Merry Christmas!

As the year comes to a close, I wish for everyone good health, access to affordable, quality healthcare, and a very Merry Christmas!

I'm sharing this article from Sister Mary Ellen Howard - the Executive Director of Cabrini Clinic in Detroit.

Many people in the community — even those close to our clinic — are asking what will be the effect of the Affordable Care Act on the Cabrini Clinic and other providers of charitable care around the state. Some wonder whether we will continue to be needed, and whether they should still support us.
There are a lot of myths out there about health care reform. But here are some facts. In 2014, the ACA will offer two new opportunities for insurance coverage:
■ One is to purchase insurance through the exchange. Small businesses and anyone whose income is below 400% of the federal poverty level may receive a tax subsidy to help them buy coverage. However, most of our patients at the Cabrini Clinic are too poor to take advantage of this option.
■ The second is Medicaid expansion, and that is more likely to affect the uninsured people served by free clinics. Up until now, many have been excluded from Medicaid, not because they have too much income, but because they are childless adults. Under the ACA, childless adults become eligible for Medicaid. In Michigan, this take effect in April.
Michigan is one of the 25 states where the legislature voted for Medicaid expansion, albeit reluctantly. Statewide, it is estimated that more than 400,000 of Michigan’s 1.3 million uninsured will people become eligible for Medicaid.
I was hopeful that about 80% of the uninsured patients we see at Cabrini Clinic would be among them. However, the Michigan Legislature asked the U.S. Department of Health and Human Services for waivers on the program that it is calling Healthy Michigan. Federal approval is required because the Michigan plan varies from the Medicaid expansion outlined in the Affordable Care Act.
For the uninsured poor, these waivers will pose barriers. They require enrollees in Healthy Michigan to establish a health savings account from which the state will deduct an income-based monthly premium for those earning between 100 and 133% of the federal poverty level.
The premiums can be reduced through healthy behaviors. The plan also requires co-pays for basic services. These premiums and co-pays will be a barrier to poor people who need care. I wonder how many will actually sign up. I am beginning to think that my 80% projection was wildly optimistic.
To make matters worse, Michigan plans to seek a second waiver in the future, imposing a soft cap on coverage at 48-months, at which point recipients would be cut off from Medicaid for life.
Michigan still has not received a ruling from the federal government on the waivers, so we are stuck with a lot of unanswered questions.
What if the feds say “no” to Michigan’s requested waivers? Do we become the 26th state to refuse the opportunity to expand Medicaid? Enrollment is to begin in April. Now is when we should be educating the 1.3 million uninsured Michiganders regarding Medicaid expansion — what is coming, what it will mean, who is eligible, what do I have to do to enroll and what will it cost? Instead, we have no answers.
There are many unknowns, but the future of free clinics for the uninsured is not one of them. In fact, it appears that we are needed more than ever.
Mary Ellen Howard, RSM, is executive director of St. Frances Cabrini Clinic of Most Holy Trinity Church in Detroit.

St. Peter’s Free Clinic is now a Certified Application Counselor Designated Organization!

What does a CAC organization do?

As a CAC organization, staff and volunteers help people understand, apply, and enroll for health coverage through the Marketplace. The organization must agree to make sure that designated individuals complete required training, and that they comply with privacy and security laws, and other program standards.

The organization must: 

1. have processes in place to screen staff to make sure that they protect consumer information
2. engage in services that position us to help those served with health coverage issues
3. have experience providing social services to the community

As of December 1, 2013, the clinic has three Certified Application Counselors: Connie, a volunteer and myself. We are now taking appointments to help people access healthcare coverage.

We are so excited to be part of this process.

If you are not part of the solution - you are part of the problem.

 

I found myself quoting Ronnie today.

And I had to smile.

Ronnie (Rhonda), Betty, Al and I were best friends in high school – actually in ninth and tenth grade. We had so much fun together – we laughed and played. Then just before our junior year, my family moved from southern Georgia to northern Michigan. A year later, we moved back to southern Georgia, but much had changed. Ronnie had a boyfriend; Al was not only going to high school but also taking classes at the local junior college and working full-time to support his family.

After we graduated from high school, we drifted apart. I completely lost touch with Ronnie.

When plans were being made for our 30 year reunion, someone called me to find Ronnie. I had no idea where she was, but I called Al. He gave me her phone number and I called her.

Turns out she became a nurse. I had ALWAYS wanted to be a nurse, so pretty much knew what I was going to do. She had NEVER mentioned wanting to be a nurse, so it was a bit of a surprise. And, not only was she a nurse – she was a Nurse Practitioner. And, her specialty area was gastroenterology. Which was perfect, because my husband had just been diagnosed with Hepatitis C.

She became such a support for me once again. She was able to be a professional and be a friend. We talked or emailed daily. We made plans for our 30 year class reunion. The four of us would be together again – and her mom was going to make a real southern dinner for us. It was everything that we wanted it to be.

Little did we realize, it would be the last time the four of us would ever be together.  

After the reunion, the daily emails and calls stopped. I spoke to Ronnie a few more times, but I had no idea of the chaos in her life.

She died in 2010.

But, today I smiled as I quoted her and remembered her. She once told me: “A Nurse Practitioner is educated; a PA (Physician Assistant) is trained.”

I love my PA’s here at the clinic, but… there is truth in her assessment of the difference.

And it was nice to be able to remember her and smile.

12/9/2013 Note:
And, just as she did in life, in death she continues to get me in trouble. This was never intended to be a reflection on PA's, it is simply my remembrances of an old friend. I apologize for insulting any of the PA's I love and work with.

Loss

I have experienced several losses over the past few years – friends, volunteers, members of the church. Those losses were deaths. But, I think the loss that has been the hardest for me is the loss of a close friend to dementia.

She was a member of the church long before I arrived. We had a lot in common – we were both nurses. But, we didn’t become friends. She taught my children in Sunday school, but frankly, she kind of scared me.

She worked in Intensive Care at the local hospital, was very involved in the church, never married – and was completely dedicated to her nieces and nephews. Probably about fifteen years ago she was in a horrible car accident. It took her years to recover – years spent with multiple surgeries, physical therapy, pain and agony.

She did not volunteer at the clinic for the first few years it was opened. Then someone told me she wanted to be asked. So, I asked her to help us out.

That was one of the best decisions of my life. She became a loyal, dedicated volunteer but more importantly, she became my friend and champion. She had the most generous heart; she always knew when I was struggling – and in the mail or under my door would come a card or a note or a small gift with her words of encouragement.

Her generosity was most evident at holidays. All the holidays – even ones I didn’t know enough to celebrate! There were cards and gifts – never with any fanfare, but always with lots of love and encouragement.

I should have noticed a while ago. First, there were multiple cards and gifts – for the same holiday. But, I never noticed those things. Then, there were some mistakes in the work she did for me at the clinic – not big mistakes, so I just corrected them, and didn’t give it a second thought. Then there was no card for a holiday; then there was no thank you note for a gift given; there were church related issues that were not done in a timely manner – and then lost – and then the accusations that someone else had lost the items.

None of us wanted to admit it. Her physical health was not good, so we attributed it to that. She was hospitalized; we were sure she would be fine. She assured us she would be fine.

But, she isn’t. It is the hardest kind of grief, because it is so mixed with guilt. Guilt about withdrawing; guilt about not seeing it sooner; guilt about not being there; guilt about not knowing how to be there. And grief. Such grief for the loss of a dear friend.