Author: raemd2016

The Mystery Of A New Administration: Complexity Is Never Of Value Where Simplicity Will Suffice

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The brightest stars see beyond the obvious to the signals that precede the obvious. They observe with equal attention what works and what does not work. They are careful to remember failures for their special power to instruct. The difference between good and great is attention to detail.

The Patient Protection and Affordable Care Act (PPACA) H.R. 3590, or Affordable Care Act (ACA) for short, was signed into law on March 23rd, 2010 by President Barack Obama. The law contains many provisions which grant Americans a number of new benefits, rights, and protections and ensure that more US citizens have access to affordable, quality healthcare. It also works to decrease the rate of growth of health care spending and enacts other reforms to “fix” the current healthcare system.

Progress requires change. A civil society attempts to accommodate this need through openness, transparency and inclusion. Change can generate fear and anxiety, but it can also ignite our inborn desire to explore, to flow and grow rather than remain the same. Change for the better is self-improvement. We were born to move, to move on, not so much to reach a destination, but to find one.

This brings me to the recent Interim Meeting of the American Medical Association (AMA) held in Orlando, Florida over this past week, in which I attended as the Chair of The New England Delegation to the AMA. The mission of the AMA is to promote the art and science of medicine and the betterment of public health. This mission does not apply to a select few, but to every American citizen. Election 2016 is now over. We now have a new President-Elect, a man who has created massive divisions and insecurities across the entire country and in many parts of the world. So, what do we do now and where do we go from here? There are numerous areas of concern regarding policy decisions and how we all will be affected by any new decisions put forth by this new administration.

During my recent Maine House Legislative campaign, one of the most pressing issues repeatedly voiced by many Maine citizens was their concern for the state of health care and how they would be impacted by the repeated republican threats of “repeal and replace”. In the past, gaps in the public insurance system and lack of access to affordable private coverage left millions without health insurance. Beginning in 2014, the ACA expanded coverage to millions of previously uninsured people through the expansion of Medicaid and the establishment of Health Insurance Marketplaces. Data show substantial gains in public and private insurance coverage and historic decreases in uninsured rates in the first and second years of ACA coverage. Coverage gains were particularly large among low-income people living in states that expanded Medicaid. Still, millions of people—28.5 million in 2015— remain without coverage.

Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2015, 46% of uninsured adults said that they tried to get coverage but did not because it was too expensive. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Some people who are eligible for financial assistance under the ACA may not know they can get help, and others may still find the cost of coverage prohibitive. In addition, undocumented immigrants are ineligible for Medicaid or Marketplace coverage.

Most uninsured people are in low-income families and have at least one worker in the family. Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Whites.

People without insurance coverage have worse access to care than people who are insured. One in five uninsured adults in 2015 (20%) went without needed medical care due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

During this year’s Interim Meeting of the AMA House of Delegates, representing more than 170 state and specialty medical societies from across the country, the delegates vociferously and passionately reaffirmed its commitment to health care reform that improves access to care for all patients. There were 5 separate resolutions presented to the House of Delegates (a combination of over 1,000 physician Delegates and Alternate Delegates), each of which was discussed in extensive and great detail. One of the core principles of the AMA is that any new reform proposals should not cause individuals currently covered to become once again uninsured. Our AMA has a strong foundation of existing policy in favor of support of efforts to provide coverage for the uninsured. In fact, the AMA Council on Medical Service (CMS) and the Council on Legislation has conducted numerous studies on various health system reform provisions in the ACA. Those extensive studies, policies and reports provide more than sufficient information that can be used to determine the best course of action by the incoming administration to improve on the ACA.

Those who are so adamantly ideologically and politically opposed to the ACA have wasted 7 years and missed numerous opportunities to improve on this worthy goal of ensuring the health of our nation’s citizens. It is the absolute intent of the AMA to continue to advance recommendations to support the delivery of high quality patient care to all citizens. We see this as an opportunity to actively engage doubters, the new administration and Congress in discussions to improve our health care system. It is time for us to move forward as a nation and the AMA will do so with a clear and simple statement communicating our message on health care reform to the public at large.

If republicans are truly concerned about the welfare of the people, they should put the health of the nation’s citizens first. Instead of “Repeal and Replace”, they should cease the divisiveness and fearmongering and think about “Repenting and Improving”.

“All Sins Cast Long Shadows”: If You Can Keep Your Head When Those Around You Are Losing Theirs, You Don’t Understand The Problem

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In order for a problem description to be complete, all factors relating to your decisions must be considered. Any solution to an incomplete problem is by definition, any incomplete solution. We have a serious problem in the decisions being made at the Department of Health and Human Services. This department is running amok, uncontrolled, unreceptive, unaccountable and reigns with the attitude that “we can do whatever we want, whenever we want and however we want”.

It comes as no surprise that there are needs of many Mainers that require our direct attention. When errors in problem identification occur, it only leads to incorrect solutions. The problems that are before us and the Department of Health and Human Services (DHHS) are those needs of low income families with children, seniors and disabled Mainers. This clearly defines the problem, and requires considerate deliberations and dedication to resolve them.

Instead of addressing all of the problems, Gov LePage and DHHS Commissioner Mary Mayhew have continued a shell game of robbing Peter to pay Paul. Their actions raise serious concerns for the health and welfare of Maine citizens. In a recent audit of the Maine DHHS by the state office that ensures government funds are used according to law, it was determined that DHHS has misspent $13.4 million in federal welfare money earmarked for low income families with children. The audit report also indicated that DHHS was aware of the fact that its use of the $13 million was questionable, but went ahead with the redistribution and spending of that dedicated money despite having this knowledge beforehand.

These funds originated from a single federal grant for Temporary Assistance for Needy Families (TANF) and accounts for $78.1 million to Maine each year to pay cash assistance, job training and placement, and child care for low-income Maine families with children. Redistribution and spending of this money occurred over a two year period. Federal law does allow for the state to transfer up to 10% of the $78.1 million each year to a smaller more flexible federal grant known as the Social Services Block Grant that states may use for a range of other social services. This is not what happened in this particular case. In 2015, DHS transferred $7.8 million to services for elderly and disabled residents. In the following year, DHHS transferred another $5.6 million TANF funds to the Social Security Block Grant for the same services. Instead of addressing the big picture and the needs of the elderly and disabled with appropriate funding, Gov LePage and the Commissioner enacted their own policies of redistribution, pitting one group of needy Mainers against another group of needy Mainers. In the end, this amounts to a lose-lose situation for those who are most vulnerable in our everyday communities.

The insulting kicker in this whole fiasco is that the DHHS response was that the fund transfers “had no net effect” because the department reversed them within the time frame allowed by the federal government. This is certainly misleading as the auditor clearly noted that there is no allowable time period where DHHS is permitted by the federal government to spend grant funds on unallowable costs. The department also had the audacity to suggest that the timing of the audit report was somehow politically motivated since it occurred outside “its normal schedule for publishing audits”. In other words, it appears that DHHS’s position is that “we knew we were cooking the books and we would have gotten away with it if the auditors had just stuck to their normal schedules”. These redistributions by DHHS are clear evidence of improper and unacceptable practices of financial administration. The auditor’s report concluded that “the decision to spend federal funds on costs un-allowed by federal regulations with the intent of returning the funds to the federal government if and when the un-allowed costs are questioned, does not represent a valid system of internal controls of federal awards.

So, back to the big picture, and that picture is a landscape of the unmet needs of Maine’s low income families with children, seniors and the disabled. Many of these unmet needs would be more easily resolvable if Maine had accepted and enacted Medicaid Expansion.

There is enough misfortune today for the citizens of Maine. It makes no sense whatsoever for our state government to continue to create new ones. This slight of hands solution to problems is entrenched in the LePage administration and is completely disengaged from how their decisions are affecting people’s lives. It seems that this administration has a unique and uncanny ability to deceive themselves, and in the process, is counting on the people to not notice or hold them accountable.

What this administration sees as a badge of honor may prove in retrospect to be a brand of dishonor, a lack of integrity and an uncaring attitude for the needs of the people of Maine. It’s time to clean house from the top down in the Department of Health and Human Services.