Alliance for Just Society

HHS Sec'y Burwell: Break the barriers to health coverage

Dear Colleague:

The Alliance for a Just Society, with funding from the Kellogg Foundation, has done research in 10 states concerning barriers to coverage and care under the Affordable Care Act facing people of color and other communities with a history of access challenges.

Based on this research, we have formulated a series of policy recommendations that we will be releasing in a national report in April. An Executive Summary of the report is available (click here for PDF).  

The specific recommendations concerning barriers to access have been incorporated in a sign on letter to HHS Secretary Burwell that we are asking organizations to endorse. You can read and sign the letter via (this link).

If you have questions please contact William Daley at

Please feel free to circulate this notice to your lists!

The Honorable Sylvia Mathews Burwell


U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201


Re: Principles for action to break barriers to health coverage, expand access to care, and reduce race-based disparities


Dear Secretary Burwell:


Across the country, the health care landscape is in a period of rapid change. As states across the country push forward with expansions in health coverage and strategies that increase access to care and improve health outcomes for their residents, national leaders face a fundamental decision: will we advance policies that give our residents the best health care possible, or will we leave our residents with a second-class health care system that lags behind other countries?


While the ongoing debate over Medicaid expansion is the most obvious health care issue this country faces, it isn’t the only area where leaders have important opportunities to improve health care for residents. There are critical decisions to be made across three core areas: safeguarding access to health insurance, moving consumers from coverage to care, and building an infrastructure to promote preventive health care.


We urge you to support the following principles and strategies in these three areas as you consider options to improve health care for residents of the United States:


Safeguarding Access to Health Insurance

  • Don’t leave money on the table.It’s time to move beyond ideological debates and accept federal funds to expand health coverage through Medicaid. This remains the most immediate and highest-impact opportunity to expand coverage for uninsured residents.

  • Seek to streamline enrollment in health coverage programs. Automatically enroll in Medicaid people who already receive need-based benefits like SNAP (food stamps) or WIC, and eliminate waiting lists, ensuring that decisions are made on ACA marketplace and Medicaid applications within two weeks.

  • Improve language access in the enrollment process. Establish a right to enroll in the applicant’s primary language and require plans to notify applicants of their right to language services.

  • Make shopping for coverage easier and more transparent. Require insurers to simplify descriptions of plans, benefits, cost-sharing, and provider networks.


Moving Consumers from Coverage to Care

  • Expand the role of navigators to help people move from coverage to care. Enlist navigators to teach new enrollees how to use their coverage and to recruit enrollees to participate in marketplace-sponsored evening and weekend clinics focusing on health education and mobile health services.

  • Establish strong network adequacy standards and ensure provider access in marketplace plans and Medicaid. Require marketplace plan networks to meet a responsible patient-to-provider ratio, and ensure that enrollees are able to make primary care appointments within 10 business days. Set reasonable geographic access standards to limit the distance and time it takes for enrollees to reach primary care providers and specialists. In Medicaid, states can improve patients’ access to doctors by ensuring reimbursement at Medicare levels.

  • Hold insurers accountable for helping reduce racial disparities in access to care. Enforce ACA statutory provisions that require insurers to act to reduce racial disparities and continually monitor implementation of insurers’ disparity-reduction plans and programs.

  • Ensure free translation and interpretation services in the care setting. Publicize the availability of these services in all languages spoken by enrollees and ensure interpreter competence by using a reliable interpreter credentialing or licensing system.

  • Enforce access to preventive care and incentivize take-up. Ensure that all health plans cover the full scope of preventive services (yearly check-ups, immunizations, screenings, well-woman preventive care including contraception and reproductive health services) at no out-of-pocket cost. Patients should have the opportunity for a free physical exam and appropriate screening within 60 days of enrollment, and plans in which few enrollees receive these services should face penalties.

  • Measure results. Require plans to track health outcomes, disaggregated by race, ethnicity, primary language, gender, disability, and sexual orientation.


Building an Infrastructure to Promote Preventive Health Care

  • Strengthen community-based health care infrastructure, especially in low-income communities and communities of color. Support essential community providers, including community clinics, individual physicians, and small community practices, that serve low-income communities and communities of color. Reduce reliance on institutionalized care by prioritizing home- and community-based services in the state Medicaid plan. Expand school-based health centers with attention to medically under-served communities.

  • Incentivize health improvement approaches that address underlying social determinants of health. Offer incentives to health plans that adopt a broad view of health benefits and tackle underlying social determinants of health. Expand medical-legal partnerships as an avenue toward the broad array of issues that lead to poor health in low-income communities (e.g., mold in housing).

  • Invest in care coordination and population-based health promotion strategies. Direct Medicaid resource to care coordination and community support for high-risk individuals with chronic disease, and develop integrated care models for joint Medicare and Medicaid beneficiaries (“dual eligibles”).  Use Medicaid waivers to leverage federal funds to facilitate population-based promotion of public health in addition to individual service-based care.Move toward delivering health care through accountable care organizations, which provide population-based health care that includes social services.


By adopting these principles and strategies, America can be a leader in breaking barriers to health coverage, expanding access to care, and reducing racial disparities in health. We urge you to champion these principles and strategies as you work to advance the promise of quality, affordable health care for everyone in the U.S.




Endorsing organizations:

9 to 5

A Community Voice

Action NC

ANEW Community Institute - PA

Angela’s Piazza: Women’s Drop-In Center

Arizona APIAVote

Asian-American Community Service Council - OH

Asian Pacific American Network of Oregon

Asian Pacific Community in Action - AZ

Asian Services in Action - OH

Basic Rights - OR

Bethlehem Lutheran Church - MT

Billings First Congregational UCC - MT

Black Women's Roundtable

Black Women's Roundtable - Osceola County

California Partnership

Cement Masons, Local 567

Center for Ethical Living and Social Justice Renewal

Center for Intercultural Organizing

Central Florida Jobs with Justice

Children's Alliance

CHOICES: Memphis Center for Reproductive Health

Christian Community Baptist Church - New Orleans, LA

Citizen Action of New York

Citizen Wealth Centers of AR, LA, TX

Coalition for Asian American Children and Families

Colorado Organization for Latina Opportunity and Reproductive Rights

Comunidades Unidas - UT

Communities Creating Opportunity - Kansas City, MO

Community Church Unitarian Universalist - New Orleans, LA

Community COuncil of Idaho

Community Service Society of New York

Community Voices Heard - NY

Connecticut Citizen Action Group

Consumers for Affordable Health Care

Deaf Equal Access Foundation of Louisiana

Democratic Progressive Caucus of Florida

Dinerral Shavers Educational Fund

Empire Justice Center

Empowering Pacific Island Communities - CA

Engage Michigan

Evening Star Missionary Baptist Church

Farmworker Association of Florida

Fair Grinds Coffeehouse

Faith in Florida

Federation of Child Care Centers of Alabama (FOCAL)

Fight for 15 Florida

First Unitarian Universalist Church of New Orleans

Florida Black Women's Roundtable

Florida Chinese Federation

Florida Immigrant Coalition (FLIC)

Florida Institute for Reform and Empowerment

Florida Latina Advocacy Network (FL LAN)

Florida New Majority

Galilee Baptist Church - LA

Greater Yellowstone Central Labor Council

Health Care for All New York

Health Equity Circle - WA

Healthy and Free Tennessee

Helena Service for Peace and Justice

House of Faith - New Orleans, LA

Idaho Community Action Network

Impact Northwest

Indian People's Action

Iowa Citizens for Community Empowerment

Jesus is the Way Church of Hartford

Jobs & Self-Development Center - New Orleans

Justice Louisiana

Keystone Progress

Korean Resource Center

Language and Cultural Awareness Services of Northern Michigan

Latin Americans for Social and Economic Development

Latino Justice PRLDEF

Lead Safe America

Lead Safe Louisiana

Louisiana Environmental Roundtable on Children's Health

Maine People's Alliance

Main Street Alliance - FL

Main Street Alliance - OR

Massachusetts Immigrant and Refugee Advocacy Coalition

Mi Familia Vota - FL

Michigan Immigrant Rights Center

Michigan United

Michigan Unitarian Universalist Social Justice Network

Mississippi Immigrants Rights Alliance (MIRA)

Missoula Area Central Labor Council

Make the Road New York

Money Management Advocacy Council

Montana Organizing Project

NARAL Pro-Choice Montana

NARAL Pro-Choice Washington

National Congress of Black Women - Orlando

National Korean American Service & Education Consortium (NAKASEC)

National Tongan American Society - UT

Nebraska Urban Indian Health Coalition

Neighbor to Neighbor - MA

New Orleans NAACP

New Orleans Triumph Baptist Church

New York Lawyers for the Public Interest

New Yorkers for Accessible Health Coverage

NH Citizens Alliance

North Dakota Women's Network

Ohio Asian American Health Coalition

Olé - NM


Oregon Action

Oregon Foundation for Reproductive Health

Oregon Health Equity Alliance

Organization of Chinese Americans - South Florida Chapter

Organize Now

The People's Lobby

Planned Parenthood of Greater Orlando

Progress Florida Education Institute

Progressive Leadership Alliance of Nevada

Raise Idaho

Rock of Ages Baptist Church - LA

Second Rose of Sharon Missionary Baptist Church - LA

SEIU Healthcare 1199 NW

SEIU Healthcare 775 NW

SEIU Healthcare 775 NW - Montana

SEIU Local 21 - LA

Snake River Community Clinic - ID

Southern United Neighborhoods

South Florida Interfaith Worker Justice

South Florida Voices for Working Families

Southwest Detroit Immigrant and Refugee Center

Southwest Montana Labor Council

Speak Up Florida

Strike Debt Helena

Strong Families New Mexico

Tabernacle of Prayer - New Orleans, LA

Take Action Minnesota

Taking Action for Peaceful Solutions (TAPS)

Taulama for Tongans

Texas Latina Advocacy Network

Texas United City and County Employees

Texas United School Employees

Three Trusts - Louisiana

Trust & Faith Community Outreach Inc

UDiON Foundation

United Chinese Association of Florida

United Faculty of Florida - University of Central Florida Chapter

UFCW 21 - WA

United Labor Unions, Local 100

United Labor Unions, Local 100 - Texas

United Vision for Idaho

United Steel Workers 11-443

Virginia Organizing

VOCES of Battle Creek - MI

Washington CAN!

Western native Voice - MT

Wisconisn Alliance for Women's Health

Woman To Woman Global Mentorship Network

Working America


YWCA of Greater Portland

210 endorsements (list in formation)

Will your organization endorse?

This letter is only open to official organizational endorsements at this time. A public petition in support of these demands will follow.