacy Program. "We educate on what the ACA is, how it can help and what's coming" in the future.
The 20-year-old program from Chesterfield, Mo.-based Mercy also helps people sign up for Medicaid and answers their questions about private and public insurance benefits. At the same time, the program pulls together coalitions of advocates to support federal and state legislation that benefits vulnerable people, including the uninsured.
Mitchell said of the dual approach of educating and advocating around the Affordable Care Act: "This is something any Catholic hospital can do to improve community health, and we would want to see our efforts replicated" elsewhere in the ministry.
Advocating social justice
The Sisters of Mercy congregation has provided health care services in Mississippi since they treated injured soldiers in the Civil War. They sponsored a hospital in Vicksburg, Miss., from 1943 until they sold it in 1991. The hospital was part of Sisters of Mercy Health System — now Mercy — at the time of the sale.
Wanting to maintain some type of health care presence in Mississippi, a small group of Sisters of Mercy conducted an assessment in the early 1990s that revealed a strong need for health improvement in Mississippi, especially among the poor. Then, as now, Mississippi ranked last or near the bottom among U.S. states for many health indicators.
In response, the sisters created the Health Advocacy Program to improve health policy, practice and funding in the state. Sr. Donald Mary Lynch, RSM, now executive director of the St. Gabriel Mercy Center in Mound Bayou, Miss., was one of the sisters who established the program. She said the sisters' goal was and is to advance social justice principles, including care of the poor, through advocacy. "This is what is needed to move our principles forward," she said.
Much remains to be done to improve the health of Mississippians. Today the state ranks dead last when it comes to obesity, diabetes and sedentary lifestyles; and it has high rates of smoking and cardiovascular deaths, according to America's Health Rankings, a service of the United Health Foundation.
Building coalitions
The Health Advocacy Program has been a small outfit from the start — today it has 18 staff members, including advocacy experts and outreach staff — and so it relies on coalition-building to pursue its advocacy agenda. "We try to be the catalyst for movements and to build the capacity of our partners," said Mitchell. Its partners include associations, government agencies, nonprofits, private organizations and advocacy groups at the state and national level.
In the 1990s, the Health Advocacy Program advocated for responsible welfare reform. Around 1997, during the rollout of the State Children's Health Insurance Program in Mississippi, the program advocated to ensure Mississippi fared well in funding formulas. Around 2004, the program built a coalition that helped pass a cigarette tax that prevented Medicaid cuts. The program later concentrated its efforts on advocating that the state fund Medicaid at levels that would secure a maximum federal match.
Sr. Lynch said the Health Advocacy Program "has made enormous strides and had significant influence on legislation." That influence has translated into benefits for vulnerable populations, she said.
Making converts
Since the ramp up to the Affordable Care Act's 2010 passage, the Health Advocacy Program has focused on health reform, initially through advocacy efforts to support passage of the federal law, and since then through promoting its full implementation in Mississippi. The Health Advocacy Program is working to counter ongoing opposition to coverage expanding aspects of the law by many top Mississippi lawmakers.
Jarvis Dortch, a program manager with the Health Advocacy Program, said staff talk about the promise and benefits of health reform at town hall gatherings, business group meetings, health fairs and churches. Dortch said the speakers tailor the message to the audience — they've spoken to businesspeople, workers, legislators, church members and community groups. "We've found that when we discuss health reform — when we break it down and talk about how it impacts real people — people are receptive," said Dortch.
He said many in Mississippi oppose reform out of concern over government spending. "But, we look at it as an investment — we show people that this can be a job creator and an economic benefit." The Health Advocacy Program speakers often cite an October 2012 study from the University Research Center of the Mississippi Institutions of Higher Learning that said "increased access to health care could enhance the overall health of Mississippi's residents. In the long term, a healthier workforce should result in a more productive workforce, leading to a healthier, more robust economy."
Polling shows that Mississippians are becoming more accepting of reform, and Mitchell and Dortch said they believe their program has helped bring about this shift.
Natural for the ministry
The Health Advocacy Program also provides hands-on help for people. The program's Health Help initiative maintains a toll-free help line and outreach offices scattered around the state. Staffers screen Mississippians for Medicaid eligibility and help with enrollment. They also are gearing up to increase their efforts if and when Medicaid eligibility is expanded under the Affordable Care Act, according to Mitchell.
They answer questions and function as ombudsmen for privately insured people, a role officially granted to the program by the federal government, Mitchell said.
The Health Advocacy Program's work is funded primarily by Mercy, the W.K. Kellogg Foundation and government grants.
Mitchell said under health reform, health care providers and organizations like his have access to a wealth of federal grant funding, particularly for outreach related to health reform. He said most hospitals and health systems have expertise in grant writing that could be applied to secure federal grants. But, he said, many providers "are not recognizing the opportunity — we're leaving millions of dollars on the table."
He said with the purposes of health reform right in line with the Catholic health mission, "there's no reason why we wouldn't work to support the act" and its implementation.
Medicaid expansion in Mississippi
Many prominent Mississippi politicians have opposed the Affordable Care Act and particularly its expansion of Medicaid and its implementation of state insurance exchanges. Mississippi Gov. Phil Bryant told Kaiser Health News in January that he opposes the creation of a state exchange in Mississippi and a related expansion in the Medicaid rolls. Bryant said Mississippi cannot afford to take on the cost of more Medicaid enrollees.
The Republican governor said about 640,000 Mississippians currently are on Medicaid, and that number could grow to 940,000 with the expansion. The act says that after three years of the federal government paying all of the costs for the Medicaid expansion, states will be responsible for at most 10 percent of the costs going forward. An economic brief from the University Research Center of the Mississippi Institutions of Higher Learning estimates that if a "moderate" number of Mississippians are added to the Medicaid rolls through the expansion, the expansion will cost the state a cumulative $530.5 million by 2025. This assumes 75 percent of eligible participants will be enrolled in the Medicaid expansion in 2014 and that 85 percent of eligible people will be enrolled by 2016.
Reuters reported in February that Mississippi had applied to establish an insurance exchange, but the U.S. Department of Health and Human Services denied that application, saying that Bryant's opposition would have made it unfeasible for an exchange to work. Now, the federal government will set up a default exchange.
Seven Republican governors who initially opposed Medicaid expansion have since changed their positions including Florida Gov. Rick Scott and Arizona Gov. Janice Brewer, but Bryant has said he will continue to work to thwart Medicaid expansion. Bills have been filed in the Mississippi legislature — some to ease and some to stop the expansion — but none currently are nearing passage, according to Roy Mitchell, executive director of the Mississippi Health Advocacy Program.
Copyright © 2013 by the Catholic Health Association of the United States
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