Last year, New Jersey enacted legislation calling for ACOs to be created in Camden, Trenton, Newark, and other cities, and to formalize their alliances as government-sanctioned Medicaid Accountable Care Organizations. The ACOs would receive a portion of the money Medicaid saves by reducing unnecessary ER and hospital use for reinvestment into improving public health services in their communities.

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Mr. R is a 60 year old man who, along with neck surgery, is recovering from addiction.  He has been on methadone maintenance therapy for years and has stayed away from heroine.  Recovering from cocaine has been far more difficult.  As goes the natural progression of addiction diseases, he has quit and has relapsed.  Before his recent hospitalization for the neck surgery, he was living with a family member.  At this home, many people use cocaine, which fueled his relapses.  When we met him in the nursing home he begged us to help him find a different place to live so that he might have a chance of staying clean.  He knows the cocaine makes him weak, incites his bad decisions, and leaves him unable to contribute to his family.

We promised to help him find a new place to live.  Like many of our patients he has a very limited income.  For Mr. R, it’s $700 a month.  He is willing to spend almost all of it on a safe home.  Yet, the 7 or 8 Camden apartment buildings that have a few rooms for less than $700 a month are full and not accepting applications.  They already have waiting lists greater than a year and a half.

Mr. R. will qualify for housing assistance offered from the state.  To apply for these housing vouchers you need to have a photo ID.  Mr. R. has lived in the city his entire life, never drove, and has no driver’s license.  He also never got a state ID.

To obtain an ID in New Jersey, you need to provide several forms of identification.  You need a birth certificate or other primary document of identification, social security card, bank statement, or current health insurance card to fulfill a six-point system.  Our patient only has a health insurance card so our first task was tracking down his birth certificate. Like many people his age, there was no official state certificate issued at his birth.  We discovered he was born in Detroit.  To send for his birth certificate we filled out an intricate form and needed a lawyers petition to acquire it.  We sent for it express 3 weeks ago–we are still waiting.  Hopefully it will come soon.

Until we can acquire his social security number, the other documents we need, and head to the motor vehicle commission for a state ID Mr. R. will remain in the nursing home.  Each day it costs Medicaid $200 to keep him there – that’s $6000 per month.  But, he’s safe there.  He’s not doing drugs and recovering wonderfully.  He has hope that tomorrow will be better and he will find a new place to live.  We’ll continue searching.

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We arrived at the ICU to find our patient sedated and intubated. Yet only 10 days earlier Mrs. P was strong enough to navigate the halls in her wheel chair, had her diabetes and COPD under control and was taking her medications for bipolar disorder. Mrs. P was discharged with an abundance of home health services – nursing, physical therapy, occupational therapy, home health aid. How had her condition declined so quickly?

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A panel of experts gathered at The Inquirer on Wednesday to review the impact of the law so far, and speculate about its future. The media, of course, tend to focus on political squabbling and efforts to undo the law. But even as criticism keeps bubbling, most states are making progress toward implementing a key part of it: insurance exchanges. Of the 50 states, only Alaska has not applied for a grant to plan an exchange, said Joel Ario, a former Pennsylvania insurance commissioner who directed until this fall the federal office overseeing the creation of state-based health insurance exchanges.

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I traveled to D.C. on November 17, 2011, with a group of organizers and community leaders representing the People Improving Communities through Organizing (PICO) National Network. Days before an important deadline for the Congressional “super committee”—a group tasked with devising a deficit-reduction plan for the federal government—we had come to deliver a message: public healthcare programs like Medicaid and Medicare, a lifeline for many million Americans, should be protected from across-the-board cuts. With alarm clocks in hand, this was our “wake up call” for Congress.

But the day proved to be an awakening for me, too. I spent my time in D.C. thinking about the power of everyday people – their voices, their stories—and how CCHP is harnessing that power to improve healthcare in Camden.

At a rally in the Dirksen Senate Building, faith leaders, seniors, and people with disabilities from across the country urged the “super committee” to protect Medicare and Medicaid. From the rally, our PICO group of about thirty proceeded through a maze of underground tunnels and winding staircases, our small, golden alarm clocks ringing all the way. When we arrived at Senator John Kerry’s office, staffers greeted us. (I was amazed at how little resistance there was to our group marching in unannounced – and with alarm clocks!) A pastor from Massachusetts shared his congregation’s healthcare concerns with Senator Kerry’s Press Secretary, and then presented him with a box of petitions requesting no additional cuts to Medicaid and Medicare.

The final item on our agenda for the day was a meeting at the Department of Health and Human Services. Seated together at a long conference table, an HHS official listened carefully while PICO leaders discussed healthcare initiatives in their communities. Pilar Perry spoke on behalf of Camden Churches Organized for People (CCOP), one of CCHP’s member organizations. Her voice was sure and strong as she explained a recent CCHP success: the opening of a healthcare clinic in Northgate II, a housing complex that is home to many of Camden’s most frequent utilizers of Emergency Departments. Pilar, who lives in Northgate II, was an important part of the team that interviewed and organized residents to make the clinic a reality.

When I consider a giant problem, something like making high-quality healthcare affordable and sustainable, I sometimes get overwhelmed. It all seems too complicated, too technical, and I decide it’s better to leave these issues up to the “experts” in a place like Washington, D.C. But on this day, PICO reminded me that everyone has experience as a patient, a healthcare consumer. It is important for this kind of “expert” to get involved in the healthcare conversation, too.

I realized that CCHP could not achieve its mission of improving the quality and accessibility of healthcare in Camden, New Jersey, without participation by the residents we represent and serve. CCHP has community members on its Board. We work closely with groups like CCOP to reach out to residents directly, both to determine their healthcare needs and to solicit their ideas about how we can provide better care. In fact, it was this grassroots, problem-solving approach that gave rise to the Northgate II clinic Pilar talked about. I believe CCHP’s consistent, concerted focus on the people of Camden, our resident healthcare “experts,” is an important reason that our work is so effective.

My D.C. adventure, along with my work with CCHP more broadly, has opened my eyes to the human side of healthcare policy.

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