Medicaid Expansion Supporters Protest at Legislative Plaza (TNReport.com)
The Moral Movement for Health Care, a coalition of students, clergy and individuals, protested, prayed and sang gospels songs at the Tennessee Capitol today, calling on the General Assembly...
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Medicaid Expansion Supporters Protest at Legislative Plaza (TNReport.com) - Video
Paula Wilson has worked as ahome health-care aide in D.C. for 18 years. When she started in the profession in the 90s, she made $8 an hour. She was laid off from an agency in 2013, where she made $10.75 per hour, and now makes about$13 an hour working part-time for an elderly patient with Alzheimers.
She says the wages are not enough to pay rent or even take her son to the movies,and she was evicted from her apartment a couple of years ago. She and her son now live with her mother in the Capitol Heights area.
This is my job, this is my duty, Wilson said. Its an unacceptable wage.
Wilson joined hundreds of other D.C. home health-care workers Wednesday night at a town hall-style meeting in a Fort Totten church to rally for a $15 wage. The rally, which featured a keynote speech from U.S. Labor Secretary Thomas Perez, was the Districts workers official foray into the national Fight for $15 movement a movement inspired by the fast-food industrys push for higher wages.
D.C.s atleast 6,000 home health-care workers workfor about26 health-care agencies. Theywereorganized by Service Employees International Union 1199, the regional chapter of a national labor union thatput on Wednesdaysevent, though few of the workers are members of the union. D.C. Del. Eleanor Holmes Norton (D) and the Rev. Graylan Hagler, a longtime activist andpastor of Plymouth United Congregational Church, where the event took place, also spoke at the event.
We need a million more [home health-care workers] in the next 10years, Norton said. They may have a hard time getting more of them if theyre not paying them.
The demand forhome health-care workersis fast growing in the United States, with more being needed as baby boomers grow older. The Bureau of Labor Statistics expects the country will need an additional 1 million such workers by 2022. According to a recent reportfrom the National Employment Law Project, the nations 2million home health-care workers took home an average salary of $18,598 in 2013, compared to the nationalaverage of $46,440 for salaried workers that year.
No one who works a full-time job should have to live in poverty, said Perez, who rallied workers to organize, with references to Selma and the words of Martin Luther King Jr.: You are not babysitters, you are professionals doing some of the most important work.
The Districts home health-careindustry made headlines last year when a long federal investigation revealedthat D.C. operators of home-care agencies and personal-care assistants had been running a Medicaid scheme, swindlingtaxpayers out of tens of millions of dollars. Because of the investigation, someagencies were cut off from Medicaid funding and, during this time, many homehealth care workers say they werent paid.
In December, some of D.C.s health-care workers filedsuit against three home-care agencies alleging that workers werent paid for all of their time and were not provided sick days. The suit, in which Wilson is a plaintiff, was later expanded to a class-action suit.
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Latinos are the largest ethnic minority group in the United States, and it's expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers.
Latinos' low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.
Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA:
"As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels," Ortega said. "Resolving these four key issues would be an important first step."
Insurance for the undocumented
Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.
For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA's expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.
For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA's exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.
In addition, previous research has shown that undocumented people often delay seeking care for medical problems.
"That likely results in more visits to emergency departments when they are sicker, more complications and more deaths, and more costly care relative to insured patients," Ortega said.
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Insuring undocumented residents could help solve multiple US health care challenges
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NEW YORK Complying with the health care law is costing small businesses thousands of dollars that they didnt have to spend before the new regulations went into effect.
Brad Mete estimates his staffing company, Affinity Resources, will spend $100,000 this year on record-keeping and filing documents with the government. Hes hired two extra staffers and is spending more on services from its human resources provider.
The Affordable Care Act, which as of next Jan. 1 applies to all companies with 50 or more workers, requires owners to track staffers hours, absences and how much they spend on health insurance. Many small businesses dont have the human resources departments or computer systems that large companies have, making it harder to handle the paperwork. On average, complying with the law costs small businesses more than $15,000 a year, according to a survey released a year ago by the National Small Business Association.
Its a horrible hassle, says Mete, managing partner of the Miami-based company.
But there are some winners. Some companies are hiring people to take on the extra work and human resources providers and some software developers are experiencing a bump in business.
Companies must track workers hours according to rules created by the IRS to determine whether a business is required to offer health insurance to workers averaging 30 hours a week, and their dependents. Companies may be penalized if theyre subject to the law and dont offer insurance.
Businesses must also track the months an employee is covered by insurance, and the cost of premiums so the government can decide if the coverage is affordable under the law.
Many companies have separate software for payroll, attendance and benefits management and no easy way to combine data from all of them, says John Haslinger, a vice president at ADP Benefits Outsourcing Consulting. And early next year, employers must complete IRS forms using information from these different sources. The process is more complex for businesses with operations in different states.
Mike Pattons health insurance broker is handling the extra administrative chores for his San Francisco Bay-area flooring company DSB Plus, but hes paying for it through higher premiums about $25,000 a year.
To pay for the extra services the business is getting from his broker, Patton cut back on workers bonuses and raises.
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Chronic disease accounts for 7 of every 10 deaths in the United States and more than 75% of total health care costs. Among people 65 years old and older, over 92% suffer from one or more chronic diseases. By 2020, it is estimated that 48% of the total population will have chronic disease. In an article published in The American Journal of Medicine, researchers discuss how existing health care delivery models are poorly constructed to manage chronic disease, and how a reengineering of the health care system might offer some hope in meeting this challenge.
"Chronic disease has become the great epidemic of our time," comment authors Richard V. Milani, MD, Ochsner Clinical School -- University of Queensland School of Medicine, New Orleans, LA, and Carl J. Lavie, MD, Ochsner Clinical School -- University of Queensland School of Medicine, and Louisiana State University System, Baton Rouge, LA. "Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic."
According to Milani and Lavie there are four factors that negatively impact the delivery of chronic disease care in the U.S.: physician time demands, rapidly expanding medical database, therapeutic inertia, and lack of supporting infrastructure.
The current U.S. model for delivery of chronic disease care rests with the primary care physician. The authors note that with a median length of a physician visit of less than 15 minutes, there is little time to address the root causes of many chronic diseases, such as poor nutrition and physical inactivity. Even when lifestyle modification advice is provided by the physician, patient adherence rates are disappointingly low.
The second factor that compromises chronic disease care is the incredible growth in medical literature, with 1.8-1.9 million articles published every year. The ability to keep up-to-date with accepted medical evidence is nearly impossible for a busy physician. This is further affected when a significant percentage of studies contradict current medical practice, adding to the burden.
Therapeutic inertia, the third factor, describes a situation in which a provider fails to modify a therapy when the original treatment goals remain unmet. For example, failure to intensify therapy in hypertensive patients with blood pressure greater than 140/90 has been reported to be as high as 86.9% of visits. The clinician, the patient, and the health care system all play a contributory role in this factor.
The fourth factor is the care model supporting the patient and physician. Studies have consistently shown that providing the primary care physician with a team-based infrastructure of specialized, non-physician caregivers whose role is to provide a continuous framework of monitoring and management, improves adherence to quality measures and yields superior outcomes, cost, and patient satisfaction.
Milani and Lavie describe specialized integrated practice units (IPUs), each employing nonphysician personnel such as pharmacists, advanced practice clinicians, nurses, health educators, dietitians, social workers, counselors, and therapists, all organized around the patient's medical condition.
The authors also note that social network influences have had considerable positive impact on behaviors associated with smoking, diet, exercise, depression, medication adherence, and obesity and successful disease management strategies that utilize the potential of social networks may provide sustainable and cost-effective solutions for patients with chronic diseases.
"Today, health care must reengineer its care delivery model to manage the chief medical crisis of the 21st century, chronic disease. The capacity of the stand-alone physician to produce high-quality, evidenced-based care, yielding meaningful and lasting change in lifestyle behaviors, has proven elusive. A new model of team-based care organized as an IPU will have the ability to deliver comprehensive consistent treatment and advice using a focused-factory approach. The IPU will employ the latest in technology innovation, thus better engaging patients, in addition to providing high-quality, consistent, personalized care delivery, and accelerate consequential lifestyle change," explain Milani and Lavie.
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Changes in health care delivery essential to combat chronic disease
By Dean Bennett The Canadian Press
Seven years after centralizing health care, Alberta decentralizes system.
EDMONTON Seven years after Alberta collapsed its health regions and centralized care in an attempt to save money and improve outcomes, it is moving back in the other direction.
Premier Jim Prentice said Wednesday that decentralization of health care is the way to go, despite earlier decisions by previous Progressive Conservative governments.
Im not going to defend what happened in the past. I wasnt the premier at the time, Prentice told reporters.
The pendulum is coming back in terms of local input into decision-making to protect the interests of people who live across the province.
The announcement followed the release of a government report into reforming rural care. Prentice said the government heard a lot from residents who have felt disenfranchised by the way the system has been operating.
(View the full report below).
Health Minister Stephen Mandel said the province will set up eight to 10 new health districts by July 1. Each will be responsible for meeting performance targets and delivering health services.
Each district will receive advice from a local advisory council.
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Back to the past: Alberta returns to decentralized health care
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