As the clock ticks toward the full implementation of the Affordable Care Act next year, Jewish federations, the largest Jewish stakeholders on the issue, are mobilizing their members to ensure that the historic health care reform does not hurt funding for communal health care institutions.
Depending on how it is implemented, the legislation, Jewish leaders fear, could have a direct impact on more than $7.5 billion that federation agencies receive annually in Medicaid and Medicare funds to provide health care services to Jews and non-Jews.
“We are working with policy leaders to ensure that the law is upheld fairly and to send a clear message that laws have an impact on real people and real institutions,” said William Daroff, vice president for public policy at the Jewish Federations of North America, a federation umbrella organization. “If a Jewish nursing home receives less money per bed, it is clear that it will not turn down the person in need, but the nursing home will have to come to the federation and to donors to cover the difference.”
In a recent conference on health care reform, federation officials urged their members to speak to lawmakers and to lobby administration officials in a last-ditch attempt to influence the regulations that will give concrete shape to the landmark law passed in 2010.
Care for the elderly is a prime concern for the Jewish community, which is aging significantly faster than the general population. Currently, 20% of American Jews are 65 or older, compared with 13% of the general population. The Affordable Care Act, commonly referred to as Obamacare, would have a direct impact on some of that funding, mainly because the structure of government funding and reimbursement is about to change dramatically.
In Chicago, for example, 19,000 older adults receive services from CJE SeniorLife, the Chicago federation’s network of elderly care services, at a total cost of $50 million a year. Most of the expenses are covered by federal programs or by recipients of the services, with 10% being paid for by allocations from the federation. Even the slightest drop in government funding would translate immediately into a need for more federation dollars to go into the community’s elderly care system.
A cut in funding could result from the transformation of health care reimbursement from a fee-for-service system into a result-based model under the new law. Jewish communal officials are also focused on the impact of incentives that the new law offers to health care providers who forge partnerships to improve their quality of care.
Hospitals, for example, would be rewarded for a low readmittance level, a decision that led Chicago’s Jewish network of senior care services to partner with three hospitals to work together on lowering readmission rates. “This will allow us to fulfill our mission in this new paradigm and to see how we can become part of the solution,” said Bruce Lederman, board chairman of CJE SeniorLife. Lederman argued that the new funding system provides federations with opportunities rather than concerns.
During the run-up to the health care law’s passage, the Jewish federation system chose to sit out the fierce debate that accompanied its passage during President Obama’s first term. The silence reflected conflicting pressures on a system. It is a system that, on one hand, provides health care needs to hundreds of thousands — mainly the elderly and mentally ill — in the Jewish community and elsewhere; but, on the other hand, it is dependent on donations from wealthy business owners, many of whom opposed the proposed law. As a result, the federation leadership during this period conveyed the message to its activists that health care reform had become “too political,” as one communal activist described it, and therefore should be left alone.
Now, however, following the defeat of legal challenges to the law, federations are seeking a seat at the table in order to influence the law’s practical aspects. “Now that the Affordable Care Act has been upheld and is going to be implemented, we need to understand what it means and how it affects our constituencies,” said Sandy Teplitzky, a federation lay leader from Baltimore who co-chaired JFNA’s recent meeting on the issue.
Some Jewish organizational leaders defended the Jewish community’s inaction during the legislation’s earlier stages.
“On this issue, it was wise to remain active listeners to the dialogue,” Lederman said.
Joining the process at the post-legislative stage does not seem to have cost JFNA any access to the decision making process. The group has, in recent months, been in dialogue with the administration over the law’s implementation. JFNA officials were even invited recently to a White House meeting to discuss ways to engage communal organizations in promoting participation in the plan. A JFNA representative was also included on a special administration commission that will soon begin working on long-term care.
“I think their input would be welcome even though they were not supportive of the plan during the earlier discussion,” said one activist, who was critical of the group’s reluctance to engage earlier.
For each federation and the agencies it supports, the Affordable Care Act, with its thousands of pages of legislation and numerous rules, represents a practical challenge.
One concern is the plan to cut in half extra funding provided for hospitals that serve a disproportionate number of low-income patients, a category that includes many Jewish hospitals. Obamacare is intended to decrease significantly the number of uninsured Americans, thus reducing the number of patients unable to pay their hospital bills. But JFNA and federation activists have argued that the cut in extra funding for these hospitals should come only after the number of uninsured patients is actually decreased, not before.
Another key issue for Jewish health care providers is funding for long-term mental health care, which has not yet been brought to the reimbursement level of other health care services.
“Everything will start rolling out in 2014, and we want the rules to be out by October so people will know what choices they have,” said Julie Kass, a member of the JFNA’s long-term care committee and a lawyer representing health care providers. “You need to get them to write these regulations. Don’t let those final rules just hang there.” Kass urged the community to take action and actively lobby Congress and the administration on this issue.