Margaret

Margaret is a reluctant patient. She came here because she has nowhere else to go.

When she married, she lost her insurance (she had been on Medicaid due to her disabilities). Her husband works a job with no healthcare benefits. Margaret suffers from bipolar disorder, depression, anxiety and COPD (Chronic Obstructive Pulmonary Disease). She came to the clinic to get help with accessing her inhalers. And the only reason she did that is because without them, she can’t breathe.

She doesn’t want to talk with our doctors about her mental health issues. So, they go untreated. And she suffers, silently, alone.

Her family will not qualify for Medicaid expansion – her husband’s job pays enough that they are above 133% of the Federal Poverty Guidelines. But, they will qualify for assistance with health insurance through the marketplace. She will be able to afford insurance and receive the comprehensive care that she needs.

Kate

Kate owns a business in our town, but doesn’t make enough money to buy health insurance for her and her husband. She comes to the free clinic, but would much prefer to see her own doctor. She just can’t afford to see him. So, she swallowed her pride and came here. It has been hard for her – she doesn’t want anyone to think she is looking for a handout; she works hard.

On Christmas Day she injured her hand, but felt like she couldn’t afford to go to the emergency room. The clinic closes for two weeks over the holidays because we are a volunteer organization, and no one wants to give up their holiday time. So, she waited until the clinic reopened in January to have her hand taken care of.

She will qualify for Medicaid under the Medicaid expansion offered by the Affordable Care Act. That will give her access to healthcare when she needs it. She won’t have to wait two weeks to access necessary healthcare.

Andrea

Back to the stories:

Andrea first came to the clinic years ago. We helped her access a maintenance medication, and that was really all she needed.

Until about six months ago. She had worked for a number of years in an extended care facility. The work is tough – a lot of lifting, moving people around, etc. She sustained a number of injuries, and ultimately lost her job.

And, with that, she lost not only a way of making a living, but lost who she was. She has always been a happy, upbeat person. Suddenly, she had become quiet, frightened and began having multiple symptoms that concerned her. That is what brought her back into our doors.

Fatigue, leg pain, back pain – a myriad of symptoms that could be anything, or could be nothing.  We did several tests including x-rays and blood work. Someone told her “it might be Lupus,” so we did some more tests.

It wasn’t Lupus. When she faced that possibility, and then learned it wasn’t that, she was then able to deal with the very real issues that she does have.

Fear is an awful thing. The fear of losing your health to a chronic illness is beyond terrifying. It can be life changing.

The relief she felt when she was told it was not Lupus was written across her face. She has the encouragement she needs to deal with the pain she is experiencing. She was so afraid that something was seriously wrong, that she lost her ability to cope.

She has been seeing the chiropractor here, working on an exercise program, and is ready to move on with her life.

If she had access to primary healthcare, she could have avoided some of this situation. She would have had a provider that knew her, knew her story, and her history. That would have made the diagnosis so much easier, and she would not have had the long wait for test results. Piecemeal healthcare is a disgrace. We can do so much better, and Andrea is one of the millions that could benefit from Medicaid expansion.

My Temper Tantrum

How does God's love abide in anyone who has the world's goods and sees a brother or sister in need and yet refuses help?  1 John 3:17

This verse has been haunting me since I read it this morning. It is so much what I feel like I am fighting for – for us to see those with needs and to offer to help them.

Instead, too often what I see and hear is judgment. “If they can’t afford healthcare, why do they have a cell phone?” “THOSE people just want a handout.” “They smoke.” The list of complaints is endless. Like none of us have any vices, right?

For those of us living as Christians, we are told pretty clearly that it is not our job to judge. I don’t believe the scripture is in any way equivocal about that. What we are to do is to love; to serve the least of these. Really, we are to see all people as being of the same value in the eyes of God.

But, what we do is judge.  There is a YouTube video called Empathy that was put out by the Cleveland Clinic. It talks about putting ourselves in the other person’s shoes in order to understand what they are experiencing. It is a powerful reminder of how each person we encounter is dealing with something.

One of the things I have learned as I have gotten older is that every one of our lives has joy, sorrow, trials and hardships; for each of us the journey is different. Each of us is dealing with our life in the best way we are able to given our circumstances.

Yes, there are those that take advantage of the system. They are not always the poor – many rich people take advantage of the system by cheating on their taxes; there are doctors and healthcare centers that commit Medicaid and Medicare fraud. 

Why are we so afraid to make available to all people access to quality, affordable healthcare? Isn’t that one of the easiest and best ways to take care of everyone? And in taking care of everyone we also take care of ourselves. The Affordable Care Act provides healthcare reform that benefits each of us – more preventive care, more of our premiums spent on healthcare delivery, eliminating the fear of policy cancellation due to illness, eliminating pre-existing condition clauses – the list goes on and on of the benefits we will all enjoy.

One argument I hear is “we can’t afford it!” Well, we can’t afford to not implement the Affordable Care Act. While we twiddle our thumbs and moan and groan about it, my patients are dying for lack of access to healthcare.  As I review stories for this blog, too often the stories I know are the ones of the patients that died. They had such limited access to healthcare that they died. Some while waiting for care, others as a result of too little care way too late.

If we are going to call ourselves Christians, it is time to live up to our calling which I think Matthew 25:44-45 makes pretty clear: “‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’  He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’”

Healthcare reform: The Uninsured

As insurance premiums rise and more employers drop coverage, an increasing number of Americans are living without health insurance. Nearly one in three non-elderly Americans—86.7 million people—went without health coverage for all or part of 2006-2007.

And four out of five of those individuals were in working families.

Why does insurance matter? People without insurance are more likely to go without preventive care, to delay or forgo medical care, and to die prematurely. When sick, the uninsured may turn to emergency rooms for care, where oftentimes they are charged more for services than insured patients. And when uninsured patients can’t afford their medical bills, the cost of this care is passed on to the insured in the form of higher premiums.

The number of uninsured Americans reached an all-time high in 2010, as nearly 50 million Americans went without health insurance for the entire year. For many of these uninsured people, the consequences of going without coverage are dire. The uninsured frequently face medical debt or go without necessary care, and too many of them die prematurely.

While it is true that hospitals cannot turn away anyone, it is also true that those individuals will end up with enormous hospital bills. Some will file bankruptcy when it becomes too much of a burden to pay these bills; some will spend their lifetime paying the bill a few dollars a month; others will just walk away from it – unable to pay the bill, and unwilling to face the shame of asking for help.

In 2002, the Institute of Medicine released a groundbreaking report, Care without Coverage: Too Little, Too Late. This report estimated that, nationwide, 18,000 adults between the ages of 25 and 64 died in 2000 because they did not have health insurance.  Since then, the crisis of the uninsured has grown even larger. During the economic downturn, millions of Americans lost both their jobs and their health coverage, and rising health insurance premiums have priced many more out of coverage.

Thankfully, the new health care law can help stem the rising tide of the uninsured. Beginning in 2014, millions of Americans will be eligible for assistance with the cost of health coverage. In addition, insurance companies will no longer be able to deny coverage or charge higher premiums to people with pre-existing conditions. These measures, among others, will help reverse the growth in the number of uninsured Americans year after year.

 

Healthcare Reform: What it means for Women

Being a Woman JustGot a Little Easier: How the Affordable Care Act Benefits Women - Historically,women have not had equal access to essential health coverage and care. Women havebeen charged higher insurance premiums than men simply because they are women.

And they’ve had no guarantee that the health coverage theypurchase will cover the women’s health services that they need. The AffordableCare Act is one of the greatest victories for women’s rights in recent decades becauseit puts an end to this discrimination. The law improves access to care that isessential to women’s health, and it makes coverage more affordable. Already,millions of women are benefiting from the health care law, and more protectionsare on their way in 2014.

Americans withPre-Existing Conditions Are Protected by the Health Care Law - More than64.8 million Americans under the age of 65 have been diagnosed withpre-existing conditions that, without health reform, could lead to denials ofcoverage in the individual health insurance market. Without health reform, onein four (24.9 percent of) non-elderly Americans is at risk of being deniedcoverage.

Protects women andtheir families from insurance discrimination:

No morediscrimination based on a child’s pre-existing conditions. Healthinsurance companies can no longer deny children health coverage because theyhave a pre-existing condition or deny children coverage for health services totreat their pre-existing condition.

 Insurance companies can no longer cancel yourhealth coverage when you get sick.

Insurance companiescan no longer place lifetime dollar limits on your coverage.

Insurance companies will have to increase their annualdollar limits on coverage until 2014, when they will no longer be able to placeany annual dollar caps on your coverage.

Young adults can now remain on their parent’s health planup to the age of 26. Already more than 3 million young adults have gainedcoverage under this provision of the law. This provides peace of mind formillions of moms and their young adult daughters.

and starting in 2014 . . .

Insurance companies will no longer be able to deny anyonehealth coverage or charge more for health coverage based on a pre-existingcondition. Nearly 30 percent of women (28.4 percent) in the United Stateshave a diagnosed pre-existing condition that, without the health care law,could lead to a denial of coverage. Thanks to the law, women will no longer be discriminated against becausethey have pre-existing conditions. They also won’t be denied coverage forhaving had a C-section or for having been a victim of domestic violence.

Simply being a woman will no longer be a pre-existingcondition. Insurance companies will no longer be able to charge women higherpremiums than men for the exact same health coverage. This will ensure that nowoman is ever again charged up to 85 percent more than a man for the exact samehealth coverage, simply because she is a woman.

Low- and middle-income families will receive tax creditsto help make coverage affordable. This means that 7 million women who arecurrently uninsured will be able to get tax credits that cover a portion oftheir monthly health insurance premiums, making coverage more affordable forthem and their families.

More low-income adults will be eligible for Medicaid. Thanksto the law, 10 million women who are currently uninsured may be able to gethealth coverage through Medicaid (if your state has opted to participate inMedicaid expansion).

The ABC's (and D) of Medicare

Medicare is the federal health insurance program for people 65 and older and for some younger adults with permanent disabilities and medical conditions. Prior to 1965, the year in which the Medicare program was established, about half of all seniors lacked health insurance. Today, virtually all people 65 and older have coverage under Medicare, and are eligible for this coverage without regard to their income or medical history. Medicare currently provides health insurance coverage for nearly 50 million Americans.

The Medicare program is comprised of four parts – Part A, Part B, Part C (also known as Medicare Advantage), and Part D. Together, these four parts provide coverage for basic medical services and prescription drugs.

 

Part A (Hospital Insurance): Part A covers inpatient hospital care, some skilled nursing facility stays, home health care, and hospice care.

 

Part B (Medical Insurance): Part B, or the Supplementary Medical Insurance (SMI) program, helps pay for physician services, outpatient hospital care, and some home health visits not covered under Part A. It also covers laboratory and diagnostic tests, such as X-rays and blood work; durable medical equipment, such as wheelchairs and walkers; certain preventive services and screening tests, such as mammograms and prostate cancer screenings; outpatient physical, speech and occupational therapy; outpatient mental health care; and ambulance services.

 

All people with Medicare pay a monthly premium for Part B. Most people who pay a Part B premium have it automatically deducted from their Social Security check. If your income is limited, you may qualify for programs that will pay the Part B premium on your behalf.

 

Part C (Medicare Advantage): Part C allows beneficiaries to enroll in a private insurance plan, called a Medicare Advantage plan. Medicare Advantage plans are managed care plans, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Medicare Advantage plans must cover all Part A and B services and usually include Part D (prescription drug coverage) benefits in the same plan. These plans sometimes cover additional benefits not covered by traditional Medicare, such as routine vision and dental care. All plans have an annual limit on your out-of-pocket costs for Part A and B services, and once you reach that limit, you pay nothing for covered services for the rest of the calendar year. The out-of-pocket limit can be high but may help protect you if you need a lot of health care or need expensive treatment. Out-of-pocket costs include deductibles, copayments and coinsurance.

Although Medicare Advantage plans must cover Part A and B services, they can have different rules, costs and restrictions.

 

Part D (prescription drug coverage): In 2006, Medicare began offering outpatient prescription drug coverage under Medicare Part D. Medicare drug coverage is optional for most people with Medicare and is offered only through Medicare private plans. If you have Original Medicare and want Part D drug coverage, you can get a stand-alone prescription drug plan (PDP). There is a monthly premium for Part D. Premiums vary widely among plans, as do the drugs that are covered and the amounts charged for prescriptions.

 

What Medicare Does Not Cover

Medicare does not cover all health care services. For example, Medicare pays for a limited amount of long-term care services; it does not pay for home or community-based care, assisted living facilities, or nursing homes. Medicare also does not cover regular eye exams, most eyeglasses, hearing aids, routine dental care, or most care provided outside the United States.

Insurance to Supplement Original Medicare

To help cover gaps in Medicare coverage and cost sharing such as deductibles and coinsurance, most Medicare beneficiaries supplement their coverage in some way. There are several types of supplemental insurance that work with Original Medicare. Some options include insurance from a former employer, supplemental insurance policies such as Medigap, or programs for people with limited incomes.

 

For more information go to http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf

Medicaid

Since 1965, Medicaid has been the backbone of this country's health care safety net. Jointly funded by the states and the federal government, Medicaid covers more than 58 million low-income Americans, including families, people with disabilities, and the elderly. Today, Medicaid provides coverage for almost 29 million children and pays for approximately half of all long-term care costs.

Medicaid insures more than one in seven Americans and accounts for more than 15 percent of our nation’s spending on health care.

Medicaid is jointly funded by the states and the federal government. Federal law requires state Medicaid programs to cover certain categories of individuals and services. Beyond that, states have wide flexibility in the design and implementation of their Medicaid programs.

Medicaid Today: Even though Medicaid has helped millions gain access to health care, many low-income people have been left out. In 30 states, income eligibility for parents is set below 50 percent of poverty (in 2012, that’s an annual income of $9,545 for a family of three). In most states, adults without dependent children, no matter how poor, cannot get Medicaid coverage at all.

Medicaid Expansion: In 2014, as a result of the Affordable Care Act, states can get substantial federal funding to expand Medicaid to all residents with incomes at or below 133 percent of poverty, thus extending Medicaid coverage to individuals who have been left out of the program. [Note: Since 5 percent of income is not included—is “disregarded”—when eligibility is determined, the expansion, in effect, applies to those with incomes at or below 138 percent of poverty.]

Financing

Medicaid Today: Generally speaking, each state receives matching dollars from the federal government, and those matching rates vary across the states from 50 to 76 percent. This means that, for every dollar a state spends on Medicaid, the federal government contributes between $1.00 and $3.17. Federal matching rates are based on the per capita income of the states, so states with lower per capita incomes get higher matching rates.

Medicaid Expansion: In 2014, the Affordable Care Act gives states the opportunity to expand their Medicaid programs to cover all individuals with incomes at or below 138 percent of poverty (see note above), an income of about $31,809 for a family of four in 2012. That will extend coverage to many low-income adults currently left out of the program and simplify eligibility determinations across the program.

Eligibility

Medicaid Today:

Federal Requirements
Federal law requires states to cover certain categories of people in Medicaid. In general, there are six categories of so-called “mandatory” individuals: 1) children, 2) pregnant women, 3) very low-income parents, 4) the elderly, and individuals who are 5) blind or 6) disabled. Eligibility levels for these groups of people vary by income.

State Options
States have the flexibility to increase these income limits to allow more people to qualify for Medicaid.

Medicaid Expansion: In 2014, states can expand their Medicaid programs to cover virtually all individuals under the age of 65 with incomes below 133 percent of poverty. Income eligibility for those over 65 will remain unchanged. For those newly eligible through this expansion, the federal government will cover 100 percent of costs for 2014 through 2016, gradually falling to 90 percent in 2020. The federal contribution will remain at 90 percent thereafter. States have the option to implement this expansion sooner.

 

Fasten your seat belts

Get ready for a lot of reading this week! I needed to get back to basics - for myself as much as anyone else. Sometimes I use words that I think I understand, but find that I don't really know the meanings. Healthcare reform can certainly be a place where that is true.

I am putting together some information about the basics of healthcare reform. What is Medicare? What is Medicaid? Why should I care about healthcare reform - what does it mean for me?

I will publish pages addressing each issue - you can pick and choose what you want to read. Hopefully, it will clarify for me and maybe for you, what it is we are fighting for - or about.

Thanks for your interest in my blog, and this subject. It really does affect each of us at some point in our lives. Whether we want it to or not.

99

Another new record at the clinic: 99.

99 uninsured residents of our county seeking healthcare services in the basement of a church; one night a week.

Is this the best we can do – in Hillsdale County, in the state of Michigan, in the United States? Really?

Our local legislators think they have a better idea than the Medicaid expansion. I’m not sure I understand why if there is a better way to do it, they haven’t done it before now. And I certainly don’t understand why anyone would oppose Medicaid expansion now.

Medicaid expansion will help those who are seeking services here. It will be a safety net for the under-employed. Do those in power in our state have so little confidence in their economic plans that they fear the Medicaid population will grow? If that is the motivation for denying people access to healthcare, maybe they should pay more attention to their economic plans, and implement Medicaid expansion as quickly as possible because a healthy population will be able to work, to contribute to our society, and be able to go off Medicaid.

The Congressional Budget Office (CBO) estimates that the Medicaid expansion will add very little to what states would have spent on Medicaid without health reform, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some — and in a number of states, possibly all or more than all — of the modest increase in state Medicaid costs. Expanding Medicaid is thus a very favorable financial deal for states.

Michigan is now considering whether to expand Medicaid under the ACA—Governor Snyder has recommended Michigan participate in the Medicaid expansion, but some have expressed concern that expanding Medicaid to more adults may pose fiscal challenges. However, purely monetary calculations ignore the potential human, financial, and productivity benefits associated with improved access to affordable health care for the millions of low-income adults without health insurance coverage and their families.

I cannot stress enough how important it is for us to let our legislators know how we feel about Medicaid expansion. It is good for our community, it is good for our state, and it might even be good for each of us individually. There are no guarantees in life, and we can all be one paycheck away from being uninsured.

Write or call, and tell your stories to Senator Bruce Caswell, 720 Farmun Building, P.O. Box 30036, Lansing, MI 48909-7536. You can call his office at 866-305-0316 or email him at senbcaswell@senate.michigan.gov

He needs to hear the stories – he needs to know how lack of access to healthcare has affected your life or the lives of those you love. He needs to know that you vote, and that you care about this issue.

Howard

Howard was a new patient this week at the clinic. He is married with two children. He had a good job in Georgia until his employer decided to give the job to his (the owner’s) brother. He was left with no job, and no prospects.

He grew up not far from here, and had a brother living in the area so he moved his family here. He now works for his brother making $8/hour, and sometimes working a lot of hours. Other times, not nearly enough. Farming tends to be seasonal.

He has no health insurance, and has some on-going health problems. He has not seen a doctor in over two years.

He and his wife will qualify for Medicaid under the Medicaid Expansion. They will both have access to healthcare, as their children do now.

These are not people “sitting on their butts doing nothing.” These are people who are working, trying to keep their family warm and fed. These are the people that will be helped by the Affordable Care Act. And, they are not alone. Every week we see too many people that do not have access to healthcare – except on Tuesday night, in the basement of a church.