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.