Friday, December 6, 2013
By Susan Henderson, who is a registered nurse
SOUTH PORTLAND — It is critical that the Maine Legislature support state Rep. Linda Sanborn’s bill to increase eligibility for MaineCare.
Passing this bill will allow Maine to receive the money allocated under the Affordable Care Act to pay for the cost of covering more people under Maine’s Medicaid program, known as MaineCare.
In order to increase access to health care, a provision of the ACA states that if a state increases Medicaid eligibility, the federal government would pay 100 percent of these additional Medicaid costs for the first three years. After that, it would pay no less than 90 percent.
For the sake of the health of Maine people and our state budget, this is an opportunity we cannot afford to miss.
Opponents may say: “We will be supporting slackers” or “We can’t afford this.”
In response to the charges that we would be helping “slackers”: Our country has been in the deepest, most severe recession since the Great Depression. Many people are still unemployed, have a low-wage job, a part-time job, work for a small business that does not offer insurance or are self-employed and thus, do not have access to health care.
In part, this is related to the nature of our rural state. Yet rural people, and Mainers in particular, are known to be proud, hardworking, self-reliant people. Our friends, family members, neighbors are among those who are trying to provide for their families and cannot afford health care. They are not slackers – they are “us.”
We all have a right to basic health care. Surgeon General Everett Koop once said that he felt that health care could be considered a right under the 14th Amendment of the U.S. Constitution under the concept of equal access.
In terms of “that’s nice, but we can’t afford this”:
There is a body of evidence building that shows that providing effective care decreases the cost of care.
After analyzing issues of quality in our health care system, the Institute of Medicine – a policy research organization that is a division of the National Academy of Sciences – identified that we need to move toward achieving health care that is safe, effective, patient-centered, timely, efficient and equitable.
Because our health care system has not met these aims, billions and billions of dollars have been spent each year for potentially avoidable emergency and hospital admissions.
Our complex, fragmented health care system has not provided the access and support that patients and families need to manage their health problems. It is far more expensive to treat an advanced problem in the emergency room than it is to prevent a problem in a primary care office.
When time is not provided to ascertain knowledge of patient goals and resources, it is more likely that a patient will not be willing or able to follow the prescribed plan of care, with potentially dire consequences.
Evidence is building that allowing patients easy access to care and taking time to learn a patient’s goals, values, strengths and weaknesses is cost-effective because it results in the development of a plan of care that the patient is willing and able to follow. This results in improved clinical outcomes, increased patient satisfaction and decreased costs of care.
The health policy decisions we make should be based on credible evidence rather than just our opinions. It is our duty to educate ourselves about complex issues that profoundly affect all of us.
The complexity of health care can seem daunting, yet there is much readable information available that can be easily accessed concerning patient-centered medical homes and accountable care organizations.
This information includes:
• A 2011 New Yorker article by Atul Gawande, “The Hot Spotters.”
• An American Nurses’ Association report, “2008 Health System Reform Agenda.”
• A 2001 Institute of Medicine report, “Crossing the Quality Chasm.”
The Affordable Care Act has incorporated data from the Institute of Medicine and from medical, nursing and other health professionals into provisions geared to incentivizing quality outcomes, patient satisfaction and decreased health care costs.
Rep. Sanborn, a primary care physician, has sponsored a bill to increase eligibility for Medicaid so that Maine can benefit from the provisions of the Affordable Care Act. Please encourage your legislators to support this bill.
– Special to the Press Herald