Hub & Spoke

In Plain Language, Today's Supreme Court Decision

 How does the Court's decision to uphold Healthcare Reform affect community clinics?

Awesome news today! As you've probably heard, the US Supreme Court supported and upheld President Obama’s Healthcare Reform law. What does this mean for community clinics and our patients? In plain language, here are the important points:

Lots more people are eligible for Medi-Cal coverage

• The Supreme Court said that if states want to grow their Medi-Cal programs to cover more people, they can

• California has already decided to expand its Medi-Cal program, for example by covering low-income childless adults

• WHY DOES THIS MATTER? Growing Medi-Cal matters because now millions more people in this state will be looking for health care providers like community clinics! Clinics will be able to serve many more low-income people

Lots more people will be able to afford private health insurance

• The Supreme Court said that it agrees with President Obama: the healthcare reform law will require adults in this country to have health insurance

• California has set up a program to help people shop for health insurance, and will provide discounts so they can afford it

• WHY DOES THIS MATTER? Requiring adults to have health insurance, and making it affordable, matters because it means millions more Californians will soon be shopping for a new place to go for medical care.  We want these newly-insured people to be community clinic patients!

• If clinics are going to attract these new patients, we need to show them why we’re their best choice: we provide excellent, cutting-edge medical care, and we know their cultures and their languages better than anyone else 

Millions of dollars are available to community clinics in California

• The Supreme Court said that the healthcare reform law can move ahead with providing millions of dollars to California community clinics

• WHY DOES THIS MATTER? This new money will help clinics across the state grow!

The America We Want

Here's a riddle: What steadily shrinks for the first 39 years of its life and grows blazingly fast for the next 30?

(Sorry, gents - the answer's unfortunately not, as a general rule, "my hairline.")

Give up? 

It's the income gap in America - the difference in the percentage of the nation's wealth held by the richest 1% of the population and that held by everyone else.  Without getting into too many details, the more-than-somewhat-alarming fact of life in the USA these days is that if you're at the very top, you're sitting prettier than ever, and if you're not up there, things are looking grimmer.  

PBS had a great segment on this yesterday, which got us thinking.  

It got us thinking about what kind of America we Americans are making with the public policies we're enacting into law.  

Because regardless of what's to blame for the widening gyre that's blasting through the middle class, it seems that at least part of the answer to social inequality has to be wise federal legislation designed to bring us all together on common ground.

Case in point: Federal Healthcare Reform. Which, incidentally, just passed its anniversary. 

Congressman George Miller was in Concord this week to celebrate what the law's already provided to the sick and otherwise hard-to-insure.  He introduced Dr. Walker of CCHS (to whom he referred as his mentor on health policy) and a panel of regular people - from all walks of life - who're now able to access medical care that just months ago would have been totally out of reach.  

And then Mr. Miller said something so spot-on we wrote it down verbatim:

“On the horizon, there’s an insane idea that they can repeal this and replace it with a voucher. A voucher is the most expensive way to do healthcare… I don’t think that’s America. I don’t think it’s our future… As people find out more and more about this plan, I hope they will understand this is a generally great American idea.”

Right and right. Half of Congress is up in arms about how un-American it is to spend tax dollars on greater healthcare access for everyone. But America is what we make it through conscious policy choices. And the America that we here at the Consortium want to see isn't one where 1% of Americans have dream lives and the other 99% just scrapes by. 

One hundred percent of us deserve some basic things equally. Including health care.

In a society wedged further and further apart, Healthcare Reform honors the American ideal that we all have the right to a fair start.  

So, Mr. Miller, count community clinics in for the fight to keep Reform on the books. And thank you, as always, for your leadership!

Explaining our healthcare system to alien invaders

Sometimes the healthcare situation in this state (and this country in general) really makes us want to cry. When things are this bad - as they are now - the only way we know to avoid breaking down into hysterics is to write short fictional pieces in which we imagine being visited by an alien species, unfamiliar to our (in)human(e) ways. 

Here's how a close encounter of the third kind would sound this week:

Alien Invader: Greetings, Earthlings! We have traveled across the Universe to search out new ways of delivering healthcare to our species.  Please teach us how you do this in "California."

Human:  We're happy to explain our healthcare system to you, friendly Alien Invader! But how much time do you have? Our system of medical services makes rocketing across the Universe seem simple by comparison. 

AI: Ah, I see.  Well, our brains are 7 times larger than yours, so go ahead and give it a try.

Human: Okay then, first thing we should say is that every person in California has a right to comprehensive, preventive medical care no matter their income or age.

AI: That's Excellent! Teach us how you do this!

Human: Right, okay, so…. see, you have to understand, the system's not perfect.

AI: No system is.  Except for the solar system.

Human: Yah, for example, every year on January 10, we have a ritual that we call the Governor's Proposed State Budget.  In this ritual, the government proposes stripping tens of thousands of people of their healthcare benefits.  

AI: I see. That does seem like a bit of an imperfection.

Human:  Right now, the state government is proposing the elimination of Adult Day Healthcare services, services that keep low-income elderly people out of nursing homes and hospitals and enrich their lives immeasurably.  

AI: Hmm. Are these cuts being made because there is simply no other choice?

Human: Well, we could modestly raise the cost of registering a car and extend existing taxes for another couple years. 

AI: That doesn't sound so bad.

Human: It does to almost half the Legislature in Sacramento, which refuses to bring the proposal to the public for a vote.

AI: Ah, those legislators must be Romulans.  We know them.

Human: Another ritual we have here on Earth is called, "Devastating common-sense healthcare programs for political gain."

AI: That sounds….fun.

Human: For example, right now our federal House of Representatives has voted to cut 1/3 of all federal funding to community clinics.  It also voted to roll back a set of improvements to the healthcare system that our President, Barack Obama, passed last year.  

AI: We are still waiting to hear how you ensure comprehensive, preventative healthcare to all.

Human: Huh? What? Oh, no no no.  You misunderstood.  

AI: We did?

Human: Right, so what I meant was that everyone has the RIGHT to comprehensive, preventative healthcare. But not everyone actually GETS comprehensive, preventative healthcare.

AI: This does not compute.

Human: Silly Alien Invader - so technologically sophisticated, so politically naive.  

AI: We are going to take off now.  We hear there is a land called "Canada" where people have the right to healthcare and actually get it, too.

Human: Yes, we have another ritual that involves packing our elderly onto busses and driving them north across the border to buy affordable prescription drugs from that land.

AI: You have a remarkable system, here, Human.  We will note it under our "Do Not Adopt" file.  Thank you for your assistance.

Human: Wait, I didn't get to tell you about local healthcare funding!

AI: If you attempt to do so, we will blast you with lasers.

Human: Okay, bye now!

 ---

Well, writing that kept us from crying. But now we're just angry! If you're similarly upset with what's going on with healthcare in this state and country, be sure to sign up to take action on our website (click here). Together, we can make a change. And there's a lot to change.  

 

Curling toward the House

We don't know about anyone else, but we here at the Community Clinic Consortium are great fans of curling.  

Often referred to (in Canada, anyway) as "chess on ice," curling is the time-honored and strategy-intensive duel between two teams of competitors battling to see who can get their polished granite stones across the skating rink and closest to the target, which is called the house.  

We particularly like the part of the game when one team arcs its polished granite stone into the other team's polished granite stone, knocking it out of the way and erasing the other team's gains. 

What we don't like is how well our beloved game of curling stands as a metaphor for the US Congress.  

Next week, leadership in the House of Reps will schedule debate over repealing last year's hard-won healthcare reform law, whose passage was a major coup for advocates of a better, more equitable, and more affordable American health system.  

In other words, Republican leadership will be sliding the political equivalent of a large polished granite stone down the ice in an attempt to knock the existing polished stone of healthcare reform away from the house.  (Get it? House?)

Well, we cry foul.  The last thing that low-income and working-class Californians need is the federal government to pull the rug out from under their feet and strip away vital funding for community clinics and basic protections for insurance customers.  

We hope you'll agree now's not the time to re-break the healthcare system.  And we encourage you not only to agree but to make your views known to your Congressmembers.  So we've set up a easy-to-use online tool that allows you to send your representatives a pithy plea for reason.  Check it out at this link, which will get you to our website's Advocacy Action page.  

Happy advocating, Team Community Clinic!  

De-Symbolizing Healthcare Reform

With a couple of breathing days since the election that swept a near-record number of majority-party congressmembers out of their seats, we thought we'd add our own voice to the din of analysts trying to figure out WHAT THIS MEANS FOR HEALTHCARE REFORM.  

Because, as we all know, the (former) majority party voted the reform law into existence.  Now that many of them are gone, we and others are left nervously wondering what the future holds.  

Couple of points here.  First of all, it's notoriously hard to judge the public's opinion on an issue based on the party it votes into power.  It's not like a vote for a Republican is an automatic vote against extending health insurance to those with pre-existing conditions.

And even direct polling, in which members of the public are explicitly asked whether healthcare reform should be repealed, is hard to decipher.  In October, the Kaiser Family Foundation published a round-up of polls on this point and basically concluded that even though about 1/2 of the country supports repeal, responses vary widely with the way "repeal" is defined and how the polling questions are asked, and that it's impossible to judge the intensity of the public's sentiments from the polling that's been done so far.  

Second, the political math of repeal is fuzzier than a new crew cut.  It's hard to see the Democrat-controlled Senate or the President acceding to any "repeal" that goes beyond some tweaks around the edges.  In the House of Reps itself, the big news is that San Francisco's Nancy Pelosi will seek election as the minority leader, and if she retains her leadership position you can be sure she'll work overtime to stop any rollback of one of her most significant policy victories.  

Also, let's not forget that the public basically doesn't know what's good about healthcare reform.  That's in large part because most of the awesome provisions of the law have yet to kick in.  The difficulty of repealing a law that becomes more and more popular as time goes on (and as benefits kick in for seniors and others) may be insurmountable.  A good discussion on the politics of taking away benefits from key constituencies played on PBS this week and is worth a gander.  

Our own take is that healthcare reform is - in the minds of many in this country - a symbol of what is perceived to be too much government control over the private sector.  

Maybe with this week's election the voting public has blown off some steam, feels more secure about its representation in DC, and no longer needs a symbol of government over-reach to rally around.  

But just in case that's not the case, it may be time that we supporters of the law start purposefully stripping it of any symbolic importance whatsoever.  That means filling in details where now there's only broad abstract ideas.  

And it means ceasing to talk about "the healthcare law" as a single Thing altogether.  Skeptics always assume that "the reform law" is an enormous, Godzilla-like creature bent on destroying mom and apple pie.  So let's start talking about one specific part of the bill at a time.  We're excited about how comprehensive it is, but that's because we're health policy nerds.  Normal people are somewhat less stoked on thousands of pages of statutory modification.  

So, no, it's not "healthcare reform."  It's "Help Paying for Prescription Drugs" when talking to seniors.  It's "No More Exclusions for Children" when talking to parents.

The more that we as supporters of reform can shine light on specific parts of the law, the less it serves as a symbol and the more it becomes an unrelated set of common-sense, average-Joe friendly rules of the road.  

Much easier to understand.  Much easier to embrace.  

So here's to the death of a symbol, and to the long, long life of a hundred really good ideas to fix healthcare in this country.  

and the worst are full of passionate intensity...

Remember those couples in high school who celebrated their six-month anniversaries? There was, as we remember it, always something pretty underwhelming about that particular milestone.  In making such a big deal of reaching half a year, these starry-eyed lovers seemed to unwittingly signal that maybe the full 12 months was a bit too much to ask for.  

The lifespan of adolescent romance came to mind this week as we read news reports marking the 6th-month anniversary of the national health care reform law.  

For health centers and our uninsured, low-income patients, the anniversary worth celebrating doesn't come until 2014, when Medicaid expansions will move millions more onto insurance coverage and into our clinics.

So while important provisions of the law take effect this week, health centers will, to extend the analogy, probably send the happy couple a card, and skip the party.  

There may, however, soon be a time when we need to organize a massive block-party style Health Reform celebration with all our friends and neighbors.  

Because we know this: Health Reform is something of a political hot potato in a country where 45% of the population still doesn't really know what the law says, and the people who feel most passionately about it seem intent on striking it from the books.  

It occurs to us that if the only people who care about Healthcare Reform are the people who want to overturn it, then eventually it really will be in trouble.  

Health centers need to take up the flag as Chief Defenders of Healthcare Reform.  We owe it to our patients to make sure that this landmark, groundbreaking, game-changing law is around in 4 years, when it really starts getting good.  

The six month anniversary of health care reform might not have significant impact for our target population, but the legacy of this law is in our hands.

Confusion Kumbaya

In a country increasingly divided between right and left, Fox and MS-NBC, climate-change deniers and Prius-drivers, it's encouraging when an issue comes along that we can all agree on.

Health care reform is a prime example. And what we can agree on about health care reform is this: it is really, really confusing.

Especially for people who don't spend their professional (or personal) lives combing through federal policy reports or fashioning wall-sized flow-charts to model the gazillion ways an individual can be insured or uninsured under the current healthcare system. 

(Incidentally, if you have a chart like that, please let us know.)

But national unity in confusion isn't actually all that great. Especially when it's our clients and patients we're talking about.

So the good folks at the California Primary Care Association in Sacramento put together an FAQ on healthcare reform that's targeted at front-line health center staff and providers so they'll be equipped to answer patient questions. 

The guide's still in "we need feedback on this" draft format, and so here's where you come in, faithful reader:

Click here to see the FAQ, and if you have a chance, leave a comment or drop us a line to let us know what you think. Are we hitting all the right issues? Are they the questions that patients in your health centers or your County clinics are asking? Are the explanations complete? Do we use language that normal people can understand?

We'd be stoked to get your thoughts and edits on this document. The goal, ultimately, is to help unify the public, not in resigned confusion, but in head-over-heels-excited, can't-wait-to-sign-myself-and-my-family-up-for-low-cost-insurance comprehension.

It's Go Time!

Faithful readers! We're back!

As you may have noted, this blog took something of a summer break.  

But, it turns out, the world of community healthcare didn't. It's been a whirlwind few weeks, and coupled with the state budget storms on the horizon, there's a lot to report and discuss.

We'll ease you back in with good news from National Health Center Week - which community clinics across the country just finished celebrating.

Last Thursday at Havana restaurant in downtown Walnut Creek we took the opportunity (with the generous help of the good folks at Kaiser Permanente) to fete the most spectacular community clinic staffers in our region, applauding the outstanding work they do on behalf of patients 24-7-365.  

Clinic managers, before a standing-room only audience, raved about their staffers, each with his or her own story of reaching above and beyond the call of duty while contending with issues ranging anywhere from chronic health conditions to domestic violence.  

Those rockstar clinic employees - medical providers and support staff alike - constitute the heart and soul of our member clinics, and it was fun to celebrate their contributions.

The icing on the cake was special guest Congressman John Garamendi, who joined us for lunch and spoke eloquently (and apparently extemporaneously) about how much health care and health care reform mean to him, not only as matters of public policy but personally as well, noting challenges that members of his own family have had navigating the current broken system of medical care in the US.

He was quick to point out that while there is still much work to be done with respect to Health Care Reform (what the heck, for example, are those Exchanges going to look like?), the Affordable Care Act is really just the beginning of real change. (His disappointment that that the Public Option wasn't part of the final package met with nodding heads and the occasional 'Amen.')

Of course, we couldn't let the opportunity go by without posing a few points of our own. Making the case that the success of healthcare reform hinges on the ease with which the feds allow us to grow to meet new demand, we urged the Congressman to streamline the process by which we can open new sites and expand existing ones. 

And, we noted, we can't grow in a vacuum. Our primary care services, to really work, have to be complemented by adequate specialty services, which of course have to be affordable for low-income patients.  So, you know, we weren't bashful.

National Health Center Week comes at the end of summer, but it always gives us the opportunity to look forward. This year we look towards the implementation healthcare reform, towards the 2010-11 state budget battle in earnest, and towards new political officeholders.  

We can't wait!

Immigration on the mind

For many of us nervously eying the state budget negotiations, perhaps the most unsettling proposal on the table is an elimination of Medi-Cal benefits for recent, legal immigrants.  That's L-E-G-A-L immigrants.  Permanent residents, actually.  Here in the US for less than 5 years.  Playing by all the rules.  

Except, of course, for Rule No. 189A-2 of the Federal Arbitrary and Inequitable Statutes of 1996, which says, in relevant part, that "unless you've been here for 5 years it's probably not a good idea to be poor because you're not likely to get any help with your healthcare."  

Okay, as savvy readers know, technically there's no such rule.  But essentially there is.  And it's the unfair singling out of immigrants that's so unsettling to those of us in the community healthcare world.

Because obviously there's no public health rationale for segmenting out recent immigrants from otherwise identical not-so-recent immigrants (or anyone else, for that matter) and blocking them from primary healthcare.  And the whole thing smacks of the same anti-immigrant fervor that's characterized legislative ridiculousness in Arizona and rhetorical ridiculousness on the California gubernatorial campaign trail this year.  Which is concerning.

Which is why this blog post from Henry Fernandez of the Center For American Progress Action Fund - which discusses the political Downside of beating up on immigrants - was so encouraging to read.

So there's your shot of optimism for the day.  Enjoy!

Celebration!

As this article by Lisa Vorderbrueggen in the Times rightly reports, while some Democrat members of Congress spent their spring breaks back in conservative districts bracing for tea party assault, our region's representatives came back to the warm embrace of a fired-up, grateful public.

At least that was the vibe at last night's town hall/reception for Congressmen George Miller and John Garamendi in Martinez.  It was triumphal, and happy.  There was levity.  Miller and Garamendi donned doctor's coats and stethoscopes (presented by Jane Garcia of La Clinica and Cheryl Johnson of Brookside clinic) and hammed it up for the crowd.  It felt like election night when your candidate wins.  It was genuine political fun.  

Community clinics owe a big thanks to both Miller and Garamendi - not to mention Pelosi and Obama - for their work and votes on healthcare reform.  We're set to double the number of patients we see (nationwide) over the next 5 years.  We're set to hire more primary care docs who are benefiting from loan forgiveness programs that incentivise community work.  We're set to build new sites and expand our current ones.  

Who says Congress never gets anything done?