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Health Care Reform in East Harlem

By Andrea Jakubowski

The DFA National Conference in April of 2013 came at an incredibly exciting time. The health insurance marketplaces were set to launch October 1st, Medicaid eligibility had expanded, and we were witnessing a historic step towards improving American’s access to health care. As a group of Mount Sinai medical students new to DFA and attending the conference for the first time, we were caught up in the excitement. But we also learned the sobering fact that millions of individuals who would be newly eligible for Medicaid or private insurance on the marketplace weren’t aware of how health care reform could benefit them. Doctors for America had helped pass the ACA and defend it from attack, and now we would need to help with its implementation.

Our group of medical students came away from the conference impressed by the urgency and importance of helping spread the word about health care reform. Mt. Sinai is located in East Harlem, a neighborhood with a high burden of disease and many barriers to health care access. Students at Mt. Sinai have a long tradition of working and serving in East Harlem, and we began brainstorming how we might bring the message of health care reform to our patients and fellow community members.

We decided to start a Mt. Sinai Doctors for America student chapter. We knew we wouldnt be working alone in East Harlem, as the neighborhood is rich in trusted organizations serving devoted clients and patients. Our first step was to form a partnership with the East Harlem Community Health Committee (EHCHC), a coalition of community organizations with a history of working on implementation of health policy changes in the community.

Our goals in forming the partnership were: 1) Educate East Harlem residents about new options for health insurance and how to enroll 2) Describe and document East Harlem’s experience of enrollment from the perspective of community organizations and 3) Facilitate communication and collaboration between community based organizations (CBOs) working on enrollment.

A group of twelve medical students, we dedicated ourselves to forming partnerships with local organizations, including three major community health centers and two large social service agencies in the neighborhood. From September 2013 until the end of the open enrollment in April 2014, we gave nine presentations with over 115 in attendance, including for a NYC Department of Health ACA forum, part-time staff of Union Settlement Association, clients of several small community organizations, and the Mt. Sinai medical community. We tabled at health fairs and tax clinics, talking with attendees about the ACA. Finding that the outreach resources from the state marketplace often lacked adequate information about eligibility and how to apply for insurance on the marketplace, we created over ten outreach documents in English and Spanish that we used and shared with navigators and many organizations in the neighborhood.

One our group’s most significant contributions was creating linkages between organizations in East Harlem. Working closely with a certified application counselor, students were able to invite her to several of our community presentations and connect East Harlem residents with her services if they needed assistance enrolling. Every month, we presented updates at the EHCHC meetings to share what we were learning through our outreach and enrollment efforts and to generate discussion about how we, as a community, could strengthen our ACA work.

Now, a year after the health insurance marketplaces launched, it seems clear that the health insurance marketplace has been a great success. In New York State, there were approximately 2.7 million uninsured before the launch of the Marketplace. By August, the number of uninsured was just over halved, with 1.4 million signing up for insurance. But as impressive as these gains are, there is still work to be done. Building on the lessons we learned through our work, we are excited to continue our efforts in East Harlem and throughout New York City to keep spreading the word about the ACA and getting covered.

Andrea Jakubowski along with the Icahn School of Medicine at Mt Sinai Student Chapter of Doctors for America

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