“Segregation now, segregation tomorrow, segregation forever!” George Wallace said this now infamous line on January 14, 1963 to thunderous applause at his inaugural address when he became Governor of Alabama.  Wallace won the election because of his defiant views towards the federal government’s efforts at racial integration, including the Supreme Court’s unanimous decision in 1954 regarding Brown vs. Board of Education, that made segregation unconstitutional.  Almost fifty years after Wallace’s speech, we once again find governors putting politics before civil rights.  In Texas, Florida, Louisiana, South Carolina, and many other states, governors have declared their defiance of the Affordable Care Act, which seeks to extend the basic human right of health care to millions of poor, working-class Americans, many of whom belong to minority communities.

Governor Rick Perry of Texas, Governor Nikki Haley of South Carolina, Governor Bobby Jindal of Louisiana, Governor Rick Scott of Florida, and Governor Scott Walker of Wisconsin have all issued statements and made speeches against the Supreme Court’s upholding of the Affordable Care Act.  They are perpetuating misinformation about the health reform law, but what is more dangerous is the fidelity these governors have for misinterpretations of “states’ rights,” like their predecessors from the 1950’s and 1960’s.  This ideology contributes to inequities in our current health care system, and we are morally overdue in establishing health justice for all.

With the recent Supreme Court decision to uphold the Affordable Care Act, we can begin to remedy some health disparities among low-income and minority Americans.  Currently, African Americans are twice as likely as whites to lack health insurance, and Latino Americans are three times as likely to be uninsured.  If the Affordable Care Act is fully implemented, the rates of uninsurance are expected to drop from 22% to 10% for blacks, and from 33% to 21% for Latinos, according to the projections of a study done by the Urban Institute and published in Health Affairs this past May.

To be clear, much of this progress will depend on the expansion of Medicaid eligibility in 2014, and this is where leadership (or lack thereof) at the state level will matter.  The Affordable Care Act seeks to expand Medicaid to include individuals and families earning up to 133% of the federal poverty level (that’s $14,500 a year for an individual, and $30,000 a year for a family of four).  But, according to the recent Supreme Court decision, the federal government is now not allowed to force states to expand Medicaid.  If a state wants to continue restricting access to Medicaid to families making less than, say, $7,000 a year, (which is Virginia state policy), then the federal government must follow the previous rules on funding that state’s Medicaid program.

However, if a state opts to participate in the Affordable Care Act’s expansion of Medicaid in 2014, then the federal government will provide 100% of funding for the state’s Medicaid program for the first 3 years, then 90% of funding every year after that.  Many health policy analysts have argued that states will take the deal, which is too good to refuse in light of rising uncompensated health care costs.  While I see reason to share in this optimism, there is plenty of evidence from the current condition of the uninsured that should make advocates cautious and vigilant.

Sadly, under the current federal-state partnerships on Medicaid, many states are falling short when it comes to enrolling eligible patients and families.  Of the 8 million uninsured children in our country today, almost 2/3 of them are eligible for Medicaid but are not enrolled in the program because states either fail to reach out to the families and/or states make the enrollment process unnecessarily difficult.   The Affordable Care Act seeks to rectify these issues, but states are not obligated to cooperate.

Indeed, where a child lives can impact his/her access to health insurance.  In six states (Maine, New Hampshire, Vermont, Massachusetts, Wisconsin, and Hawaii), the uninsured rate for children is 5% or less.  That rate increases to 15% or more in four states:  Florida, Texas, New Mexico, and Nevada.  Over a third of all of our country’s uninsured children live in just five states:  New York, Georgia, Florida, Texas, and California.  Most of these variations in coverage can be attributed to how state policymakers use (or misuse) their “states’ rights” to determine which families qualify for Medicaid/CHIP and how they are enrolled.

The disparities between states’ Medicaid eligibility standards and enrollment procedures plays a part in the disparities in uninsurance between different ethnic groups.  With over half of all American children now being born to minority families, it is worth considering that 1 in 9 black children and 1 in 5 Latino children lack health insurance (that’s compared to 1 in 14 white children).

In June 1963, six months after Governor Wallace promised to defy federal policies and to keep Alabama segregated, he physically stood in a doorway at the University of Alabama to stop two qualified black students, James Hood and Vivian M. Jones, from enrolling.  This ugly episode of American history became known as the “Stand in the Schoolhouse Door.” Local law enforcement was unable to convince the Governor to step aside and allow the students to enter.  Resolution of this conflict ultimately required President Kennedy to federalize the Alabama National Guard, who ordered Wallace to step aside and allow the students to enroll.

I do not anticipate Governors Perry, Haley, Jindal, Scott, Walker, or others doing anything cruel like standing in the doorway of a community clinic, blocking eligible patients from entering.  Nonetheless, their political stance against the Affordable Care Act, and their apathy for the seriousness of health disparities, will deprive families of their right to the highest possible state of health.  The Affordable Care Act offers a starting point for building a better health care system, but real progress will depend on policymakers in every state abandoning the obsolete ideologies and misinterpretations of “states’ rights” held by their predecessors.  Real progress will require state and federal policymakers deploying their political will and resources to promoting a new age of health justice for all.

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On June 28, the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). After nearly 2 1/2 years of partisan misinformation, the Court has established the law’s legitimacy.

This is an enormous step forward. The PPACA incorporates many patient protections that will reduce the profit-centered influence of for-profit insurance companies on American’s healthcare. Once the law is fully implemented in 2014, insurers will no longer be able to deny insurance coverage to any American even if they have pre-exisiting medical illnesses and will no longer be able to place yearly or lifetime limits on members’ benefits. Insurance companies will be required to spend 80-85% of the money members pay in premiums on providing benefits to members as opposed to salaries and administrative costs. Young adults will be able to stay on parents’ insurance plans until they turn 26–meaning that they can keep necessary insurance coverage as they finish their educations or start their careers. Federal subsidies will make insurance affordable for Americans who are not offered insurance through their jobs and cannot afford to purchase it on their own. Private insurers have called the shots for too long, and restricted access to necessary care for Americans who could not afford it or who were already ill. These days are now coming to an end.

The PPACA also addresses key needs in our healthcare system. It will strengthen our primary care workforce and our community health centers. It will encourage research that is both patient-centered and evidence-based, to help patients and physicians make informed decisions about the best approaches to individuals’ care. The PPACA also makes preventive care available for all without co-pays, allowing healthcare providers to detect and treat (or even prevent) chronic disease before they cause permanent harm. The law will increase Medicaid access and will strengthen Medicare. Finally, the PPACA includes programs to explore new ways of providing (and paying for) healthcare services that are more effective, more coordinated, and less expensive.

All of these are critical patient protections and healthcare system reforms. The protections will allow us to make sure that healthcare is available with less interference on the part of insurance companies and reforms the most egregious insurance company practices. The reforms will allow us to start to move our healthcare system away from one providers are paid more for doing more care and towards a system that provides better care. These are significant steps, and reforms that the Supreme Court has now endorsed and guaranteed so long as the Affordable Care Act is in effect.

We must monitor how the PPACA is enacted, and we must avoid its reforms being co-opted or weakened by special interests and the law’s stubborn opponents. Where the law does not meet its intended results, we must revise it to ensure that it will. We must identify those who do not benefit from the law as written and work to find ways to extend the law’s benefits to all. We must continue to speak about the law’s benefits and make sure that our friends, families, and colleagues understand how very important this law is.

We must be vigilant heading forward. Although the PPACA is constitutional, congressional opponents can continue their attempts to repeal and defund the law. Rest assured that, if they are able to, they will do just that. The House is already planning a repeal vote on July 11. Under the PPACA, the economic and human costs of allowing millions of Americans to go without health care are finally being addressed. We cannot afford to take any steps backwards: there is still a long road ahead.

Dear Ms. Patient,

I hope this letter finds you well.

Let me begin by saying that it is such a privilege to care for your family.  It has been a joy to watch your children grow and your family thrive.  I’m sure you will agree that we have been through a lot together.

As you know, I am devoted to help in keeping your family healthy, despite the many obstacles that have arisen.  Remember the time when your husband lost his job?  You not only lost your family’s main source of income, but everyone lost their health insurance.  It was a dark time.  We were both surprised to learn that insurance premiums were so expensive.  We thought that those prices were crazy until we factored in your diabetes (a preexisting condition) and then realized it was worse than we thought . So you and your husband made the hard decision to go without insurance for a while. Even without insurance premiums, you ended up paying so much for your health care during that time. Minor aches and pains were ignored.  I recall that your daughter had a difficult winter with asthma attacks, where you reluctantly agreed to expensive trips to the emergency room.

Having worked your entire life, you never imagined that you could be in this situation….

Click to read the full article

*PRESS RELEASE* Click here for pdf

Supreme Court Upholds Health Care Law: Physicians’ Group Praises Ruling

(Washington, D.C.) – Today the U.S. Supreme Court confirmed the constitutionality of the Patient Protection and Affordable Care Act (ACA).  The National Physicians Alliance (NPA) praised the ruling, citing the benefits of the health care law for America’s families:

NPA President Dr. Valerie Arkoosh: “Physicians and families across America are celebrating today. Today we’ve learned that benefits like secure coverage for children with pre-existing conditions will not be eliminated.  Seniors will see an end to the prescription drug donut hole.  Freedom of choice over health care decisions is returned to patients and physicians, who are now protected from the whims of insurance companies. At last, the country is moving in a healthy direction on health care.”

Valerie Arkoosh, MD, MPH, is Professor of Clinical Anesthesiology and Clinical Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania School of Medicine.

NPA President-Elect Dr. Cheryl Bettigole: “Under the Affordable Care Act, millions of young adults have secured coverage through their parents’ insurance, seniors are getting vital preventive care under Medicare, and insurance companies will be prohibited from discriminating against women by charging them more than men for the same coverage. Along with guaranteeing new protections, the law is streamlining insurance paperwork, allowing doctors to spend more time with patients and less time fighting with insurance companies.”

Cheryl Bettigole, MD, MPH, is a family physician and the Chief Medical Officer of Complete Care Health Network, a group of community health centers serving southern New Jersey.

NPA Immediate Past-President, Dr. David Evans: “As a family physician, I feel that our health care system is finally pointing in the right direction. The human and economic costs of millions of American citizens unable to obtain health insurance are finally addressed by the law’s bold consumer protections, expansions of coverage, and commitment to preventive health.  The law promotes care coordination, provides for the training of more primary care doctors and nurses, and ensures coverage of many preventive health services without co-pays.”

David Evans, MD, is an Assistant Professor in the Department of Family Medicine at the University of Washington School of Medicine.

NPA Founder and Past President Dr. Lydia Vaias: “As a surgeon with years of experience studying and advocating for health care reform, I can say with certainty that the Supreme Court has saved millions of lives with this historic ruling. While the court’s decision will not put an end to the political debate around health care in an election year, it does clarify that the unregulated financial self-interest of insurance companies can no longer dictate the conditions under which I care for my patients. Physicians and patients are well served by this ruling, and by the Affordable Care Act.”

Lydia Vaias, MD, MPH, is a board-certified general surgeon in southern California.

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Uniting physicians across medical specialties, the National Physicians Alliance creates research and education programs that promote active engagement of health care providers with their communities to achieve high quality, affordable health care for all.  The NPA offers a professional home to physicians who share a commitment to professional integrity and health justice.  The NPA strictly refuses financial entanglements with the pharmaceutical and biomedical industries.  www.npalliance.org

Read the full decision here:   http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

Broadcast live from George Washington University School of Medicine

This event took place Wednesday, June 6

Click here to view the archived recording (1-hour)

The Affordable Care Act is the signature domestic achievement of President Obama.  The plan put forward by Rep. Paul Ryan in the House of Representatives Budget has been broadly embraced by conservative lawmakers.  In their contrasting visions for Medicare and Medicaid, they represent a choice of two healthcare futures.

This event was a special livestream webinar with Dr. Cheryl Bettingole, President-Elect of the National Physicians Alliance, and Dr. Jack Lewin, former CEO of the American College of Cardiology, to learn about the policies and the politics inherent in these two competing plans for the future of the American healthcare system.

View a narrated version of NPA President-Elect Dr. Cheryl Bettigole’s power point slide presentation (16-minutes)

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Sponsored by: the American Medical Student Association, Association of Clinicians for the Uninsured, the Committee of Interns and Residents, Doctors for America, the National Physicians Alliance, and SEIU Healthcare.

The President may have buried the lead on Tuesday night, but we don’t have to.  Women know how to share good news.

Here’s the thing: family health care is one area where men readily cede decision-making and control to women—and most will even admit it.  As CEOs of a family’s health care management, women are responsible for their own health care, their children’s care, their spouse’s care, and in ever growing numbers, the care of their aging parents.  This means that in addition to the economic burdens and job insecurity facing American women today, there is also the terrible weight of anxiety surrounding access to reliable, affordable health care.   Not to mention the overwhelming emotional burden and immediate practical demands that a family member’s illness presents to women in particular.  Women are still the country’s front-line caretakers and now the law is on our side.

In his State of the Union Address, President Obama promised the country that he, “will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage or charge women differently from men.”

Repeal of the Patient Protection and Affordable Care Act would do just that.  Take us backwards.  The ACA has moved the nation toward fairness: fairness for women, fairness for those with pre-existing medical conditions, and fairness between the health insurance choices available to members of congress and those available to millions of Americans.

Beyond the list of new benefits—such as annual wellness visits, cancer screenings, and birth control all at no additional cost—the ACA changes the very horizon for women in this country.  We are no longer on our own against the insurance companies, struggling to manage family health in a system that ignores the desperate need for care coordination, preventive services, affordability, access, and security.   The law now guarantees protection in each of these realms.  It begins to measure the quality of our health care by the actual health and well being of our people.  These are gains that we as women must actively defend.

Pass the word on to your friends, so that we may pass the power on to our granddaughters.

 

Mr. M walked into the community clinic where I work with a portable oxygen tank in tow. At 62, he’s gaunt and winded, battling a disease that is progressively scarring his lungs. Every breath is a fight. Instead of the clear flow of air, I hear the sound of velcro ripping when I place my stethoscope on his chest. In medicine, his illness is idiopathic, which means the cause is a mystery.

But the cause of his distress yesterday was clear. Medicaid, which helps nearly one in every four Americans and could be a lifeline for my patient, is under attack.

Despite working hard for most of his life, Mr. M is uninsured. His medicines are expensive and, without insurance, the odds of getting more intensive treatment are slim. Hoping to change the odds, he applied for Medicaid. But now plans like the State Flexibility Act are working their way through Congress, on the heels of the recently defeated Ryan budget plan. And 2012 federal budget negotiations are starting with a $100 billion cut to Medicaid. These proposals will make it easier for states to kick people off Medicaid and reduce eligibility, keeping people like Mr. M away. Instead of trying to improve health care and help those in need, some are debating ways to take the lifeline of Medicaid away from seniors, the disabled, low-income adults and children. That’s a prescription for disaster.

Most Americans agree. A poll by the Kaiser Family Foundation found that only 13 percent of Americans would support major reductions in Medicaid spending as part of Congress’ efforts to reduce the deficit. A majority, 53 percent, want to see no reductions in Medicaid spending at all.

This support is well-founded. One out of every two Americans has either received Medicaid benefits, like direct health coverage, long-term care, or Medicare premium assistance, or knows a relative or close friend who has. Many realize what the Center on Budget and Policy Priorities has confirmed. Medicaid is cost-effective. After adjusting for health differences among enrollees, the per-capita costs of Medicaid for children and adults are 27% and 20% cheaper, respectively, compared to private insurers.

Yet, at a time when Americans like Mr. M need it most, Medicaid is under attack. At least 25 states are trying to further cut benefits and provider rates, restrict eligibility or increase cost-sharing for the poor. Through the State Flexibility Act, some lawmakers want to repeal a component of the Affordable Care Act which requires most states to preserve current eligibility levels and enrollment procedures for most adults and children. If passed, it will mean that community clinics like ours which have managed to stay open despite massive state budget cuts will have a hard time staying afloat. Without access to care, Mr. M is more likely to end up in overburdened emergency rooms or hospitals.

Whether by intent or irony, these and similar block-grant plans will restrict opportunity in the name of “state flexibility” by cutting care, prolonging illness, and driving up health care costs. The risk is real. If Congress jettisons Medicaid in budget reconciliation or in a deal to extend the debt limit, tens of millions of children, seniors and the disabled will face catastrophic threats to their health and security.

Lawmakers would be wise to protect Medicaid, heed voter sentiment and consider smarter approaches to save costs and improve health care. First, states should take advantage of available enhanced federal funding to set up “health homes.” These models not only better coordinate the care of chronically ill Medicaid beneficiaries but also drive down costs. A pilot Medicaid medical home program saved North Carolina nearly $170 million in its first year. Illinois saved $220 million in a similar program over two years and an additional $300 million over 3 years by helping Medicaid patients with chronic diseases adhere to their medicines. States should also align funding and “health home” models to scale up prevention initiatives like Community Transformation Grants, made available under health reform to help local communities address root causes of costly disease. With fast-track support offered by the US Department of Health and Human Services, states can scale up community-based care managers, who can significantly reduce unnecessary patient visits to emergency rooms and hospitals by coordinating prevention and treatment. A care management initiative in California reduced hospital admissions due to asthma by 90%. Lastly, states should raise the bar set by the Affordable Care Act by further incentivizing Medicaid providers to reduce avoidable complications, like hospital-acquired infections. These measures will lower costs and improve outcomes for our sickest relatives, neighbors, and communities.

Protecting and improving Medicaid is an uphill battle, in large part because children and the disabled lack political power. So efforts to bring the voices of patients like Mr. M and providers into the democratic process are vital. The question is whether our leaders have the political and moral courage to listen. Our nation’s health depends on it.