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.

Happy Thanksgiving

I received a call at home Sunday night. It was the sister-in-law of the young woman with the Glioblastoma. She called to let me know that her sister-in-law had surgery. They removed a golf ball sized tumor from her brain.

She is home now. Home for Thanksgiving.

The family wanted us to know that they would be celebrating Thanksgiving because of the clinic; because we had sent her to have the test that found the tumor.

Good health, when we are lucky enough to have it, should be at the top of our gratitude list this Thanksgiving.

UGH.

UGH.

That seems to be my tag line lately. Ugh. I am so tired on NOT being able to help people.

We seem to have more and more complicated issues each week. Remember the young woman I told you about – the one needing an MRI? Well, the MRI was negative, but her issues continue. She has headaches that are debilitating, yet she works full time. She keeps a complete headache diary – the headaches sometimes come 6 to 8 times per day. She suffers from memory loss, she is sometimes unstable walking. She is scared, and frankly, so am I after hearing her symptoms.

The doctor that saw her last night wrote for referrals to ophthalmology, hematology and neurology. I laughed – not because it was funny, but because I know that other than ophthalmology, there is very little chance I can get her seen by the specialists she needs.

The woman with the glioblastoma was transferred from the local hospital to a regional center where she was scheduled for surgery. I may or may not ever hear the outcome. At least I know she is getting care.

Today, I get a call from the health department. A young man seen here last night was there today trying to get help. We were not able to make the referral he needed. He works full time as well, for a large local company; one that hires full time help through a temp agency. That way, they don’t have to pay for benefits. Yes, I am bitter and angry. If we expect employers to provide insurance, why don’t we make sure that they provide insurance? And, if it is each person’s responsibility, why don’t we make it possible for them to GET insurance?

I had to tell one of my nurses last night to instruct patients to use the insulin syringes we were able to provide for a couple of injections. I thought she was going to be sick – physically sick – when I said that. As nurses, we teach people to never re-use their syringes. But, since I don’t have enough to ensure that all of my diabetic patients have enough syringes for all of their injections, it is better to give them what I can and have them re-use them than it is to not have any syringes to give some of the patients. I can do a half-assed job for more people that way.

Yup, I love our healthcare system.

Gratitude: Pass it On

Last week I received a card with this note in it:

Hello,

I just received some great medical news and I wanted to pass this blessing on. I hope this donation helps. Thank you.

Enclosed was a check for $500.

Yes, it will help. Thank you for making your good news our good news.

100

This is my 100^th blog post.

Wow. I am so awed by all of you that take the time to read what I write. I never anticipated being a writer of any sort, so this is such a stretch for me. I have to thank my amazing daughter for all of her assistance and support. She proof reads everything that I write so that I don’t embarrass myself. Any and all mistakes are mine.

This has been such an amazing journey for me; it has been so important for me to share the stories of the people that I serve. These are our friends, our neighbors, and the people that work in the establishments we frequent: grocery stores, restaurants, nursing homes, many of the businesses in our community. Their stories are important; they say a lot about our society and how we treat people. Their stories also tell a great deal about the real values in our country today.

We proclaim loudly that we are a Christian country, that we live by Christian values. But, that is not what I see. To me, living by Christian values would mean that we live out the words of Jesus from Matthew 25: The Judgement of the Nations

 “When the Son of Man comes in his glory, and all the angels with him, then he will sit on the throne of his glory. All the nations will be gathered before him, and he will separate people one from another as a shepherd separates the sheep from the goats, and he will put the sheep at his right hand and the goats at the left. Then the king will say to those at his right hand, ‘Come, you that are blessed by my Father, inherit the kingdom prepared for you from the foundation of the world; for I was hungry and you gave me food, I was thirsty and you gave me something to drink, I was a stranger and you welcomed me, I was naked and you gave me clothing, I was sick and you took care of me, I was in prison and you visited me.’ Then the righteous will answer him, ‘Lord, when was it that we saw you hungry and gave you food, or thirsty and gave you something to drink? And when was it that we saw you a stranger and welcomed you, or naked and gave you clothing? And when was it that we saw you sick or in prison and visited you?’ And the king will answer them, ‘Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.’”

When we refuse to take care of people because we don’t think that they are worthy, we are not living our lives as Christians; when we refuse to provide equal access to quality healthcare to everyone, we are not living our lives as Christians.

We are ALL better off when everyone has access to healthcare.

And, that is my sermon for the day. Thank you to all of you who care, all of you who donate your time, talent and treasures to this clinic or wherever your passion leads you. Thank you for letting me tell the stories.

Crazy Night

I know that there was NOT a full moon on Tuesday night, but… oh, my. It was a crazy night.

So, first of all, we were short staffed. That happens sometimes, and we can usually make it work. Well, actually, we always make it work – we have no other choice.

The symptoms people were presenting with were crazy – things way beyond the scope of a free clinic, or so one would hope.

The first patient I dealt with had come in with a compliant of headaches. We had ordered an MRI – which, I have to tell you, usually I say no. What are we going to do with the information once we have it? Is there anything we can do? We don’t have access to a neurologist, there is no neurosurgeon, so… what can we do with the information? But, this gentleman had the MRI – which showed “his brain was shrinking.” Honestly, I have no idea exactly what that means. I am sure there must be a real diagnosis in there somewhere, but that is what he heard and what he shared with me. Understandably, he is scared. He didn’t know what to ask the doctor, and I didn’t know what to tell him. We are working on getting him seen at one of the larger medical centers in the state. It is a slow process.

Then, there was the young woman with headaches, memory loss, and some other vague symptoms. We made the decision to have an MRI done on her; we are still waiting for those results.

The third person I met Tuesday night is 39 years old, which means she is just a little too young to qualify for the Breast and Cervical Cancer Screening Program. But, she found a lump under her arm, near her breast. She is terrified, in tears, and I have very little to offer her. But, I tell her we will get the ultrasound, if there is anything suspicious, we can get her into a surgeon, and we will go from there. I know a little bit about her fear; I found a lump near my breast when I was about her age. I was lucky – it was nothing. I share that with her, but am not sure if it helps or not. When it’s your life, other people’s stories don’t really help.

And, then there was the patient I didn’t see. But, I saw her test results today, and my heart sank. She too presented with headaches, memory loss, some balance issues. Her diagnosis: Glioblastoma multiforme (GBM), which is the most common and deadliest of malignant primary brain tumors in adults.

Holy crap. I envisioned a clinic where we would take care of people with minor issues – colds, asthma, diabetes, high blood pressure. Not where we are having to tell people that the diagnosis is going to change their life forever… and we have almost nothing to offer them. Healthcare reform is not coming soon enough for some of these individuals.

What do I tell them?

On a lighter note, I did get a marriage proposal on Tuesday night. Well, sort of. He wants to run off with me – or would if I weren’t married. I told him THAT would be the biggest mistake of his life.

At least there is something to make us smile!

A better way? I sure hope so......

I tend to be a “cup is half-full” kind of a person. I am usually optimistic and I like to believe the best about people and things.

So, it has been difficult for me to receive criticism for my championing of the Affordable Care Act. I have never intended to hurt anyone’s feeling or step on any toes. But, I am very passionate about the work that I do, and the population that we care for. I am anxious for people to have access to healthcare – real, meaningful access.

The work of the clinic, while it makes those of us doing it feel good, it is not what is best for the population we serve, or even what’s best for our community. Month after month I see hundreds of uninsured, low-income individuals walk through the door of the clinic. They are sick, they are vulnerable, and they are tired. And, we do the best we can to put the pieces together for them. They see a healthcare provider, they get their medications, someone listens to their story (hopefully) and they go on their way. God forbid that they end up sicker – because then their only choice, at least until the next Tuesday night, is to go to the emergency room or go without care.

I love these people. I love that they trust us enough to come here. I love that I get to do work that has meaning. And, believe me, I am not a saint, I am not even always a nice person. I am just incredibly fortunate to be here, now, and to get to do this work.

So, I apologize for feelings that I have hurt. I am sorry that the clinic has lost your support. But, I do not apologize for how I feel, for the passion that I have for this work and my belief that there is a better way.

It's all OK

Nathan was in last night. We haven’t seen him for several months. He has been receiving his care from a referral source.

I have a soft spot for Nathan, as he suffers from the same chronic health condition my husband has. I know what a tough journey it has been for us, and we have so many resources – insurance, a primary care provider, family and friends – so much support.

Nathan told me last night that he is no longer receiving treatment for his condition – the side effects of the medication had taken a toll. So, he’s off treatment until next spring.

He also told me that he lost his job; the company he was working for has closed. He was without work for a few weeks; fortunately he was able to borrow money from his dad and his sisters in order to make it. When he can’t pay his rent, he works for his landlord – painting, yard work, whatever needs to be done. He just started a new job making $7.40 an hour. His paycheck covered his car payment, with $1 left. He is thankful he was able to make the car payment after not having any work. But he is having a hard time making ends meet. He finally broke down and applied for food stamps – “just to get through” he told me. He doesn’t want a handout.

He told me several times “It’s all OK” as he told me his story.

He proudly showed me his 10 year sobriety token. He told me as long as he stays sober, it is all OK. That is his primary focus; he needs this new job to provide for himself, and to stay sober.

It’s all OK.

Maybe I need to remember that sometimes.

It’s all OK.

The Beginning, Not the End

I was so excited about October 1, 2013 arriving, with the promise of healthcare reform, or more accurately, access to healthcare insurance.

But, it has been messy.

The website is overwhelmed, and not functioning as we had hoped. But, that doesn’t mean that healthcare reform has failed, or that it will fail. It just means that many of us who hoped to help people find access to healthcare insurance will have to wait.

We will wait, patiently, until the bugs are worked out. We will still be able to help people with finding access to real healthcare.

Here at the clinic, many of our patients will qualify for the newly expanded Medicaid that Michigan passed. It was a battle, but next spring we will see the benefits of having healthcare coverage for our most vulnerable.

October 1, 2013 was the beginning – not the end. The opportunities are still there. Open enrollment will last until March 31, 2014. In the meantime, we continue to provide healthcare to those in our community who have no other resource.

OCTOBER 1, 2013

Today is a historic day. The major provision of the Affordable Care Act begins to take place today. Millions of uninsured, working Americans can begin to apply for healthcare coverage using the newly developed Marketplace.

So, what is this Marketplace? It is a one-stop shopping arena for purchasing health insurance. You can look at all the options and have all the information you will need to make a decision. The Marketplace will be available online, by phone, or in designated locations. If you don’t get your insurance from your employer, then you can shop the Marketplace. The information from all the insurance companies will be available in one place and you can compare coverage options – side-by-side, with the same information for each company explaining the coverage and the cost.

The Marketplace offers insurance in what they call “Four Metal Levels”: Bronze, Silver, Gold and Platinum. The factors affecting your cost are the premium, or monthly cost for health insurance, the out-of-pocket expenses that you will pay at the time of service, the benefits you will receive and the amount the insurer will pay.

In order to make the health insurance more affordable for working families, there will be tax credits that will go towards your monthly health insurance premiums. These tax credits will vary depending on the size of your family and your income. There is also some money available for cost sharing, which means you could get lower deductibles and co-payments if you meet the income guidelines.

There are penalties for not purchasing health insurance. If you have insurance through your employer, you are all set. If you are uninsured and do not purchase health insurance, the penalty is 1% of your income or $95 – whichever is greater. But, by the year 2017 that amount will increase to 2.5% of your income or $695 – again, whichever is greater. There are some exceptions to the mandate.

For those in our state with the lowest incomes – those living at or below 138% of the Federal Poverty Level, you will qualify for Medicaid when expansion takes affect sometime next year (hopefully, by April). If you have a family of 4 and make $31,322 or less, you may qualify for Medicaid next year.

If you have questions, call 1-800-318-2596 or go online to healthcare.gov. They are available 24/7 and can answer your questions about healthcare reform.

 

What does healthcare reform mean for Michigan?

From FamiliesUSA

Robert Update

Following his hospitalization for atrial fibrillation, Robert came into the clinic every single Tuesday night. Sometimes he needed medications, sometimes he needed to see the doctor, but what he ALWAYS needed was the reassurance that he was doing okay. He was so scared, and this was the place that he felt safe. Safe – here at the free clinic, he felt safe. How did he feel the other six nights a week? Frightened, alone, scared – I can only imagine.

We noticed that he had not been here for a couple of weeks. One of the volunteers expressed concern; I had noticed too that he wasn’t here.

Last night he came in – almost dancing. He feels good. His health is so much better and he feels alive again. He needed his medications, so he came in to pick those up and was on his way saying: “Thank you. I feel GREAT!”

Rose Update

Rose has not had an easy path post-amputation. She was re-hospitalized with an infection; she was wearing a pump on her leg to assist with circulation the last time I saw her.

She seems to be doing okay emotionally, but her daughter who is her caregiver is really struggling. It is so hard as a child to have to become the parent to your parent – to be the caregiver.

Yesterday I received a call from one of the larger regional hospitals – not the one where she had her surgery – and they were discharging her. I asked why she was there, since her surgery had been done somewhere else. She wasn’t there because of her leg – she had been admitted there with Congestive Heart Failure. Another example of how fragmented our healthcare system has become.

Veterans

Last night, I talked with one of our veterans for quite a while. He had come to the clinic for healthcare. He’s a veteran – served in both Gulf Wars. And he is getting his healthcare in the basement of a church. We really can’t do any better than that? He is entitled to VA benefits – we have tried to help him access them. But, there has been a change in personnel in the local office; he has been lost in the chaos. He’s a veteran, for crying out loud. Can’t we do better?

Eleven Years!

Today we celebrate 11 years of service to our community. As I reflect on that amount of time, there are so many things that come to my mind.

First and foremost – I have never been at a job for 11 years. I never imagined I would be here for 11 years. Of course, I never imagined the need, the number of people we would see, the number of volunteers we would have, the fight for healthcare coverage for all Americans. Pretty much, I had no imagination – just a willingness to do the work.

In 11 years we have seen 4,237 individuals come through our door seeking services; nearly 85% of them qualify for services here. Some people we see one time – they are sick or have had a minor injury, and come to us for help. Others are temporarily without insurance and come to receive the medications they need for a short period of time. For some, we become their primary care location long term. Some are unable to get insurance or jobs because of health conditions; many are in the 50+ age group – unemployed, and often unemployable. For whatever reason, they have not been able to find employment. There are many individuals who work low-wage jobs with no benefits. Often these individuals are working multiple jobs – all minimum wage with no benefits. Sometimes the spouse has insurance; almost always the children qualify for Michigan Medicaid for Children.

In 11 years we have had 23,840 patient encounters – the cumulative number of visits to the clinic. It includes all the services provided – physician visits, medication refills, chiropractor, podiatrist, and other specialty clinics.

In 11 years we have provided medications to the uninsured residents of our community with a retail value of $7,562,587. Those medications have kept innumerable patients out of the emergency room. By providing the medications necessary to treat high blood pressure, diabetes, asthma, and other chronic conditions, the clinic has saved our community countless dollars, countless hours in the emergency room. Our community IS healthier because of the clinic.

Since January of this year, the clinic has averaged 60 individuals each week. We are able to handle that number with amazing ease. We never know who or what will show up when we open the doors at 5 pm. Some nights the line has been forming since 2 p.m. Other nights, the crowd comes in slowly, gradually. We have set two records this year for the most patients seen – first 83, then three weeks later we saw 99.

Usually about half of the patients come in to get medication refills. We fill all of our prescriptions for 30 days, so we see people regularly. It is sometimes a burden for people to have to come in every month. But, it is a bigger burden for the pharmacists to have to fill prescriptions for longer periods of time. Sometimes patients forget, or maybe they really don’t know, that the clinic is staffed by volunteers who have worked all day, then come to the clinic to give of their time. One of my main jobs on Tuesday night is to take care of my volunteers.

There is energy on Tuesday nights that can’t be explained. Yes, there are the patients that try our patience and nights when we want to (and sometimes do) scream. But, then someone walks up to me and quietly says “Thank you.”

But, after 11 years, what I know is that we are not enough. People should have a basic right to healthcare - real healthcare – in a doctor’s office, in the hospital when appropriate. Everyone should have access to preventative care, annual physicals and immunizations; healthcare WHEN they need it – not just on Tuesday night.

I am so grateful to so many people that I have met over the years. The congregation of St. Peter’s Episcopal Church, Hillsdale – who had the vision and wisdom to start this ministry; the staff and volunteers at the clinic – who keep me on my toes; the patients who have changed my life – hopefully for the better; the donors and supporters of the clinic – even those who didn’t initially believe in our mission or our ability to carry it out. My life is so full and rich because of all who have passed this way.

Yes, I am glad that healthcare reform has passed and that Michigan finally has voted to accept Medicaid Expansion. I am so glad that my patients will have access to healthcare. I look forward to the next phase of life for the clinic – helping people access healthcare. We will help them with the applications for healthcare, with transitioning from the clinic to private providers, and I suspect we will be here for the foreseeable future – providing healthcare to those that continue to fall through the cracks. The ACA (Affordable Care Act) is a good beginning, but does not solve all the problems.

Happy 11^th Anniversary to St. Peter’s Free Clinic! Thank you staff, volunteers, supporters, donors, and patients – for all that you do and all that you are. We couldn’t do it with out you!

 

Medicaid Expansion in Michigan

This information comes from FCOM, or Free Clinics of Michigan:

Time to celebrate – Medicaid expansion has PASSED in the Michigan Senate!

 For those who have not been following the Senate in the months of the tantalizingly slow process to expand Medicaid, here is what has happened:

 On June 12, 2013, the Michigan House of Representatives voted to pass the Medicaid expansion bill, HB 4714. The result was 9 votes in support of the bill, and 5 votes against it.

The bill then went to the Michigan Senate for a vote, but with an insufficient number of the majority party (Republican) agreeing to take a vote, Majority Leader, Senator Randy Richardville (R-Monroe) decided to postpone the vote until after the summer break. He assigned a group of six Republican senators to study and amend the bill over the summer, so the Senate would have a refined piece of legislation to vote on upon their return in August. Governor Snyder (Republican) was upset by the fact the Senate had refused to take a vote, and he spent his summer traveling across the state to increase support for the expansion, also requesting that voters contact their senators and ask them to, “Take a vote, not a vacation.” While the senators met periodically throughout the summer, a vote was never taken during the break; however, when the senate returned to start a new session on August 27, 2013, it was a high priority agenda item.

While the senators assigned to the bill over the summer made some minor adjustments, HB 4714 remained basically intact. There were, however, two other bills that were designed by Republican senators, Patrick Colbeck and Bruce Caswell, which were allowed to be presented as well. Both reforms essentially scratched the Medicaid plan altogether, and both were rejected by the senate.

After many hours of debates, votes on other bills, and recesses, the time for the much anticipated vote on HB 4714 finally arrived. The vote resulted in a 19-18 vote, with Senator Patrick Colbeck abstaining from the vote. Despite the majority in behalf of the expansion, a bill cannot pass without a minimum of 20 votes in support. Had Senator Colbeck cast his vote very likely ‘no’ vote, there would have been a 19-19 tie, and Lt. Governor Brian Calley would have been ready to cast the tie-breaking vote in support of the expansion.

Just when it looked as though all hope was lost for the expansion, a surprising turn of events led to a vote to reconsider the bill immediately. An amendment was added that stated that hospitals will not be allowed to charge Medicaid patients more than 115% of what they charge Medicare patients. With this amendment, a new vote was taken around 8 p.m., and the vote ended in a 20-18 vote in support of the expansion, after Senator Tom Casperson (R- Escanaba) switched his initial ‘no’ vote to a ‘yes.’

Despite the bill passing, there is a required two-thirds majority for a bill to go into immediate effect. Because there was only a simple majority, the expansion cannot take effect until at least April 1, 2014, or an Immediate Effect (IE) vote is approved by the Senate. Unfortunately the delay will cost the state approximately $7 million dollars from the federal government for every day it is not implemented, but Medicaid expansion will be moving forward.

While the bill has passed in the Michigan Senate, it must now return to the Michigan House of Representatives for another vote, due to the minor amendments added to their original bill, and then passed onto the federal government for the final approval.

 

What does this mean for the State?

Currently, most of those covered by Medicaid are children and those with incomes less than half of the poverty line. This leaves many citizens unable to afford private health coverage, and unable to qualify for Medicaid. With the passage of the bill, citizens earning up to 133% of the Federal Poverty Line (FPL), or approximately $15,282 for an individual and $31,322 for a family of four, will become eligible for Medicaid once the bill goes into effect. In the next few years, it is expected that approximately 470,000 additional Michiganders will be eligible for insurance under this reform. The expansion, or “Healthy Michigan,” as it is referred to by Governor Snyder, will be paid for in full by the federal government until 2017. This contribution will gradually decline until it hits 90% in 2020, where it will remain.

Individuals covered by Medicaid will be helping to fill the gap as the amount contributed by the federal government declines. As part of the bill, newly covered individuals will be required to contribute 5% of their medical costs. This number will increase to 7% after 48-months, unless deemed otherwise on a case-by-case basis.

With the expansion underway, it is expected that the number of emergency room visits will decrease and will no longer be a very expensive alternative for primary care of routine visits. This should also lead to better health benefits of these individuals, as they will be able to see a regular health care provider who will get to know their circumstances, and health history, to provide the best care.

 

 

Clinic Tonight

As I look out over the clinic tonight, I see so many faces – some I know, many I don’t know. In the early years of the clinic, I knew everyone by name and knew most of their stories. But now, we see so many patients and I don’t get to work as closely with them as I used to.

I miss that.

Tonight we have a young girl who is battling opiate addiction. She just moved here to have the support of her family in this battle. We can help her with the depression and anxiety she is experiencing, but we have nothing to offer her in her battle with addiction. We send her out – wondering how she will cope in a new community without the resources she needs.

A mid-30-year-old man who I would describe as “simple” was here for help with his medications. He had the lab work done that we had ordered and it showed that he now has diabetes. That is a huge diagnosis to take on in one short appointment. We were able to provide him with a glucometer and test strips. One of the nurses spent a lot of time showing him how to use the machine, teaching him the basics. I worry that he will not remember what she has told him. I don’t know what kind of support he has at home. We make an appointment with the dietician for him, but can he afford the foods that will make it easier to control his blood sugar? Will he be willing and able to change eating habits that he has had for a lifetime?

Two patients ask for copies of their medical records. One of them is applying for disability. We see that often – some are truly disabled; others are just tired – tired of not being able to find a job – tired of not having enough to eat. The other one is asking for her medical records so that she can access some rehabilitation services – they will look over her medical records and help train her for a job that she can handle. Why are there not MORE of those kinds of services available?

There are some patients pacing – frustrated with how long the process takes. I want to scream at them: “It’s Free!!!” But, I remember – they are human beings, with obligations, with families, with feelings. Many are embarrassed to have to be here; some have taken time off from their job to be here, because we are only open on Tuesday nights – and they need their medications.

I too, am tired. It has been a long day, a long week, a long summer.

Summer of 2013

Healthcare reform, family healthcare crisis, clinic, doctor appointments, webinars, presentations, healthcare reform, clinic… My head is spinning this summer, and it appears the blog is one of the things that have been neglected.

The Michigan Senate is still on vacation, while the hardworking low-income residents of Michigan continue without healthcare coverage. We wait… and wait… to plan, to put into action, to teach, to help… until they act.

According to the SEIU Blog, “Every day the state of Michigan delays implementing Medicaid expansion costs the state $7,000,000 in federal tax dollars. This breaks down to $241,667 an hour, $4,861 a minute, and $81 a second.” That is real money that would provide real care to the uninsured residents of Michigan. It would also provide for jobs, increased spending – a boost to our economy.

October 1 is the day open enrollment begins for the Marketplace and for Medicaid, if expansion is approved. There is a lot to do in that short amount of time. The primary job is to educate those who will be most impacted by this – the uninsured. According to Kaiser Family Foundation, over 80% of those who will be eligible for Medicaid don’t know about the changes in the law. Most of the uninsured do not know about the Marketplace, and that they will be eligible for tax credits to help them buy insurance.

There is a lot of work to do. I hope I am ready.

An Invitation

Join National Episcopal Health Ministries for a special informative session: Navigating the Healthcare System: The Affordable Care Act  Jill Pavka, Executive Director, St. Peter's Free Clinic August 22, 2013  2-3:15 PM EDT/1-2:15 PM CDT In the fast changing world of healthcare, finding the appropriate resources can be challenging for under-served populations. We will identify the under-served and uninsured population; explore the resources available for them; examine the rationale for providing healthcare to all, not just as our obligation as Christians but to provide for a healthier nation; and discuss how healthcare reform will/might affect these populations.  Participants will be able to 1) identify the under-served and uninsured population. 2) identify resources available for under-served and uninsured populations. 3) discuss and examine the rationale for providing healthcare to all. 4) discuss how healthcare reform will/might affect these populations.  Jill is the Executive Director at St. Peter's Free Clinic and the Diocesan Liaison for Michigan.  CEUs available! For participants who attend the complete webinar and fill out the post-event survey, 1 CEU will be awarded. Continuing education credits are provided at a cost of $10. This session is limited to 100 participants so register today!  Just click the link below: https://attendee.gotowebinar.com/register/5554613248811272448 After registering, you will receive a confirmation email containing specific information about joining the webinar. Brought to you by GoToWebinar® Webinars Made Easy®   Matthew Ellis CEO, National Episcopal Health Ministries    6050 N. Meridian Street, Indianapolis, In  46208

Forward this email This email was sent to spfc3@sbcglobal.net by nehm@episcopalhealthministries.org |   Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy. National Episcopal Health Ministries | 6050 N. Meridian St. | Indianapolis | IN | 46208

So Angry

I am so angry that I have to keep reminding myself to breathe. Just breathe.

There was a posting on Facebook that was about a person seen in the emergency room. The article described all the – gasp – negative things about this person: a gold tooth, tattoos, name brand jeans, smokes, etc. The “doctor” writing this post was angry about having to provide care to this person who has MEDICAID!

Really? I am so tired of a person’s worth being tied to things such as gold teeth, tattoos and Medicaid. That person was of no less worth to God than the grandchild of the person who posted it – and by the way, that grandchild was/is on Medicaid. It doesn’t matter – at least to me.

If we are going to talk about how broken the system is, then let’s have this discussion. Is an emergency room physician who spends 5 minutes with a patient, putting in 3 stitches really worth over $900? Or, how about the physician who sees a patient in his office for a 10 minute appointment – and spends 8 of those minutes catching up with a personal friend – then charges the insurance company $800 for a follow-up visit? Or, the physician who sees a person with a common “stomach” virus, and sends the patient on to the hospital for a CT scan – because he has good insurance that will pay for it? Seriously – and we think the problem is a person with Medicaid?

The problems with the system are not at the bottom – they are at the top. The problems are with our legislators who are stuffing their pockets with money – and have forgotten the poor that they are supposed to represent. The problems are with lawyers and bankers on Wall Street, who have taken so much that can never be recovered. The problems are the greedy, the self-righteous, and the bigots.

The problem is not the poor.

Yeah, I am pissed.

 

 

Rose

Rose is almost exactly eight years younger than I am; when I was asked her age last night I guessed her to be at least eight years older than I am. Poverty ages a person. That was one of the first lessons I learned here at the free clinic. People who live in poverty, on average, look about 10 years older than their actual age.

Rose has been a patient here for two years. She is separated from her husband – divorce is a luxury of the middle class and the rich. She lives with her daughter and helps by taking care of her grandkids.

She came to the free clinic with a non-healing sore on her right foot. She had been seen in the emergency room for the wound and was sent here for follow-up. We made referrals to a surgeon and a podiatrist. She was admitted to the hospital for IV antibiotics and surgical debridement of the wound.  Her health history includes diabetes and high blood pressure, as well as chronic kidney disease and anemia. 

She was transferred to one of the larger hospitals outside our area. They diagnosed her with osteomyelitis – an infection in a bone – as well as with peripheral vascular disease. She had a stent placed in the right femoral artery to help with blood flow to her right leg. They also amputated her right little toe as a result of the infection.

Less than a year later, she was back with another non-healing sore on her right foot.  The MRI showed early osteomyelitis. Ugh.

So, for the past year we have been fighting this infection. She saw our podiatrist once a week, and was seen regularly at the clinic. But, ultimately, the sore wasn’t getting any better. The only advice we had to give her was to go to the emergency room at the university hospital that is an hour and a half away. So, that is what she did – she was admitted right away, treated with IV antibiotics…

I cried when I saw her last night. She had a below the knee amputation.

Would it have made a difference if she had healthcare insurance? I don’t know the answer to that, but she would have received the care she needed WHEN she needed it – our clinic is only open one night a week.

How many people have to die, how many limbs have to be lost before our legislators see the need for healthcare for all? Why does everyone pat themselves on the back for supporting the free clinic, but turn their backs on the people in need? I am so frustrated.

And, so sad.

My Prayer for Today

A Four-fold Franciscan Blessing

 May God bless you with a restless discomfort about easy answers, half-truths and superficial relationships, so that you may seek truth boldly and love deep within your heart.

 May God bless you with holy anger at injustice, oppression, and exploitation of people, so that you may tirelessly work for justice, freedom, and peace among all people.

 May God bless you with the gift of tears to shed with those who suffer from pain, rejection, starvation, or the loss of all that they cherish, so that you may reach out your hand to comfort them and transform their pain into joy.

 May God bless you with enough foolishness to believe that you really CAN make a difference in this world, so that you are able, with God's grace, to do what others claim cannot be done.

 And the blessing of God the Supreme Majesty and our Creator, Jesus Christ the Incarnate Word who is our brother and Saviour, and the Holy Spirit, our Advocate and Guide, be with you and remain with you, this day and forevermore

I'm Back!

Thank you for all the thoughts and prayers. My husband is doing well after his surgery; recovery will be slow and take a while, but so thankful to be on the road to recovery!

Now it is time to get back to work. The clinic has been closed for two weeks, and so the uninsured residents of our county have not had access to healthcare.

Our legislators are in the second full week of their vacation. They are enjoying full access to healthcare, but have continued to neglect the poor living and working in the communities they are supposed to represent. So, it is time for us to get back to work and let them know that this is not acceptable. We want Medicaid Expansion for Michigan. If you live and vote in Michigan - please call your state senator, and let them know the time is NOW! We want Medicaid Expansion.

Here is a great article on Medicaid Expansion that I want to share:

Expand Medicaid in Michigan

• Michael P. O’Donnell

 

 

The prestigious Institute of Medicine has estimated that having access to medical coverage would reduce adult mortality by 25 percent. 

 

A subsequent study published in the New England Journal of Medicine showed that expansion of Medicaid eligibility in New York, Maine and Arizona reduced the mortality rate (the number of deaths in a population) among those newly eligible for Medicaid and improved access to care and overall health.

 

How often in a lifetime will any of us have the opportunity to have so much positive impact on another person’s life?

 

The people of the state of Michigan have that opportunity right now.

 

The Affordable Care Act (aka Obamacare) allows the state of Michigan to extend Medicaid access to an estimated 450,000 Michigan residents with incomes up to 133 percent of poverty, ($15,282 for an individual and $31,322 for a family of four), who do not qualify for Medicaid under the rules set by the state of Michigan.

 

Amazingly, we can do this and save the state money for at least a decade.

 

The only thing that stands in our way is the Republican caucus in the Michigan State Senate, which refuses to support the expansion. Our Republican governor, Senate Democrats and our House of Representatives all support expansion.

 

Why does the Senate Republican caucus oppose expansion?

 

It is not about taxes or state budget fiscal responsibility.

A recent study by the Center for Healthcare Research & Transformation (CHRT) estimated that expanding Medicaid eligibility would save the Michigan state government $983 million over the next decade (2014-23).

 

This happens because the federal government pays 100 percent of the cost of the expansion in 2014-16, 95 percent in 2017-19 and 90 percent starting in 2020. There would be a net cost in the second decade, but it would be less than the savings in the first decade.

 

It is not about the impact on employers or local communities.

Hospitals are the largest employers in most towns in Michigan and employ more than 219,000 people; other health care organizations directly employ an additional 210,000.

The nearly 140 hospitals in Michigan will receive several hundred million dollars from the federal government each year if Medicaid is expanded in Michigan.

 

My congressional district around Ann Arbor is projected to receive $182 million a year.

This is critically important because Michigan hospitals provide an estimated $1.9 billion a year in uncompensated care.

 

Historically, some of this uncompensated care has been covered by federal payments but those payments are scheduled to decrease because the federal government assumed all of the states would be expanding Medicaid to low-income residents and would receive offsetting Medicaid payments.

Expanding hospital revenue means more jobs; reducing it means layoffs.

Some of the uncompensated care is passed on to Michigan employers and residents in the form of higher medical charges.

 

The CHRT study estimates that expanding Medicaid in Michigan will reduce costs for employers and residents who purchase insurance by $640 to $985 billion over the next decade.

 

It is not about equity.

Michigan state senators and their families are covered by the state of Michigan health insurance program, which is funded through our taxes.

 

Their monthly premiums range from 0 to 20 percent, depending on the plan they choose.

 

If these senators, who have good-paying jobs, receive government health insurance, does it seem fair that poor people are denied?

 

It is not about religious values.

Every major religion in the world stresses the importance of caring for the poor.

 

So what is it actually about?

It’s partly about politics; about making a stand against Obamacare.

 

But it is mainly about the citizens of the state of Michigan putting up with this behavior. If the citizens of the state of Michigan call their senators to ask them to support Medicaid expansion, it will get done.

 

I am going to call my senator, Randy Richardville, every week until he agrees to support Medicaid expansion. Will you? I will vote for his opponent in the next election if he refuses.

 

Will you?

Michael P. O’Donnell is a clinical professor in the School of Kinesiology and director of the Health Management Research Center at the University of Michigan.

From The Detroit News: http://www.detroitnews.com/article/20130711/OPINION01/307110004#ixzz2ZECj9OTl

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.