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As I’ve said in past posts, health care reform is much more about insurance reform of the health insurance system than it is about real and fundamental change to the health care delivery or public health systems (see “The Case of the Missing $115 Billion“). The bulk of the dollars included in the Patient Protection and Affordable Care Act (PPACA) go toward expanding coverage rather than improving the delivery system.

But the PPACA includes many good concepts that would – if funded – strengthen clinical and public health outcomes. To capitalize on these opportunities, however, it will be essential for those who care about these issues to be actively engaged at the federal, state and local levels.

On May 25, 2010, our organization released a policy brief to help guide advocates, consumers and others to take advantage of those opportunities. Those opportunities for state and local action fall into two broad categories:

• Appropriations. At the federal level, it is essential to address the issue of funding for provisions in the Act that are authorized but not appropriated. Our Congressional delegation and others in Congress need to hear that these ideas are important and have strong local support.
• State and local approaches to implementation. At the state and local levels, there are many choices to make as the Act is implemented, and many opportunities for providers, advocates and others to come together to improve the quality, efficiency, and safety of the health care system. Citizens’ voices will be important to define the best way to set up things like insurance exchanges, select approaches to Medicaid expansion, and pursue demonstration projects at the state and local level.

What is important to understand about these opportunities, however, is that they will only be available to the extent that groups and individuals come together to develop a collective view on what should be done. Groups are so much more effective in Washington or Lansing when they speak with a common voice rather than advocate for their own individual ideas or agendas.

Michigan has both a special challenge and opportunity in that regard. Over the next several months, the executive branch in state government will go through wholesale change as the Granholm administration leaves office and a new administration comes in. All of the decisions being made now could be fundamentally changed by a new administration. In addition, virtually the entire Michigan Senate will be changing in January. This inevitable change in leadership makes it even more important in Michigan than in most other states for voluntary groups to come together to help lay the ground work for health reform.

For years in Michigan, we were told that we did not get more funding for federally qualified health centers (FQHCs) because we had no common vision and too many groups competing against each other. FQHCs are now coming together with a shared voice: are other groups ready to do the same?