Personal

So, now I go from being a healthcare provider to being a healthcare consumer. My husband is having surgery tomorrow - I get to be on the other side. I think the provider side is easier.

I ask for your prayers for him, for me, and for the people taking care of him.

I will be back in a couple of weeks.

Thanks.

I am outraged.

I am outraged.

I am outraged that Representative Ken Kurtz voted no on Medicaid Expansion; I am even more outraged that Senator Bruce Caswell was among the senators for whom vacation was more important than voting on Medicaid Expansion. Rep. Kurtz and Sen. Caswell will enjoy their insurance benefits – even through a two month vacation -unlike nearly 2400 residents of Hillsdale County.

By not supporting Medicaid Expansion, you didn’t hurt President Obama – you hurt the residents of the county you are supposed to represent. You hurt Cindy, Lynne, Curt, Robert, Charles, Mike, Susan, Elizabeth, Sam, Marvin, David, Karen, Ed, Terry, Mark, Joe, Betty, Kathrin, Amanda – the list goes on and on. For the past nearly eleven years, I have searched for ways to provide care to the uninsured, low-income residents of Hillsdale County. You had it at your finger tips and CHOSE not to do it.

I am outraged.

Update on Cindy - June 17, 2013

Cindy came by to see me today. She had a big smile and a new haircut. Except, it wasn't a new haircut - she was wearing a wig.

Cindy will finish her chemo next month and will then go through the testing to determine if she is in remission, and to make sure there is no spread of the cancer.

Last week she was able to get a couple of wigs, a bra, and (her words) "a boob". She feels great, looks fabulous, and couldn't stop thanking me. I am not sure why because as I recall, I'm the one who told her she had cancer. Yikes.

But, she feels lucky. Her daughter will be here from out west next month and she is well enough to spend time with her and enjoy the visit.

While she is receiving treatment she is covered by Medicaid. Once she is through with her treatment, she will no longer receive the Medicaid. Can anyone tell me how/why that makes sense??

A Message for Michigan's State Senate:

This can't be repeated often enough.

 

Gov. John Kasich said to one of the members of the Ohio legislature: “I respect the fact that you believe in small government. I do, too. I also know that you’re a person of faith.

“Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.”

-Columbus Dispatch

State House Passes Medicaid Expansion - from the Detroit News

Lansing — Legislation to extend Medicaid health coverage to as many as 470,000 Michiganians passed 76-31 in the state House late Thursday.

The controversial bill, unpopular among many Republicans, broadens the federal health insurance program for the poor to include adults with incomes up to 133 percent of the poverty level, or $15,281 a year for an individual.

It heads to the GOP-led Senate, where it will face its final, and possibly toughest, hurdle before it can go to Gov. Rick Snyder for his signature.

Thursday’s vote, which spared Snyder a defeat from his own party, was delayed late into the evening as House Republicans sought assurance the Senate GOP caucus would back them up if they approved the bill. Republican lawmakers are under heavy pressure from tea party and other conservative groups that have threatened to withdraw political support from lawmakers who vote for the measure.

Snyder lauded the passage Thursday, saying it would “reform and strengthen the state’s Medicaid program.”

“This is a Michigan plan for Michigan families, communities, businesses, and our economy,” he said. “It will help to curb skyrocketing medical costs by encouraging wellness, healthy behaviors and personal responsibility, reduce the burden of uncompensated care that shifts costs onto businesses and taxpayers, and help our citizens access affordable care.”

The measure passed with 28 Republicans joining all but one Democrat.

Michigan is among a number of states on the fence about Medicaid expansion. Those states are under pressure to decide the issue before federally mandated state health insurance exchanges are required to start operating Oct. 1.

The bill needs 20 votes to pass in the Senate — or 19, plus the lieutenant governor’s tie-breaking vote.But even if all 12 Democrats vote for the bill, it would need the support of at least seven Republicans.

Rep. Mike Shirkey, R-Clarklake, who pushed the bill through, urged his caucus to support it. “There are perfectly good legitimate reasons to oppose” but “sound, reasonable reasons to support” it, he said.

“I believe it’s time to stop playing defense on something that’s the law of the land and begin playing offense,” Shirkey said.

Democrats lauded the bill as a bipartisan effort. Rep. Scott Dianda of Calumet was the sole Democrat to vote no.

As few as six Senate Republicans were believed to support the Medicaid expansion as of Wednesday, but Shirkey, who chaired the House committee that shaped bill, said the number grew as senators learned details of the legislation.

“I will do my best to ensure that the passage is limited to the House,” said Sen. Patrick Colbeck, R-Canton Township, late Thursday on his Facebook page.

Even after passage, the bill would face another hurdle from the federal government, which would have to agree to Michigan’s requirement that able-bodied adults with incomes between 100 percent and 133 percent of the poverty level contribute up to 5 percent of their income to their health care. Another federal waiver would be needed to require the contribution be raised to 7 percent after four years in the program.

Snyder announced his support for the massive federally funded expansion of the Medicaid health insurance program for the poor in February, joining a cadre of Republican governors who broke party lines to support a key component of “Obamacare.” A coalition of tea party groups Tuesday issued an open letter calling on conservatives to withdraw support for Snyder’s re-election bid.

Many Republicans have said they don’t trust the government’s promise to pay for the program; others have vowed not to implement the Affordable Care Act, saying that it would amount to tacit approval of “Obamacare.”

Some House Democrats objected to a requirement beneficiaries contribute part of their income to their health care.

Under the Affordable Care Act of 2010, the federal government has committed to funding the Medicaid expansion, estimated at $2 billion annually for Michigan, and save the state $200 million annually. Starting in 2017, the state would start picking up part of the costs, reaching a total contribution of 10 percent in 2020.

Snyder has proposed putting half the $200 million annual savings into a fund for later years “to offset those costs when the state has to start paying.”


From The Detroit News: http://www.detroitnews.com/article/20130614/BIZ/306130140#ixzz2WCWU9Ybd

The Good, The Bad and The Ugly

I typically tell the story of an uninsured individual that works hard and has a tough story. But, as everyone assumes, we do have some come through our doors that make us wince. Last Tuesday night must have been a full moon. (I checked - it wasn’t!)

There was Nathan – someone we know well and see frequently. But, Tuesday night he came in here drunk. He disappeared for a long period of time, and then showed up again to pick up his meds. He will not be seen here again in that condition.

There was Janice, who had a bruised face and was crying. She’s usually a strong and stable person, so this was a change. Turns out she was injured at work by a client hitting her in the head; the hospital discharged her to our care. Medical advice I never thought I would give was: call an attorney. Now. Her needs were/are way beyond the scope of a free clinic.

There were two new patients who did not stay to be seen once they learned that we do not dispense or prescribe controlled substances.

There was Jane, who told us one story, but the next day we heard “the rest of the story” from a local physician’s office. Her problems are also beyond the scope of a free clinic.

Jeff was here from a local halfway house, which means he is fighting some kind of addiction. He was told that he has Hepatitis C. Again, that is beyond the scope of a free clinic. The treatment is expensive, intense and the patient needs frequent monitoring.

Robert was back; he is doing everything he can to manage his care following his hospitalization. But, it is tough. He is on his own, with very little support. His medications are expensive, and the clinic can’t monitor his Coumadin – he needs a primary care physician for that. We are able to help with most of his medications, we can do some teaching and give him some support, but not enough. We are only here one night a week. It isn’t enough.

In all, we saw 61 patients Tuesday night. There was the good, the bad and the ugly – to borrow a phrase. We do make a difference in the lives of the people we see. The volunteers are caring, compassionate, knowledgeable and just plain awesome.

But we all know this is not the way healthcare should be provided.

 

Robert

Robert came into the clinic a couple of weeks ago and complained of dizziness, “heart racing,” diaphoretic (sweating), with some shortness of breath and feeling like he had “water in left ear.” His blood pressure was 82/52 (normal is 120/80).

He was seen by the doctor but kept saying “I just got too hot.” We gave him some water to drink, and told him we would recheck his blood pressure in half an hour.

In half an hour, he was still very shaky and his blood pressure was 90/60 with a heart rate of 88 and irregular.

I consulted with the doctor, and we decided that he had to be transported to the Emergency Room. Since he had come to the clinic alone, we had to call the ambulance.

Ugh. I always hate to call the ambulance, and for a number of reasons – it is frightening to the patient; it is frightening to the other patients at the clinic; they always send the fire truck because of where we are located. But, the Emergency personnel are great, and they always try to help us minimize the chaos. So, we sent Robert to the hospital via ambulance.

The following Tuesday he was at the clinic again. I sat down with him to see how he was doing. When he saw me he said, “Thank you.” He had been in the hospital from the evening we sent him until the following Monday. They diagnosed him with A-Fib, or atrial fibrillation. A-Fib is an irregular heartbeat that can increase the risk of stroke.

To treat the A-Fib, he was started on Coumadin. Coumadin is a “blood thinner” that has been around for a long time. I did not think it should be too expensive – though I was wrong about that. We do not carry Coumadin at the clinic because it requires frequent monitoring with a blood test. Not having medical staff here makes it impossible for us to monitor the medication.

We sent him with his prescription to the local Wal-Mart. We were to make a referral to the local cardiologist for follow-up care.

Robert called me the next morning; his prescription for Coumadin would have cost him $380 for a month’s worth. The pharmacist called and got the prescription changed to a generic formula; it still was going to cost him about $25/month. He got half of the prescription filled. I’m not sure what he will do when he runs out of the medication.

I’m not sure what to do. Without the ability to monitor the medication, it is very dangerous for him to be on it. Without the medication, his risk of stroke is increased. With the medication, his risk of bleeding is increased.

What he needs is a Primary Care Provider that knows him and can manage the medications, the risks and the benefits. He needs care that is available to him every day of the week ­– not just on Tuesday evenings.

How can we continue to debate the need for healthcare reform, for healthcare expansion? We are not talking about fictional characters – we are talking about real people, with real lives.