Essential Health Benefits

All insurance plans purchased from the ACA Marketplace must include the following Essential Health Benefits. These benefits include,

·         Emergency Services

·         Hospitalization

·         Laboratory tests

·         Maternity and Newborn care

·         Management of chronic diseases, such as diabetes

·         Mental health and substance-abuse treatment

·         Outpatient care

·         Pediatric services including dental and vision care

·         Preventative services such as immunizations, mammograms and colonoscopies

·         Rehabilitation services

 

There are other protections in the Affordable Care Act that benefit all of us. No one can be denied healthcare insurance because of pre-existing conditions; there can no longer be annual limits on the benefits you receive; there is a ban on lifetime limits; preventive care and annual check-ups are free.

Current Clients

Who are you seeing at the clinic now? I am asked that question frequently. Now that everyone – in theory – has access to healthcare, who are we serving?

It has been an interesting journey – from anticipation to implementation – of the healthcare law. Connie and I became Certified Application Counselors in order to assist those looking to purchase healthcare insurance; we had very mixed results – some success, some who couldn’t afford to purchase the insurance that was offered. There were some who were skeptical about the whole process – they didn’t trust the system or didn’t understand what insurance would do for them.

Then, April 1, 2014 finally arrived and we were able to sign people up for the Healthy Michigan Plan (HMP), which is Michigan’s version of the Medicaid Expansion, a key part of the Affordable Care Act. It has been beyond our wildest imagination. From January to April we were seeing an average of 65 patients each week; we are now seeing an average of 31. And lately, that number is dropping.

So, who do we see? We see people who have fallen through the cracks – maybe they don’t qualify for Medicaid, but cannot afford insurance; maybe they were not aware of Medicaid expansion or the fact that this program is very different from the Medicaid of the past, so we provide them with healthcare, and we help them enroll in the Healthy Michigan Plan. We see immigrants, who have not lived in the country long enough to qualify for any of the programs; we see those who have enrolled in HMP, but have not received their insurance card in the mail – or who can’t get an appointment for another month; we see those that are new to our community and have no healthcare insurance. We are seeing fewer with chronic conditions and more with acute conditions. Most of the people we see are working and need to be healthy to keep their jobs.

We continue to help with enrollment; we are teaching those newly insured how to be healthcare consumers; we are offering smoking cessation sessions; we are going to start a program this fall or winter helping people make better lifestyle choices.

The clinic will be here as long as there is a need in our community. Our mission has always been to fill the gap in healthcare in our community. The gap has changed, but the fact that there is a gap has not.

Honestly, I feel like I can take a breath – we are able to be more present to those who walk through our doors when we are not so overwhelmed by the numbers. We can teach, we can listen, and we can provide a better quality service.

Smile!

I don’t know what made me think of Mark the other day, but something did. He was a patient here at the clinic from 2003-2006. He had a job – seasonal work with no benefits and not much income.

Mark had been in and out of trouble at times, but was a really nice guy. He’s a few years older than me, but had a mother who was supportive and worried about him. She and I became friends. We helped him get the medication that he needed, but that’s not the reason I remember Mark.

I remember him because of his smile. Not at first – he came in with dental issues the very first time we saw him here at the clinic.

Over the years here at St. Peter’s Free Clinic, we have tried to address the multitude of unmet needs that exist in our community. We have been fairly successful in providing healthcare services and medications to the low-income, uninsured residents of our county. But, not as successful in providing some of the other unmet needs – and dental care is a huge unmet need.

The importance of dental care has been expanded over time – we now know how important it is to maintain good oral health to protect physical health. Some of the disease processes affected by dental health are:

·         Diabetes: People with diabetes who happen to have periodontal disease may suffer excessive bone loss of the jaw or surrounding bone structure and have difficulties in healing.

·         Heart Disease: Experts have concluded that poor oral health caused by chronic dental infections may increase the risk for cardiovascular disease and stroke.

·         Stroke: Recent studies have linked periodontal disease with strokes.

Mark came in during a time when one of the local dentists was very eager to help our patients. Mark was one of the first patients to be seen by the dentist for the clinic. He came in, we made the referral, and then I didn’t see him for several months. When he came back to the clinic, he had a smile as big as the moon. His teeth had been fixed or replaced; he was no longer embarrassed to smile. He was grateful beyond words.

For many people, poor dental care is a barrier to jobs. No matter how smart, how personable, or how well-dressed a person is, if they have bad teeth, or no teeth, they are not going to get hired. Dental care can change a person’s life. It may also save a life!

I am so thrilled that the Healthy Michigan Plan (what Medicaid expansion is called in Michigan) includes access to dental care for adults (children on Medicaid have always had this benefit in Michigan). It will make a huge difference in the life of the working poor in our state.

Maybe we will see more people smiling?

Book Recommendations

When I am faced with a problem or a challenge, I tend to turn to books, both to gather information and as an escape.

Recent family health issues have led me to read several books that I highly recommend to anyone facing end of life issues. These books are much more about gathering information, but most of them are also about someone else on this journey at the end of life. Their stories have encouraged me, given me much-needed information and insight, and have helped me form the questions I have that need answers.

In no particular order, here are the books that have really spoken to me:

My Mother, Your Mother: What to Expect as Parents Age by Dennis McCullough, MD

 

Knocking on Heaven’s Door: The Path to a Better Way of Death by Katy Butler

 

The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life by Ira Byock, MD

 

A Bittersweet Season Caring for our Aging Parents – and Ourselves by Jane Gross

 

 

Planning Ahead: Durable Medical Power of Attorney

As you learn about making your way through the healthcare system, there are many things to think about. An important tool is the Durable Medical Power of Attorney.

A Durable Medical Power of Attorney helps to assure that the medical professionals and your family/friends are able to carry out your wishes if you are unable to communicate due to illness or injury.

A Durable Medical Power of Attorney is a document that you create. It grants the authority to a person of your choice to make medical decisions on your behalf if you are unable to participate in the care planning.

Durable Medical Power of Attorney is also known as Advanced Directives.

A Living Will provides instructions to doctors, hospitals and family/friends concerning the use of specific procedures designed to sustain life – such as ventilators, feeding tubes, or dialysis. A living will also authorizes medical facilities to withhold certain procedures if there is no reasonable chance for recovery. This document outlines YOUR wishes – there is no need to appoint anyone to carry them out.

You may have both a living will and a Durable Medical Power of Attorney.

To create a Durable Medical Power of Attorney, check the laws of your state. Often the forms are available at no charge online or at your healthcare provider’s office.

With a Durable Medical Power of Attorney, you are not giving up control; rather you are making sure that your wishes will be carried out if you are unable to make the decisions.

The person you choose does not have to be a family member, nor does it have to be the family member that lives closest. It should be someone who is readily available by phone in case of emergency. Select someone who knows you and is willing to carry out your wishes about your medical care.

Copies of your Durable Medial Power of Attorney should be given to your physician, your hospital, the person(s) you have chosen to represent you, and extra copies in a safe place such as a safety deposit box or a fire-proof cabinet. Make sure your emergency contact and at least one other person knows where you keep it and how to access it.

Often, we find it too difficult to think about these issues – we still have YEARS of a good life. But, if we don’t plan for the unforeseen, we could end up in a situation where our wishes are not taken into consideration. It is important to plan ahead, and to talk to those who will be making decisions on our behalf about what we consider to be quality of life. These conversations are much easier in theory than they are in reality, so plan ahead. Make your wishes known, and choose who will make those decisions if you can’t.