Why It Matters
On May 23, Kim Schwartz and 29 other CEOs from the North Carolina Community Health Center Association wrote a 2,200-word letter to Senators Richard Burr and Thom Tillis about the American Health Care Act (AHCA).
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Moved to Action: Health Center CEOs Pen Letter to Senators

By IHI Multimedia Team | Monday, June 19, 2017

The letter wasn’t about politics to Kim Schwartz, CEO at Roanoke Chowan Community Health Center (RCCHC) in North Carolina. To her, it was about patients. 

“Dear Senators …” 

On May 23, Schwartz and 29 other CEOs from the North Carolina Community Health Center Association wrote a 2,200-word letter to Senators Richard Burr and Thom Tillis about the American Health Care Act (AHCA). The letter lays out five core concerns and five recommendations about health care reform in the United States. “We urge you to take these recommendations into the coming deliberations with your colleagues,” the letter says, “and ask that you work together with us in the coming weeks and months to ensure any and all legislation considered by the Senate meets these principles.”

Neither Senator has yet to reply. Schwartz and the Association members, which includes 220 locations across the state that provide care to 438,000 North Carolinians, are still waiting.

“Our intent in writing the letter was, education, engagement, and information,” she says. “It was about taking a stand for our patients.”

The action wasn’t political, says Schwartz, a member of the IHI Leadership Alliance. Instead, it was a matter of sharing facts. 

“It is strictly about patients and patient care,” says Schwartz, the Board Chair of the Association. “It is   clearly about the health system. We are the guardians of patients’ access to care and their chronic disease management.” 
A majority of primary care associations from other states sent similar letters, Schwartz says, explaining that this was an opportunity to help senators understand how their votes will affect the people in their state. 

“It wasn’t so bold and brazen to put out a letter because our patients have a lot to lose,” she says. “And it wasn’t meant to be partisan. We just happen to have Republican senators.”  

Meanwhile, many health care leaders have stayed out of the spotlight and kept quiet as the bill has winded a complicated path through the legislative branch, including a tightly contested vote in the House and the swift, closed-door sessions now happening in the Senate. Last week, a columnist in The New York Times called the opposition to the bill ‘halfhearted.’ 

Don Berwick, MD, President Emeritus and Senior Fellow at IHI, has urged a full-hearted effort. In a call that drew nearly 1,000 health care leaders on May 31, Now What? A Policy Q&A with Don Berwick and the IHI Leadership Alliance, Berwick gave this advice: “I hope and think that the providers of care around the nation need to speak up at this time politically and say, “No, this isn’t right. It’s going to hurt people. It’s going to hurt care. It’s going to take a step back from care as a human right.”

Schwartz and the Association Board members had the same idea when they wrote, “On behalf of our patients, we offer … our concerns with the health-related legislation … and our recommendations and principles for health reform moving forward.” The letter listed these five concerns with the AHCA in its current form:
  • Capping the federal portion of Medicaid spending
  • Rollback of Medicaid expansion
  • Changes in tax credits for purchase or private insurance
  • Weakening covered benefits and consumer protections
  • Overall impact on coverage

Explaining the last point, the group wrote, “The Congressional Budget Office has estimated that the original version of the House bill would cause 24 million Americans to lose coverage within ten years. Yet every health center clinician and staff member can attest to the difference having health insurance makes in the lives of our patients — in terms of their personal and family security, access to specialty care, and likelihood to seek the cost-saving, primary and preventive care services we offer. Our nation can do better.”

Others in the Leadership Alliance shared similar viewpoints. John B. Chessare MD, MPH, President and CEO at the GBMC HealthCare System in Maryland, said, “I believe that health care is a right. I [hope] the Senators maintain the progress we have made on coverage and to maintain the incentives present in the Affordable Care Act to achieve the Triple Aim.” Angela Shippy, MD, the Chief Quality Officer at Memorial Hermann Health System in Texas, said, “It is time to make substantial change in how health care is delivered. Leadership outside of the beltway needs to be empowered to lead the change. Politics as usual does not work for such a fundamental need as health care.”

What change is needed? Schwartz and the Association Board members offered these five recommendations to Senator Burr:
  • First, do no harm — do not eliminate coverage for any American in your proposal.
  • Maintain a strong and viable safety net through Medicaid.
  • Strengthen Medicaid’s connection to health centers.
  • Strengthen tax credits, minimum benefits, and consumer protections in the individual marketplace.
  • Sustain and grow direct investments in health centers and the primary care workforce.
You can click here to read the full letter

Schwartz is hopeful the senators will reply, but, until then, she’s watching and waiting like the rest of us. And if the bill makes its way through the Senate and becomes law?

“We have to plan for all outcomes,” Schwartz says. “We’ll work collaboratively with other stakeholders in the state and do our best with less resources.” 

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