Month: January 2017

“This Is All Too Real Folks”: The Future Of Rural Hospitals And The Failure Of Medicaid Expansion In Maine

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Health is the first wealth, however Congressional Republicans could care less. “Repeal” of the Affordable Care Act (ACA) is a senseless, ideological and irrational act unto itself. As a part of the ACA, Maine has been derelict in its duties and responsibilities to protect the public health. With the Governor’s repeated ideological decisions not to expand Medicaid and now Congressional republicans attempts to derail the Affordable Care Act, things are about to get even worse for all Maine patients and their local rural hospitals. Now is as good a time as any to take a look back at where and how rural hospitals in Maine will be affected by these decisions:

The Future of Rural Hospitals and the Failure of Medicaid Expansion in Maine (August 6, 2016)

There are some subjects that many would simply prefer not to talk about. That doesn’t mean however that we should bury our heads in the sand and simply hope those issues go away. When elephants fight, it’s the grass that gets trampled. When we talk about health care, we are talking about people’s lives. This is not an issue that we can skirt around or ignore.

Maine is a very rural state with a population of approximately 1.3 million residents. The poverty rate, that is the number of people who had incomes below the poverty line ($23,834 for a family of four) in 2013 was 14%, ranking 20th in the nation. The percentage of all workers who were unemployed in 2013 was 6.7%, 23rd in the nation. The percentage of households who were food insecure on average from 2011 to 2013, meaning that at some point during that year, experienced difficulty providing enough food due to a lack of money or resources was 15%, ranking 34th in the nation. The percentage of people under age 65 and below 138% of the poverty line who did not have health insurance at any time in 2013 was 18.2%, ranking 7th in the nation.

Approximately 51 million Americans live in rural areas and depend upon the local hospital in their communities for their health care needs. Their remote geographic locations, small size, limited workforce and often constrained financial resources pose unique challenges for rural hospitals. More often than not, the patient mix of rural hospitals makes them more reliant on public programs and thus, particularity vulnerable to Medicare and Medicaid cuts. With deficit reductions and a continued threat from Washington, the continued viability of small and rural health care providers remains in jeopardy.

To date, more than 70 rural hospitals spread across 20 states, have closed since 2010, and many more may be headed down the same path. Rural hospitals are facing a myriad of financial challenges, and those in states that have not expanded Medicaid are feeling the most financial pressure, According to a report by iVantage Health Analysis, 673 rural hospitals are vulnerable to closure. Sixty-eight per cent of these hospitals are Critical Access Hospitals, a designation that requires certain conditions be met, including being located at least 35 miles from another hospital. Hospital closure, as defined by the North Carolina Rural Health Research Program (NCRHRP), is the cessation of a hospital to no longer provide inpatient services. Many of these hospitals however are still able to offer services, including outpatient care, imaging, urgent care, primary care and some rehabilitation services. In Maine, there are approximately 37 hospitals, 16 of which are Critical Access Hospitals. The bottom line is that many of these hospitals may no longer be able to provide inpatient care, and in a state like Maine, this would impose significant stresses and strains on patients and families alike.

It is clear that in states that have expanded Medicaid, there has been a positive effect on state and local budgets. On average, states that expanded Medicaid in January 2014 saw jobs grow by 2.4%. The Bureau of Labor Statistics projects that health care and social assistance jobs will grow to nearly 22 million by 2022 due to Medicaid Expansion

Because the waters are calm on the surface doesn’t mean there are no crocodiles. Already on the table is a proposal by the Centers for Medicare and Medicaid Services to reduce Critical Access Hospital’s reimbursements from 101% to 100% of reasonable costs in fiscal year 2017. This proposed reduction neglects to take into consideration the cost reimbursement reductions imposed by sequestration. Should these further reductions go into effect, the ability of Critical Access Hospitals to provide necessary health care in rural communities would be severely compromised.

According to the North Carolina Rural Health Research Program, several hospitals in Maine have already been significantly impacted due to Governor LePage’s ideological decision not to expand Medicaid. Hospitals affected to date are Parkview Adventist Medical Center in Brunswick, Southern Maine Health Care-Sanford Medical Center and St. Andrews Hospital in Boothbay Harbor. Earlier this year, besides hurting thousands of uninsured Mainers, the effects of Maine’s rejection of Medicaid Expansion was quite evident and contributed to immediate layoffs of 22 employees from the Farmington based Franklin Community Health Network. In addition, 40 full-time positions were eliminated at Franklin as a part of its cost-reduction plan, just to stay afloat. At Franklin and other Maine hospitals, Maine’s failure to broaden Medicaid is seen as a primary driver in soaring health care costs, from over $100 million in 2000 to over $570 million in 2014. Not expanding Medicaid is clearly a factor in the financial hardships of Maine hospitals. Over the next 10 years, Maine hospitals will lose about $900 million unless the state expands Medicaid.

This brings me to our local Critical Access Hospital in Dover-Foxcroft. Despite the pro-active efforts of the Hospital Board, the Administration and the Medical Staff, like other Critical Access Hospitals across the state, Mayo Regional Hospital is also being impacted and struggling for its existence because of the lack of Medicaid Expansion. Of the federal monies that would come to the state for enhanced patient coverage through expansion, roughly $90 million would go to hospitals based on their current spending rate. About $1.4 million of that would come to Mayo based on its current Maine Care volumes. Medicaid Expansion would go a long way in bolstering our struggling hospital as the hospital currently has a negative operating margin of $1 million and is on track to provide $3 million in charity or free care to the local community this year. Will Mayo be forced to implement layoffs or worse yet, eliminate full time positions?

By not accepting Medicaid Expansion and its federal funds, there remains a coverage gap for many of our poorest friends and neighbors. In 2013 the Maine Legislature voted to accept those funds, however Governor LePage vetoed that decision. As a result, 25,000 Mainers lost MaineCare coverage in 2013, including 10,000 childless adults below the poverty line and 14,500 parents making 100%-138% of the federal poverty level. If Maine had accepted those federal funds, it would have restored health care for those individuals and covered an additional 45,000 Mainers who would have been eligible for insurance for the first time. This year, the Maine Legislature had another opportunity to override the Governor’s veto but fell 2 votes short of an override.

If our society allows these wrongs to go unchallenged, the impression is created that those wrongs have the approval of the majority. Lawmakers who refuse the opportunity to cover uninsured people are telling those people that their lives don’t matter. For the republican lawmakers who say, “Well, I voted for expansion”, I say that’s not good enough. We all know that in politics, if the majority party whip is certain that he or she has the votes needed to pass a bill, or in this case, override the Governor’s veto, those representatives in that party who may be vulnerable for re-election are given the green light to vote with the minority, simply so they can go home to their constituents and say “Well, I supported expansion, but it just didn’t pass. There was nothing more I could do”. This on its face is deceptive and hypocritical. This is what happens when lawmakers decide issues purely on political and self- merits.

More is required of public officials than slogans, handshakes, press releases and a wink and a nod. They must be held strictly accountable. Legislators must not only provide a vision for the future, they must share in the responsibility and delivery of that vision, and be willing to implement and uphold what they know is right for the common good of our communities. Quality healthcare expands well beyond political boundaries and should not be dependent on the whims of ideological political positions.

What Constituency Is Senator Susan Collins Representing?

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First we have Senator Susan Collins disgracing herself with her overt support of Senator Jeff Sessions for Attorney General of The United States, despite his 30 year history of racial insensitivity, bias towards immigrants, his lack of respect for the rule of law, women’s rights, civil rights and LGBT rights. Apparently that was not debasing enough for the good Senator. For reasons known only to her, Senator Collins joined her republican colleagues in last evenings Senate “vote-a-rama” to adopt a budget plan that would destroy the Affordable Care Act (ACA). Her vote was cast despite her previous position that republicans should not consider repealing the ACA until they could offer a replacement plan. Despite also the fact that if republicans had been serious about the health of the American people, they would not have repeatedly refused time and time again over the last 7 years to offer any type of plan or make any efforts to improve a much needed program. Never mind still, the fact that the Center for Budget Policy and Priorities estimates that 95,000 Mainers and 20 million Americans who rely on this valuable program could lose their health insurance. Many of these non-privileged people will be thrown into immediate bankruptcy.

Our political system is based on the presumption that political figures are reasonably responsive to their constituents. One cannot show different faces to different constituents, one face to those who elected them during daylight hours, and the other face to those who stroke their ego’s when the sun goes down. Senator Collins, and far too many republican public officials, has allowed their judgments to be befuddled by conflicting pressures with their character eroded by selling out to their party over the best interests of their constituents and the American people. This however, doesn’t seem to bother them in the least.

When representing people who elected you, this granted privilege of power should be neutral at the least, and tilted to those who elected them at its best. It becomes necessary to advance that power towards the moral framework that permits us to judge the purpose of good over bad. Constituents cannot support an elected representative leader who betrays the common good in the interest of personal aggrandizement. Partisanship that reflects no commitment to the common good is partisanship gone berserk.

Unfortunately, a high proportion of political leaders in our society are rewarded for their single minded pursuit of their own group interests. They are rewarded, not for compromising, but for participating in the battle in order not to become inferior in the eyes of their God-like leaders and colleagues. This should not be the role of responsible elected officials. That role should be one of functioning in the framework of our representative institutions to accomplish the mediating and brokering necessary to reconcile the diverse views and needs of the people. The concept of the reality of community should not be so easily cast aside. First-hand contact with reality should remind them of their original purposes.

People want to believe that their lives have meaning. They want reassurance. It is the reckless and uncaring representative who violates these expected cultural norms of their constituents.

As citizens and constituents, we have a sterner duty. The simple rule is: Hold power accountable. The prime instrument of political accountability is the electoral process. Elected officials must be attentive to and responsive to their constituents needs. They must not allow the hopes and dreams of the citizenry to remain dormant volcanoes of distressed emotions. When the eruption of these emotions eventually surfaces and spews its hot lava, Senator Collins and her many vindictive and irresponsible colleagues are sure to get burned.

Senator Susan Collins, Once Again On The Wrong Side Of History

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The decision by Senator Susan Collins to support the nomination of Senator Jeff Sessions for Attorney General of the United States is mindboggling. A decision is a choice. Whenever a decision is made, the decision maker must and should be aware of all the consequences that could result from choosing a certain act.

Sen Collins’ decision to endorse Sen Sessions has brought dishonor to her own credibility, to her integrity, to many of her Maine constituents and to the cause of fair and equal justice for all Americans. Her stance is an indictment of a failure of her moral duties and responsibilities to stand for the rights of the people. Her teeth may be smiling, but is her heart? Injustice is a two-edged sword. Sen Collins should be embarrassed.

Jefferson Beauregard Sessions, III: Unfit For A Federal Judgeship, Unfit To Be Attorney General Of The United States

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Next week, Senate Republicans will begin their process to fast-track nominees for various positions in Donald Trump’s cabinet. One of the most controversial figures in this process that begins on January 10 will be Senator Jefferson Beauregard Sessions, III of Alabama, and nominee for Attorney General of the United States. This nomination is extremely disturbing and distressing. In essence, it represents a throwback to the bygone days of the old South.

In an unprecedented move, The Senate Judiciary Committee is allowing the hearings, now limited to two days, to bypass their usual vetting process. It is unquestionable that Senator Sessions’ record must be carefully scrutinized, given his checkered and extremist views that continue to be expressed even today.

It is inconceivable that a man who was denied a lifetime tenured Federal Judgeship in 1986, a seat on the U. S. Court for the Southern District of Alabama, by his own republican colleagues on the Judiciary Committee, would now be considered and allowed to proceed through the process with minimal to no vetting. Most of us are aware of Senator Sessions’ history of racial insensitivity during his tenure as a U. S. Attorney. As the U. S. Attorney for the Southern District of Alabama, Sessions went out of his way to prosecute civil rights workers in the Alabama “Black Belt” for voter fraud in Black communities, while overlooking the same perceived violations in white communities. One of the workers was an aide to Dr. Martin Luther King, Jr. The focus of these workers was on voter registration and it took a jury only 4 hours to render an acquittal. This is the same Jeff Sessions who labeled the NAACP, the National Council of Churches, the Southern Christian Leadership Conference and the American Civil Liberties Union as “un-American” and “communist inspired”. As if those denunciations were not enough, Sessions casted a white civil rights lawyer as a “disgrace to his race” for litigating civil rights cases.

Fast-tracking of Sessions’ nomination lay at the feet of his republican colleagues in the Senate, the integrity of his nomination lies in his hands. To date, Sessions continues to withhold from the Judiciary Committee, information surrounding decades of his career. As with any other such nomination, the committee requires complete documentation of employment history, published writings, interviews and speeches. The questionnaire that Sessions has submitted to the committee omits major details from his years as U. S. Attorney for the Southern District of Alabama from 1981 to 1993, his tenure as Attorney General of Alabama from 1995 to 1997, and his first term as a U. S. Senator from 1997 to 2002.

More recently, there have been several interviews during which he has once again made controversial statements. He is on record giving Donald Trump a pass for making sexist comments stating “everybody knows Trump likes women and uses this kind of talk”. In another interview he stated “the predictions aren’t coming true” about the deleterious effects of climate change. None of these interviews were identified in his questionnaire that he submitted to the Judiciary Committee. Sessions maintains an extreme bias against immigrants, a bias so right wing that it has even alienated many of his republican colleagues.

The irony is that as a member of the Senate Judiciary Committee, Sessions chided Supreme Court Nominee Sonia Sotomayor for what he perceived as incomplete answers in her judiciary committee questionnaire. He went even further during the hearings for Goodwin Liu, nominee for the U. S. Court of Appeals for the 9th Circuit, warning that Liu “might be breaking the law” by leaving information out of his questionnaire, punishable by two years in jail. It seems hypocritical that Sessions feels so high minded to slam past nominees for incomplete documents, only to blatantly do even worse himself today.

Cowardice is the greatest vice. A man’s vanity tells him what is honor; his conscience tells him what justice is. The truth is tough and Sessions must face up to this fact. In his attempt to mislead and erase his hateful and willful past and present misdeeds, Sessions continues to thumb his nose at the American people, placing himself above the law.

The U. S. Attorney General is supposed to be the lawyer for the people. He should be above the fray. The U. S. Justice Department has a duty and a responsibility to uphold the laws of the country, protecting all Americans, no matter race, religion, gender or sexual orientation. These responsibilities must apply equally to all, in an even-handed manner. This office has jurisdiction over such vital areas as enforcing civil rights, voting rights protections, prosecution of hate crimes, protecting women’s health clinics and upholding the constitutional right to marry. The Attorney General’s personal views must be set aside.

For republicans to shorten this confirmation process in a burst of self-will may get Sessions through the committee, but this tactic only sends a reverberating message that the cause of equal justice is not on their radar screen. It means that the fortunate and especially the unfortunate, in the end will suffer. The position of U. S. Attorney General is much too important to be rubber-stamped. As noted by Martin Luther King, Jr., “When civil men would seek to perpetuate an unjust status quo, good men must seek to bring into being a real order of justice”.  The nomination of Senator Jeff Sessions, extreme and unrepentant, is surely not a good sign for the future of justice and equality in America.

The 30 year record of racial insensitivity, bias against immigrants, disregard for the rule of law and hostility to the protection of civil rights make Senator Jefferson Beauregard Sessions, III totally unfit to be granted the privilege of serving as the Attorney General of The United States of America.