This is the reason we need Medicaid expansion.....

Thomas is 53 years old. He first started coming to the clinic three years ago. He came with bronchitis; he smokes, and ultimately was diagnosed with Chronic Obstructive Pulmonary Disease (COPD).

COPD is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD:

• Chronic bronchitis, which involves a long-term cough with mucus
• Emphysema, which involves destruction of the lungs over time

Most people with COPD have a combination of both conditions.

Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. Of course, not everyone who smokes will develop COPD.

Thomas was seen fairly frequently for bouts of acute bronchitis. He would be put on antibiotics and sent on his way.

About seven months ago, he began to complain of headaches and some dizziness. We did a sleep study, thinking that he wasn’t getting enough oxygen at night. His sleep study showed periods of decreased oxygenation overnight – and it was assumed this was the cause for his headaches.

The headaches got worse as did his shortness of breath. A chest x-ray was done which showed “stable chronic changes consistent with COPD. No acute findings.”

In November he complained of weight loss, fatigue and a lump on the right side of his neck. Labs done were normal. The physician seeing him ordered a CT scan of his neck. The CT scan showed evidence of carotid artery aneurysm, located in the area where he felt the lump. The recommended follow-up was a MR angiogram in three months.

Aneurysms happen when the wall of a blood vessel becomes weakened and starts to dilate. The weakened area can balloon, causing the side of the vessel to become very thin, and there is a risk that the aneurysm could rupture, potentially causing serious medical complications. In the case of a carotid aneurysm, the weakening occurs in one of the two carotid arteries which run along either side of the neck.

He had the MR angiogram last week. It shows an aneurysm. The radiologist recommended that he be followed up by a neurosurgeon. Of course, there are no neurosurgeons in rural, southern Michigan. So, we try to get him an appointment at one of the major medical centers. But, he is uninsured. He cannot be seen until we get him qualified for their charity care program.

If the aneurysm ruptures, he may not die. He could have “stroke-like” symptoms, requiring months, if not years of rehabilitation services and medical care.

If he had insurance, and had access to healthcare, it is possible that this could be easily treated – or at least treated – and he could continue to live a productive life.

The lack of access to healthcare could cost him his life. If the aneurysm ruptures, it will cost all of us as we provide for his long term needs.

A Letter to, well, everyone.....

On February 12 of this year, St. Peter’s Free Clinic saw 83 people. A new record, but we really don’t want to be setting new records.

83 people who have put off receiving healthcare until our doors open on Tuesday night; 83 people who were sick, suffering, frightened and probably, embarrassed to be receiving care in a church basement because that is all that is available to them.

We should be ashamed. And, we have an amazing chance to change all of that now.

We have an opportunity to change the world.

Governor Snyder has proposed implementation of the Medicaid expansion provided for in the Affordable Care Act. This is huge for Michigan – an opportunity to bring in money to provide healthcare for those who cannot afford it.

676,000 people will be eligible for Medicaid if it is expanded. In our community, over 4,100 individuals have come to the Clinic at least once seeking care. That number represents nearly 10% of the population of Hillsdale County. According to the Census Bureau, 17.6% of the residents of Hillsdale County live below the Federal Poverty Level. Some of those are already insured under Medicaid. Many others will benefit from the Medicaid expansion.

These are real people, living next door to us; people who are trying to keep a roof over their head, food on the table and are not able to afford healthcare. 

There is Patricia, who had worked for years as an aide in an assisted living home, who when she hurt her back, was let go from the job that had provided her with an income, but not healthcare. Now she has neither and no place to go, except the Free Clinic. Or, Jennifer, who has two jobs, her husband has one job, and none of the employers provide healthcare. They make enough money for a place to live and food to eat, but not for healthcare. Or Susan, who works in a factory, hired by a temp agency. She risks losing her job every time she comes to the Clinic to access the medications that make it possible for her to work.

This is the difference we can make in people’s lives NOW.  We have the opportunity to change the world. Let’s not pass that up.

So, please write/email/call your state representatives and senators. Tell them your stories or the stories of your neighbors, your families, your friends. They need to know that Medicaid expansion matters, to “we the people”.

A Tale of Two Patients

Teresa and Tamara had a lot in common. Teresa was here the very first night the clinic opened; Tamara came a few months later. They were about ten years apart in age; both suffered from diabetes, hypertension and depression. Both were overweight – Tamara more so than Teresa.

Teresa worked three jobs – all of them part-time. She pulled together enough work to provide her and her disabled husband with a place to live and food. Her husband had some income from disability – he had suffered a serious head injury years ago, and is unable to work. He has been disabled for many years and has Medicare. She was uninsured.

Tamara was also married, but she did not work. Her husband was employed full time, but at the time, his job did not provide health insurance for her.

Their health issues continued to follow similar paths, with both of them developing heart problems, and later problems with their kidney function. We watched and worried as their health deteriorated. We were able to beg for help and get Tamara into see a Nephrologist – a kidney specialist. Teresa ended up hospitalized with congestive heart failure and renal (kidney) failure. She was 53 years old.

Teresa ended up on dialysis, which means she ended up receiving Medicare to pay for this very costly care. She is no longer able to work – no longer able to take care of her family – no longer able to contribute to our society.

Tamara, on the other hand, ended up getting insurance. She became fully insured by her husband’s employer, and the last time I saw her she shared with me that her kidney function had improved significantly. She is no longer in danger of having to go on dialysis, or worse – to need a kidney transplant.

The difference in their outcomes: Insurance: Access to healthcare. It is as simple as that.

So, why are we not providing access to healthcare to ALL Americans? We can certainly afford it. When did access to healthcare become a privilege?

A Needless Death

We just received word that one of our patients died. Here is her story, or at least the part of it that I know. She was homeless – sometimes living with relatives, other times in a hotel room. She was probably illiterate – or at least minimally educated. She was seen at the clinic for a non-healing wound on her foot – it continued to not heal and we sent her emergently to Hillsdale Community Health Center, where her toe was amputated. She had no insurance, so the cost was born by the hospital, and ultimately, all of us. The foot improved some, but her health didn’t. She had a massive heart attack, and was on life support at one of the hospitals in Kalamazoo. But, she lived. She came back to the clinic one last time – she had finally qualified for Medicaid. We provided her with the medications she needed until she could get in to to see her provider. And, a few weeks later, she was dead.

It is my belief that, had she had access to healthcare earlier, she would not have died. She might not have ever had to lose her toe.

To Do List

I was fortunate to attend Health Action 2013 put on by Families USA in Washington, D.C. What a fabulous conference. Great speakers, great break-out sessions and great energy!

The highlight of the conference for me was not just hearing Sister Simone speak, but actually meeting her. Her words ring in my brain – “Be bold.” There is a lot of work ahead.

Indeed there is. While I was attending the conference, Governor Rick Snyder recommended that Michigan participate in Medicaid expansion. A huge hurdle has been overcome; now on to the next set of hurdles.

First, we have to convince our legislators that this is good for Michigan. Why is it good for Michigan? Let me count the ways: 676,000 uninsured residents of Michigan will be eligible for Medicaid; in 2014 to 2016, the expansion is paid entirely by federal funds. That money will go somewhere – it may as well come to Michigan! Michigan’s health status will improve when the needed care is provided in the appropriate setting, rather than in the hospital emergency room – or in a free clinic one night a week.

Once we have convinced our legislators, then we need to educate our community about the benefits of Medicaid expansion. Many of the patients seen at the free clinic will qualify for services. They will have real access to real healthcare, not the piecemeal one-night-a-week kind that we can offer them now. It will be a real step forward.

And then, our biggest job will be to enroll those who are eligible. Help people find their way through the system.

I am so excited! This is what we have been hoping for, working for, for so many years. There is a light at the end of the tunnel.

Now all you skeptics out there are already with your arguments to shoot me down. I know this is not a perfect system. I know there will be pitfalls and that not everyone will be covered. But it is a step in the right direction and one I personally welcome.

Medicaid Matters

As the Executive Director of a free clinic in rural southern Michigan, I see patients every week that would benefit from the Medicaid expansion. We see individuals who are working - but have no healthcare; those looking for work; and those who have given up the search for work.

We see individuals with disabilities who have no healthcare, because they "make too much" to qualify for Medicaid. When I first learned that people receiving disability income did not have healthcare, I was appalled. How can it be that we deny healthcare to those in the most need?

It is not uncommon for our patients to hold two or three jobs, but have no healthcare. Many places of employment will only hire part-time help, in order to avoid having to provide benefits, including healthcare.

We all benefit from increased coverage for healthcare.  Healthier individuals make for a healthier society.  We are able to help people stay employed when we provide medications necessary to control chronic health conditions.

On a typical Tuesday evening at St. Peter’s Free Clinic, the following patients may be seen. Sue, who has a cough and fever, is worried about losing her job if she calls in sick, and she has no health insurance. Lynn is a 50 year old widow, who has been having heart problems since before her husband died, and now has no health insurance. And, Jim, who due to multiple health problems, has recently lost his job and along with it his health insurance, and has no idea where to go for help. While he was at the Clinic he not only received health care and medications, but was given a list of community resources to help him access other needed services and a small box of food to feed him that night.

But we are only here one night a week. With Medicaid, these people will have access to healthcare WHEN they need it, not when we are here. No one should have to put off getting the healthcare they need for a week because the clinic is only open once a week.

According to a report from the Institute of Medicine, uninsured Americans get about half the medical care of those with health insurance. As a result, they tend to be sicker and to die sooner. About 18,000 unnecessary deaths occur each year because of lack of health insurance.

We see it too often. Now is the time to act, and prevent some of these unnecessary deaths.

Cute Shoes!

Theresa comes in wearing the cutest shoes – that’s why I notice her tonight. It is an unusual sight here at the clinic – someone well dressed.

She tells me that is why she’s here – her feet hurt! Oh, my. And you are wearing those shoes? She laughs, but she likes her cute shoes.

It is interesting what you notice. I didn’t see the depression and anxiety. But she has been a patient here for six or seven years – mostly dealing with depression, anxiety and asthma. That is a pretty common list of diagnoses for someone coming to the clinic.

She is married with three children. Her husband works full-time, as does she. Neither of their jobs provides healthcare insurance. The children are covered by the Michigan Medicaid program for children, so they have full coverage – healthcare and dental.

The clinic is able to provide her with the medications she needs to control her asthma. She gets medication for the depression and anxiety – but, is a pill really enough? I always worry that we are unable to do enough – a pill won’t fix the problems… just help deal with the day to day.

And, her foot pain, what is that about? She was able to see the podiatrist here and have x-rays done. The x-rays were “normal for a patient of this age.” The podiatrist diagnosed her with “foot pain due to pinched nerve.” He recommended she wear a “good shoe.”

She was here in snow boots the last time I saw her, which is a good choice in this climate! She told me her feet hurt no matter what shoes she wears, so she wears her cute shoes when she wants to, and “sensible shoes” the rest of the time.

Maybe by this time next year, she will have healthcare insurance. Until then, we will help her to deal with the asthma and the depression. And, admire her cute shoes.