Dear Friends of Mt. Sinai:

The words spoken by President Kennedy at his inauguration held great promise for our country. They paved the way for the Great Society of the 1960s, when both Medicare and Medicaid were created. For more than fifty years, our country has provided a safety net for the populations that Mt. Sinai Hospital, and now the Mt. Sinai Foundation, have served: Children, seniors and the poor.

Today, our nation's safety net is under attack. Efforts are underway to shrink the size of government on the backs of poor people, the elderly and the disabled. It is difficult to believe that there are 50 senators who could choose to bring an end to the health safety net as we have known it for more than half a century. Yet today it is a real possibility.

The working poor, including those who do not receive health insurance benefits through their employers, largely rely on government to access health care. In turn, access to health care remains a significant determinant of who lives and who dies in this country.

And while no one wants big government, we must recognize that Medicaid, particularly in Ohio, is among the most efficient government programs serving the poor. Other government programs have been efficient and effective as well. Without the Social Security Act, 40 percent of our nation's elderly would live in poverty. Thanks to government and our collective responsibility, that figure is closer to 10 percent.

After the Affordable Care Act (ACA) was enacted, Mt. Sinai reaffirmed its commitment to move away from investing in health care access and instead focus on its overarching strategic approach in health promotion and disease prevention. We refer to this approach not as health care but "health before care." And yet here we are, just eight years later, facing the largest threat to our nation's health care system in recent memory. Every aspect of the health care system is at stake.

Take long-term care, for example. Medicaid covers more than 70 percent of the nation's long-term care residents. As financially inadequate as that coverage has been for providers, Congress and the President's budget aim to slash Medicaid by up to 40 percent --nearly one trillion dollars in the next ten years-- as it seeks to roll back Medicaid expansion and most other components of the Affordable Care Act.

Cleveland would bear a disproportionate burden should proposed cuts take effect. As one of the nation's poorest cities, and as a city that boasts some of the nation's finest health care institutions that attract patients from all over the world, both the economic costs and the costs of human suffering would be enormous. There is no doubt that repealing the Affordable Care Act would be a major blow to urban employment and would threaten our ability to grow the regional economy.

At its 2013 annual meeting, Mt. Sinai honored Ohio Governor John Kasich for not bowing to the political winds and instead expanding Medicaid in Ohio, thereby providing access to care to an additional 700,000 Ohioans. Before the expansion, doctors reported that the working poor would present in emergency rooms with more advanced disease that was more difficult to treat. Since the Medicaid expansion, people have received medical treatment much earlier. Human suffering has been averted.

It is for all these reasons that the Foundation has been active in the health policy debates happening at the local, state, and national levels. We come by this work naturally. Our predecessor institution, The Mt. Sinai Medical Center, was a safety net hospital for our community and indeed the largest private provider of care to the poor in all of Ohio. While the Affordable Care Act has helped communities like Cleveland make progress toward ensuring access to high-quality health care for its residents, our country has not yet built the political will or the economic structure to extend this opportunity to everyone.

In the breach there were --and there are-- the Mt. Sinais of the world. When it comes to the issue of health care for all, we at the Mt. Sinai Foundation, as we say here in Cleveland, are "all in." We invite you to learn more about our health policy work and all of our 2016 activities in the pages of this annual report. As always, we welcome your feedback and thank you for your support.

Sincerely,

Susan Ratner
Board Chair

Mitchell Balk
President