Sunday, August 25, 2013

Obama Budget Cuts to Medicare Will Close Rural Hospitals

The Obama Administration has proposed changes to Medicare reimbursement to CriticalAccess Hospitals (CAH).  Critical Access Hospitals are medical facilities in rural areas that serve communities where there is no other option available and therefore Medicare reimbursements are higher for those hospitals.  Senator Tammy Baldwin is leading a fight against Obama’s proposed Medicare Reimbursement cuts.

Obama’s proposal would remove the CAH designation for hospitals within 10 miles of another hospital from 101 percent to 100 percent of reasonable costs in 2014 and in some cases hospitals would lose their classification and would receive no Medicare reimbursement.  Obama’s proposal would save more than $2 billion over 10 years.  This could cut funding to 53 out of 58 Hospitals in Wisconsin currently designated as Critical Access Hospitals. 

Nationwide there are more than 1,300 critical access hospitals.  The CAHs patient populations are largely elderly and low income without access to the larger, more expensive healthcare systems in urban areas and many have 25 or less hospital beds. In addition to providing basic outpatient care and inpatient care, they provide long term care for patients.

There are serious concerns that Obama’s requirement changes for designation as critical access hospitals will limit the care their patients receive, force layoffs of hospital workers in rural areas and lead to closures.  In other words, rural healthcare would be devastated.  According to Alan Morgan, CEO of the National Rural Health Association, “most CAHs operate with a negative operating margin, even with the current enhanced reimbursement’.  Terry Eisinger, president of the National Organization of State Offices of Rural Health said “rural health care is fragile as it is without any additional cuts.”

On the August 22nd edition of ABC’s Nightline, Remote Area Medical (RAM) Facility’s annual visit to West Virginia was featured. 

Remote Area Medical was started in 1985 by Stan Brock after years of working deep in the Amazon where medical care was 26 days away by foot. He began bringing healthcare to poor, under developed countries like HaitiAfricaIndia and Guyana.  After setting up headquarters in KnoxvilleTennessee he realized that larges swaths of citizens of the United States had no access to healthcare.  

“You’ve got 40 or 50 million people that are in this category that don’t have insurance and can’t get the care that they need or can’t afford it.”

He’s held more than 700 RAM events around the world, and has helped more than 550,000 in the United States alone. 
Teresa Gardner, who runs the local free clinic, first invited Brock to Wise, West Virginia 14 years ago and now the RAM visit is an annual event.  
"It's always an amazing sight, isn't it? That here in America at 5 o'clock in the morning, with rain threatening, there are 1,500 people out there," Brock said, standing by the entrance gate overlooking the crowd on the first morning. "It's sort of the one time opportunity that they know they can afford to get the care that they need. ... It's a pretty sad sight."

"The economy here has hit a downturn. We've had a lot of mining layoffs, which is really the only industry here," Gardner said. "It's just incredible the desperation that people have for health care."
Gardner first invited Stan Brock and RAM to Wise 14 years ago and helps organize the 1,400 dentists, eye specialists, doctors and volunteers who all donate their time and expertise. Approximately 80 dental chairs are fully manned, as well as 16 eye examination stations.
 At Wise, RAM has "all the different specialists, all the way from cardiology, OB-GYN, pulmonology, nephrology, dermatology," Gardner said. "It's a really good opportunity for the patients to come out and get some very good care that they wouldn't otherwise have access to."

"You find people having strokes, heart attacks, elevated blood sugars. We do a lot of emergency care here on sight," she said.

In fact, six people over the course of the weekend are found by the mobile X-ray unit to be walking around with broken limbs.

"Even though the care here is quality care, we don't need to be doing this in the world's richest country," Brock says. "I would rather be back in Haiti, in India andAfrica, and where this organization began in the Amazon than doing it here in the world's richest country. But I don't see this ending anytime soon".

RAM is funded by donations and receives no government funding.  One of the major setbacks for RAM is that RAM has an army of volunteers, many of whom have volunteered for years and pay their own travel expenses to provide care.  A problem in providing care in the United States is that each state has requirements for volunteers to be licensed in that state to practice medicine. 
Brock said he would be able to hold more events around the country and help more patients if states would be less strict about allowing volunteer doctors from other states to practice temporarily within their borders.

"People come all the way from Florida, all the way from Michigan, all the way from Wisconsin, New Jersey ... because we're not allowed in those states because they won't allow doctors to cross state lines," he said.

It is the thought of having to turn away people that haunts Brock.

In a New York Times article dated May 13, 2011 entitled “Health Insurers Making Record Profits as Many Postpone Care” you can see who Obama is looking out for.

“The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care”.

“The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use”.

“Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care”.

Yes, you read that right.  “The insurance companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends”.  The insurance companies and their CEOs with their million dollar and some times billion dollar salaries just keep getting richer, while the American people travel for days in inclement weather hoping to get a coveted space on a gurney in a cattle stanchion to receive life saving medical care.  These greedy bastards are nothing more than merchants of death.

Make no mistake about it, Obamacare was written of, by and for the insurance industry.  When you hear that Healthcare is one-fifth of the economy, what they really are saying is that one-fifth of the profits on Wall Street come from our for profit healthcare system. 

This is the richest country in the World but the wealth is concentrated at the top.  Our congress has some of the richest people in it.  Darrell Issa’s net worth since he has been in congress is over $355 million dollars, and he’s not the only one. 

By Patricia Baeten


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