The Civil Legal Aid Community Needs its Own Affordable Care Act

Whether you agree with the specific strategies of the Affordable Care Act (ACA) or not, it is a call to action for the health care community. It acknowledges that health has not always been at the center of how health care approaches either its service delivery or its business model. The ACA prioritizes prevention and asks the health care community to re-examine every aspect of how it trains professionals, partners with communities, and delivers care. It sounds to me like the kind of call to arms that the civil legal aid community needs.

When someone living in poverty is unlawfully evicted from their apartment or faces employment discrimination, it's a civil legal aid lawyer who intervenes--a public defender of sorts for any legal problem that isn't criminal. The demand for these services far outstrips the supply. Every individual who lives in poverty in the U.S.-over 45 million people-has 2-3 unmet legal needs, but there are only 6,953 civil legal aid attorneys in the country. The access to justice conversation doesn't have the same momentum as conversations about health and health equity, in part because the need for and work of civil legal aid is largely invisible. Other sectors and the general public are not aware of and do not understand what civil legal aid lawyers do, which is particularly problematic because these lawyers have a powerhouse skill set that could be a secret weapon in promoting not only justice, but health in vulnerable communities. More fundamentally, however, to reach its true potential, the civil legal aid community needs to rethink its approach to the civil legal aid crisis in America.

As we have learned in the recent health care debate, more funds without reform is not necessarily the answer. Is the civil legal aid community radically underfunded given its potential and importance to ensure fairness for people and communities and systems? Absolutely. But, have we examined our professional priorities and delivery systems to synchronize with a 21st century approach to problem-solving? No, we have not.

Like the health care sector's struggle to move patients from expensive emergency room visits to better, cheaper, preventative or "upstream" care, it is time for the civil legal aid community to think about prevention strategies for the people and communities it serves. The civil legal aid office that allocates the overwhelming majority of its scarce, sacred resources to the hardy individuals and families who make it through the intake process is missing the opportunity to align its service provision "upstream" in a community setting, using public health data to identify and reach more vulnerable people before their civil legal problems turn into legal crises.

This requires a wholesale shift in the conception of legal work and how it is valued internally in the civil legal aid community. Litigation, like its health care equivalent, surgery, will always have a place in the armament of legal tools. But like the health care system overhaul that has brought thousands of patient navigators and community health workers front and center into the health care team, it is time for the civil legal aid community to re-conceptualize the roles of those attorneys and paralegals on the front lines so they can prevent, rather than react to, civil legal problems. It will not be easy. Look how hard the health care profession has worked-and is still working-to build the army of primary care physicians and nurse practitioners funded under the ACA to take care of the millions of Americans who will now have access to primary care.

This, of course, brings me to the question of funding. How can chronically underfunded civil legal aid agencies besieged with demand take a deep breath and realign their work toward prevention? Many are treading water, jockeying for scarce funds while continuing to churn out a myriad of critical advocacy successes against the odds. A realignment of this scale requires investment. When dozens of families are in court every day facing eviction, it takes a leap of faith-not to mention leadership and the support of funding partners-to reallocate those resources to a "primary care" legal team further upstream, tasked with preventing those families from ever reaching the courthouse. Some civil legal aid agencies are bravely innovating preventive strategies, but they need help to scale them. They need the commitment of their peers and allies in the legal community.

Indeed, to move toward prevention, we in the civil legal aid community need our own version of the ACA. We need the incentive to change and the resources to develop the roadmap for that change. When the civil legal aid community succeeds at becoming visible, we are going to need better strategies to meet the sea of civil legal needs that we know is out there.

We won't get it all right the first time. But the lesson we in the legal community need to take from our health care partners and the ACA is that business as usual is not going to cut it.