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Medicaid

Nurses raise their voices: “Do No Harm”

By Editorial Staff

June 28, 2017

 

 

This post is written by George Washington University faculty member Joyce Pulcini, PhD, RN, PNP-BC, FAAN, with contributions by Kari Deakins and Jennifer Kanelos, George Washington University School of Nursing students who attended the action. Dr. Joyce is a member of the National Advisory Council at the Center for Health Policy and Media Engagement.

 

 

On a hot Washington Thursday, June 22, a group of health care professionals and students in white coats descended on Capitol Hill to protest the proposed American Health Care Act (AHCA)

 

This new Act would replace the current Affordable Care Act. President Trump was quoted as saying that the House-passed health care reform bill as being a “mean” health insurance bill. The AHCA would leave almost 24 million uninsured. Nurses, physicians and other [health] professionals stood tall at this press conference.  House Minority leader Nancy Pelosi, Congressman Raul Ruiz, a physician from California and Congressman Steny Hoyer from Maryland [were] in attendance.

 

The vehemence with which this group expressed their displeasure with the bill was refreshing.  We heard physician after physician speak of the horrors and dangers of having no insurance, the consequences of which we all have seen in many patients who deserve better.  Possible victims include: elderly patients in nursing homes, whose costs represent 42% of the Medicaid dollar (nursing home residents account for about 6% of Medicaid enrollees); women seeking gynecological care; pregnant women whose pregnancy may now be defined as a preexisting condition; children on Medicaid, which covers 40% of all children; and disabled individuals living in facilities covered by Medicaid.  All will be vulnerable. 

 

The [health care] group continued to voice the mantra, “Do no harm” and speakers addressed the harms of this proposed bill would have if passed. Passage of this bill would devastate a population that finally received health insurance through the ACA, after many years of poor or delayed care. Today’s American population is aging.  The proposed legislation would turn the clock back for the elderly, women and children toward failed “uncompensated care” pools.  We spoke of people with conditions that are preventable or curable if picked up under current routine preventive care (“essential health benefits”), which could disappear under the new law by 2019. 

 

GWSON students who attended the briefing share their reactions about attending:

 

Kari Deakins:

As a student it was very inspiring to be able to stand shoulder to shoulder with providers of the interdisciplinary team to share our disagreement with the new AHCA. Our patients will be from many socioeconomic backgrounds in the future, and we must ensure that vulnerable populations are protected. The newly proposed AHCA risks the loss of health care benefits to millions of Americans, the possible denial of future benefits to millions more. It was motivating to listen to our future colleagues and physicians tell countless stories about their patients who would be affected by this damaging legislation. We must be vigilant and active as students to protect our patients and those that who need our help, and as we move into our practice and nursing careers, we must remain proactive in the advocacy of our patients.”  

 

Jennifer Kanelos:

“Participating in the white coat press conference was one of the most inspiring and memorable days I’ve had at GW to date. Gathering on Capitol Hill with nurses, physicians and med students united in the belief that all Americans deserve access to affordable health coverage, left an impact on me that will last a lifetime. From day one, we learn at GW SON to provide patient centered care focused on evidence based research. The facts are unequivocal, denying millions of people health coverage like the AHCA would do, will have devastating results on our ability to provide care for those that need it most.

I am halfway into my nursing education, and something in me has changed for the better. My experience at GW and with patients in the clinical rotations, have given me a new outlook on the world. I see people and our country differently now, and standing among so many providers with the Capitol and Washington Monument behind us, I truly felt like I belonged to something bigger than myself. Energized by the passion and commitment of the speakers and elected officials, I became a healthcare advocate that day. I look forward to a lifetime of speaking out on behalf of my patients, working towards a more perfect union, and maybe even one day asking for your vote”.

We were all there to prevent the devastating effects of the AHCA. We cannot afford to harm the American people with this bill, which would dismantle care that had finally become a reality for so many. As health care professionals we must DO NO HARM!

 

 

Update: On Tuesday, June 27, Senate Republican leaders bowed to pressure from within their own ranks and postponed a vote to overhaul the Affordable Care Act until after the Fourth of July recess. 

 

This post is written by Joyce Pulcini, PhD, RN, PNP-BC, FAAN, with contributions by George Washington University School of Nursing students Kari Deakins and Jennifer Kanelos who attended the action with her.

Editorial Staff

HealthCetera Celebrates Pride Month: Luna’s Story: How one health center cares for the transgender community

By Liz Seegert

June 12, 2017

In celebration of Pride Month we are reposting this HealthCetera show produced by Liz Seegert and previously aired in March 2017.

 

 

The American Health Care Act, the proposed Republican health plan, would deal a major blow to Medicaid funding for the states. The Congressional Budget Office projects that if it passes, Medicaid cuts will total about $800 billion over the next decade, and leave 24 million more people uninsured—including many in the LGBT community.

Under the ACA, health plans cannot refuse coverage based on pre-existing conditions, such as HIV, substance abuse, or a transgender medical history. There are non-discrimination protections based on sex, which  include gender identity and sex stereotypes, in any health program receiving federal funds (including Medicaid and in state marketplaces). This also includes sexual orientation.

The Center for American Progress found that among lower income LGBT individuals (making between $15,000 and $22,000 annually), the uninsured rate dropped 18 points since the ACA’s Medicaid expansion.

Luna Hernandez is among those benefitting from enhanced Medicaid coverage. She is a transgender woman who receives care through Community Health Center, Inc. in Middletown, Conn. Thanks to the Center’s Project ECHO program, an education program for safety-net providers, Luna’s care team is knows more about prevalent health issues among the transgender community and understands how to best interact with their patients.

Luna discusses her struggles and triumphs, her focus on staying healthy and the importance of the care CHC provides. I also speak with Wanda Montalvo, PhD, an advance practice nurse at the Weitzman Institute the policy arm of CHC that oversees Project ECHO, about what the real-world ramifications of Medicaid funding cuts mean to vulnerable populations.

 

You can also listen to the interview here.

Liz Seegert
Liz Seegert is a health care journalist and directs the media fellows program at the Center. She serves as topic editor on aging for the Association of Healthcare Journalists, writes for a variety of print and online publications and coproduces HealthCetera Radio on WBAI-FM. She tweets @lseegert. 

AHCA: Far-reaching and Substantial Negative Impact

By Carole R. Myers

June 2, 2017

PhotoCredit: CR Myers

There is plenty not to like about the American Health Care Act (AHCA), a center piece of President Trump’s legislative agenda.  The prospect of someone without health care coverage being penalized when they seek health coverage (the opposite of the Affordable Care Act) is all wrong.  Millions of Americans covered under the Affordable Care Act (ACA) will once again find health care coverage unaffordable if the AHCA is passed and federal tax subsidies for coverage and funds for Medicaid expansion are eliminated or people can once again be denied coverage because of pre-existing conditions.  How is this making health care more affordable and better as President Trump promised?  How is this making America great?

By far the biggest negative is the threat of blowing-up Medicaid as we know it.  Medicaid is an entitlement program that provides health care to low-income Americans.  As an entitlement program, Medicaid guarantees certain benefits to groups of people who qualify.  If an eligible individual receives eligible health care services, they are covered.  The federal government’s funding is based on need and it is open-ended.  The AHCA ends Medicaid as an entitlement program and morphs it in to a block grant program.  The proposed Medicaid block grants fundamentally change how the federal government pays for the Medicaid program.  The implications of the proposed change are far-reaching and substantial.  With block grants, the level of federal funding is capped and details about administration of the program are largely deferred to the states (this is one mechanism for removing protections from being denied coverage if you have a pre-existing condition or eliminating what the ACA deems as “essential benefits”, including maternity and substance abuse care).  In general block grants are not responsive to increased needs such as an uptick in unemployment or erosion of benefits due to inflation.  The design of the Medicaid block grants in the AHCA is particularly ominous because the proposed funding is capped at levels significantly below current costs.  Federal funding is slated to decrease by 50% over 10 years culminating in an $880 billion loss of federal funds and a projected 14 million beneficiaries losing their coverage. 

States cannot bear this shifted burden. Currently the cost of Medicaid is split between the states and the federal government.  The federal government pays 50-83% of the cost of Medicaid depending on the state.  Medicaid represents the largest source of federal dollars that are transferred to states and major portion of state budget revenues.  States will be faced with reducing Medicaid benefits, eligibility, and/or payments for services if the AHCA becomes the law of the land. 

The challenges we face in Tennessee where I live will be exacerbated by enactment of Medicaid block grants.  Tennessee is already on the bleeding edge of harmful trends, in part because the state has not expanded Medicaid.  We are already losing ground.  This will only get worse if the AHCA is passed.  Tennessee is a relatively rural and poor state.  Too many Tennesseans are already burdened by worse health care and outcomes because of where they live and limited resources.  Approximately 36 percent of Tennesseans live in a rural county; 82.1 percent of Tennessee rural counties are classified as rural.  Seventeen of Tennessee counties, all rural, rank in the bottom 10 percent of counties across the country relative to unemployment, poverty rates, and per capita market income.  An additional 35 Tennessee counties rank in the bottom 25 percent nationally.   Eleven percent of all Tennesseans are currently uninsured, compared with six percent in neighboring state Kentucky which did expand Medicaid.  Rural residents across the country have higher rates of chronic diseases and higher rates of low birth weight infants, teen birth rates, overweight children, preventable hospital admissions, and incidence of Diabetes, along with lower life expectancies.  Tennessee has been hard hit by the opioid abuse epidemic.  It is estimated that one in six Tennesseans is abusing or misusing opioid drugs.  There has been a ten-fold increase in the incidence of babies born with Neonatal Abstinence Syndrome in Tennessee over the past decade.  Rural Tennessee residents are about twice as likely to overdose on prescription opioid drug as their urban counterparts.  The rate of use of prescribed opioid drugs among young adults in Tennessee (ages 18-25) is 30 percent higher than the national average.    There has been a 600 percent increase in hospital charges associated with opioid poisoning in Tennessee 1999-2011.  Passage of the AHCA, further loss of Medicaid funding, and an increase in the number of uninsured Tennesseans will result in further regression in the state.

Alarmingly Tennessee leads the country in rates of hospital closures.  Closure of a hospital, especially in a rural area can start a cascade of deleterious effects.  Tennessee had 9 rural hospital close since 2010, only Texas with 11 closures had more.  Seventy-seven percent of all rural hospital closures since 2010 when the ACA was enacted have occurred in states that have not expanded Medicaid.  The links between Medicaid expansion and hospital closures are in part an unintended consequence of the Supreme Court decision that wiped away mandatory Medicaid expansion in the ACA.  When the ACA was being drafted it was thought that payments to hospitals for uncompensated care accrued by uninsured individuals would no longer be needed because the number of uninsured individuals would steeply decline.   However, hospitals in non-expansion states are faced with the double whammy of reduced payments for uncompensated care and higher rates of uninsured individuals, an unsustainable combination.  Already burdened hospitals are too-frequently unable to withstand revenue deficits associated with uncompensated care.  Profit margins are just too thin.  Adding to the rash of hospital closures is the significant number of rural hospitals that have been identified as currently facing a high risk of closing.  In Tennessee, 32 hospitals are vulnerable to significant reductions in services, if not closure, because on average over a three-year period they have operated in the red.  The situation will only worsen if the AHCA becomes law.

It is incongruent to me that blocks of Americans, including a majority of Tennesseans who voted for President Trump based on the promise of better health care, will be the people who suffer most under the AHCA.  This is not great!  This is a dismal prospect and a potential burgeoning human tragedy.

 

Carole R. Myers, PhD, RN is an Associate Professor at the University of Tennessee with a joint appointment in the College of Nursing and the Department of Public Health.  She has recently been appointed as Senior Fellow for the George Washington University Center for Health Policy and Media Engagement.

Carole R. Myers