Dear Friends:

2012 was a whirlwind for the Council's policy team, with the direction of health care policy lurching from the June Supreme Court decision that upheld the Affordable Care Act (but made Medicaid expansion optional) to the November national election that did not resolve ongoing budget concerns or Congressional tensions. All year there was a constant stream of impending budget disasters, proposed federal rules and implementation guidances, think tank analyses, and media hype. Closer to home, every state had some combination of debate & negotiation, task forces & councils, decision-making & decision-avoidance - on a spectrum ranging from political gridlock to early implementation of Medicaid expansion. It's exhausting and exciting at the same time.

The irony is that (in most places) nothing has really happened yet. Planning for and gaining consensus around needed health care delivery system changes does take a lot of time and effort. 2013 will only bring a more intense pace, as open enrollment for the state health insurance exchanges and the Medicaid expansion begins on October 1, 2013. The HCH community will work to maximize each state's progress, seeking to improve the health status of our very vulnerable neighbors. For good or ill, that process will look different everywhere.

In 2013, our priorities will include the following:

• Ensuring that all states expand Medicaid to the full 138% of the federal poverty level, as authorized under federal law
• Promoting proactive outreach and barrier-free enrollment into health insurance
• Ensuring that the delivery system provides comprehensive, high-quality and integrated care
• Ensuring that the safety net is able to serve people - like undocumented people - who remain uninsured 
• Continuing to push for truly universal health insurance coverage
• Protecting public funding for the programs upon which our clients rely 

This is no small task, but the HCH Community has been at the forefront of collaboration and innovation for over 25 years. If we can design a health care system that works for people experiencing homelessness, we've succeeded in designing a system that works for everyone. Take care of yourselves and find some peace this holiday season, as we'll need a renewed vigor and focus for the work yet to be done in 2013.