Insuring the Uninsured

SSA's CHAS played key role in ACA

Since the Affordable Care Act took effect, more than 20 million uninsured individuals have gained insurance coverage.

By: Professor Jeanne C. Marsh, George Herbert Jones Distinguished Service Professor and Director of the Center for Health Administration Studies (CHAS)

(This article appeared in the Summer 2016 issue of SSA Magazine.)

On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act (ACA) into law after nearly 100 years of effort to bring comprehensive health care reform to the United States. The impact of the ACA can be measured in the millions of previously uninsured Americans who have insurance. Since the Affordable Care Act took effect, more than 20 million uninsured individuals have gained insurance coverage. The rate of uninsured before the Affordable Care Act took effect was 20 percent and has now fallen to 13 percent. Although uninsured rates declined across all race and ethnicity categories, it declined most significantly for African Americans and Latinos.

The passage and implementation of the Affordable Care Act can be seen as an extended, uneven, and even painful exercise in health policy research dissemination and utilization. New York University’s professor of public service Sherry Glied, who worked in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) during the passage of the legislation, describes how the legislation would not have been possible without 50 years of research conducted by the Center for Health Administration Studies (CHAS) and research centers such as the Commonwealth Fund, Kaiser Family Foundation, and the W.K. Kellogg Foundation. An excellent video by Glied, “The Affordable Care Act: An Insider’s View,” is available on SSA’s YouTube playlist here.

In 1966, health policy visionary and CHAS founder, Odin W. Anderson, described the basic value guiding health policy research in the United States: That all people should have equal access to health services regardless of financial status. It was not until nearly 50 years later that this value was realized in the Affordable Care Act. Anderson viewed social research as the means by which this value could be debated and ultimately implemented:

Social research relating to (health) policy is then largely instrumental, serving to analyze the context in which public policy decisions are made to implement such decisions and to evaluate alternatives and their consequences in terms of objectives sought.1

With this vision, Anderson set in motion the research and training activities at the University of Chicago that would ultimately contribute to the development of the Affordable Care Act. The University of Chicago’s Health Information Foundation joined with the university’s Graduate Program in Health Administration in 1962 to become CHAS, located in the Graduate School of Business. In 1990, CHAS moved to its current home in the School of Social Service Administration.

The historic commitment of CHAS to health equity was reinforced in its move. At SSA, the center focuses on health policy and services for the disadvantaged by engaging an interdisciplinary, international group of policy and services researchers on topics of health policy innovation and reform, health and social service integration, health access, cost and quality, behavioral health and preventive intervention. Five SSA faculty, Jeanne C. Marsh and Colleen Grogan (Co-Directors), Deborah Gorman-Smith, Curtis McMillan and Harold Pollack guide the work of the Center. An additional twenty University of Chicago faculty participate as fellows.

Innovative health policy and services research is supported each year through the CHAS Seed Grant Program. The 2015- 16 cycle funded projects related to preventive reproductive health care for women, prescription drug out-of-pocket costs and adherence, STI/HIV risk perceptions among young men who have sex with men, partnerships to advance quality services, and factors affecting implementation of asthma care in schools. Additionally, each year, CHAS sponsors the Michael Davis Lecture Series that brings distinguished health policy and services researchers to the University. Finally, CHAS actively pursues partnerships and co-sponsorships, which have recently included conferences including: Social Work and the Affordable Care Act; Diffusion of ACA Policies across the American States: What, Why, How?; The Smart Decarceration Initiative; Health Policy Innovation and Reform in the US and France; STI and HIV Intervention Network; and the Health Leads Summit.

Building on its rich tradition, CHAS continues to explore new questions, identify knowledge gaps and promote the translation of research to policy and practice to the end of promoting health care for the disadvantaged.

1 Odin W. Anderson, “Influence of social and economic research on public policy in the health field: A review.” The Milbank Memorial Fund Quarterly, 44 (3), 11-51, July 1966.

Jeanne C. Marsh, PhD, MSW is the George Herbert Jones Distinguished Service Professor and the Director of CHAS.