Lebanon Family Health Services: Maternal and Newborn Health

This is the first of a 5 part series on "Women's Health".  Thank you to Lebanon Family Health Services for their assistance with this series.

Lebanon Family Health Services
Ann Biser, Donna Williams, Kim Kreider Umble, Vicki DeLoatch

A young couple with a newborn infant fastened to a car seat carrier was exiting Lebanon Family Health Services on a late September day.  In the brightly lit waiting area with neatly arranged children’s toys, a new mother nurses her infant.  Next to her, a pregnant woman waits.  Nutrition information is displayed about the room that is also the home for the WIC program (Women, Infants and Children-special supplemental nutrition program).  As you enter the upstairs hallway, one will find displayed the remnants of a “clothesline project”, an exhibit where colorful t-shirts depict the tragedy endured by those who are survivors of domestic abuse and rape put together by the Sexual Assault and Resource Center.  Each shirt tells its own story of pain, sorrow and agony.  However, like a mother’s embrace, the warmth that permeates the walls of this central Pennsylvania facility encircle the display and all the empowered souls it represents.  They have endured and they are safe in this place.

 It hasn’t always been this way.  In 1973, when Lebanon Family Health Services began, these women had nowhere to go for women’s health services.  Through the years, as the ranks of the uninsured grew, so did the number of women showing up to the emergency room in the Lebanon County community ready to deliver a baby that had never received any prenatal care.  In 1990, their services expanded to include prenatal care.  For over 35 years, The Lebanon Family Health Services has been serving uninsured and underinsured woman with reproductive health and nutrition services. 

 The benefits of prenatal care are conclusive.  Women who receive prenatal care while pregnant experience a dramatic reduction in maternal deaths, low birth-weight babies, miscarriages, birth defects and many other preventable infant problems.  However, with roughly 13% of woman being uninsured and many others considered underinsured because their health insurance policies either do not cover prenatal care or consider it a pre-existing condition, many woman, particularly minority woman are not able to access this vital and research proven medical care.[1]  The sad reality, as the numbers of uninsured has grown over the past few decades, so has the grim statistic of infant mortality.   According to the Centers for Disease Control, in 1960, the United States ranked 12^th in infant mortality, 23^rd in 1990 and 29^th in 2004.

 In 2014, because of the Patient Protection and Affordable Care Act (PPACA), these women that have utilized Lebanon Family Health Services will now be insured.  Above all however, the PPACA also states that as part of the essential benefits, healthcare items that insurance plans are now mandated to cover, prenatal and infant care are included.   It has become a question to many that have worked for decades helping the uninsured acquire access to healthcare what will happen to places like The Lebanon Family Health Services.  For Kim Kreider-Umble, CEO of Lebanon Family Health Services, she welcomes this change.  “Bring them on,” she responds in response to the new inflow of patients.  After all, this is what she and advocates like her have been fighting to achieve for decades.  “Now, this can be a place of choice instead of a place of need for our clients,” she explains.  They plan on marketing directly to this population with their quality services and meet the increased demand with smart utilization of resources such as schedule adjusting and doubling duties.  “After all,” Kim concludes, “Healthcare is a right, not a privilege!”

---

[1] “Health Insurance for Pregnant Women,” American Pregnancy Association, http://www.americanpregnancy.org/planningandpreparing/affordablehealthcare.html

To mandate or not to mandate: Is there a question?

The old cliché, “politics makes strange bedfellows” seems to come to mind a lot lately.  This week marked an important week for the PPACA.  In light of 11^th Circuit Court of Appeals rulings regarding the constitutionality of the PPACA, the Supreme Court has decided to take on the case.    While all 5 of the lower Appellate Courts have upheld the law in its entirety, it is the individual mandate that seems to be the pesky element that has rattled the political dialogue.  The individual mandate was deemed unconstitutional in the 11^th Circuit Court.  This ruling has sparked a debate from all angles of the political spectrum. 

 Since its passage in 2010, there are those that sit in the “anti-mandate” camp based on the grounds that the law represents government and congressional over-reach.  This argument insinuates that the mandate is unconstitutional on the grounds that the government can’t force individuals to purchase a product.  This sentiment has resonated with many of those that have supported the Tea Party movement in the past 2 years and expressed by the voters in Ohio last week.

On the other hand, another “anti-mandate” camp argues that the mandate is a reflection of the billion dollar corporate lobbying power of the health insurance industry in the writing of legislation that ultimately becomes public policy.  After all, the mandate will allow the health insurance industry to gain 32 million new unsolicited customers.  This camp argues that if the mandate is eliminated, we can ultimately get big insurance out of the game and open up the doors for “Medicare for all”.  Recently, the public hasn’t had the stomach for corporate power.  This distaste for the lobbying power of corporations is reflective in the wave of national Occupy protests. 

If only American political discourse was that simple.  In that fuzzy gray area, there are those that sit with one foot in each of the camps.  Regardless of which side of the “anti-mandate” camp you may (or may not) sit on, the reality is that large numbers of uninsured people aren’t good for anyone and it is in the national interest to improve access to healthcare.  According to the Kaiser Family Foundation, in 2009 32% of the uninsured postponed seeking treatment due to cost, 26% simply went without care due to inability to pay for it and 27% could not afford prescription drugs.  As a result, the uninsured become sicker and more costly.  In the end we all end up paying for them when they are admitted to emergency rooms and hospitals.  They go bankrupt and the insured pay the bills with our rising premiums, deductibles and copayments. 

So this brings us back to our original question. As the ranks of the uninsured have escalated in recent decades, does the existing free-market approach to accessing healthcare still remain a viable option?  Since the 1980’s, we have watched the lobbying industry balloon from a small cottage industry to a draconian giant, can we really afford to wait for our political system to change before we conquer our challenges with accessing healthcare?

The answer lies within the power of the Supreme Court.  In the end, maybe the only thing that all the camps will agree on is that this decision will go down in history as a defining moment for public health.

The Shop Owner

This project formally began in the summer of 2011.  However, thinking back on it, it actually began much earlier.  I just didn’t realize it.  Hind-sight is always 20/20.  This journey informally began in a small clothing shop in my home county in March of 2010. 

Artwork by:  Jennifer Tracy

It was shortly after the passage of the PPACA when I wandered into a small business that I had driven by many times before.  For months I had wanted to check out this small clothing shop and this day I stopped.  It was a quiet Saturday afternoon and I was the sole customer in the store.  As I was sifting through the racks, the owner, who was sitting leisurely behind the counter, struck up an informal conversation.  I could tell he was somewhat bored and that the day had been a slow one. 

He told me all about how he began his business and the challenges of being a small business owner when Wal-Mart, Target, Kohl’s and the like are within a short drive.  I listened with a sympathetic ear.  He continued to talk about his daily challenge to make a livable wage in this establishment that was clearly struggling.  It was then that the infamous lines I was so accustomed to hearing in our media rang out of his mouth, “My taxes are killing me!” he stated.    He continued with, “Now with this health care law they are going to go up even more!”

I had to step back, take a deep breath and gather my thoughts.  I knew from this shop owner’s description of economic struggle, this wasn’t true.  However, to him and the perception of many other citizens, it felt very real.  I understood that.   This fear had to be taken seriously.  Like many people in March of 2010, I had grown tired of controversy and debate.  I was mostly tired of lack of information, misinformation and media sensationalizing.  This encounter was evidence it was taking a real and damaging toll. 

Ironically, according to a public opinion quiz conducted by the Kaiser Family Foundation in February of 2011, 75% of Americans did not know basic pieces of information about the PPACA.  Meanwhile, 84% of these people believed they would be harmed by the law.[i]  These were also individuals that got their information primarily from cable news outlets, a testament that the main objective of these “news” outlets is to merely entertain for profit motive and not inform and educate us. 

It was time to turn down the noise.  In a quiet and subdued tone I began to explain all that I knew about the PPACA.  I informed him about the Small Business TaxCredits, SHOP (Small Business Exchanges), Basic Patient Protections, MedicalLoss Ratio and Rate Review.  Above all however, I could tell I needed to address his real fear, taxes.

It was evident from our dialogue that this gentleman did not make more than $200,000 a year and he would therefore not see any tax increases.  In fact, he would see tax credits and subsidies.  I explained how it would be paid for with a tax on wealthier Americans who make over $200,000 and not the working and middle class.  As I explained how the funding of this bill would work, I could tell from looking at him that he also didn’t appear to be someone who went “tanning”!  With that said, I explained how the bill would be funded with a 10%tax on tanning salons.    He also didn’t appear to be someone that would be impacted by the excise tax on high-end healthplans, a plan that is often enjoyed by individuals in much higher paying professions.  The other revenue sources come from stricter requirements on Health SavingsAccounts and fees on the medical device and drugindustries.  Finally, there would be a shared responsibility between employer and employee.  Individuals will pay a fine if they violate the individual mandate and employers will pay a $2000 fine if they do not provide health insurance and their employees receive premium tax credits to purchase on the exchanges.

As he packed the last item into my bag, the shop owner held a blank and confused stare on his face.  His world had been shaken.  As I thanked him for his time and neighborly conversation, his muddled look sank into the pit of my stomach.    I had not convinced him.  I carried an odd emotion that falls somewhere between anger and sadness.  I looked around at the surrounding store fronts and was quickly reminded the time of year.  It was lent.  Outside the clothing shop I gave up cable news and I have never gone back.

---

[i] Kaiser Family Foundation.  Public Opinion:  Assessing Americans’ Familiarity with the Health Care Law.  February 2011.


Next Week:  The Supreme Court takes on the PPACA

Theresa BrownGold

In the tradition of The Hopi people, oral storytelling from generation to generation is used to educate about their history, traditions and morals.   A tradition that has withstood the test of time.  When I began the "Summer at the County Fair" series, my mission was similar, to educate about the bigger social issue of the uninsured through the use of storytelling.  See their faces, hear their stories and link them to the public health research.  In my journeys around the state of Pennsylvania, I met Theresa BrownGold from Bucks county.  Theresa tells the story of the uninsured through portrait art in her Art As Social Inquiry project.  Like The Hopi, Theresa inspired me to pursue the art of storytelling.  Whether it be the stroke of the paintbrush or the keyboard, our hope is that these stories too will impact future generations to make change.  Theresa is this week's guest blogger.

An Artist’s Call to Action: ART AS SOCIALINQUIRY
By Theresa BrownGold (guest blogger)

Anyone who is indifferent to the well-beingof other people and the causes of their future happiness, can only be layingthe ground for their own misfortune. Dalai Lama

In 2008 I started an art project I call Art As SocialInquiry.  The idea for this project surfacedafter decades of observing the hundreds of thousands of people (and I mean thatliterally) I encountered in 30 years of working in the restaurantbusiness.  You can imagine that, after somany conversations, I had heard many thousands of stories of people helpingpeople.  One day it struck me, “Why do somany people who support so many charitable causes with their time and money getabsolutely livid and resolute in opposing real reform for creating a system inwhich all people can access healthcare in the United States?” 

Surely, if these good people really knew what washappening to the “others,” the ones who had no or not enough health insurance,the ones not like them, they might feel differently.  I wanted to create an honest dialog byconnecting the issue of access to healthcare to real lives affected by ouropinions.

Also at this time I was phasing myself out of the restaurantbusiness and returning to art-making, something I had studied for a brief timein my twenties.  I had the idea that I couldpaint portraits and tell every kind of healthcare story I could find.  If I created an overview by lining up theseportrait-stories side-by-side, and then invited people to look at was happeningin real lives across the spectrum of healthcare access, would our opinions abouthow we get healthcare change? 

Any doubts I might have had about this new venture werequickly scuttled when I felt a bit of a spiritual push.  I recognized that I, in my small way, wasresponsible for creating this class of “others” who could not get healthinsurance.  As a small business, our healthinsurance group was comprised of my husband, me and one other full timeemployee. When our one full time employee decided to leave after 3 years, Isaid to my co-owner/husband, “If we hire only part time employees, we won’thave to provide health benefits.”  I feltnauseous.  I had to either lie to myselfabout how I was planning to control costs in our system of employer-basedcoverage.  Or, I had to admit that Iwould be contributing to this national epidemic of the uninsured like thehundreds of thousands of other small businesses looking to hire only part-timeworkers.  I thought, “Is this any way torun a country?”

Fast forward to the present. I am 45 portraits into my social inquiry of how we access healthcare inthe US. My goal is to paint at least 100 portraits and have an art show travelthe country for many people to see the portraits and hear the stories.

The portraits I paint are large, expressionistic canvases,40 x 30 inches.  I have no interest inpainting literal images of my subjects. First I listen listen listen thenintuitively express in the painted faces what I’ve heard.  The subjects of my paintings retell what isoften the most harrowing emotional, financial and health nightmares of theirlives.  To paint their faces, I must feelas they do in the recounting of their stories. When the image I paint on the canvas stares back at me as the real liveperson did from across the table during the interview, I know I have succeeded.

These portraits stories and the people behind them havetaught me a few things.  For 2 ½ years Ihave listened to real people tell me how they accessed or tried to accesshealthcare. My conclusions reflect the lessons I have taken away from listeningto the stories of my subjects, and so many others I have not painted.  I encourage you to read the stories online(ArtAsSocialInquiry.org) and draw your own conclusions.

But the one glaring finding from all my interviews:  It isin all our best interests for all to access healthcare in the US. 

For more detailed insights into what Theresa has learned from her work documenting the portraits of the uninsured, visit the extended version of this blog at the Art As Social Inquiry website.