Accepting applicants for the second annual Rebecca Copeland Memorial Internship

Accepting applicants for the second annual Rebecca Copeland Memorial Internship

February 22, 2023
Rebecca Copeland

CHRT is now accepting applicants for the second annual Rebecca Copeland Memorial Internship.

CHRT seeks a high-achieving individual who is thoughtful and analytical, with interests and experiences in health policy analysis. This is a full-time paid summer internship, with flexible start and end dates. Graduate students who have completed at least one year of coursework in public policy or public health are encouraged to apply.

The intern will have the opportunity to work on relevant, timely health policy issues. The intern will be responsible for elements of health policy and research projects that align with CHRT’s mission of improving the health of people and communities.

Apply now or learn more.

About the CHRT Rebecca Copeland Memorial Internship

Rebecca Copeland was a dual masters degree student in public health and public policy at the University of Michigan, and graduated in the spring of 2021. She had a deep interest improving population health by addressing social needs. Rebecca sought out mentorship from Terrisca Des Jardins, CHRT’s former executive director serving from late 2020 – February 2023. 

Rebecca was deeply committed to improving health, health care and social justice. She brought enthusiasm and excellence to analysis of important health policy issues and inspired those alongside whom she worked.

At CHRT, Rebecca interned with Nancy Baum, CHRT’s health policy director. At CHRT, she worked to improve the public mental health system, among other projects. “Her energy was amazing,” says Baum. “Rebecca showed us just how valuable interns can be in an organization like ours. When an intern is both smart and dedicated to making systems better to improve health, as Rebecca was, they are a real asset,” says Baum.

Rebecca Copeland passed away in July 2021. CHRT honors her memory by offering the Rebecca Copeland Internship to students with an interest in health policy.

15 years in review with Executive Director Terrisca Des Jardins

15 years in review with Executive Director Terrisca Des Jardins

November 16, 2022


Fifteen years ago, no one could have anticipated where the Center for Health and Research Transformation (CHRT) would be today. We’ve gone through many iterations, making our 15th anniversary truly significant. 

We were only guaranteed three years of funding when we opened the doors of our center. We started as a grant-making nonprofit to support health services research. For many years, much of our work sought to improve health care and access to care. Then in 2018, we changed our name from the Center for Healthcare Research and Transformation to the Center for Health and Research Transformation. This shift highlighted our recognition of the critical role that health-related social needs and influencers have on the health of communities, as well as the substantive number of projects in our portfolio designed to address those needs. 

Today, all of our work asks: How do we create healthier populations, healthier individuals, and healthier communities? Three primary strategies guide our work and help us answer these questions.  

The first: To be, and be known as, a key source for evidence-based, non-partisan information on health policy issues and trends. 

  • Our policy briefs have remained neutral, trusted sources of information. We’ve analyzed a wide range of topics—like ways to recruit and retain behavioral health workers in rural America and effective state and federal policy options designed to support family caregivers—to determine how we can reshape policy to better serve vulnerable populations. We place a lot of attention on disseminating our briefs to policymakers, stakeholders, and other leaders, and have influenced several local, state, and federal policies.
  • Our policy fellowship—which is now celebrating its tenth year—has greatly influenced the health policy space. Historically, we’ve welcomed a diverse set of researchers and policymakers. In recent years, we added nonprofit leaders to the fellowship. In the ten years the program has run, we’ve had 122 fellows. And we launched a new fellowship for Detroit Health Department (DHD) staff, the DHD Public Health Practice and Policy Engagement Fellowship. This fellowship program has trained 37 frontline DHD staff to date, helping them build knowledge in systems thinking, data analytics, public policy, and communications. We are currently training our third cohort of DHD fellows. 
  • Our communications work has grown to be its own area, expanding from supporting CHRT’s core communications to helping partners and funders raise awareness about their programmatic efforts. For example, CHRT’s communications team is working with the national Social, Behavioral, and Economic COVID-19 Coordinating Center (SBECCC) to develop a research report showcasing NIH-funded COVID-19 research projects centered on disparities. The SBECCC hopes the report will help highlight evidence-based COVID-19 mitigation strategies and provide important data to inform future pandemic mitigation strategies across the country. 

The second: To help community-based health collaborations improve population health and magnify their impact. 

  • Our backbone support has helped community-based collaborations like MI Community Care, Vital Seniors and the subsequent Healthy Aging at Home Network, and the Washtenaw Health Initiative get started and off the ground. We’ve also facilitated the evolution of their work. Over time, that has positively impacted both individuals and populations. 
  • Our technical assistance has facilitated health care delivery transformation, new initiatives, and evolving strategies. For example, we’ve recently worked with the Michigan Department of Health and Human Services to identify more equitable long-term services and supports. In this work, we focus on data analytics and strategic planning to help our state scale solutions to a range of populations. 

And the third: To build the evidence base for local and state programs that can be replicated and scaled to improve health and social welfare. 

CHRT has evolved a lot over the past 15 years. It’s even evolved significantly over the past two years since I assumed my role as executive director in 2020. Reflecting on my time at CHRT, I think of three meaningful shifts we’ve made. 

CHRT has covered topics including health care access, health care delivery, health care integration, healthy aging, behavioral health, unpaid caregiving, health equity, the social determinants of health, and pandemic response, to name only a few of the areas we’ve addressed in our first 15 years.

We are a team of problem solvers and thought partners working alongside our funders and clients. While our approaches are evidence-based, we can also push the envelope and contribute to the evidence as we identify creative solutions to the pressing health challenges of the day.

I’m grateful to have the CHRT team by my side as we move into our next chapter. Our team is incredibly passionate. Everyone brings a unique perspective and experiences to the table, and I’m continuously humbled to be a part of it.  

In partnership,

Terrisca Des Jardins 

Insurance companies are no longer waiving cost-sharing for COVID hospitalizations. Seems fair to me.

Melissa Riba

Insurance companies are no longer waiving cost-sharing for COVID hospitalizations. Seems fair to me.

October 1, 2021
By Melissa Riba, director of research and evaluation, Center for Health and Research Transformation (CHRT)

In the early stages of the COVID-19 pandemic, insurers stopped charging their members for COVID-related hospitalizations. 

Partly, that was just common sense. Charging copays and deductibles in the middle of a global pandemic–when people were sick and worried and losing their jobs–would have discouraged people from seeking care. 

But insurers were also in a really good financial position to waive those fees. 

People were continuing to pay their premiums while delaying routine care, skipping wellness visits, postponing preventive screenings, and generally toughing it out until the coast was clear. All of that saved insurers money. 

Now, consumers seem surprised that insurance companies are planning to reinstate copays and deductibles during a significant COVID-19 surge. I’m not entirely sure why that’s surprising. 

As research and evaluation director at the Michigan-based Center for Health and Research Transformation (CHRT), I have seen the data and heard the stories. And it shows that over 90 percent of the folks who are really sick–the ones who are crowding hospital ICUs and EDs–are unvaccinated. And that’s a situation that’s easily remedied. 

Vaccines are safe, free, and plentiful. Plus they’re highly effective at protecting us from COVID-19. 

Sure, there have been breakthrough infections among the vaccinated. But the evidence demonstrates that people who are vaccinated have less severe symptoms, and are less likely to end up in the hospital costing insurers a ton of money. 

A recent Kaiser Family Foundation study shows that in Michigan, only 1.6 percent of new COVID infections are occurring among the fully vaccinated. And even among those relatively rare cases, incidence of serious illness or hospitalization is practically zero (.01 percent to be precise). 

In the U.S., health insurance isn’t a human right; it’s a market commodity. 

Whether we believe that’s right or wrong, our health care system is built on a very basic capitalist principle–provide a good or service and try to make money doing it. 

Unvaccinated COVID-19 hospitalizations cost the U.S. health system $2.3 billion in June and July 2021. And if costs exceed what insurers anticipated, or result in excessive uncompensated care for hospitals, who do you think will make up for it? We all will:  Through higher premiums and cost sharing requirements; through increased hospital charges. Vaccines can save money–for insurers, for individuals, and for society. It’s as simple as that. 

Waiving copays and deductibles at the start of the pandemic was a way for insurers to encourage members to take care of themselves and others by seeking necessary care. Reinstituting copays and deductibles is a way for insurers to encourage members to take care of themselves and others by getting vaccinated. 

We’ve already done a lot to incentivize people to get vaccinated. 

There are free donuts, cash payouts, scholarship lotteries, free transportation. 

We’re now starting to see vaccination requirements at work and play. I just uploaded a photo of my own vaccination card, and my daughter (who is also vaccinated) tells me that you can’t see Harry Styles at Little Caesars Arena in September unless you can show you’re vaccinated (for those of you with a Harry fan in your household, you know this is a really big deal).

Penalties are the logical next step. We’ve tried the ‘carrot’; now it’s time for the ‘stick’ to encourage (some might say ‘force’) individuals to get vaccinated. Health insurers might not deny coverage, but they can definitely make it more expensive to make the choice to remain unvaccinated. That’s health insurance 101.

This blog post originally appeared in The Detroit News on September 3, 2021 (Op-ed: Insurers are driving up the price of staying unvaccinated)

Welcome new staff and interns

Welcome new staff and interns

August 11, 2021

CHRT is pleased to introduce its newest hires in finance, data use, and programming. New finance team members will enhance our organization’s ability to conduct financial planning, ensure compliance, and improve operational procedures. New programmatic staff members bring expertise in health information technology, data use, public policy, mental health and substance use disorders, and more. 

Gudrun Bossman

Gudrun Bossmann is a senior financial analyst at CHRT and is responsible for financial planning. She holds a bachelor’s degree, with honors, in international business and management studies from the Hanzehogeschool, Groningen, The Netherlands.

Prior to joining CHRT, Bossmann built up the financial controlling of a media research company in Ann Arbor and managed financial operations for the premium resort sector of Thomas Cook, one of the largest travel companies in Europe.

Ayşe G. Büyüktür

Ayşe G. Büyüktür is a senior research area specialist with the University of Michigan School of Information and holds appointments at the Center for Health and Research Transformation (CHRT) and the Michigan Institute for Clinical & Health Research (MICHR).

Büyüktür first started working with CHRT in 2016 as a consultant for the Livingston – Washtenaw State Innovation Model (SIM) intervention, the predecessor to MI Community Care. She subsequently joined the intervention team in the design, implementation, and operations of the program.

Allison Fritsch 

Allison Fritsch is an intern at CHRT. She is a Master of Public Health and Master of Social Work dual-degree candidate (2022) at the University of Michigan.

Before coming to the University of Michigan in 2020, Fritsch worked in the hospitality industry.

Wendy Hawkins

Wendy Hawkins is a senior health policy analyst at CHRT. She graduated with her master’s in public policy from the University of Michigan Gerald R. Ford School of Public Policy in 2021.

Prior to joining CHRT, Hawkins worked in the harm reduction field in San Francisco and Los Angeles, providing harm reduction materials and support to people who use drugs and those experiencing housing instability. She also provided HIV/STI and Hepatitis C testing and referrals to wraparound services.

Amy Martinez

Amy Martinez is University of Michigan School of Public Health, Future Public Health Leaders Program (FPHLP) fellow, completing her field placement with CHRT. She is currently pursuing her bachelor’s degree in psychology and public health at Williams College, located in Williamstown, MA

Prior to joining CHRT, Martinez served as a public health intern in the Berkshire Area Health Education Center (AHEC) where she helped develop mental health and COVID-related programming for improving healthcare professionals’ relationships with themselves and their patients during and post-pandemic.

Augustina Nguyen

Augustina Nguyen is a University of Michigan School of Public Health’s Future Public Health Leaders Program (FPHLP) fellow. She graduated from Wheaton College in Massachusetts in 2021 with a BA in biology and business management.

Before joining CHRT, Nguyen was a public health intern at the Brigham and Women’s Hospital, doing health equity research and intervention.

Angela Palek

Angela Palek is a senior financial specialist at CHRT. She holds a master’s degree from Michigan State University in higher, adult, and lifelong education and a bachelor’s degree from Central Michigan University in administration, with an emphasis on organizational administration.

She began her career at Eastern Michigan University working for the EMU Wraparound Project which provided wrap around services for at-risk teen parents. While at EMU, she was instrumental in the development of the non-profit student food pantry.

Ivana Tullett

Ivana Tullett is compliance staff specialist at CHRT, with a focus on regulatory data compliance and data privacy. She holds a master’s degree in law from the Charles University in Prague and a master’s degree and research doctorate in law from the University of Michigan Law School.

Prior to joining CHRT, Tullet supported the University of Michigan research enterprise by negotiating data use agreements and coordinating related compliance reviews.

Luoluo Xu

Luoluo Xu is a senior accountant at CHRT, supporting the administrative and business functions. She holds a master’s degree in accounting from Eastern Michigan University.

Prior to joining CHRT, Xu worked as an accountant for MHealthy, which offers U-M faculty and staff a broad range of health and well-being programs, and the U-M Shared Services Center, which oversees a range of human resources and financial administrative functions across the University. 

New CHRT projects focus on integration, learning networks, and social determinants of health

New CHRT projects focus on integration, learning networks, and social determinants of health

August 11, 2021

CHRT has launched six new projects over the past few months, including designing a public health and primary care integration demonstration project, participating in a learning action network team to support integrated delivery networks, launching a new practicum and fellowship for Detroit Health Department staff members, and providing training in communicating for policy change to a national network of cancer care organizations.


Coaching members of a national learning and action network of integrated care delivery leaders

National: Institute for Healthcare Improvement (IHI)

While understanding that the social conditions in which a person lives, works, and plays is critical to health, only 24 percent of hospitals and 16 percent of physician offices report screening patients for social needs. More and more, however, health systems are recognizing the imperative of understanding the social needs of their patients and helping to resolve unmet social needs that directly impact health, well-being, and equity. 

In order to support the journey of these health care organizations, Pfizer is funding work with the national Institute for Healthcare Improvement (IHI) to create a Learning and Action Network. CHRT’s executive director will participate in a multi-disciplinary national faculty team that provides coaching and guidance to competitively selected integrated delivery networks. Read more

Integrating public health and primary care and developing sustainable funding mechanisms for both systems

National: American Board of Internal Medicine (ABIM) Foundation

The lack of connection between primary care and public health has had serious consequences during the COVID-19 pandemic. Public health messages about the measures necessary to keep people safe–masking, social distancing, the need for internal eating closures, and the like–have been highly politicized. But in many communities, it was hard for public health leaders to reach and convince their constituents.

CHRT is working with the American Board of Internal Medicine (ABIM) Foundation to Identify ways to integrate public health and primary care and to develop sustainable funding mechanisms to strengthen both systems. In the first phase of this work, CHRT will focus on key informant interviews with representatives from a range of organizations and entities such as public health and primary care professionals from states with advanced integrated systems and states identified by the National Health Security Index 2020. Read more

Expanding the Home Nutrition+ integrated infrastructure

Regional: Michigan Health Endowment Fund

Several national studies have demonstrated a return on investment for nutrition programs. Specifically, a Commonwealth Fund review identified multiple papers that provide strong evidence that medically tailored meals (MTM) improve outcomes and have a positive return on investment. Furthermore, the Commonwealth Fund found that a community-based care transition program, provided to older adults as part of a combined MTM intervention, saved $3.87 for every $1.00 spent, likely driven by a significant decrease in the 30-day readmission rate in the intervention group.

Vital Seniors Initiative grantees–five social service agencies for which CHRT provides backbone support–are forming a community integrated network with the goal of delivering MTM and coordinated service delivery to clients. The end goal: To more effectively and efficiently serve older adults and individuals with disabilities so they can remain in their community and home of choice. To do this, the network needs to develop a hub model structure, governance, and operations as well as new partnerships to expand the Home Nutrition+ program.

CHRT will provide backbone support to the community integrated network, helping network members develop strategic objectives with existing partners, develop the governance structure required to support expansion, set up the appropriate legal agreements, engage with community-based organizations beyond Washtenaw County, and develop the framework to offer Home Nutrition+ based on the “Food is Medicine” model.

During the first quarter, CHRT will identify potential geographic regions for expansion, conduct an analysis of services and gaps of MTM offerings in those regions, engage with a health plan to support the operational objectives for expansion, and conduct visioning sessions to define mission and execute delivery. During the second quarter of the grant period, CHRT will facilitate governance and geographic expansion decision making, set up legal structure and applicable agreements, and more. Read more

Public Health

Developing and delivering a fellowship and practicum for Detroit Health Department staff

Local: Detroit Health Department

In 2019, CHRT launched the Detroit Health Department Public Health Practice and Policy Engagement Fellowship, training two cohorts of DHD staff in four key areas–systems thinking, communications, policy engagement, and data analytics–so they may ultimately lead collaborative, cross-systems work, eliminating silos and addressing the social determinants of health. A shortened, supplemental virtual fellowship for alumni will continue to elevate their public health skills and professional development experience.

CHRT will lead alumni in a six-session fellowship, covering a host of current policy issues and trends. The alumni fellowship will touch on long-standing, complex issues of public health, many of which have been exacerbated by COVID-19. It will create a space to identify and discuss these dynamic problems and provide tangible ways for fellows to address them and affect change. The fellowship also includes a small-group practicum project, focused on real issues faced within DHD departments. At completion, the fellows will have a fleshed-out plan for improving processes–one that is rooted in systems thinking. Read more

Healthy Aging

Informing the development of Michigan’s statewide LTSS strategic plan

State: Michigan Department of Health and Human Services

In 2019, the Michigan Department of Health and Human Services (MDHHS) engaged in preliminary preparation for strategic planning activities around long-term services and supports (LTSS). MDHHS has now asked CHRT to facilitate a comprehensive process to inform a statewide LTSS strategic plan.

In Phase I, CHRT will review MDHHS work to date and interview key staff. CHRT will then conduct an environmental scan of federal policy and funding changes, both planned and existing, as well as examples of how states are applying these federal changes. CHRT will review best practices on equity initiatives and key LTSS options, then develop a white paper on LTSS options. CHRT will also conduct a series of internal and external key informant interviews, and complete a literature review on home- and community-based services, with high-level recommendations for the state. Read more

Communication for Policy Change

Training members of a national cancer care consortium in communicating for policy change

National: Alliance to Advance Patient-Centered Cancer Care 

The national Alliance to Advance Patient-Centered Cancer Care seeks to ensure that findings from the alliance’s six participating sites and cross-site evaluation–particularly those that demonstrate evidence-based mechanisms for advancing patient-centered care and reducing disparities–reach, inform, and inspire national decision and policy leaders.

CHRT is collaborating with the alliance around communicating for policy change. The focus: Developmental editing, as alliance staff write a policy brief to share with national policy and decision leaders, and webinar development and delivery to help alliance members in several states as they communicate their own findings to policymakers and practitioners. Read more

Special open enrollment period allows Michigan consumers to purchase 2021 health insurance on national ACA marketplace

Special open enrollment period allows Michigan consumers to purchase 2021 health insurance on national ACA marketplace

February 12, 2021

On January 28th, President Biden signed an executive order to initiate a nationwide special enrollment period and reopen the ACA Health Insurance Marketplace. The Marketplace will reopen from February 15 – May 15, which will give consumers in Michigan (and in 35 other states that use the federal exchange) an additional opportunity to purchase 2021 health insurance coverage amidst the backdrop of the COVID-19 pandemic.

The state of Michigan experienced a 46 percent increase in the number of uninsured adults from February to May of 2020, due in large part to the pandemic.[1],[2] While over 267,000 Michiganders were able to enroll in health insurance plans during the regular 2021 open enrollment period, a 2 percent increase from the 2020 open enrollment period, thousands of Michiganders currently remain uninsured.

Governor Whitmer has announced that the state of Michigan, in tandem with this special enrollment period, will be launching outreach efforts to help uninsured Michiganders learn more about the coverage options available to them. Many uninsured individuals may find that they have subsidies that are large enough to cover the entire cost of a health insurance plan.

For more general information regarding the 2021 Health Insurance Marketplace, including an in-depth rate analysis, see CHRT’s Rate Analysis: 2021 ACA Health Insurance Marketplace for Michigan. To explore health insurance plans available through the Marketplace, visit

[1] State Leaders Applaud Biden Administration for Opening Marketplace Special Enrollment Period and Making Medicaid more accessible. (2021, January 28). Retrieved February 11, 2021, from,4669,7-192-29943_34759-550797–,00.html

[2] A 46% increase equates to roughly 834,000 Michiganders without health insurance coverage.

Webinar: CHRT Policy Analytics Director Robyn Rontal offers webinar on policy solutions to support family caregivers

Webinar: CHRT Policy Analytics Director Robyn Rontal offers webinar on policy solutions to support family caregivers

February 11, 2021

In this hour-long webinar by Policy Analytics Director Robyn Rontal, viewers will learn about the current state of informal and family caregiving in the U.S., factors that impact caregiver stress, and a variety of policy solutions to support family caregivers.

Rontal discusses the prevalence of family caregiving and the impact of the COVID-19 pandemic on caregivers and families. She presents research showing that almost 40 percent of caregivers find their caregiving situation to be emotionally stressful, and shares examples of strategies to address these problems with policies at the local, state, and national level.

Listen to Policy solutions to support family caregivers to learn more about ways we can support unpaid caregivers in the U.S.

What COVID-19 teaches us about health and human services integration by Melissa Riba

What COVID-19 teaches us about health and human services integration by Melissa Riba

June 4, 2020
Melissa Riba, Director of Research and Evaluation

For much of the last year, CHRT has been working with The Kresge Foundation and other national partners to better understand and advance the concept of health and human services integration.

At CHRT, we are focusing our health and research transformation lens and our expertise in systems change to learn about the challenges and opportunities that occur as organizations work to connect historically separated systems to improve the health and socio-economic opportunities of communities. Throughout this work, we are mindful of the critical importance that racial inequities play in individual and community health and well-being.

Working on health and human services integration during and through the COVID-19 crisis, our team is learning at an accelerated pace. Our awareness of barriers and policy issues are heightened as we see the real-world impact of this pandemic.

Here’s what we’re learning:  

Our most vulnerable citizens are at greatest risk: The negative effects of this pandemic are falling disproportionately on our most vulnerable citizens—people who struggle to earn enough to live on; to maintain a roof over their heads; to stay clean and sober; to maintain their mental health; to feed themselves and their families; to be safe from violence—all while trying to keep safe from a deadly virus for which there is no vaccine or cure.

The pandemic is exposing and exacerbating racial inequality: In Michigan, 40 percent of COVID-19 deaths are among our African American residents, yet they are only about 12 percent of the population. Why is that? Health, and alternatively, vulnerability to a devastating virus, is not something that happens in isolation. It is impacted by historical and structural inequalities that have been shaped by racist policies and practices and the lack of economic and social mobility that came along with them.

The ability to share data safely, securely, and meaningfully is key: In order for health and human services systems to effectively address the complex, multi-faceted needs of individuals, information needs to flow across systems, programs, and agencies. Such information can help to identify which individuals and families need extra support and can support ‘no-wrong door’ approaches for them by using universal enrollments, assessments, and protocols.

Tele-health has expanded, but it is re-exposing our digital divide: Until recently, expanding tele-health existed mostly on health care wish-lists. Now it has been thrust to the forefront of health interventions. As CHRT senior analyst Karen Teske points out in a timely April, 2020 publication, since the beginning of the year 80 additional services are now billable through Medicare for telehealth with a certified clinician. But even as we see tremendous progress, we ae mindful that disparities in access to high-speed internet determine how effective tele-health is as a means to deliver care and services—rural communities, lower income households, and older individuals are far less likely to have the high-speed internet that makes effective use of this innovation possible.

Right now, and far into the future, we need our health and human services systems to:

  • Share information, reduce duplication, and create and maintain an organizational culture that puts people at the center.
  • Address health while at the same time addressing the social determinants of health, racial inequalities, and barriers to social and economic mobility.
  • Implement more culturally competent, trauma-informed practices and ‘no wrong door’ approaches to ensure people can get the services and resources they need, when they need them, delivered in ways that elevate, rather than marginalize.

Across the country, more and more organizations are examining and talking about their integration work, but we are coming to recognize that true integration is often difficult to achieve.

While consolidating offices or administrative tasks and collaborating on individual programs may be part of an integration framework, achieving real health and human services integration means unwinding entrenched systems, reintegrating the cultures of organizations, the data systems they use, the funding streams they require, and the governance structures they depend upon—all while recognizing that social determinants are inseparable from the health and wellbeing of people and communities.

Another existential threat to the Affordable Care Act in the midst of the COVID-19 pandemic

Image of Marianne Udow-Phillips

Another existential threat to the Affordable Care Act in the midst of the COVID-19 pandemic

April 16, 2020

Having health insurance is essential to getting early diagnosis and treatment.  And if we’ve learned one thing during this coronavirus crisis, it’s that early diagnosis and treatment isn’t just important for the individual affected, it’s important for all of us. That’s why I was so troubled this week when, during a press conference, President Trump reaffirmed his support for a Texas lawsuit—set to be reviewed by the U.S. Supreme Court this year–that threatens to eliminate the entire Affordable Care Act.

The Affordable Care Act just turned 10 years old.  The Act’s successes are well documented – the steep reduction in the numbers of uninsured Americans from 15.4% in 2009 to 9.5% in 2018; the fact that coverage is now available to those with pre-existing conditions who were unable to get it before; the fact that preventive services are now covered in full with no cost-sharing for consumers; and the fact that fewer people report not getting needed medical care because of cost than they did before the ACA.  That last fact could not be more important as we face the most critical public health issue of our lifetimes – the coronavirus.

The Texas lawsuit I’m referring to—the one that President Trump supports—was filed in February 2018 by 18 Republican Attorneys General and 2 Republican Governors who challenged the constitutionality of the Affordable Care Act in light of the 2017 tax bill that eliminated the tax penalty for individuals who did not enroll for minimum health coverage under the ACA.  The plaintiffs argued that without the penalty, the mandate was unenforceable as a tax, and that since the entire ACA relied on the mandate, the law itself should be struck down. In December of 2018, a federal judge in Texas agreed with the plaintiffs and determined the entire ACA to be invalid

Many of the judge’s legal rulings were criticized by both conservative and liberal legal scholars. And the case was immediately appealed. But the Trump administration sided with the plaintiffs and supported the ACA being struck down in its entirety.  In December 2019, the appeals court determined that the individual mandate was unconstitutional but made an inconclusive ruling on the constitutionality of the rest of the ACA. And earlier this month, the Supreme Court agreed to take up the case in its next term.

There is no question that the Texas lawsuit poses an existential threat to the ACA. And, there is also no question that that threat could not come at a worse time. The full story of the coronavirus is yet to unfold.  But, one thing that the coronavirus makes clear: health care coverage is a public health measure.

With a disease as infectious as the coronavirus, we need public health measures to protect us all.  The coronavirus doesn’t skip infecting people just because they are uninsured. And uninsured people are just as likely to infect others as are people with insurance. It is essential to all of us that people who are sick get tested early to both save their lives and protect others from being infected.

Unfortunately, financial barriers keep people from seeking need medical care. The first phase emergency measures that Congress put in place to address the coronavirus acknowledged how much cost can be a deterrent to care by making sure that there would be no copays for people getting tested

One issue the Congressional measures did not address is the fact the thousands of Americans who get the coronavirus will now be considered to have a “pre-existing” condition. The emergency measures don’t need to address that issue because the ACA is in place today and Americans with pre-existing conditions are protected from losing health coverage because of the ACA. But, if the Trump administration has their way, the ACA will go away; the health care system will face further chaos and there is no certainty that a replacement will be put in place to protect the millions likely to be infected with this virus over time. There is simply no doubt that the ACA is essential to our fight against the coronavirus. Now is the time to be expanding the ACA, not throwing it away.

Backbone Organizations: What they do, and why they matter – Nancy Baum

Backbone Organizations: What they do, and why they matter – Nancy Baum

March 30, 2020
Backbone organizations and why they matter

At CHRT, we devote much of our time to policy analysis, research and evaluation, and project management.  More recently, as our emphasis on collective impact has grown, CHRT is expanding our role as a backbone organization. So what does it mean to be a backbone organization, and why does it matter?

One way to conceptualize a backbone organization is that its goal is not to work one-on-one with individuals or organizations, but to create a broader understanding of what a community needs and provide capacity to address those needs in the community. Backbone work is accomplished working among multiple organizations in a community, rather than between two entities, as might occur in project management or traditional consulting work.

Until very recently, foundations and other organizations historically hadn’t funded the infrastructure necessary for this type of coalition work. Now, as government agencies and NGOs increasingly recognize the interconnectedness of multiple factors affecting the health of people and communities, support for the work of backbone organizations is growing. Backbone work provides both infrastructure and context for mission-based organizations, and can help focus efforts taking place across entire communities and among those community organizations.

CHRT’s work with the State Innovation Model (SIM) is one example of the role a backbone organization can play in facilitating collaborative efforts to reach shared goals across regions and organizations. CHRT’s job with the SIM is, in part, to help develop key strategies and provide capacity to align resources so that regional partners – social service and health organizations in two counties – can achieve their specific missions as service providers while working together to focus on the needs of their shared clients. In the case of the SIM, care management services are provided to individuals who have high health and social needs to help them achieve their health goals and to reduce reliance on emergency departments.

As we collect and aggregate partner data locally we can start to see what the need is at a community level and measure collective impact of our joint work. We can also disaggregate the data in nuanced ways to pinpoint specific challenges key populations face and identify best practices that help our partners better address those specific needs. Similarly, in the process of facilitating the collaborative approach, we learn how to help the organizations we work with more effectively carry out their complementary work. The vantage point and capacity of a backbone organization helps local organizations that individually deal with housing, or food insecurity, or complex health care to talk to each other, collaborate, and work more efficiently together for the good of the individual.

The perspective and expertise of a backbone organization also extends beyond the ability to connect and synergize mission-driven organizations with differing core competencies. As collective work becomes more effective through better insight into process and practice, backbone organizations like CHRT also help ensure that funders understand what the partners are addressing in their community, what’s working, and where further efforts should be focused. Backbone organizations can provide expertise in budgets, offer administrative capacity and resources, create summary documents or presentations, and implement convenings to make it easier for foundations and legislative allies to support regional collaborations and tout the results of ongoing public, private or non-profit investments.This level of backbone work provides the partners with crucial resources to make the case for longer-term sustainability. 

To learn more about CHRT’s backbone work, policy analysis, research and evaluation click here.