Tuesday, February 21, 2017

Republicans Moving Ahead with Repeal & Replace Strategy of the Affordable Care Act

By Scott Rollett, MBA, CMPE

In recent weeks, there has not been a lot of talk about the G.O.P.'s plans to "Repeal and Replace" the Affordable Care Act (ACA).  In fact, from the silence coming out of Washington on the topic, one might mistakenly believe that this has dropped pretty far down on their priority list.  However, nothing could be further from the truth.  The fact is, Republicans have used these last few weeks to come up with a viable strategy to try to accomplish a repeal of the ACA without the appearance of throwing 30 million people under the bus who have gained access to healthcare through the ACA, without destabilizing the health insurance industry, and without damaging the economy in the 31 states that have already expanded Medicaid.

Insiders report that the G.O.P. now has a "working outline" of what they hope to pass in early-to-mid March 2017.  Below are some of the key ideas and elements that are believed will make up the core of the Republican’s ACA’s Replacement legislation.      

·       Fixed Tax Credits vs. Income-Adjusted Premium Subsidies.  Under the ACA, if one meets the eligibility criteria, one can receive a premium subsidy to offset the cost of a Marketplace Exchange policy.  The G.O.P.'s plan would, instead, offer an aged-based flat tax credit to anyone purchasing an individual health insurance policy.  On the surface, this would seem like a good idea as the current ACA subsidies phase out at 400% of the Federal Poverty Level.  However, the proposed tax credit would not be income-adjusted and would likely be significantly less that than ACA subsidies and/or the actual cost of health insurance premiums.  One healthcare analyst suggested that the proposed age-adjusted tax credits might look something like $1,200 (per year) for individuals 18-35; $2,100 for those $35-50, and $3,000 for those 50+.  The average ACA premium subsidy is currently estimated at about $3,500 [1].  Hence, the average person who is presently getting an ACA premium is likely to find themselves paying more out-of-pocket for their premium in 2018.       

·       Decreased Coverage.  One of the criticisms of the ACA is that it “raised the bar” in terms of the types of things that are required to be covered in order to be considered a Qualified Health Plan (QHP).  Things like free mammograms, free preventative cancer screens, and free wellness visits were thought to help decrease healthcare costs in the long run through the use of early detection and prevention.  However, critics state that this has only served to increase the cost of premiums as insurers adjust to the increased cost basis.  The G.O.P.’s theory is that they can make health insurance premiums “affordable” again by dumbing down the coverage and that’s one of the primary goals of an ACA repeal.  In fact, Speaker of the House, Paul Ryan, recently said this measure would then “allow people to buy the health coverage that they want".  It's a nice sentiment, especially if you are young and healthy.  But he didn't address at all the situation that most Americans find themselves in - - how can they afford the health care coverage that their families need?       

·       Health Savings Accounts (HSA's).  Coupled with the expectation that making premiums more "affordable" for families comes with increased deductibles, more cost-sharing, and lesser coverage, it should surprise no one that increased utilization of tax-free Health Savings Plans would also be a core piece of any ACA Replacement plan.  Speaker of the House, Paul Ryan’s “A Better Way” blueprint, he proposes to raise the annual allowable HSA contribution to $6,550 for single people and $13,100 for families [2].   This DOES make sense to expand the use of this tool to help set aside tax-free monies to cover increased health care expenses.  The problem with HSA's is that most lower and middle-income families can’t afford to contribute to them.  For example, the Average Household Income in the State of Indiana in 2015 was $50,532 [4].  In order to make the maximum contribution under Speaker Ryan’s plan, a Hoosier family would need to allocate 26% of their Household Income to their HSA.  Therefore, Health Savings Accounts are an insufficient tool for a majority of Americans and primarily benefit the wealthy as a tax shelter.       

·       Medicaid Reform.  Medicaid plans, including the Children’s Health Insurance Program (CHIP) are administered by the individual 50 states.  However, in order to qualify for federal funds, there are minimum standards and universal guidelines that must be followed unless CMS grants the state an 1115 Waiver.  It is thought that any ACA Replacement plan will focus heavily on giving states much more flexibility to administer their Medicaid Programs the way they think is best.  Now this isn’t necessarily a bad thing.  As some of the Innovation Programs funded under the ACA have demonstrated, there are cost-saving ideas out there that could help decrease the overall cost of states’ Medicaid Programs.  The only downside is that the current protections offered by CMS to all recipients of Medicaid will likely be diminished.  

·       Medicaid Block Grants.  For decades, state Medicaid Programs have been jointly-funded by state governments and the Federal Government.  Depending on the state, the federal “match” could range anywhere from 50%-74% of total Medicaid expenditures [2].  Further, the ACA took the burden of Medicaid Expansion off the states by funding 100% of the expansion costs in the beginning but decreasing to 90% over a period of about 9 years.  The G.O.P.’s Replacement plan proposes to end the federal “match” and cap it instead through the use of “Block Grants” or a “Per Capita Allotment”.  This, in turn, caps the federal investment in the 50 states’ Medicaid Programs and forces them to cover the additional costs themselves or cut benefits or reduce eligibility for the program.  With 70 million Americans now on Medicaid, that’s a lot of people who will likely see their current health care coverage reduced or eliminated [2].            

·       Elimination of Medicaid Expansion.  The 2015 “Obamacare Repeal” legislation that was passed by the G.O.P. Congress and vetoed by President Obama was widely considered to be the “test run” for an ACA Repeal bill.  This bill called for the elimination of Medicaid Expansion.  However, now that President Obama is no longer available to block this bill from becoming law, some Republican legislators are realizing just how much this would harm a sizeable portion of their constituents back home as well as the economies in the states they represent.  It is estimated that 11 million people gained coverage through Medicaid Expansion in 31 states, including 16 Republican-led states, and including VP Mike Pence’s home state of Indiana (HIP 2.0) and Mitch McConnell / Rand Paul’s home state of Kentucky (Kynect) [3].  It’s a conundrum for sure as Medicaid Expansion flies in the face of the conservative ideal, but the success of Medicaid Expansion under the ACA cannot be denied.  Therefore, in order to secure the necessary votes for a successful ACA Repeal, compromises are going to have to be found.  Some proposals have called for “transitional plans” that eventually ease these 11 million people off of Medicaid Expansion over time and into “something else”.  Other proposals call for eligibility reductions back down from 138% of the Federal Poverty Level under the ACA to 100% which would have the same effect [3].  Of all of the current ideas in the ACA Replacement Plan, this one is the thorniest and perhaps most difficult to find G.O.P. consensus.                

In a nutshell, these core elements represent the basic tenets of the coming Republican ACA Replacement Plan.  If you oppose these ideas, I encourage you to write your House Rep and your two Senators and urge them to vote against this bill when it comes before Congress.  There is still time to preserve the ACA and all of the good that it does, but not much.  Let your Congressional Reps know TODAY how you feel.  Call them, email them, or fax them.  Just let your voice be heard.  Finally, remember this, we don’t need to convince 52 Republican Senators to vote against the ACA - - we only need to convince 2 or 3!        

[1] Matthews, Merrill.  “Now We Know What The Republican Obamacare Replacement Plan Will Look Like,” Forbes.com, last modified December 1, 2016. http://www.forbes.com/sites/merrillmatthews/2016/12/01/now-we-know-what-the-republican-obamacare-replacement-plan-will-look-like/

[2]  Luhby, Tami.  “Three ways Republicans want to replace Obamacare,” CNN.com, last modified February 17, 2017, http://money.cnn.com/2017/02/17/news/economy/obamacare-republicans/index.html

[3]  Sullivan, Peter.  “Republican Senators Wrestle with Changes to Medicaid”, thehill.com, last modified February 9, 2017.  http://thehill.com/policy/healthcare/318789-republican-senators-wrestle-with-changes-to-medicaid/

Monday, February 20, 2017

A Smile Is A Smile In Any Language

By Beth Sullivan, CIN, CAC, SHIP Counselor

Recently, I had the pleasure of spending time at Windrose Health Network's (WHN) Epler Parke Health Center on the south side of Indianapolis. Now, if you have ever visited there, you'll quickly notice that it is very different from WHN's other Health Centers. You see, our Epler Parke location serves a very large immigrant and refugee population. The faces you see and the languages you hear in the waiting room are quite different from what you might experience throughout most of Indiana. The time I spent there gave me food for thought. 

Have you ever moved to a completely new city? If so, how did you go about finding where to get your groceries or where to buy shoes for your kids? Didn't have a car? Did you have to try and figure out the local public transportation - the bus or train? How about finding a new doctor for you and your family, especially when you really liked the one you had "back home?" 

Now, I've moved around some in my life and I can tell you that it's not easy to uproot yourself from that which is familiar. Yet, I met some people at Epler Parke that, not only had to move to a new town, but a new continent. They had to move to a place where they didn't know anyone and they didn't speak the language. Have you ever thought about how bad the lives of some of these refugees must have been in their homeland? How bleak the circumstances must have been to cause husbands and wives to decide to pack up their small children and leave all that is familiar, to travel through horrid conditions to finally arrive months or years later in a place which is totally unfamiliar, and which you had no idea even existed, when you started out on your journey?

Have you ever thought about what America looks like through the eyes of a young child from Syria or Myanmar (Burma)? The language is different with sounds that are so foreign it must sound like gibberish. The noise of the city and the smells must be overwhelming. What does it feel like coming to a city where people look different and dress different? How do you know what the rules are? How do you fit into the community? 

There are so many agencies that help refugees get settled into their new lives. They help find them homes and jobs, and even places to worship. They also help find them "Healthcare Homes." In fact, it's one of the first "stops" they make along the path to their new lives, as ensuring good health among refugees and the communities they settle in remains a primary concern of local Health Departments. Therefore, Federally Qualified Health Centers (FQHC) are privileged to play a key role in welcoming these newcomers to their new homes. FQHC's are then, in many ways, not only ambassadors for all Americans, we are also the faces of American health care to people who may have never received medical care in their homeland or if they did, it may have been limited. Therefore, FQHC's must be a welcoming place that makes them feel safe. 

Now, as many of you know, navigating the U.S.'s healthcare system can be challenging enough for those of us who speak English and have lived here all of our lives. As I thought about this, I realized that those of us who choose to work in an FQHC have an awesome responsibility. We must be compassionate and caring and embrace the differences that we have with these newcomers who are entrusting us with their health and that of their families. 

Recently, I overheard one of our doctors talking to another doctor. The other doctor was commenting on how terribly difficult it must be to take care of these people. Her response made me proud! She simply shrugged and said, "It's not hard at all. They're just regular people. No different from anyone else." I love that she said that! Not black, not white. Not Muslim, not Christian. Not old, not young. Not English-speaking, not Burmese-speaking. Just regular people. 

Now, I don't often work at Epler Parke, so I don't often work directly with immigrants and refugees. Furthermore, I don't speak a lick of anything other than English. But, in helping some folks that day day through the use of an interpreter, I learned a valuable lesson. A smile is a smile in any language. 

Monday, February 6, 2017

National Burn Awareness Week 2017: How Can You Prevent Burn Injuries

By Lee Rollett, Guest Blogger

According to the World Health Organization, burns are a global public health problem that accounts for an estimated 265,000 deaths annually. They continue to be one of the leading causes of accidental death and injury in the United States. Between 2010 and 2014, approximately 486,000 people were seen in Emergency Departments for treatment of non-fatal burn injuries. In 2014 alone, there were 3,275 deaths from fires, which includes 2,795 deaths from residential fires, 345 from vehicle crash fires, and 135 from other sources.

One civilian fire death occurs every 2 hours and 41 minutes. The odds of a U.S. resident dying from exposure to fire, flames or smoke are 1 in 1442. Most of the injuries occur in the home (73%) followed by work (8%). Tragically, children, the elderly, and the disabled are especially vulnerable to burn injuries, and almost one-third of all burn injuries occur in children under the age of 15.

To help prevent injuries in your own home, there are several precautions you can take:

  • When cooking, use back burners and turn pot handles toward the back of the stove so children cannot pull them down. 
  • Keep children away from the stove when cooking by using a safety gate for younger children and marking with tape a 3-foot "no-kid zone" (in front of the stove) for older children. 
  • Keep hot drinks and food away from table and counter edges. Avoid using tablecloths and placemats.
  • Use a travel mug with a tight fitting lid for all hot drinks. 
  • Never hold an infant or child while cooking, drinking a hot liquid, or carrying hot items. 
  • Keep children away from electric cords and outlets to prevent shock, burns or electrocution. Use (clear) plastic covers for all outlets. 
  • When using appliances that get hot (such as an iron, curlers, crockpot, coffee pot), make sure the device and cord are placed out of the reach of children. 
  • Teach children that matches and lighters are tools for adults only. Older children may only use them (after obtaining permission) in a safe manner and while under proper adult supervision. 
  • Keep matches and lighters high out of the reach and sight of children, in a locked cabinet. 
  • Closely supervise older children when using microwaves, or have them prepare non-hot food. Many burn injuries occur from children pulling hot foods and soups out of microwaves. 
  • Teach children to stop, drop, and roll if their clothes catch fire. 
  • Test the water before placing a child in the tub. Fill the tub by running cool water first and then adding hot water. Seat the child facing away from the faucets. 
  • Glass doors on gas fireplaces (GFGF) can remain hot enough to cause deep burn injuries up to 1 hour of being shut-off. Fit GFGF with protective barriers, maintain a 3-foot no kid zone, and keep wall switches and remote controls out of reach of children. 
  • Encourage parents, caregivers, and babysitters to ask for assistance when they are feeling frustrated or overwhelmed. Instruct them to set a child down, walk away, deep breathe, count to ten, and ask for help if they feel they can't control their anger or are having thoughts of harming a child. 
  • Leave fireworks shows to the pros! Do not allow children to play with fireworks. Sparklers, often erroneously considered "safe," burn at about 1,800°F or 8.5 times hotter than boiling water!
  • Keep babies out of direct sun exposure until they are at least 6 months old. For older children, apply sunscreen 30 minutes before they go outside and reapply it every two hours-more often if they go swimming or are sweating. 

Today, 96.8% of those who suffer burn injuries will survive. Unfortunately, many of those survivors will sustain serious scarring, life-long physical disabilities, and adjustment difficulties. By taking precautions and using the previous list as a guideline, you can prevent burn-related injuries in your own home and workplace. Be safe...not sorry. 

"Burns." World Health Organization. World Health Organization, Sept. 2016. Web. 04 Feb. 2017. <http://www.who.int/mediacentre/factsheets/fs365/en/>.

"American Burn Association." American Burn Association. N.p., n.d. Web. 04 Feb. 2017. <http://www.ameriburn.org/preventionBurnAwareness.php>.