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ID ’em. Inform ’em. Insure ’em.

The fast-approaching opportunity to obtain affordable health insurance likely means something different to each and every one of the half-million Chicagoans now estimated to be going without.

LISC Chicago's 13 Centers for Working Families sites will provide enrollment assistance to Chicagoans seeking health coverage.

Gordon Walek

For working families earning too much for Medicaid and too little to afford private insurance, subsidized coverage opens the door to regular checkups, inoculations and screenings – things their children should have had but, until now, their budgets wouldn’t allow. For others it might mean coverage, at last, for a previously uninsurable “existing condition” such as diabetes or prostate cancer.

For veteran community organizers on Chicago’s Southwest Side, however, this fall’s grassroots rollout of the federal Affordable Care Act (ACA), popularly known as ObamaCare, has the potential to impact just about every aspect of community life.

“More home foreclosures happen because of medical bills than any other reason,” said David McDowell, a veteran organizer with the LISC-affiliated Southwest Organizing Project, or SWOP.

“And education,” he added. “You can’t learn if you’re sick … It’s no exaggeration to say that access to healthcare is an issue that wraps around everything we do.”

Much the same could be said in all of the 30-plus neighborhoods served by LISC Chicago. Which is why, early in 2012, the organization launched its Healthy Communities Campaign – a direct reflection of its comprehensive approach to urban redevelopment.    

David McDowell is an organizer with the Southwest Organizing Project, which will be signing up residents for the insurance exchanges.

Eric Young Smith

It’s also why, this year, with the coming of ACA, LISC Chicago and its many partners offered its network of neighborhood organizations to the State of Illinois as a platform ideally positioned to reach tens-of-thousands of uninsured families in the city’s most disadvantaged neighborhoods. And why Gov. Pat Quinn announced on July 17 that LISC would be responsible for managing one of the larger allocations among the $27 million distributed statewide to 44 groups chosen for Illinois’ In-Person Counselor Grant Program.

(See map of the 21 partner organizations providing outreach and enrollment assistance.)

National effort, local savvy

This puts LISC squarely in the middle of one of the most ambitious social undertakings in the nation’s history – a massive effort to locate, inform and, ultimately, enroll into public or private coverage some 55 million uninsured Americans … including the estimated half million here in Chicago.

But there’s not a lot of time to do it.

Not if folks need to be signed-up by Dec. 15 if they are to be insured as of January 1, 2014, when coverage begins. And not when the “window” to enroll doesn’t open until October 1st, when the Illinois Health Insurance Marketplace opens for business online at a Web address soon to be released by the state.

There folks will be able to compare and choose from dozens of coverage plans offered by six major insurance companies. All will include coverage for an expansive list of benefits, from preventive screenings to complex medical procedures, required under the federal ACA law. Plans will be priced according to the cost split between patient and insurer and any optional coverages included in a plan.

Who qualifie$

Under ACA, families with incomes between 139% and 400% of the federal poverty level (FPL) will be eligible for federal tax credits to help pay their premiums, with lower income families getting the most help. In 2013 that 400% of poverty level roughly translates into an income of $46,000-a-year for an individual and $94,000 for a family of four. Those earning more can also buy through the online Marketplace, though they won’t qualify for a tax credit. Bottom line: all taxpayers are required to obtain insurance … or incur a tax penalty that will rise by 2016 to over $2,000 per family.

Dominique Williams, left, is leading LISC Chicago's work around the Affordable Care Act.

Gordon Walek

But not everyone is being urged to buy private insurance.  

Families with annual incomes below 139% of poverty level ($15,856 for individuals, $32,500 for a family of four) will be encouraged to enroll in Illinois’ expanded Medicaid program at little or no cost. In fact, Cook County residents already are able to enroll in the wider Medicaid program called CountyCare. This program covers health clinic visits, emergency room visits, many inpatient and ambulatory services and family planning. Information is available at www.cookcountyhhs.org/patient-services/county-care/

Network at work

None of this is as simple as it sounds, of course, which is why the federal and state governments are scrambling to recruit and train outreach workers capable of guiding ordinary, non-medical-conversant folks through the enrollment process. This is where LISC Chicago’s neighborhood platform adds major value.

“Our is a well-established network of community-based partners that reaches nearly half of all Chicago neighborhoods,” said Dominique Williams, LISC Chicago’s health programs officer.

LISC’s $1.35 million state grant is being distributed to 21 sub-grantees, including 10 of its local community lead groups and 13 Centers for Working Families (CWFs). Each will hire and train counselors who, in turn, will help residents research their insurance choices and enroll online.

Most of the sub-grantees will make great use of their considerable local contacts and knowledge to do concentrated local outreach, though they will serve any Illinois resident seeking assistance. Three LISC-supported CWFs (Jane Addams Resource Corp., Center for Changing Lives and Safer Foundation) will target the vulnerable populations they serve (dislocated workers, the homeless, and individuals with criminal records respectively) citywide.

So this September is all about hiring and training. Williams explained the education of In-Person Counselors and federally-funded “Navigators" begins with a state-designed online course; continues with a two-day classroom sequence run by the School of Public Health at the University of Illinois Chicago (UIC); and ends with an on-line federal tutorial and test.

The goal, she said, is to have all the counselors on deck and up-to-speed by October 1st, when the state’s online Marketplace goes live.

Through the ACA, many people "not poor enough or sick enough" to quality for Medicaid will be able to afford insurance, said Juana Ballesteros, a registered nurse with a strong community health background.

Eric Young Smith

Valuable experience

Not surprisingly, several LISC-supported groups, especially those that participated in the network-building New Communities Program, have been quickest to mobilize. Several had previous experience enrolling families in health benefit programs such as Illinois’ All Kids insurance for children under 18. (Successes such as this recently encouraged Blue Cross Blue Shield to grant $100,000 to LISC and partners to enroll eligible Chicago Public School students for Medicaid coverage.) 

As for experience, SWOP’s McDowell said their chosen In-Person Counselor, Maggie Perales, is a seasoned organizer with prior experience in health outreach as well as strong connections to local faith organizations.

Perales, in turn, will organize smaller leadership teams that will arrange and promote educational events such as the weekly workshops she’ll run at carefully chosen sites across the Southwest Side. Interest should be high, McDowell predicted, in that an estimated 45,000 residents of SWOP’s Greater Southwest service area are believed to be uninsured.

SWOP’s own network of local health partners also will be deeply involved, McDowell said, including the LISC-supported Elev8/Esperanza Clinic at Marquette School, Holy Cross Hospital and the Inner-city Muslim Action Network (IMAN) clinic on 63rd Street.

Indeed, traditional care providers such as Holy Cross can be counted on to support the ACA enrollment to the max.

“We’ve been trying to get our patients signed up for CountyCare,” said Juana Ballesteros, a registered nurse with a strong community health background. She’s project manager at Pilsen’s Alivio Medical Center, a former manager of the Humboldt Park Community of Wellness and a board member of Enlace Chicago, LISC’s lead agency in the Little Village neighborhood.

When the ACA Marketplace opens, Ballesteros said, an entire new demographic – those “not poor enough or sick enough” to qualify for Medicaid – will be able to afford insurance. That means chronically short-changed medical providers such as Alivio and Holy Cross will get improved compensation for services provided.

"Health is one area where our model of comprehensive community development is particularly appropriate and necessary," said Susana Vasquez, LISC Chicago's executive director.

Gordon Walek

Insurance isn’t all

The next big hurdle, according to both Ballesteros and McDowell, will be access to affordable care for undocumented immigrants. But that will require federal immigration reform and a “path to citizenship” that includes inclusion in the ACA fold. There are over 100,000 “uninsured non-citizens” living in Chicago, according to “Enroll Chicago!” a partnership between the city’s Department of Public Health and non-profit Health & Disabilities Advocates.

Then again, hardly anyone conversant in public health thinks insurance alone is a guarantor of community wellness.

“Maybe the best thing about our enrollment work,” said LISC’s Dominique Williams, “is that it leverages a broader conversation about community health.”

By itself, she said, an insurance ID card cannot “change the habits of thousands of individuals and families” who, of necessity, have developed a “decades-old culture of seeking emergency room care” as well as some not-so-healthy habits and lifestyles.

So LISC’s Healthy Communities Campaign is diversifying with support from funders such as the Otho S.A. Sprague Memorial Institute and Blue Cross Blue Shield of Illinois. Activities range from helping finance full-service grocery stores on the South and West Sides to hosting “Healthy Wednesday” brownbag discussions; from temporarily blocking-off “PlayStreets” where families can safely exercise to Zumba aerobic workouts in West Humboldt Park.

“Health is one area where our model of comprehensive community development is particularly appropriate and necessary,” summed up LISC Chicago Executive Director Susana Vasquez. “Housing? Sure. Jobs? Of course. But a good neighborhood also is one that promotes good health.”

More information: Dominique Williams 312-422-9571 DWilliams@lisc.org  

Posted in Health

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Local Initiatives Support Corporation Chicago connects neighborhoods to the resources they need to become stronger and healthier.

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