Has the "Silly Season" begun already?

Join "Health on the Horizon" on Facebook!

Mitt Romney on the campaign trail during the Republican Primary

The term “Silly Season” has been popping into my mind a lot lately.   “Silly Season” is typically described as the time in late summer into early fall of an election year where candidates engage in political posturing for media attention.  This will usually results in ridiculous claims.  My question then is, has the “silly season” already begun?

 After the recent primary caucuses and elections, presidential hopeful, Mitt Romney claimed that if he became president he would tackle the deficit by repealing the health care bill (Patient Protection and Affordable Care Act).  He continued to claim that repealing the bill would save $95 billion a year.  Not only is the latter statement completely false according to politicafact.com, but it is quite the opposite of the reality.  Over the next 10 years, the PPACA is projected to lower the deficit by $143 billion[1].  This will be done through a variety of means including a medicare payroll tax to those earning over $200,000 being the primary method.  Others include some fees on the medical industry, the tanning industry, and a $2000 fine to large employers that do not offer insurance and their employees who therefore utilize the individual exchanges (marketplace).  Finally,  there are measures to cut down on waste, fraud and abuse, end overpayments to medicare advantage, an excise tax on high end plans, stronger restrictions for Health Savings Accounts (HSA) and of course the highly debated fine for not adhering to the mandate.

While I have come to expect our politicians to flat out lie for political pandering, what has come to disturb me most is the statement concerning a commitment to repeal the bill and the political weight the argument is carrying.  I often wonder if those that support the rally cry have stepped back and asked themselves exactly what this would mean.  As I have explored this issue around the state of Pennsylvania, I have often become frozen in dismay regarding the lack of information and belief in misinformation many people possess.  They know little about the details that lie behind the political rhetoric.  Sadly, our politicians take advantage of this ignorance.

Therefore, I challenge those that support Mr. Romney’s rally cry to repeal the healthcare law by asking them to consider some of the following hypothetical situations: 

·         Should we now tell 2.5 million young adults (and their parents), like Eric, that they are no longer able to access affordable care?  As of January 2011, the PPACA has allowed young adults under the age of 26 to stay on their parent’s health insurance until they obtain a policy of their own.

·         Should we tell small business owners like Susan, and Laura/Michael that they will no longer have access to small business tax credits and the small businessexchange (marketplace) in order to purchase affordable healthcare?  Do they have to instead continue spending over 30% of their take home pay on health insurance?

·         Do we now have to tell every single insured American that health insurance companies can continue the same consumer abuses they have done for decades?  In other words, are you going to explain to the American people that when the Medical Loss Ratio is repealed, insurance companies can spend unrestrained amounts of patient premium dollars on advertising, CEO bonuses and lobbying instead of on their health care?

·         Do you also intend to tell every single American that health insurance companies can continue arbitrarily raising your premium rates year to year because you support repealing rate review?

·         Are you going to explain to Gary that when his company laid him off and moved to Venezuela or Brianna, whose company refuses to offer her healthcare that they will no longer be able to access affordable healthcare from the individual exchange (marketplace) ?

·         Finally, try explaining to me that because I have a pre-existing stroke condition that if I someday change insurance plans I can be denied coverage, subjecting myself to financial peril.

As the silly season seems to be upon us a bit early this election season, I leave those that support repeal with one final statement:   Be careful what you wish for….you just might get it.

---

[1] Kaiser Family Foundation:  Summary of Health Reform law.  March 2010

Eric's Story

Join "Health on the Horizon" on Facebook!

Eric with his parents at Cabrini College Graduation
May 2011: Radnor, PA

On April 20, 2010, The Deepwater Horizon, BP’s oil rig stationed in the Gulf of Mexico, exploded.  In its aftermath it left suffocating sludge that not only smothered the life out of the plants and wildlife in the region, but the hopes and dreams of the inhabitants that found their livelihoods along the gulf shores.  Like the native egret that gasped for its last breath beneath BP’s mess, the fisherman watched hopelessly as their only ability to support their families floated away in the mucky waters.  Vietnamese Americans composed 1/3-1/2 of all fish vessel workers that navigated the gulf shores on a daily basis. The only skill they were trained to sustain their livelihoods was now gone.  Almost 2 years later, BP is back in business while these fishermen still struggle to survive.  Who is going to look out for the gulf coast families?

In 2010 Eric was a college student at Cabrini College in Radnor, Pennsylvania.  As an optimistic student that interned with Catholic Relief Services he understood the plight of the underrepresented in society.  Soon after graduation in the spring of 2011, he got a job with NETWORK, an agency that advocates for the families impacted by the oil spill along the gulf coast.  On a daily basis, Eric advocates for the fisherman, the small business owners who run hotels and restaurants in this tourist heavy region to make sure BP reimburses them for their loss.

Youth like Eric are a valuable asset to society.  What is protecting them from falling into financial ruin like the victims in the Gulf?  Prior to the passage of the Patient Protection and Affordable Care Act (PPACA), recent graduates would be left uninsured upon graduation.  In fact, in 2009 40% of all the uninsured came from the youth population between the ages of 18-34[1].  With half of all bankruptcies being triggered by a costly illness[2], this left our youth population at a high risk for starting off their lives in financial hardship. 

In 2011, Eric and his peers were the first graduating class to be protected by a provision in the Patient Protection and Affordable Care Act (PPACA) that allows young people under the age of 26 to stay on their parent’s health insurance following college graduation until they found a job.  Eric was able to remain on his parents insurance until he began his employment with NETWORK, where he then received his own insurance.  In July 2012, when his contract with NETWORK ends, he will be able to go back on his parent’s insurance until he finds further employment.

By requiring insurance companies to keep young people on their parent’s health insurance, we have seen a lot of success in filling the gap of the uninsured.  Statistics released around the time of Eric’s graduation by the Center’s for Disease Control  have found an additional 2.5 million people now have access to healthcare that otherwise would not have had it.[3]  Over the past few decades, the rising rates of the uninsured has been one of many contributing factors to rising healthcare costs, this success therefore amounts to a roughly 5% decrease in the gap of the uninsured in the US.

As of this past year, we no longer need to liken our youth population with the egrets and fisherman who continue to struggle along the gulf shores because of corporate irresponsibility and greed.

---

[1] KCMU/Urban Institute Analysis of 2009

[2] The Fragile Middle Class: Americans in Debt; by Elizabeth Warren, Harvard Law School and Smith Business Solutions

[3] Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–March 2011. National Center for Health Statistics. September 2011

Sheila's Story

With an I-Phone in hand, Sheila e-mails her professor about a recent assignment and texts a coworker as she informs me of next weekend’s ‘on call’ duties.  With a backpack filled with Cheerios and string cheese strung to her back, she also entertains her young child.  The upcoming paper was weighing heavily on her mind and this evening is sure to turn into a late night.  It was mid September, a new academic year was in full swing, and I had at last found an individual who had discovered the knack for striking that delicate balance between professional, personal and student life. 

 Sheila is a Certified Registered Nurse Anesthetist at Lancaster General Hospital and represents one of the many Advanced Practice Nurses we will be relying on in the years to come.  Sheila recently completed a master’s degree program and is currently working towards a doctorate of nursing practice in anesthesia.  The need for these doctorate level nurses will be in great demand.  By 2020, the United States will be looking at an estimated physician shortage of about 91,000, split evenly between primary care and specialty areas, such as anesthesia.[i]  With our aging population and more people being able to access healthcare because of the PPACA this has become a startling reality and has called upon our healthcare industry to make some changes.

The future of our healthcare will be one in which there will be more of an emphasis on collaborative care, where physicians will play a more supervisory role over advanced degree nurses.  Advanced degree nurses hold training that will be relied on for routine care and will play more of a direct role with patients, referring to their physician supervisor when situations have more complex problems and multiple diagnoses.  A substantial body of research has shown that when advanced degree nurses such as Nurse Practioners (NP’s) are utilized in this role, it has resulted in positive clinical outcomes and compares well to those that solely relied on one-on-one physician care.[ii]   According to the Institute of Medicine (IOM), these changes are allowing advanced degree nurses to utilize the full extent of their education and training.   Significant cost savings have also been noted in 26 studies by an increased reliance on NP’s.[iii]  In specialties such as anesthesia, studies have recommended that the industry embrace this model.[iv]

For the first time in over 30 years, the nursing industry will accept major changes in order to keep up with the times.  Promoting a doctorate of nursing practice has been a direct response to the changes in healthcare.  These changes are necessary in order to meet the demands of the greater patient load, keep up with technology and innovation and meet the demand for higher knowledge.  These advanced degrees will come with a higher expectation for continuing competency, more frequent recertification and continuing education.

The Patient Protection and Affordable Care Act (PPACA) includes multiple provisions in order to meet these new demands in the healthcare industry.  Beginning in 2010, funds were available to nursing schools and training facilities in order to increase the number of Nurse Practitioners and Physician Assistants.    $15 million was also made available for Nurse Led Clinics in underserved and rural communities.   The PPACA also invests multiple other resources for workforce development and support for existing nursing infrastructure.

As Sheila works to balance her busy life, she has a positive and hopeful outlook on the future of her profession.  She states, “The changes represent a smarter and better use of resources, a more holistic and well-rounded approach to patient care and it is an exciting time to be in healthcare.”

---

[i] Association of American Medical Colleges (AAMC) Center for Workforce Studies, “Physician Shortages to Worsen without Increases in Residency Training,”

[ii] Kaiser Commission on Medicaid and the Uninsured. “Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants”.  March 2011.

[iii] Roblin D et al, “Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO,” Health Services Research, 2004 June; 39(3): 607-626.

[iv] Brian Dulisse and Jerry Cromwell.  Health Affairs, 29, no.8 (2010):1469-1475

No Harm Found When Nurse Anesthetists Work Without Supervision By Physician

Sue's Story

My travels around the state of Pennsylvania have led me to find healthcare advocates in unusual places.  I first met Sue in my children’s music class.  Each week after the class in which she taught was completed; we found a common bond in the passion each of us shared for access to healthcare.  Through the year, we shared literature, research and exchanged insight into the subject.  It was through her that I learned about Lebanon Family Health Services.  Sue’s guest blog is the conclusion of my five part series on Woman’s Health.

 

Ten years ago I began volunteering for the Lebanon Family Health Services as a board member.  Prior to my time at LFHS, I served on the Girl Scout Council Board of Directors.   For years, I had long been familiar with LFHS, but felt an agency of such value to the community deserved my full attention.

When I became a member of the Board, I realized the breadth of services provided to the community far outreached my previously held perceptions.  It took me about a year to fully understand the range of services and the diversity of clients served by this wonderful agency.  As luck would have it, I became chair of the marketing and Public Relations department, a perfect opportunity to “spread the word”.

To me, Lebanon Family Health Services fills the need of a vastly diverse population of women, children, men and families. Our clients range in age: pre-natal, newborns, toddlers, teens, adults and seniors.  The clients all utilize the OB/GYN, WIC, family planning, job related physical and drug testing, driver license physical and general health services.   These services also include smoking and tobacco cessation programs.

It is an honor to support an agency which provides safe, respectful, clinically sound and above all, affordable opportunities to improve the lives of the members of our community. I feel passionately that families of all backgrounds deserve the best medical care regardless of economics.  LFHS provides a safe environment for teens in need of contraception and counseling with unique teen walk-in clinics.  Another aspect of LFHS that stands out for me is the WIC program (Women-Infants and Children) which not only provides funding for healthy foods, but also includes nutritional counseling, farmers market opportunities and breast feeding support.

I have long believed in the importance of all people acquiring quality healthcare.  The new healthcare law, the Patient Protection and Affordable Care Act (PPACA), will allow the uninsured this dignified access to basic healthcare needs.  The healthier our population, the more productive our community.  LFHS has provided reproductive healthcare opportunities for families of diverse backgrounds, regardless of financial status, with great success. Excellent healthcare is a right, not a privilege.  As a Board Member, I feel it is our duty to promote these opportunities and I am proud to serve this agency and above all, to support our clients.