Rural Health Care – Nevada, Kentucky

  • Health-care ‘have-nots’: Nevada’s rural residents face fraying safety net, By Pashtana Usufzy, November 19, 2016, Las Vegas Review-Journal: “Tears well up in the eyes of lifelong Tonopah resident Acacia Hathaway as she talks about last year’s closure of Nye Regional Medical Center, the only hospital within 100 miles of her home.  ‘It was … like the end of the world here,’ says the 24-year-old mother of three, including a daughter who suffers from Goltz syndrome, a rare illness that requires frequent care from medical specialists.  Now, instead of visiting the local hospital when 4-year-old Ella suffers one of her seemingly inevitable infections, Hathaway or her husband, Justin, drive to Las Vegas – three hours each way. That’s in addition to twice-monthly trips for regular appointments with her doctors — all eight of them…”
  • In depressed rural Kentucky, worries mount over Medicaid cutbacks, By Phi Galewitz, November 19, 2016, National Public Radio: “For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America’s poorest places, the Affordable Care Act was life altering.  The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years…”

Medicaid Coverage and ER Visits

Emergency room use stays high In Oregon Medicaid study, By Kristian Foden-Vencil, October 19, 2016, National Public Radio: “Will Medicaid expansion save the country money as people stop using expensive emergency rooms for primary care? Not yet, suggest the latest findings from a landmark study published online Wednesday in the New England Journal of Medicine.  The study of Medicaid patients in Oregon who got Medicaid in 2008 found their ER use stayed high two years after they gained the health insurance coverage — even as they also increased their visits to doctors’ offices…”

Medicaid Expansion – Indiana, Ohio

  • Hospitals boosted by Medicaid expansion, By Maureen Groppe, February 1, 2016, Indianapolis Star: “The biggest obstacle a Richmond, Ind., hospital has had in signing up low-income Hoosiers for Indiana’s expanded Medicaid program is convincing them it’s real.  ‘These are people who have never had this type of coverage before,’ said Chris Knight, the chief financial officer and vice president of Reid Health. ‘We have had very touching stories where people just break down and cry when they’re given this coverage.’  As Indiana enters its second year of expanded Medicaid coverage created by the Affordable Care Act, hospitals around the state report it has helped patients gain needed coverage.  But it’s helping hospitals, too.  The amount of unpaid bills Reid Health can’t collect from patients has dropped about 40 percent…”
  • Do Indiana’s poor Medicaid recipients really have skin in the game?, By Maureen Groppe and Shari Rudavsky, February 1, 2016, Indianapolis Star: “When Gov. Mike Pence sought federal permission to run an alternative Medicaid program in Indiana, one aspect was non-negotiable: Participants in the joint federal and state health care program for the poor would have to have ‘skin in the game.’  Even those with no monthly income would have to pay a minimum $1 a month toward their care, if they wanted to stay in the part of the Healthy Indiana Program (HIP 2.0) that offered better benefits and no co-payments…”
  • Medicaid cuts number of uninsured Ohio workers, By Randy Tucker, February 3, 2016, Dayton Daily News: “The number of Ohio workers who were employed but uninsured fell sharply in the first full year of expanded Medicaid coverage under the Affordable Care Act, according to a report released Wednesday by Families USA. On average, the rate of uninsured, mostly low-wage workers, fell by 25 percent in the 26 states that expanded Medicaid in 2014, the non-profit health care advocacy group found. That was about twice the rate of decline in non-expansion states, where the share of uninsured workers was cut by an average of 13 percent, according to the report…”

Hospitals and Food Insecurity

Some hospitals prescribe food, take other steps to fight food insecurity, By Christopher J. Gearon, December 8, 2015, US News and World Report: “At Boston Medical Center, physicians write prescriptions for food when patients don’t have enough to eat. Doctors in the center’s emergency department and more than 20 clinics screen all patients for hunger, writing those who struggle to feed themselves a script to the on-site Preventive Food Pantry. They write a lot of food prescriptions – enough to keep the food pharmacy serving 7,000 people each month…”

Urban Hospitals and Poverty

Surrounded by poverty, urban hospitals reach out, By Michael Ollove, October 12, 2015, Stateline: “As a child, Bishop Douglas Miles heard the warnings about vans trolling East Baltimore streets, snatching up young African-Americans for medical experiments at nearby Johns Hopkins Hospital. Whether there was any truth behind those stories—Hopkins has always denied them—hardly mattered. The mythology lived on and, combined with the hospital’s very real development decisions, contributed to a persistent view of Hopkins as an imperious, menacing presence amid the largely poor and African-American neighborhoods surrounding it.  ‘Hopkins was viewed with a great deal of suspicion and anger,’ said Miles, who graduated from the school in 1970 and is the bishop of Koinonia Baptist Church in northeast Baltimore. But now, Miles says, that perception could be changing. Johns Hopkins University and the Hopkins hospital and health system have launched an ambitious initiative to fill many more jobs with residents from distressed Baltimore neighborhoods, boost the use of minority contractors and vendors from those areas, and require their partners to follow their lead…”

Safety Net Clinics – Twin Cities, MN

Twin Cities safety net clinics call state’s rating system unfair, By Glenn Howatt, September 8, 2015, Star Tribune: “Safety net clinics, which serve the Twin Cities’ neediest neighborhoods, are arguing that Minnesota’s quality rating system unfairly penalizes them for serving a poorer, sicker population. The clinics are known for helping their patients not just with medical care, but with such basic needs as food, ­shelter and personal safety…”

Rural Hospitals

To survive, rural hospitals join forces, By Michael Ollove, August 17, 2015, Stateline: “Ask Sam Lindsey about the importance of Northern Cochise Community Hospital and he’ll give you a wry grin. You might as well be asking the 77-year-old city councilman to choose between playing pickup basketball—as he still does most Fridays—and being planted six feet under the Arizona dust. Lindsey believes he’s above ground, and still playing point guard down at the Mormon church, because of Northern Cochise. Last Christmas, he suffered a severe stroke in his home. He survived, he said, because his wife, Zenita, got him to the hospital within minutes. If it hadn’t been there, she would have had to drive him 85 miles to Tucson Medical Center. There are approximately 2,300 rural hospitals in the U.S., most of them concentrated in the Midwest and the South. For a variety of reasons, many of them are struggling to survive…”

ACA and Safety Net Hospitals

Some public hospitals win, others lose with Obamacare, Reuters, July 23, 2015, NBC News: “A year and a half after the Affordable Care Act brought widespread reforms to the U.S. healthcare system, Chicago’s Cook County Health & Hospitals System has made its first profit in 180 years.  Seven hundred miles south, the fortunes of Atlanta’s primary public hospital, Grady Health System, haven’t improved, and it remains as dependent as ever on philanthropy and county funding to stay afloat.  The disparity between the two ‘safety net’ hospitals, both of which serve a disproportionate share of their communities’ poorest patients, illustrates a growing divide nationwide…”

Medicaid Expansion and Safety-Net Hospitals

Economy boosts safety-net hospitals in states not expanding Medicaid, By Phil Galewitz, March 1, 2015, Washington Post: “Hospitals that treat many poor and uninsured patients were expected to face tough financial times in states that did not expand Medicaid under the Affordable Care Act.  That’s because they would get less Medicare and Medicaid funding under the health-care law, while still having to provide high levels of charity care.  But in some of the largest states that did not expand Medicaid, many ‘safety net’ hospitals fared pretty well last year — better than in 2013 in many cases, according to their financial documents…”

Medical-Legal Partnerships

Need a doctor? This anti-poverty program will get you a lawyer, too, By Seth Freed Wessler and Kat Aaron, December 13, 2014, NBC News: “When Tony Cox, 53, woke up in the hospital after suffering a heart attack when he fell off a ladder during a roofing job, he figured he’d hit bottom. ‘All I could think about was getting better and getting back to my family,’ he says. But that day in the hospital was not his lowest point. Over a year later, a sheriff’s deputy arrived at the modest two-bedroom house Cox shares with his wife Donna and their now 16-year-old son bearing a notice that their home was in foreclosure. Out of work from the injury, Cox had fallen behind on mortgage payments. ‘We were getting ready to be homeless, to move in with family,’ Donna says. ‘We would have been separated.’ The couple tried to catch up, to renegotiate their mortgage, but could not make the payments—not until they sought help from a legal services attorney, who brought the foreclosure case to court and compelled the bank to renegotiate the terms of their loan. Over the coming years, the person who saved Cox from the worst consequence of his heart attack was not a doctor but a lawyer…”

Hospitals and Medicaid Expansion

  • Hospitals see major drop in charity care, September 24, 2014, The Tennessean: “The number of uninsured patients admitted to hospitals has dropped markedly this year, reducing charity care and bad debt cases, particularly in states that have expanded Medicaid coverage under the new federal health care law, a government report released Wednesday found. The report from the Department of Health and Human Services said hospitals in states that have taken advantage of new Medicaid eligibility levels have seen uninsured admissions fall by about 30 percent. The report estimated that the cost of uncompensated hospital care will be $5.7 billion lower in 2014…”
  • Affordable Care Act reduces costs for hospitals, report says, By Robert Pear, September 24, 2014, New York Times: “The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility. In states that have expanded Medicaid, the White House said, hospitals are seeing substantial reductions in ‘uncompensated care’ as more patients have Medicaid coverage and fewer are uninsured…”

Hospitals and Medicaid Expansion

  • Report: Hospitals in Medicaid-expansion states performing well, By Chelsea Keenan, September 8, 2014, Cedar Rapids Gazette: “Hospitals in states that expanded Medicaid are seeing higher revenues and a reduction in uninsured patients, according to a new report by PwC’s Health Research Institute. The report analyzed financial data from the country’s five largest for-profit health systems, which represent 538 hospitals in 35 states. ‘There were lots of debates in (Washington) D.C. around these issues,’ said Gary Jacobs, a managing director at PWC. ‘There were lots of promises and good intentions. But the jury was still out on how it would shape up.’ The growth in the 26 Medicaid expansion states and Washington, D.C., starkly contrasts the experience in the 24 states that did not expand the program, the report found…”
  • Hospital officials frustrated with financial losses since state did not expand Medicaid, By Shannon Muchmore, September 8, 2014, Tulsa World: “Tulsa hospital executives are frustrated at losing out on reimbursements because of what they say are purely political decisions. Hospitals in Oklahoma are projected to lose more than $4 billion in reimbursements between 2013-22 because the state chose not to expand Medicaid, according to a recent report by the Urban Institute…”

Medicaid Coverage

  • State’s low Medicaid payments pinch doctor practices in low-income areas, By Guy Boulton, July 19, 2014, Milwaukee Journal Sentinel: “Mohammad Qasim Khan, a primary care physician who oversees a private practice in a low-income neighborhood, well knows the discrepancy between what private insurance pays for his services and what the state’s Medicaid program pays. Khan, who works with another physician and three nurse practitioners at the Family Medical Clinic, 5434 W. Capitol Drive, estimates that the program’s payment rates are half — and in some cases, less than half — those of private insurance…”
  • U.S. hospitals get lift from surge in Medicaid sign-ups, By Susan Kelly, August 1, 2014, Philadelphia Inquirer: “U.S. hospitals are getting a stronger-than-expected benefit from a new influx of low-income patients whose bills are paid by the government’s Medicaid program, raising their profit forecasts as a result. The growing numbers of Medicaid patients helped hospital operator HCA Holdings Inc, the largest for-profit chain, post stronger earnings in the second quarter than initially forecast…”
  • CDC: Many kids with Medicaid use ER as doctor’s office, By Steven Reinberg, July 29, 2014, Lafayette Journal and Courier: “Children covered by Medicaid, the publicly funded insurance program for the poor, visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds. And kids with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention…”

ACA and Safety-Net Hospitals

Cuts in hospital subsidies threaten safety-net care, By Sabrina Tavernise, November 8, 2013, New York Times: “The uninsured pour into Memorial Health hospital here: the waitress with cancer in her voice box who for two years assumed she just had a sore throat. The unemployed diabetic with a wound stretching the length of her shin. The construction worker who could no longer breathe on his own after weeks of untreated asthma attacks and had to be put on a respirator. Many of these patients were expected to gain health coverage under the Affordable Care Act through a major expansion of Medicaid, the medical insurance program for the poor. But after the Supreme Court in 2012 gave states the right to opt out, Georgia, like about half the states, almost all of them Republican-led, refused to broaden the program…”

Medicaid Patients and Hospital Readmissions

NC study cut hospital readmissions among state’s sickest, poorest patients, By John Murawski, August 7, 2013, News and Observer: “A North Carolina study on reducing costly hospital visits cut readmissions by 20 percent among the sickest and poorest patients who are most prone to relying on hospitals for their medical care. The project, believed to be the largest of its kind in the nation, was conducted by Community Care of North Carolina, a Raleigh-based physician-led program that focuses on helping poor people get health care and avoid hospitalization. It involved some 800 nurses and social workers doing intensive follow-ups with Medicaid patients. They sometimes shadowed patients for months to make sure they took their medications, kept their doctor’s appointments and followed all instructions…”

Medicaid Coverage and Prison Inmates

States missing out on millions in Medicaid for prisoners, By Christine Vestal, June 25, 2013, Stateline: “Only a dozen states have taken advantage of a long-standing option to stick the federal government with at least half the cost of hospitalizations and nursing home stays of state prison inmates. The other states have left tens of millions of federal dollars on the table, either because they didn’t know about a federal rule dating to 1997 or they were unable to write the laws and administrative processes to take advantage of it. States and localities have a constitutional obligation to provide adequate health care to prisoners, and they must pay for it out of their own budgets. However, a 1997 ruling says that care provided to inmates beyond the walls of the prison qualifies for Medicaid reimbursement if the prisoner is Medicaid eligible. The federal government then pays 50 percent to 84 percent of Medicaid costs…”

Health Insurance Coverage and Access to Care

Costs of expanding health coverage reduced by fewer hospital stays, study shows, By Guy Boulton, June 3, 2013, Milwaukee Journal Sentinel: “A state health insurance program that provided improved access to care for adults with very low incomes in Milwaukee County sharply reduced hospitalizations, suggesting that the cost of expanding coverage could be partially offset by the money saved from fewer high-cost hospital stays, according to a study led by researchers at the University of Wisconsin-Madison. The study, which was published Monday in the policy journal Health Affairs, found an increase in visits to clinics and emergency departments, but a 59% drop in hospitalizations and a 48% drop in preventable hospitalizations. The study supports the idea that if people, particularly those with chronic illnesses, have better access to care, they may be able to manage their health better, said Thomas DeLeire, a professor of public affairs and economics and director of the La Follette School of Public Affairs at UW-Madison…”

States and Medicaid Expansion

  • Hospitals lobby hard for Medicaid expansion, By Michael Ollove, April 17, 2013, Stateline: “With billions of dollars at stake, hospitals are lobbying hard for Medicaid expansion in Columbus, Tallahassee and other state capitals where state legislators oppose the extension of the program to some 17 million Americans. Hospital associations have paid for television and newspaper ads, organized rallies, and choreographed legislative testimony in support of the Medicaid expansion, which is part of the Affordable Care Act. They also have united disparate groups which are used to being on opposite sides of legislative debates. In Columbus, for example, Ohio Right to Life and Planned Parenthood Advocates of Ohio are working side-by-side to persuade state lawmakers to approve the expansion. Both groups say they want to make health insurance available to the poor…”
  • Arkansas OKs compromise plan to use federal Medicaid expansion funds for private insurance, Associated Press, April 17, 2013, Washington Post: “Arkansas’ plan to use federal money to buy private insurance for low-income residents won final approval from state lawmakers Wednesday, endorsing a model that several other states are eyeing as a possible alternative to expanding Medicaid. The Republican-controlled Legislature narrowly reached the three-fourths majority needed to pass the proposal, which was a compromise reached between leading GOP lawmakers and Democratic Gov. Mike Beebe…”
  • New Jersey Medicaid expansion seen as on schedule, By Chris Mondics, April 17, 2013, Philadelphia Inquirer: “New Jersey is gearing up for a huge expansion of its Medicaid health-care plan for the poor and, despite uncertainty over federal eligibility requirements, new enrollees are expected to begin receiving services by the Jan. 1 deadline, Human Services Commissioner Jennifer Velez said Tuesday. Velez, who testified before the Assembly Budget Committee on her department’s proposed $15 billion budget for the fiscal year that begins July 1, said she expected about 300,000 new Medicaid enrollees to be added to the 1.3 million who receive care under the program. The state will get slightly more than $1 billion from the federal government under the Affordable Care Act to pay for the expansion…”
  • Legislator unveils another approach to insure low-income Texans, by Chuck Lindell, April 16, 2013, Austin American-Statesman: “With staunch Republican opposition leaving Medicaid expansion on life support, a GOP lawmaker is pushing legislation to spend billions of government dollars to purchase private-market health insurance for the state’s poorest citizens. State Rep. John Zerwas, R-Simonton, calls it the ‘Texas Solution.’ Instead of adding up to 1.5 million uninsured Texans to Medicaid under the Affordable Care Act, the Zerwas plan would extend coverage by plowing the money into private insurance policies, similar to an arrangement Arkansas is working out with the federal government, he said…”
  • House wants waiver on Medicaid for now, By Jim Siegel, April 18, 2013, Columbus Dispatch: “In the latest chapter of the Medicaid expansion debate in Ohio, the House tonight is expected to ask Kasich administration to seek a waiver from the federal government and return with a new proposal this fall. The amendment will be part of final changes the House will make before giving final passage to the two-year, $61.5 billion budget…”
  • Medicaid expansion debate suspended, By JoAnne Young, April 18, 2013, Lincoln Journal Star: “Talk isn’t cheap. It’s a valuable commodity when the clock is ticking down on the long session of the Legislature. On Tuesday and Wednesday, the Legislature spent a lot of words — 10 hours and 20 minutes worth — on Medicaid expansion. But it went away empty-handed, without even a vote on an amendment on the bill (LB577)…”

US Health Care System

This election, a stark choice in health care, By Abby Goodnough and Robert Pear, October 10, 2012, New York Times: “Joyce Beck, who runs a small hospital and network of medical clinics in rural Nebraska, is reluctant to plan for the future until voters decide between President Obama and Mitt Romney. The candidates’ sharply divergent proposals for Medicare, Medicaid and coverage of the uninsured have created too much uncertainty, she explained. ‘We are all on hold, waiting to see what the election brings,’ said Ms. Beck, chief executive of Thayer County Health Services in Hebron, Neb. When Americans go to the polls next month, they will cast a vote not just for president but for one of two profoundly different visions for the future of the country’s health care system…”

States and Medicaid Expansion

  • FSSA: Indiana Medicaid costs to grow under health law, By Eric Bradner, September 18, 2012, Evansville Courier and Press: “Even if Indiana policymakers opt to turn down the Medicaid expansion envisioned in the federal health care law, the program’s enrollment is expected to grow in the coming years. It’s because of a ‘woodwork effect’ that the actuary for Indiana’s Family and Social Services Administration is projecting. It means that due to the law’s individual mandate that all Americans have health insurance, those who are eligible for Medicaid but aren’t currently signed up will, as the expression goes, come out of the woodwork. The cost of such an effect, with up to 123,000 Hoosiers potentially becoming part of it, would be about $600 million over a seven-year period, according to a new round of estimates that the actuary, Milliman, Inc., provided Tuesday…”
  • Utah doctors give qualified nod to Medicaid expansion, By Kirsten Stewart, September 17, 2012, Salt Lake Tribune: “Utah doctors support expanding Medicaid but with a few caveats. After hours of contentious debate Saturday over a provision in federal health reform that would expand the health safety net to cover more of the nation’s poor, the Utah Medical Association’s (UMA) House of Delegates approved this carefully parsed statement: ‘When health care reform measures are under consideration by the governor and Legislature, the UMA will support such measures as will improve our patients’ access to care, including the expansion of Medicaid coverage if that is the best way to provide coverage to all Utahns.’ It seems a tepid endorsement for a policy that would insure a third of the state’s uninsured, about 105,000 people. But advocates for the expansion, such as Ray Ward, a family physician in Bountiful, say it’s the best they could hope for given the circumstances…”
  • Hospitals may lose money if Medicaid not expanded, Associated Press, September 17, 2012, Kearney Hub: “The University of Nebraska Medical Center’s two hospitals in Omaha stand to lose millions of dollars in federal aid under the new federal health care law unless the state expands Medicaid coverage, and administrators said those cuts could mean problems for academic programs that rely on the hospitals for revenue.  Administrators said the law will eliminate federal payments to the Nebraska Medical Center and the Children’s Hospital and Medical Center. Both qualify for special aid because they serve as safety-net hospitals for patients who are on Medicaid or uninsured, said Cory Shaw, the chief executive officer of UNMC Physicians. Medicaid is a federal health program administered by states covers low-income adults and children as well as people with certain disabilities…”