Category Archives: Affordable Care Act (ACA)

Aug 14 2013
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U.S. Needs Primary Prevention, Especially for the Poor and Underserved

Adrian L. Ware, MSc, is a third-year graduate student in public health at Meharry Medical College. He holds a BSc in biology from Alabama Agricultural and Mechanical University, and an MSc in biology and alternative medicine from Alabama Agricultural and Mechanical University. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.  He aspires to become a Christian psychiatrist serving the poor and underserved. Read all the blog posts in this series.

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With innovation, brilliance, passion, and robust planning, public health students and practitioners ask: How can we protect the health of the nation? According to the Centers for Disease Control and Prevention, seven out of ten deaths in the United States are caused by chronic disease. The need for more cost-effective, comprehensive care has never been greater. Within the world of public health, there are three levels of prevention: primary, secondary, and tertiary.

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Primary prevention reduces both the incidence and prevalence of a disease, because the focus is on preventing the disease before it develops. This can change the health of the nation for the better. Secondary and tertiary prevention are also significant.

It is well known that emergency care is vastly important, given the sheer complexity of episodic clinical cases that present to the emergency room in “life or death” situations. These “provisions” are necessary for the United States to uphold its high ideals of liberty and justice for all. Adequate, culturally competent, comprehensive health care for all citizens is a social justice issue, and a fundamental right. To this point, our health system’s extreme emphasis on tertiary care is amongst the most fiscally irresponsible ways to improve the health of the nation.

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Aug 13 2013
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Right, Privilege—or Tragedy of the Commons?

Matthew M. Davis, MD, MAPP, is associate professor of pediatrics, of internal medicine, and of public policy at the University of Michigan in Ann Arbor and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. In February, he coauthored a commentary in the Journal of the American Medical Association that asked, to paraphrase: Why does the United States ensure universal access to basic, life-saving treatment in emergency rooms but not to more cost-effective, comprehensive, and preventive treatment, and how can it achieve the latter? The RWJF Human Capital Blog asked Davis and his coauthors, both RWJF Clinical Scholars, as well as others from RWJF programs, to respond to the question. Davis’ response follows. Read all the blog posts in this series.

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The debate about whether health care is a right or a privilege is familiar and polarized. A quick online search in this topic area yields strong statements, deeply held convictions, and stern admonishments for those who hold opposite views.

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As RWJF Clinical Scholars Kate Vickery, MD, and Kori Sauser, MD, (2012-14) point out in their recent blog posts, primary care physicians and emergency physicians can agree that the Emergency Medical Treatment and Active Labor Act (EMTALA)—by focusing exclusively on assuring access to emergency care—fails to ensure that health care is a right for all individuals in the United States across all health care settings. 

As the three of us wrote in a Journal of the American Medical Association commentary earlier this year, the Patient Protection and Affordable Care Act (PPACA) will likely fall short of ensuring health-care-as-a-right-for-all as well.[1] That’s largely because one-to-two dozen Americans (or more) will likely remain uninsured even with implementation of all of the coverage provisions of the PPACA. Congress did not have the appetite for even broader coverage initiatives that were considered in PPACA discussions but ultimately left out of the legislation.

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Aug 12 2013
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Drawing a Line in the Sand: Where Do We Stand on Universal Health Care?

Kori Sauser, MD, is an emergency medicine physician and a Robert Wood Johnson Foundation (RWJF)/U.S Department of Veterans Affairs Clinical Scholar at the University of Michigan (2012-14). In February, she coauthored a commentary in the Journal of the American Medical Association that asked, to paraphrase: Why does the United States ensure universal access to basic, life-saving treatment in emergency rooms but not to more cost-effective, comprehensive, and preventive treatment, and how can it achieve the latter? The RWJF Human Capital Blog asked Sauser and her coauthors, both affiliated with the RWJF Clinical Scholars program, to respond. Sauser’s response follows. Read all the blog posts in this series.

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I am struck by the fact that we are still discussing whether health care is a right or a privilege, because it has been long-determined that the medical care that I provide is a right. As an emergency physician, I am held to the standards of the Emergency Medical Treatment and Active Labor Act (EMTALA), which mandates that I provide basic, stabilizing treatment to all who present to the emergency department (ED), regardless of ability to pay.

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So when a patient presents to the ED when I am working a shift, I take care of the patient appropriately and without a thought to their payment status. When “Juan,” a young Mexican day laborer without insurance presents with an advanced toe infection as a consequence of his undiagnosed diabetes, I am able to start his diagnostic work-up and treatment, and to admit him to the hospital for continued antibiotics and definitive care of the toe.

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Aug 9 2013
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Medical Innovation Should Not Overshadow Primary Care

Katherine Vickery, MD, is a family medicine resident and a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan (2012-14). In February, she coauthored a commentary in the Journal of the American Medical Association that asked, to paraphrase: Why does the United States ensure universal access to basic, life-saving treatment in emergency rooms but not to more cost-effective, comprehensive, and preventive treatment, and how can it achieve the latter? The RWJF Human Capital Blog asked Vickery and her coauthors, both affiliated with the RWJF Clinical Scholars program, as well as others from RWJF programs to respond to the question. Vickery’s response follows. Read all the blog posts in this series.

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Before I joined the Robert Wood Johnson Foundation’s Clinical Scholars program, I trained in family medicine at a federally-qualified, or community health center, United Family Medicine, in St. Paul, Minn.

Many of my patients, and the struggles they faced in trying to access health care, motivate the work I’m doing as a scholar. At the top of this list is “Juan,” a 35-year-old Mexican man working as a day laborer to support his family. 

I became Juan’s doctor after a hospitalization where his toe was amputated due to advanced infection resulting from his undiagnosed type II diabetes. He had no insurance and had not seen a doctor in years. The preventability of Juan’s amputation and treatability of his disease was always a frustration to me, and I began to wonder, “What kind of backwards system do we have that ensures a man’s access to a costly hospitalization to remove his toe but bars him from the primary care which can prevent or diagnose and easily treat his disease?”

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Aug 9 2013
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The Real Deal: ACA and the Underserved – Panel Discussion at the National Association of Black Journalists

Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice. As a Robert Wood Johnson Foundation New Connections grantee, his research focuses on the social and economic conditions structuring disparities in the health of African American males.

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The Real Deal of the Affordable Care Act (ACA) is that many Americans have many questions regarding how the ACA will affect their health care coverage or if they will be covered at all. Our panel discussion at the National Association of Black Journalists (NABJ) convention revealed many of these questions concerning how Americans will be enrolled, how their existing health insurance plans will change, and what means tests will be used to determine their eligibility. This panel discussion suggested that many Americans were not aware of what the changes will be and if their state will expand Medicaid.

Medicaid expansion will not occur in many states where close to six of ten African Americans reside. This suggests that many African Americans will remain without health insurance or will be under-insured. This is a real challenge to improving health care outcomes and reducing health care costs over time.

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Aug 8 2013
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Advocates' Role in Helping Media Tell the Story of the Affordable Care Act

Jacquie Anderson is chief operating officer of Community Catalyst and director of the Robert Wood Johnson Foundation (RWJF) Consumer Voices for Coverage.

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Last week, the National Association of Black Journalists (NABJ) hosted a great workshop at its annual convention in Orlando on the Affordable Care Act (ACA) and the underserved. The RWJF-sponsored discussion entitled "The Real Deal: ACA and the Underserved" was a candid conversation about what members of the media need from the advocacy community to 'get the ACA story right.' 

Clearly, the media and communications professionals are hungry for information on the ACA and how it will affect consumers.  They find it challenging to keep up to speed on all the details and report it in an accurate, fair manner.

It is also clear our role and responsibility as advocates is to get them the information they need in a timely fashion. We shouldn't assume that the media are only interested in sensational stories: They want to know how the law is affecting people’s lives in the communities they live in.

They need to hear that getting people enrolled is a door-to-door, grassroots retail campaign, and we need them to understand these key takeaways:

  1. Consumers are hungry for factual information about how the ACA will affect their lives
  2. Advocates and community-based organizations along with others (including the media) have a key role to play in providing that information
  3. Given the size of the opportunity, as millions of people enroll in health insurance for the first time, there will be bumps along the road. But getting people access to health care is worth the journey
  4. The role of the media in providing factual information will be critical over the next few months

So advocates should reach out to media in their states and offer to get them up to speed on the ACA and to connect them to consumers who have compelling stories to tell. Make yourself indispensable!

Learn more about the Robert Wood Johnson Foundation event at the NABJ convention here and here.

Jul 31 2013
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Implementing the Affordable Care Act: Getting Beyond Drama to the Real Deal on Health Reform

Linda Wright Moore, MS, is a senior communications officer at the Robert Wood Johnson Foundation (RWJF).

Linda Wright-Moore

The swirl of controversy and nonstop debate around the Patient Protection and Affordable Care Act  (ACA) is like a play that never ends: Every time you think you’re coming to the finale, another character or plot twist crops up—and the production drags on … and on.

So it goes with the ACA: Last year, the U.S. Supreme Court ruled the new law to be mostly sound, but fudged on the state mandate to expand Medicaid just enough to keep the drama twisting and turning—and to make many poor and uninsured people ineligible for government subsidies.

Meanwhile, repeated attempts to repeal the law—at least 38 to date—have contributed to a jarring statistic: 42 percent of Americans are unaware that the ACA is the law of the land. In light of the lack of knowledge that the health reform law is the law—it’s no surprise that half of the public admits to not having enough information to understand the likely impact of the ACA on themselves and their families.

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Jul 26 2013
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Increase in Funds for Primary Care Residencies

The U.S. Department of Health & Human Services (HSS) last week announced that it will support twice as many primary care residencies during the 2013-2014 academic year as it supported last year, thanks to $12 million in funding from the Affordable Care Act. The new funds will support more than 300 residents at community-based Teaching Health Center programs across the country.

“Teaching Health Centers help attract students who are committed to serving communities of need and prepare them to practice in these communities,” HHS Secretary Kathleen Sebelius said in a news release.  “Students exposed to training opportunities in health center settings are more likely to stay in these communities and continue to contribute to the care of their residents.”

Residents will be trained in family and internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and general and pediatric dentistry.

Read more about the new awards.

Jun 25 2013
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HealthCare.gov

This week, the U.S. Department of Health and Human Services is rolling out a new website that provides educational tools designed to help people understand their insurance choices and select coverage that best suits their needs when open enrollment begins on October 1st.  With 99 days to go until then, the new effort includes a consumer call center that will offer help to consumers in more than 100 languages. It will eventually employ 9,000 people, who will answer questions from the public 24 hours a day.

HealthCare.gov is designed to be the destination for the new Health Insurance Marketplace, also called exchanges. The new website will add functionality over the next few months so that, by October, a consumer will be able to create an account, complete an online application, and actually shop for an insurance plan.

For Spanish speakers, CuidadoDeSalud.gov offers the same information and functionality in Spanish.

Jun 18 2013
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Where Supply Meets Demand: Why Medical Students Should Aim Their Sights at Primary Care

Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.

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In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.

This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.

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