#KingvBurwell #DontTakeMyCare

Healthy Michigan Plan

The Healthy Michigan Plan – Michigan’s expanded Medicaid has been a phenomenal success.

But the law was written so that there were 2 waivers that had to be granted by the Federal government. The first waiver was to allow certain cost-sharing requirements including co-pays to go into effect, as well as special cost-sharing accounts. Newly eligible Medicaid enrollees would contribute a portion of their income into these accounts. Incentives for healthy behaviors could help lower the amount of contribution required.

This waiver was granted, and the Healthy Michigan Plan began taking applications on April 1, 2014.

The second waiver would allow the state to require individuals who had been on the Healthy Michigan Plan for 48 months and who were between 100 percent and 133 percent of the federal poverty guidelines to choose to either:

 1) Remain in Medicaid but increase their cost-sharing obligations, or

2) purchase private insurance coverage through the Michigan’s federally-operated Health Insurance Marketplace (in so doing, take advantage of the federal advance premium tax credit and cost-sharing subsidies).

The Federal government will make a decision on this waiver later this year.

IF this waiver is not granted, the way the law is written, it will cause the entire program to be null and void. The 546,000+ individuals enrolled in the Healthy Michigan Plan would no longer have any insurance. None.

And, remember – the way the Affordable Care Act was written, those under 100% of the Federal poverty level cannot access the Premium Tax Credits to purchase insurance. That is because the law was written so that all of those under 100% of the Federal Poverty Level would have access to the expanded Medicaid, but that portion of the law was declared unconstitutional by the Supreme Court.

King v Burwell

Once again the Supreme Court will have a say about healthcare reform. The Supreme Court has agreed to hear the case King v Burwell. To put it simply, if supporters of this lawsuits succeed, the government will take away premium tax credits from residents in all of the states with federally facilitated marketplaces. Those tax credits help low- and moderate-income people afford to pay their monthly health insurance premiums. Without this benefit, millions would not be able to pay for their health insurance.

The extent of the problem is enormous. More than 7 million people in states with federally run marketplaces currently receive tax credits. But, if they suddenly had to pay unsubsidized premiums, most would no longer be able to afford their coverage.
 
Premium tax credits don’t just help those purchasing healthcare – they increase and strengthen the pool of enrollees helping to create a stronger and more robust health insurance market. In doing so, they help keep health insurance premiums from becoming unaffordable for all of us.

Michigan is one of 34 states that has a federally facilitated marketplace.

 It would affect all the people that we have enrolled in healthcare.

The Supreme Court will hear oral arguments in this case on March 4; we will most likely hear their decision in late June.

 

 

ACA Impact

·       Marketplace enrollment:

o   Nationally, 11.4 million people enrolled in healthcare

o   290,400 people in Michigan enrolled in a Marketplace plan

·       Healthy Michigan Plan enrollment:

o   Statewide - 546,807

o   Hillsdale County - 2328

Special Enrollment Period announced

The Centers for Medicare & Medicaid Services (CMS) announced a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30.  If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.
Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:

• Currently are not enrolled in coverage through the FFM for 2015,
• Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
• Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

The special enrollment period will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015.  If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

Special Enrollment Periods

Also known as SEP’s are when a “qualifying life event” takes place. These qualifying life events can include any of the following:

• Getting married
• Having a baby
• Adopting a child or placing a child for adoption or foster care
• Losing other health coverage
• Permanently moving outside your plan’s coverage area
• Losing job-based coverage for any reason, including resigning, getting laid off, or getting fired
• Gaining citizenship or lawful presence in the U.S.

Losing coverage through a divorce

• Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder.
• COBRA coverage ending (but not cancelling it yourself before it expires)
• Leaving incarceration
• Aging off a parent’s plan when you turn 26
• For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.
• Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)

·         verage that doesn’t qualify as minimum essential coverage doesn’t qualify you for a Special Enrollment PerIf any of these events occur, and you are interested in obtaining healthcare you can call 1-800-318-2596 or go on-line to healthcare.gov

 

Peg and Paul

Peg has been a patient at the clinic for several years. She comes in once a month to get her medications for high blood pressure. She usually sees the provider once a year or if something unusual comes up. We have been talking to her about insurance for a while, but she was reticent for various reasons. Her husband Paul has healthcare – he is 65 and qualifies for Medicare.

Finally, we convinced her to apply for the Healthy Michigan Plan. She was denied. They made too much money.

Let me explain their situation. It is just the two of them in the household. Between the two of them, they work three jobs. Paul has worked for a local business for over 20 years; he makes $9.50 per hour and typically works 25 hours or less a week. Not because he wants to, but because that is how this particular business operates. He also works a second job. Peg works 24 hours per week, and just got a raise. She will now be making $10.50 an hour.

The two of them, along with their adult daughter, came in to apply for health insurance through the Marketplace. They qualify for Premium Tax Credits, which are applied to the premiums for her healthcare insurance. That brings the premium down to $120 a month. Her raise will almost cover the cost of her healthcare insurance.

For those of us NOT living on the edge of poverty, $120 a month for healthcare seems like a deal. But, when you are just barely getting by and have huge hospital bills from years ago that are still being paid on, well, it is not that easy to make the decision to use your raise to pay for healthcare.

They did make the decision – for peace of mind. They are in their 60s and know that life can change in an instant.

The decision will impact their life. There will be no extra income now – it is all committed to her healthcare insurance.

Why do we make it so hard for people? This is not a problem with healthcare; it is a problem with our society.

Julian

Julian moved back to the area recently. His mom lives in the area – and for various reasons, it was time to come home.

He came to the clinic soon after arriving – he was unemployed, but looking for work and was optimistic about being able to find a job. I talked to him about applying for Medicaid, but he didn’t want to.

He came because he had not been feeling well – general symptoms of anxiety, depression, sleep issues, fatigue, shortness of breath and vague aches and pains. His major symptom was that his neck was swollen.

Given that the symptoms were general and vague, he was treated with antibiotics and blood work was ordered.

He returned a few weeks later with no improvement. The lymph nodes in his neck were swollen and at that time there was suspicion of a mass in the neck area. He was sent for a CT scan.

The lab work was basically normal – no issues were found. The CT scan came back inconclusive – it could be lymphoma, it could be an infection, possibly TB. He needed a specialist.

By this time, he had found a job and was working. Still no insurance, and there is no way to see a specialist without insurance. So he finally consented to apply for Medicaid.

Today, I got word that his TB skin test was positive. And about 5 minutes later, I got word that he had been approved for Medicaid.

He sees the specialist on Tuesday of next week. Without insurance… well, I don’t even want to think about that.

Whatever happens next Tuesday, it will be life changing for him. Now he has insurance, and whether he knows it or not, he has a group of people who are pulling for him. He is not alone in this journey.

In the Blink of an Eye

Dan has been a patient at the clinic for a little over a year. He takes a few medications and sees a provider rarely. He applied for the Healthy Michigan Plan (Medicaid expansion), but was denied. He scheduled an appointment with me to apply for insurance through the Marketplace in December. The day before our appointment, I received a call from his significant other cancelling the appointment because he had just had surgery at the University of Michigan.

He had suffered from a detached retina. Retinal detachment is an emergency situation in which vision can be permanently lost.

Retinal detachment describes an emergency situation in which a critical layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nourishment.

Retinal detachment leaves the retinal cells lacking oxygen. The longer retinal detachment goes untreated, the greater the risk of permanent vision loss in the affected eye.

Retinal detachment itself is painless, but retinal detachment warning signs and symptoms almost always appear before it occurs or has advanced. Retinal detachment symptoms may include:

• The sudden appearance of many floaters — small bits of debris in the field of vision that look like spots, hairs or strings and seem to float before the eyes
• Sudden flashes of light in the affected eye
• A shadow or curtain over a portion of the visual field that develops as the detachment progresses

 

Retinal detachment can occur as a result of:

• Shrinkage or contraction of the vitreous— the gel-like material that fills the inside of the eye. This can create tugging on the retina and a retinal tear, leading to a retinal detachment.
• Injury
• Advanced diabetes
• An inflammatory eye disorder

 

Dan does not know what caused his retinal detachment. But, he was lucky that it was recognized and he was sent to the proper place for treatment. He won’t lose his vision. And his care was provided by the University of Michigan’s Charity Care.

Once he recovered, he came in to apply for healthcare coverage. He is lucky, because before the implementation of the Affordable Care Act, he would not have been able to get insurance because of his pre-existing condition: the retinal detachment. Now he can get coverage and it will cover any medical care that still may be needed for the detached retina. He is a lucky man.

FamiliesUSA

I have just returned from the FamiliesUSA annual conference. It was just what I needed to be re-energized. I attended some amazing break-out sessions on Medicaid, enrollment and engaging consumers in healthcare transformation.

I had the opportunity to meet people from all over the country who are involved in various roles in healthcare advocacy, enrollment and policy.

My overwhelming feeling the first couple of days was of being old. The conference provided young professionals the opportunity to attend the conference at a reduced rate and offered break-out sessions designed specifically for that group. It was a great idea! It was wonderful to see young, energetic people working passionately for the issues I believe in.

My new favorite song is a rap song – Glory – from the movie Selma. These lines from the song keep going through my mind:

“Somewhere in the dream we had an epiphany
Now we right the wrongs in history
No one can win the war individually
It takes the wisdom of the elders and young people's energy…”

It takes the wisdom of the elders and young people’s energy… how true. We really have to value each other and the role of both the young and the old. The healthcare battle is one that will not be finished in my lifetime. The fight for healthcare equity has been going on for over 100 years. The resolution is not at hand.

But it is so reassuring to see so many people who feel as passionately as I do about this issue. While many disagree with me, at the end of the day we are all better off if everyone has access to healthcare. We have to continue the work to ensure that healthcare is accessible, affordable, and quality. We still have a lot of work to do.

I am ready to do my part – thank you FamiliesUSA for my “booster shot”!

NEHM

Today’s email brought this message: “The Board of Directors of Episcopal Health Ministries, facing the reality of the funding environment, has concluded that we can no longer maintain our current staffing.”

A transition team has been put in place…

Another loss.

National Episcopal Health Ministries (they dropped National from the name a couple of years ago, but I still always think of them as NEHM) has been such an important part of my journey for the past eight years.

I have attended every one of the national conferences put on by NEHM; I have presented at three of them. Because of one presentation about healthcare reform, I had the opportunity to do a national webcast. Matt and Sue have supported me and encouraged me.

I have met people from all over the country who are involved in healthcare in various ways. There are parish nurses, nurse practitioners, priests, and people involved in every aspect of healthcare and faith.

At the conferences we have heard amazing speakers – Edwina Gately and Sara Miles among them. We have visited amazing places – Kanuga in North Carolina; San Francisco; Racine, Wisconsin; and, my favorite - New Orleans!

This news just makes me so sad…I will miss the people and the opportunities that NEHM gave me.

Matt and Sue, thank you for all you have done, and best wishes for the future.

Christmas Gratitude

Merry Christmas!

The end of the year is always a time for reflection and for gratitude. I want to take a moment of your time to thank my staff, the clinic volunteers, my family and friends for their support and encouragement over the past year.

To quote Charles Dickens – “it was the best of times, it was the worst of times…” and 2014 had plenty of both.

We began the year with the Open Enrollment in the Marketplace – and continued to attempt to enroll our patients. It was a frustrating endeavor at times, but when we successfully enrolled someone in an affordable healthcare plan, it was cause for celebration. Open enrollment lasted until the last day of March.

April 1 brought the best news to the population we serve –“opening day” for the Healthy Michigan Plan – Michigan’s Medicaid expansion. I will never forget the first person I helped with enrollment in the Healthy Michigan Plan – the tears in his eyes, and the words his friend spoke: “now you can get your heart fixed.”

The first four months of 2014 the clinic continued to be incredibly busy with an average of 64 patients every Tuesday night. That number began to decline steadily after April 1. We saw an average of 29 patients each week from April through December.

I have to thank Connie and Linda, and our volunteers, who worked in a time of great uncertainty. There were hopes and fears about what the role of the clinic would be – would there continue to be a need? Would there be funding? What would we do?

I am one of those people that love change – and embrace the challenge of something new. For many though the uncertainty is unsettling and difficult. But, everyone persevered and we continued to care for those in need in our community.

We spend hours trying to teach people about the value of insurance; assisting them with enrollment in healthcare; and helping with the transition to a primary care provider. It is some of the best work we have ever done!

We continue to see people in need here at the clinic.  The population of the clinic has changed over this year. Many of those we see are employed, making in the $8 -$14 per hour range. Their employer either doesn’t provide healthcare or they cannot afford it. They make too much to qualify for the Healthy Michigan Plan, and cannot afford the premiums of the Affordable Care Act, even with the tax subsidies. It is not my job to judge what is “affordable” for any family – I give them the information they need to make that decision.

And, with all of these changes at the clinic, I also had family issues to deal with. My husband was hospitalized for a week in May; my dad was diagnosed with bladder cancer – and died in September; my mother had a major heart attack in July.

It is amazing to have a staff that can pick up the pieces and make sure that the clinic can continue without missing a beat. Connie and Linda did that for me all spring/summer/ and into the fall. The support from the two of them, and the volunteers at the clinic helped me to survive all that this year had in store.

And, then there was the joy that came with the birth of my second grandson –Andrew James. The circle of life was so evident, as he was born 2 weeks before my dad died.

It is impossible for me to express my gratitude adequately. I am humbled and awed to work with such an amazing group of people. In addition to Connie and Linda, I have the most amazing board of directors, who support and encourage me always. The volunteers here at the clinic are the heart and soul of the clinic. We would not exist without them.

So, thank you to each and every one of you. Merry Christmas to you and your families.

And, I for one, can’t wait for the New Year!

Ted and Alice

Ted and Alice showed up one night at the clinic several years ago. I swear – they were both blue. OK, maybe more of a gray-blue. Clearly in respiratory distress. Clearly not doing well at all. They scared us, and we are pretty used to seeing all kinds of things.

He was a farmer and worked part-time in a retail store; she was a farmer’s wife. They had no health insurance. It was the dead of the winter, and they had run out of money – for food, for heat and for medications.

They both had a history of asthma/COPD but had not had any medications for a while. They both had acute bronchitis. I don’t usually believe that we have “saved” someone’s life, but in this case… maybe. If they had not showed up at the clinic, they would have eventually showed up at the emergency room – in worse shape than they were here.

They both recovered and were long-time patients here. They made enough money that they did not qualify for Medicaid, but his job was part-time so he was not entitled to any health insurance.

She ultimately was determined to be disabled due to her respiratory status – she was on oxygen full-time.

Ted was one of the original Diabetic Clinic patients. He was as compliant as he could be. He came to the clinic each month, took the medications we gave him, checked his blood sugar and tried. Dietary habits are hard to change for people on limited incomes. He continued to farm, so he was active.

As I think about the success of the Affordable Care Act, Ted and Alice come to mind. We supported them while there was nothing else available, but now they have access to healthcare whenever they need it. They have both found a primary care provider that they like. Plus, Ted has had some of the preventive healthcare services that are not available to the uninsured.

Today, I can smile knowing that they are in a much better situation – and we helped them on the journey there.

The Importance of Stories

Richard Rohr writes: “I’ve never known anyone who really shared all of their story with me whom I could not love.”

It is so true – we make assumptions about people when we meet them or observe them a setting. It is easy to dislike or distrust someone who is not known. But, once you sit down with a person and hear their story, it changes everything.

I had that experience last week. A former patient called, wanting an appointment to review his health insurance coverage. He had been paying his premium for a year, had used his health insurance appropriately, and wanted to review it. A total success story! Except for the fact that when I heard his name, I just shuddered.

We ran into a few roadblocks during the process of reviewing his insurance coverage, so we had some time to talk. I had made some judgments about him. What I learned in the time we spent together was a completely different person than I had assumed.

His mother died when he was 8 years old. It had clearly impacted his entire life – including the fact that he was not able to finish school. He wasn’t “stupid,” he was uneducated.

He is married to a woman who lost five children in an intentionally set fire decades ago. She is broken – emotionally, physically, and mentally. His concern and love for her was evident.

Because of the time we spent together, my attitude toward him changed dramatically.

I see this so often with the population we see here at the clinic. It is so easy to make assumptions. I often hear someone say, “he’s just a user.” But sometimes that “user” is taking care of an elderly mother with dementia, or is the only parent to a young child, or is recovering from substance abuse. We never know the battles people are fighting in their lives.

We really need to take the time to hear their stories. 

Holy Batman!

Well, that was a first. We had to delay the opening of the clinic tonight… because we had a bat.

Oh, it’s not the first time we have had a bat – the clinic is located in the basement of a church, and bats seem to like churches. They are frequent visitors here. And we have even had them during the clinic, but we have never had to delay opening the clinic.

My feelings about bats vary on a scale between grossed out and terrified – depending on how close the bat is to me. I loathe them – especially when they are indoors. (Shudder!!)

Fortunately, we had a couple of volunteers that were eager to escort the bat out. If it happens when I am here alone, I have “Batman” on speed dial. Batman is my hero Patrick who serves as the sexton for our church and the Catholic Church next door. I’m guessing he has lost count of how many bats he has rescued me from!

Monica

As she walked into the clinic, my eyes about popped out of my head. She was beautiful – looked absolutely fabulous.

When I first met Monica, that is not how I would have described her at all.

I had known Monica’s mother for a few years. She called me one day very concerned about Monica and wanted to know if we could see her here at the clinic. They both came in on Tuesday evening. Monica was 21 years old at the time. She presented with fever, nausea, vomiting, weight loss, headache, aches and fatigue. She was dressed in jeans and a baggy sweatshirt. She was pale and clearly did not feel good.

We ordered some tests and put her on some medication for the nausea and vomiting. She returned two weeks later for test results, still not feeling any better.

At that point, I helped her with her application for the Healthy Michigan Plan. She was working in a low-paying job. She qualified immediately for the Healthy Michigan Plan, and was able to see a provider in our community. I lost track of her after that.

She came into the clinic to bring some paperwork. I hadn’t seen her in six months – and could not believe it was the same young woman. Because of having health insurance, she was able to get the care she needed. She still has some problems, but they are minor compared to what she was dealing with a few months ago.

She is in school, motivated to live her life to the fullest.

The outcome could have been very different – without a parent who cared and without access to healthcare.

It’s Flu Season

Everyone was in a panic about Ebola a few weeks ago, but how many of you have had your flu shot? It is the easiest way to prevent a disease that causes illness, loss of productivity and too often, death.

The timing of the flu season is unpredictable and varies from year to year. Most commonly it peaks between December and February. But, it can occur as early as October and as late as May.

Contrary to popular belief, the flu is actually a respiratory disease, not a gastrointestinal disease! The flu can cause vomiting and diarrhea, more commonly in children.

Flu symptoms include:

• A 100^oF or higher fever or feeling feverish (not everyone with the flu has a fever)
• A cough and/or sore throat
• A runny or stuffy nose
• Headaches and/or body aches
• Chills
• Fatigue

In general, the flu is worse than the common cold. Symptoms such as fever, body aches, tiredness, and cough are more common and intense with the flu. People with colds are more likely to have a runny or stuffy nose.

Seek medical attention immediately if you experience any of the following:

• Difficulty breathing or shortness of breath
• Purple or blue discoloration of the lips
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Seizures
• Flu-like symptoms that improve but then return with fever and worse cough

The flu is most dangerous for infants, the elderly, and those with chronic health conditions such as diabetes, asthma, COPD, and cancer.

So please, get your flu shot!

Buzz

I wanted to take an opportunity to say goodbye to a dear man.

I met Buzz and his wife several years ago. The clinic was fairly new and one of the local food pantries called asking for some flyers so that they could let their clients know about it.

I put a handful of flyers in an envelope, but then decided it would cost too much to mail it. So, I got in my car and drove over to the food pantry to deliver them.

Buzz and his wife were volunteering at the food pantry when I got there. We just hit it off right away. They were so excited about our new ministry and were so aware of the need in our community.

I have always called this meeting a “God moment.” It was meant to be.

Buzz was very active in the community – he arranged for me to speak a couple of times at a service club where he was a member. He and his wife sent the clinic a check every single month.

Buzz died a couple of weeks ago. He will be missed by us here at the clinic, by his community and all of those who knew him.

Our sympathy to his wife and family. Buzz made a real difference in this world.

Happy Thanksgiving!!

A Prayer for Thanksgiving

Dear Lord,
As we gather together around this table
laden with your plentiful gifts to us,
we thank You for always providing
what we really need even when we didn't know we needed it.

Today, let us be especially thankful
for each other--for family and friends
who enrich our lives in wonderful ways,
even when they present us with challenges.

Let us join together now
in peaceful, loving fellowship
to celebrate Your love for us
and our love for each other.

We thank you for the turkey, the dressing and the gravy.
This table overflows with your abundant blessing.

Remind us always that all gifts come from you.

Amen.

Thank you Sr. Mary Ellen Howard for sharing this!

It’s the Most Wonderful Time of the Year!

I’m not talking about Christmas – I am talking about Open Enrollment in the Marketplace.

Open Enrollment for plans starting January 1, 2015 began on November 15. I LOVE helping people enroll in a healthcare plan – whether it is through the Marketplace or helping them enroll in the Healthy Michigan Plan – Michigan’s expanded Medicaid.

It brings me such joy to see people finally be able to afford and enroll in healthcare. Some of the people I am working with this year are re-enrolling. I love hearing the stories of how having insurance changed their lives – how they were finally able to have some long-needed surgery, or see a specialist that they could not afford before.

It is exciting to see people enrolled for the first time. I love teaching them about how insurance works, what their options are and showing them how their tax subsidies will make the insurance affordable for them.

This year, the clinic is once again providing individuals and families with a place to come enroll in healthcare with the assistance of Certified Application Counselors. Connie and I both completed the training for both the Marketplace and to assist in enrollment for the Healthy Michigan Plan.

Give us a call – see if we can help you!