The Unfinished Business of the ACA

This year, the Affordable Care Act (ACA) celebrated its 10th anniversary. While we join our peers in applauding this bedrock legislation ensuring greater access to healthcare for all, we know there’s still unfinished business to attend to: interoperability.

“Interoperability” is the ability of systems to interact with each other to share data so that a consumer is connected with as many benefits as possible in an efficient way. The original vision was that the ACA would not only connect people to healthcare coverage, it would also help people connect with the range of supports available that improve a person’s life, including food support. Somehow along the way, that important component was diluted. In 2009, Maryland Senator Barbara Mikulski asked Social Interest Solutions co-directors Claudia Page and Bobbi Wilbur to help write the “Health Information Technology Enrollment Standards and Protocols” section of the ACA. Mikulski knew SIS had deep technology and policy experience, and we were mission-driven to increase people’s connections to support—not just medical support. Section 1561 gives specific direction to develop interoperability between the health exchanges and enrollment and health and human services programs. “It’s really the unfinished business,” says Claudia. “It’s in the law, but yet to be realized.” Ten years in, we can recommit with a broad coalition of changemakers to make robust connections the norm.

Interoperable systems need to be intentionally designed from the outset—a truly interoperable system will streamline enrollment and eligibility processes. Interoperability will be built into the digital tools, written into policies, and enacted via procedures that agencies use. Put simply, if interoperability is achieved, one application will determine your eligibility for many programs and initiate enrollment when appropriate. Currently, when a person logs into the health care exchange system, their eligibility for either subsidized private insurance exchanges or Medicaid is determined. In an interoperable ACA, if they are determined eligible for Medicaid, their eligibility for SNAP (food assistance), WIC, TANF, and other support programs would also be completed. Once a person is deemed eligible for a program, the system will initiate enrollment.

Why now? Because it’s possible, and it’s sorely needed.

The initial technology challenges of the ACA have, for the most part, been resolved and stabilized. The governance procedures to administer the ACA are established in each state, and many states have recently expanded Medicaid coverage. As we continue to rework the way medical coverage functions in our country, can we harness what’s already available within the law to integrate eligibility and enrollment between systems? It may be challenging, but it’s certainly possible. Many states share data between programs in some basic ways, but the intent behind interoperability in the ACA was more comprehensive; our solutions are focused on integration of needs that are addressed through one efficient pathway to support. We remain committed to working with partners to finish this unfinished business because too many people who are eligible for and need support aren’t getting them.

Why is this so important? Let’s take California as an example.

If robust interoperable protocols had been implemented as outlined by Section 1561, many food-insecure people in California (who are also likely eligible for or enrolled in MediCal) would have had a direct pipeline to automatic eligibility and enrollment when they applied for MediCal or CHIP. The California Food Policy Advocates estimate that 83% of low-income children living in Sonoma and Napa Counties experience food insecurity. There are more than 11 million people enrolled in Medicaid and CHIP in California (MediCal), but only slightly more than 4 million people enrolled in SNAP (CalFresh) programs.

The enrollment pathways for federally funded support programs should be connected. We know implementing an integrated system and interoperability pathways pose a big challenge—it will require resource investments, system changes, and tenacity to figure it out. SIS Senior Policy Analyst Khaliyl Lane’s recent paper, Maximizing Linkages, highlights some case studies of how it can work and pathways that are available between programs. As we continue to fine-tune, expand, and transform the way people apply for and receive healthcare coverage in every state of the U.S. we hope that interoperability can grow from the letter of the law into an inter-connected network of support that is offered when people need it most.

We’d like to know: what do you think of as the “unfinished business” of the ACA? Share your thoughts in the comments or via Twitter.

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