Health Safety Net Programs

  • Clock ticking on federal funding for CHIP, other health safety net programs, By Kate Giammarise and Sean D. Hamill, September 26, 2017, Pittsburgh Post-Gazette: “Federal funding for several health care safety-net programs is set to expire at the end of the week unless Congress takes action — a prospect that is looking increasingly less likely, advocates say, as the clock ticks and congressional energy is consumed by an 11th-hour attempt to repeal the Affordable Care Act…”
  • Medicaid covers all that? It’s more than just health care for the poor, By Phil Galewitz, September 27, 2017, Governing: “When high levels of lead were discovered in the public water system in Flint, Mich., in 2015, Medicaid stepped in to help thousands of children get tested for poisoning and receive care. When disabled children need to get to doctors’ appointments — either across town or hundreds of miles away — Medicaid pays for their transportation.  When middle-class older Americans deplete their savings to pay for costly nursing home care, Medicaid offers coverage.  The United States has become a Medicaid nation…”

State Medicaid Programs – New Mexico, Colorado

Community Paramedic Program

These house calls save money for EMS, social services, By Robert Mittendorf, September 4, 2017, Bellingham Herald: “Bellingham Fire Capt. Jeff Brubaker carries a pager like any other firefighter, and he still uses his paramedic skills to help people. But these days he’s not riding a fire engine or an ambulance and most of his patients haven’t called 911. Not as much as they used to, at least. Brubaker is Bellingham Fire Department’s community paramedic, a relatively new position that puts him in touch with people who are frequent 911 callers but who don’t need emergency care…”

Rural Health Care

  • Deaths from cancer higher in rural America, CDC finds, By Lena H. Sun, July 6, 2017, Washington Post: “Despite decreases in cancer death rates nationwide, a new report shows they are higher in rural America than in urban areas of the United States. The report released Thursday by the Centers for Disease Control and Prevention found that rural areas had higher rates of new cases as well as of deaths from cancers related to tobacco use, such as lung and laryngeal cancers, and those that can be prevented by screening, such as colorectal and cervical cancers…”
  • Kids in pro-Trump rural areas have a lot to lose if GOP rolls back Medicaid, By Noam Levey, July 6, 2017, Los Angeles Times: “Communities like this aging West Virginia coal town along the Kanawha River were key to President Trump’s victory last year; more than two-thirds of voters in surrounding Fayette County backed the Republican nominee. Now, families in this rural county and hundreds like it that supported Trump face the loss of a critical safety net for children as congressional Republicans move to cut hundreds of billions of dollars over the next decade from Medicaid, the half-century-old government health plan for the poor…”

Medicaid Cuts and State Programs

  • From birth to death, Medicaid affects the lives of millions, By Alison Kodjak, June 27, 2017, National Public Radio: “Medicaid is the government health care program for the poor.  That’s the shorthand explanation. But Medicaid is so much more than that — which is why it has become the focal point of the battle in Washington to repeal and replace the Affordable Care Act, also known as Obamacare. President Barack Obama expanded Medicaid under his signature health care law to cover 11 million more people, bringing the total number of people covered up to 69 million…”
  • For people who depend on Medicaid, proposed federal caps in health care plans instill fear, By Guy Boulton, June 24, 2017, Milwaukee Journal Sentinel: “Aaron Christensen was born with a condition so rare that fewer than 100 people have been diagnosed and reported with it worldwide. The boy, now 6, has Nicolaides-Baraitser syndrome, which is characterized by intellectual disability, distinctive facial and other physical features, and often seizures. When he was born, ‘everything kind of changed,’ said his mother, Sara Christensen. ‘We still don’t know what the future looks like.’ Aaron could depend on Medicaid to pay for all or most of his health care his entire life, through a special program. And that’s why they’re extremely anxious about congressional Republicans’ plans to cap what the federal government spends on Medicaid in future years…”
  • The who, what and how much of Mississippi Medicaid, By Sarah Fowler, June 28, 2017, Clarion-Ledger: “Each morning, Samantha Manning rushes to get her family ready for the day. Her eldest, 13-year-old Kennedy, is involved in a number of sports. Combine that with twin 8-year-old boys, and each day is different. Kennedy is a type 1 diabetic and goes to a small school that doesn’t have a nurse on staff. Because of the teen’s diabetes, the school’s policy demands one parent is present at all of her games…”
  • Veterans helped by Obamacare worry about Republican repeal efforts, By Stephanie O’Neill, June 28, 2017, National Public Radio: “Air Force veteran Billy Ramos, from Simi Valley, Calif., is 53 and gets health insurance for himself and for his family from Medicaid — the government insurance program for lower-income people. He says he counts on the coverage, especially because of his physically demanding work as a self-employed contractor in the heating and air conditioning business…”

Medicaid Cuts and State Programs

  • Republicans’ proposed Medicaid cuts would hit rural patients hard, By Bram Sable-Smith, June 22, 2017, National Public Radio: “For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher. Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding…”
  • G.O.P. health plan is really a rollback of Medicaid, By Margot Sanger-Katz, June 20, 2017, New York Times: “Tucked inside the Republican bill to replace Obamacare is a plan to impose a radical diet on a 52-year-old program that insures nearly one in five Americans. The bill, of course, would modify changes to the health system brought by the Affordable Care Act. But it would also permanently restructure Medicaid, which covers tens of millions of poor or disabled Americans, including millions who are living in nursing homes with conditions like Alzheimer’s or the aftereffects of a stroke…”
  • Republicans’ Medicaid rollback collides with opioid epidemic, By Ricardo Alonzo-Zaldivar (AP), June 20, 2017, ABC News: “The Republican campaign to roll back Barack Obama’s health care law is colliding with America’s opioid epidemic. Medicaid cutbacks would hit hard in states deeply affected by the addiction crisis and struggling to turn the corner, according to state data and concerned lawmakers in both parties…”
  • How states like Kansas punish the poor for being both too poor and not poor enough, By Max Ehrenfreund, June 19, 2017, Washington Post: “Obamacare was designed to make it easier for poor Americans to buy insurance. In many states, though, the law has left a hole where less needy households can receive benefits, while millions of Americans living in poverty cannot. They are, in effect, too poor to get help…”
  • In expanding Medicaid, Utah wants to make some enrollees work and cap their lifetime coverage, By Alex Stuckey, June 20, 2017, Salt Lake Tribune: “Utah health officials are proposing lifetime limits and work requirements for childless adults who would gain coverage under a Medicaid expansion plan, hoping the changes will help persuade the federal government to approve it…”
  • With Medicaid under the gun, new study highlights program’s successes in Cheshire County, By Ethan DeWitt, June 23, 2017, Keene Sentinel: “Amid fierce national clashes over the future of health care, and a new Republican bill unveiled Thursday, one federal program has proven a particular emotional flash point: Medicaid. Efforts to pare back the program, which provides coverage to low-income adults and children, have drawn alarm from Democrats and some Republican senators representing rural states…”

Health Insurance Coverage in the US

  • Charity care dips at Wisconsin hospitals, with more people insured; trend could end with Obamacare repeal, By David Wahlberg, June 11, 2017, Wisconsin State Journal: “Hospitals in Madison and throughout Wisconsin have provided less charity care in recent years as more people have gained insurance through the Affordable Care Act, with some hospitals directing the savings to disease prevention. That could change if Congress overturns the law, known as Obamacare, and increases the ranks of the uninsured. And if Medicare payment cuts that helped pay for the law’s expanded coverage also remain, hospitals could end up shifting more costs to people with private insurance, officials say…”
  • What the Obamacare overhaul could mean for Texas’ terrible maternal mortality rate, By Katie Leslie, June 12, 2017, Dallas Morning News: “Texas officials were already investigating why an alarming number of Lone Star women are dying from pregnancy-related complications when a study last year ranked the state’s maternal mortality rate as the nation’s worst. That’s why many doctors and health care advocates are watching Republican-led negotiations in Washington over replacing the Affordable Care Act, with some worried about what the changes could mean for Texas’ maternal health crisis…”
  • Nevada may become first state to offer Medicaid to all, regardless of income, By Alison Kodjak, June 13, 2017, National Public Radio: “Nevadans will find out this week whether their state will become the first in the country to allow anyone to buy into Medicaid, the government health care program for the poor and disabled…”
  • In Texas, people with erratic incomes risk being cut off from Medicaid, By Shefali Luthra, June 14, 2017, Iowa Public Radio: “Worries about whether her children can still get the health care they need are never far from Dawn Poole’s mind. It’s a constant, underlying concern. Much of her anxiety is a direct result of living in Texas. To qualify for Medicaid in the state, most children must come from families with incomes at or below 138 percent of the federal poverty level. In 2017, that’s $33,948 for a family of four. Texas also has one of the country’s strictest Medicaid verification systems: It runs regular checks on family finances after children are enrolled to make sure they continue to qualify…”

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…”