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The healthcare war: Round and round it goes again, and where it stops, nobody knows

August 18, 2018 Leave a comment

The healthcare war:

Round and round it goes again, and where it stops, nobody knows

©by Leo Adam Biga

Originally appeared in the August 2017 issue of The Reader (www.thereader.com)

 

As we go to press with this issue, the Republican-led attempt to repeal and replace Obamacare struggles on..

One of the most controversial things the GOP plan broached was severely cutting Medicaid, the nation’s largest health care program. Critics see it as an entitlement grown far beyond its original scope. Most recipients are children, mothers, the disabled and the elderly. The proposed $770 billion cut – spread out over several years – would have impacted millions, particularly the working poor in rural regions, who account for many of those added to the rolls through the ACA’s Medicaid expansion.

One World Community Health Centers CEO Andrea Skolkin said far from an automatic hand-out, qualifying for Medicaid is actually “very difficult.” She added, “There’s a lot of myths about Medicaid and who’s eligible to be enrolled. If you’re an able-bodied adult, you’re not really eligible. You really have to be an advocate for yourself in getting enrolled with all the paperwork because you have to prove your income. It’s an arduous process.”

The program, said Skolkin, places severe limits on not only eligibility, but coverage for certain things. Any tightening of eligibility and reduction of spending, she said, would result in even less access to care.

“As Medicaid ratchets down what it pays to providers, providers are less likely to want to accept Medicaid and so this vulnerable population doesn’t have as much choice of provider of where to get care, and that’s a problem.”

Currently, one in five Americans is enrolled in the program. In Nebraska, which refused Medicaid expansion, one in eight or some 230,000 people are enrolled. Skolkin estimates about 70,000 Nebraskans fall in the gaps – either not eligible for the marketplace or not covered by a private plan or by Medicaid.

Nebraska Methodist Health System vice president and CFO Jeff Francis was most troubled that “draconian cuts” to Medicaid were even on the table for so long.

“The thing that still looms out there that bothers me is that there wasn’t much budge on that,” Francis said. “I  understand the partisan divisions on that, but at the end of the day that degree of cut to Medicaid is going to really impact individuals and individuals’ coverage. In Nebraska we get a bit of a double whammy, no matter what happens with the cuts because, one, we weren’t a Medicaid expansion state, so we’ve not benefited at all from some of the expanded coverage in federal dollars that went along with that. And, two, historically we’ve been lower on the Medicaid spending spectrum, and so as that translates into cuts and block grants for the states, Nebraska’s going to get hit pretty hard.”

Medicaid is crucial for millions getting treatment for maladies, and Skolkin said, “It also has an impact on long-term care in a tremendous way.”

Low weight new babies, infant mortality, STD and teen pregnancy rates are at crisis levels. The opioid epidemic got highlighted in the recent care plan debates. Mental illness is increasingly recognized as an acute public health problem. In the proposed Medicaid cut, some public schools would have lost funding for screenings and other care that students from low income families rely on.

In this high needs scenario, cutting access to care means some people will delay or defer treatment, and those with conditions that could be prevented or controlled will get sicker, while others will seek care in emergency rooms, all of which puts more pressure on providers. The system’s closely interwoven nature is such that pulling hard on one strand, like public health, will fray or undo other strands in this fragile crazy quilt.

“The tapestry doesn’t work without all the threads,” said One World pediatric nursing practitioner Sara Miller.

Nebraska Medicine CEO Dr. Daniel DeBehnke appreciates how those outside the industry often fail to see just what a tightly-knit fabric it is.

“I don’t know if it’s a disconnect or just a reflection of the complexity of it,” DeBehnke said.

In the event of cuts, he said, “low income individuals are going to need to make really tough choices about how to pay for a roof over their head and feed their family and pay for healthcare, and some may put off healthcare, and that has several domino effects. People become less healthy and when they do access healthcare, they require more services. Once they do require services, a lot of that financial burden gets shifted to the facilities caring for them, be it a local clinic, provider or large health system.”

Sara Miller envisions “life expectancy decreasing because you don’t have the opportunity to intervene in the early years, especially for kids to have healthy habits, and to do preventive medicine, so that folks don’t have diabetes or high cholesterol by the time they’re in their mid-20s.” She added, “My fear most is for the families that it affects and their deciding between food and electricity and healthcare. That’s a decision nobody should ever have to make.”

Exacerbating it all, DeBehnke said, is the “skyrocketing” cost of care.

“We should be focusing on that as well and not just in cutting the dollars that go for healthcare – but how can we decrease the cost of healthcare, the cost of prescription drugs driving a lot of the cost. How can we drive healthcare systems like ours and others to be more efficient and cost-conscious. We’re working on that every single day because we know that’s how we’re going to be paid in the future,” DeBehnke said. “But there are all those other things we should be working on as well so that we pay less for healthcare as opposed to just giving less money for healthcare.”

No matter where this all lands, he said, “When we talk about Nebraska Medicine and our mission, we’ll take care of anybody that walks in our door. That’s who we are and that’s what we do and we’re big enough to be able to do that.”

As a Federally Qualified Health Center, One World takes anyone, too, but it doesn’t have as deep of pockets as Nebraska Medicine.

“When we have increases in numbers like we have seen – we cared for over 18,000 patients last year who were uninsured, which is more than half of all of our patients – that’s an increasing burden as an organization in trying to leverage other funds so we can take care of all people,” Skolkin said. “If Medicaid reduces what it reimburses for certain services, again that’s a reduction to every provider, including us. So, whether you need an x-ray or some lab work. as things get reduced we get less payment for that and then it just has a ripple effect.

“So, cuts do impact us and at some point we won’t be able to provide the extent of care we provide. I would hate to see that happen, but at some point you have to be able to make your budget.”

DeBehnke said no matter what happens, “there’s going to be people left behind,” adding, “The idea that I hope legislators are thinking about is how do we leave the least amount behind.”

Jeff Francis said this is no time to be complacent even as Nebraska Methodist Health System is “operating well under the Affordable Care Act.” He added, “It took some time for us to be able to understand it. We’re now into the fourth year of the federal exchanges and the insurance aspects of it. Other parts of it we’ve been operating under for about six years. And so it’s going on. We’re seeing better outcomes because the focus is on quality and outcomes as opposed to just the fee for service or being paid for services.”

But just as the ACA was never meant to be a panacea for all the system’s faults, Francis said major cuts to public health would have negative consequences.

“To the extent there are less insured and so people are doing less preventive, that would be a step backwards from a public health standpoint. We still have the vulnerable populations – those with chronic conditions, in some cases multiple chronic conditions, those with mental health challenges, the working poor.”

Methodist Health and others are working to fill the gaps where they can.

“We’re reaching out to try and address that,” Francis said “by opening up a community health center in downtown Omaha to work with other entities-services to reach vulnerable populations. That center is going to have Lutheran Family Services associated with it to try to deal with that behavioral health component.”

The center is part of the Kountze Commons project on the former KETV site at 26th and Douglas. It’s an expansion of existing Kountze Memorial Lutheran Church health and food services.

Andy Hale, Vice President of Advocacy for the Nebraska Hospital Association, said his organization has been lobbying the state’s congressional delegation to “ensure all Americans can access the compassionate, patient-centered and affordable healthcare they deserve.”

“Nebraska’s hospitals serve as the safety net in each of their communities,” Hale said.

Hospital programs benefit the state, he said, by “providing free care to individuals unable to pay, absorbing the unpaid costs of public programs such as Medicare and Medicaid,” as well as “subsidizing health services reimbursed at amounts below the cost of providing the care … and incurring bad debt from individuals that choose not to pay their bills,” according to Hale.

Hale said hospitals serving more rural regions typically to treat “older, poorer, sicker populations” who tend to be on Medicare or Medicaid.

“Medicaid plays a critical role for Americans who live in small towns and rural areas,” Hale said. “Almost half of all children living in small towns and rural areas receive their health coverage through Medicaid. Research shows Medicaid provides families with access to necessary health services.”

He said any drastic cuts will be felt most in rural areas.

“Many hospital margins are already thin, but when you begin cutting reimbursement rates, it hits their bottom lines and drives those hospitals to significant losses.”

One World’s Andrea Skolkin said even in this repeal and replace mania, vital aspects of public care should not be lost in the shuffle.

“The expansion of Medicaid funding for children through CHIP (Children’s Health Insurance Program) expires on September 30. All of these things are tied together.”

DeBehnke would like whatever process follows this latest effort to undo the ACA to be deliberate.

“President Trump said at the beginning of all this, ‘Who would have thought this was so complex?’ Well, we’ve all known it’s this complex and we’ve been trying to warn it’s this complex all along,” DeBehnke said. “As opposed to rushing to try to get something done because it was a campaign promise lawmakers made to their constituents, let’s take our time and try to figure it out and get it right. Obamacare wasn’t perfect either. There are good things we can pull from there that are in the right direction.”

Behind-the-scenes, executives like DeBehnke and Francis are bending elected officials’ ears.

“We’re wanting to make sure legislators and policymakers keep that longer view perspective. I think that’s coming out in some of the town halls the senators and congressman are hearing,” Francis said.

Meanwhile, the leadership of Nebraska Medicaid is in transition. Longtime director Calder Lynch left for a federal job in May. Former deputy director Rocky Thompson is serving as interim head until a permanent replacement is found.

Andrea Skolkin is unsettled, too, by the unknown but feels something like universal care will emerge and retain a public health haven.

“We are having those conversations – trying to make our representatives aware of the patient base we care for and what the impacts of cuts would be. Many of our patients, almost all of them, fall into this vulnerable bracket. If you cut too hard, then that social compact becomes less available for the people that need it most.

“I do believe there will be something for everyone. I think Medicaid is still going to be there. There’s a lot of argument-dialogue going around right now. It hasn’t been as productive as it could be. But I am hopeful it will end in the right place. Whether the Affordable Care Act is repealed or not, there has to be a safety net in place for people who are more vulnerable.”

Read more of Leo Adam Biga’s work at leoadambiga.com.

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Diana Acero heads county effort to get the lead out

March 23, 2018 Leave a comment

Diana Acero heads county effort to get the lead out

©by Leo Adam Biga

Originally appeared in El Perico

 

Diana Acero is squarely focused on helping others as Douglas County Health Department‘s Childhood Lead Poisoning Prevention Program coordinator.

“Having this position has helped me realize how much I enjoy working with people and letting the community know we’re here to help you,” says Acera, who took the job in 2007 after working for One World Community Heath Centers.

Lowering children’s lead levels brings satisfaction. She says, “Then I’m like, Wow, the family really got the message, this child is going to get better, they’re going to be successful in life. We made a difference.”

Lead poisoning is directly linked to developmental and behavioral problems in children. The condition can be symptom-less until a child begins falling behind or acting out in school. It can only be diagnosed through testing.

Using various means Acero informs parents, educators and daycare providers about lead hazards and prevention resources. She also tests children, She, a fellow case manager and allied community health workers visit homes, schools, community centers, Head Start centers and health fairs. Acero finds it hard not personalizing the affected youths she meets.

“These are my children,” she says. “I call them my babies.”

Her passionate work earned her the Heartland Latino Leadership Conference Government Award in 2010.

“It’s nice to be recognized for what you do for the Latino community but it also means you have to do even more — to reach more people, to do more prevention,” she says.

She won’t rest until every child’s tested and childhood lead poisoning is eliminated.

“I’m working for a better Omaha, healthier children, a healthier community.”

Acero and her husband have lived in Omaha since 2000. She came here from her native Bogota, Colombia to learn English at the University of Nebraska at Omaha.

She worked in the University of Nebraska Medical Center microbiology department before joining One World as lab technician, Later, as lab coordinator, she grew aware of Omaha’s childhood lead poisoning problem through collaborations with the county lead prevention program, whose then coordinator recommended Acero as her replacement.

Acero’s lab background, bilingual abilities and community-based experience made her a natural choice. Her primary mission is education aimed at prevention. A major challenge is informing people about environmental dangers, whether lead-based house paint (prevalent in homes built prior to 1978) or car and house keys. Some cultural practices introduce additional risks. For example, ceramic bean pots many Hispanics cook with and popular Mexican candies are tainted with lead. Some African refugees eat dirt, risking exposure to lead contaminated soil.

Partnering her efforts is the Omaha Lead-Based Paint Hazard Control Program, the Environmental Protection Agency and the Omaha Healthy Kids Alliance. At-risk families that meet income guidelines may receive home lead abatement assistance from partnering agencies.

Children are referred to local Women and Infant Care or WIC programs for nutrition consultation. Increased calcium and Vitamin C can fight lead poisoning.

A common myth, says Acero, is that lead risks are an inner city issue. “It doesn’t matter where you live. If you let your child play with keys and your child goes to a pinata party where there’s Mexican candy, your child’s’ going to be exposed.” She adds that homes with lead-based paint aren’t confined to east Omaha. That’s why she says, “parents need to be concerned and they need to ask for a test.

Graciela Sharif’s mission is to empower parents

March 23, 2018 Leave a comment

Graciela Sharif’s mission is to empower parents

©by Leo Adam Biga

Originally appeared in El Perico

 

When Graciela and Ayman Sharif’s son Nidal was born with Down Syndrome the couple didn’t know how to respond to having a special needs child.

Graciela, a native of Peru, now recognizes she and Ayman went through a cycle of guilt, sadness, anger and, she says, “the loss of dreams.” Little did she know it was the start of her journey as a special needs advocate. Today, as outreach coordinator for Parent Training and Information (PTI) Nebraska, she helps lost parents find their way.

“At first you feel like you’re navigating a foreign land in a foreign language,” she says.

She recalls the first time she and Ayman met with a caseworker they were so hungry for answers and hope they half-way expected a cure.

“This is how desperate parents are for information,” says Sharif. “But she guided us to resources, and from that point I realized we’re going to have to learn this new language. We kept reading books and navigating the Internet and asking questions and visiting other parents.”

While still a stay-at-home-mom she helped create a support group for parents of Down Syndrome children.

“Sharing experiences is the best way to overcome many of our obstacles and to feel better,” says Sharif.

She further educated herself at a PTI workshop. Armed with special needs protection laws, she forced a school district to accept her son at his neighborhood school.

While she and Ayman, a Middle Eastern native, are fluent in English — they met as international students at the University of Nebraska at Omaha — she says parents with minimal English language skills face more obstacles.

“This is why I joined the PTI staff,” she says. “They needed somebody bilngual — who spoke Spanish and English, and who was the parent of a child with a disability and had a college degree. I filled all three requirements.”

She likes the fact PTI services are free.

Additionally, she serves on the Nebraska Advocacy Services board and the Munroe Meyer Institute’s Consumer Advisory board. In her various roles, she says, “I always try to speak on behalf of the Spanish-speaking families. I am their voice.”

Her work earned her the 2010 Heartland Latino Leadership Conference Heath and Human Services award.

“It was an honor,” she says of the recognition. “It told me I’m doing a good job and to keep up the good work. I know the importance of supporting my community.”

She says a cultural stigma makes some Hispanics reluctant to reveal they have a special needs child or reticent to talk about the situation. Her job is identifying families and empowering them to get the help or take the action they need.

“The families and I really connect,” she says. “They trust me. Sometimes they just need to talk. It’s listening to them and crying with them. I know what they’re going through. I always tell parents, ‘We are the teachers. You need to talk about your child’s disability, you need to be involved. You have to get your kid in as many regular education classes as possible — the other kids need to learn from them. It’s for their future.’”

Sharif trained to be an architect, but she’s found a new calling with PTI.

“I love what I do. It enriches me. This is my project in life.”

Once Nidal and his brother Nader complete school, she might pursue a social work degree.

Health and healing through culture and community 

November 17, 2017 1 comment

Donna Polk was raised African-American but she’s also part Native American, which is a common story. Still, she never imagined she would one day head a Native agency, but she has for decades now. The story of Natives being among us and yet unseen is also a common one. Csn Native Americans be any more invisible in this country? Were it not for the travesties of Whiteclay and Dakota Access Pipeline, where would Native voices be heard and Native faces seen? This marginalized people constituting many sovereign tribes and nations presents very real health challanges that only an organization like the Nebraska Urban Indian Health Coalition (NUIHC) can meet while still respecting Native cultural traditions. This long-standing nonproft has, until recently, been nearly invisible itself as far as the majority population is concerned because its clients are so far off the mainstream radar. But with the Coalition now in the news for plans to establish a new campus, director Donna Polk and programs director Nicole Tamayo are out front and center taking about Native needs and how the organization responds to them. Read my story about NUIHC in the November 2017 issue of The Reader (www.thereader.com).

 

Health and healing through culture and community 

©by Leo Adam Biga

Originally published in the November 2017 issue of The Reader (www.thereader.com)

Donna Polk and Nicole Tamayo decry developer-led gentrification driving their Nebraska Urban Indian Health Coalition out of downtown Omaha.

Headquartered at 2240 Landon Court on 24th Street, between Farnam and Leavenworth, the nonprofit feels the squeeze enough from encroaching development  that it plans moving to South Omaha to be closer to its Native base and to have larger facilities.

“We intend to move because we’ve outgrown this facility and we no longer fit into the demographics of this area. Gentrification is chasing us out. Our target population is no longer here and we need more space,” said Polk, longtime CEO of the agency formed in 1986.

The 12,000-square foot building contains residential and outpatient treatment, youth and elders programs, communal-event rooms, all within close proximity,

“By moving into a larger building well be able to have one floor more for the community and a second floor for programming. We’re very excited about that.”

She plans a small culinary training program.

Meanwhile. she and Tamyao don’t like how rising property values and rents displace residents in a long dormant, mixed-use urban area being revitalized.

But Polk is also practical enough to work with one of those gentrifying developers, Arch Icon. For the new NUIHC site, they’ve fixed on the former South Omaha Eagles Club at 24th and N. It has more than double the square footage. Adjacent to it, she wants to build 44 low-income transitional housing units to “provide secure, sober housing for a displaced community.”

Tamayo, NUIHC Youth and Family program director, said the city’s Native community once lived near downtown but long since dispersed. Transportation’s an issue but will be less so with the move.

Both women are mixed heritage like most of their clients, “There aren’t that many pure bloods,” said Tamayo, who’s Mexican and Native. Polk is African-American and Native. The agency has an all-Native board of directors except for one member. Board and staff dislike any efforts, intentional or not, that further marginalize an already nearly invisible population. Though not widely seen – the census estimates 3,400 reside here  – Natives have real lives, families, issues and needs NUIHC responds to with culturally competent programs and services.

Tamayo oversees the Soaring Over Meth and Suicide (SOMS) program that gives young people preventive tools to avoid abusing substances or doing self-harm. The mother of four brings “a lot of life experience” to the job. People close to her have committed suicide, battled drug addiction and suffered mental illness.

She sees herself in the clients she serves.

“I grew up in the area. i did the gangs and the drugs and the running around. Anything positive that I can keep my kids in and the bigger support system that I can put around them is definitely a plus.”

NUIHC provides that safety net.

“There’s not a whole lot else here. There’s no Indian (community) center. There’s nothing for the kids. The family supports for most of them are not there.”

Omaha’s lacked a full-fledged Indian center since 1995.

“We try to fill that void,” Polk said, “but our focus is heath basically.”

NUIHC accepts some clients other Indian Health Service (IHS) centers don’t.

“You have to be an enrolled member of a federally recognized tribe to be able to receive services from an IHS,” said Tamayo. “A big part of our push, especially with the Adolescent Health Project we’re part of through the Women’s Fund of Omaha, is to build bridges and fill gaps between the different services so that other organizations work better with our community.

“That way clients will have better options.”

NUIHC operates a federally qualified community health clinic in Lincoln, Neb. serving Natives and non-Natives and a free transportation service in Sioux City, Iowa.

“At our Lincoln clinic we provide healthcare services to a large population of undeserved people in Lancaster County,” Polk said. “Incidence and prevalence of chronic disease in the Native community probably puts them at greatest risk than any racial or ethnic group with diabetes, heart disease, cancer, respiratory issues. It’s horrific. It mirrors the mortality and morbidity rate of the dominant culture but the effect is more devastating because diagnosis is often in late stages.”

In Omaha, NUIHC offers mental illness counseling and drug-alcohol addiction treatment. The brick building houses 10-in-patient beds. The campus includes five transitional living units across the street owned by the Winnebago tribe and leased back to NUIHC.

“When people graduate from this (treatment) program or any program in the country, they’re eligible to go to the transitional housing.”

NUIHC’s not seen an upsurge in treatment referrals since since Whiteclay, Neb. liquor stores closed, though alcohol remains a huge problem.

The agency’s broader health focus extends to teaching young people healthy choices and life skills and providing social-recreational activities for elders.

“The programming we do, even sex education, is working with the culture, bringing back traditional values in how to conduct yourself to have high self-esteem and self-worth for making healthy choices,” Tamayo said. “In the majority of our families, the youth do start to drink, use, smoke, whatever, by 10-11 years old.

“It’s looking at underlying issues rather than just educating them about using condoms and getting tested. We have to help them change their mindset. It’s getting them to understand what’s important and how to take care of themselves. We tell them you may not be able to control the environment you’re put in or what’s going on around you, but you still have control of the choices you make going forward  What you did yesterday doesn’t have to dictate what you do today. If you choose to go to school today, then that’s one step closer to doing what you need to be doing to better your life. We keep encouraging them.”

Two annual NUIHC events happen this month: Empowering Youth to Lead a Healthy Life: Native American Health Conference on November 10 and Hoops 4 Life 3-on-3 basketball tournament on November 11. Both are at NorthStar Foundation.

The organization works closely with local colleges and universities. Some Native post-secondary students mentor Native high schoolers.

“We want our kids to see that this is possible – that this is something they can get to,” Tamayo said.

NUIHC convenes an All Nations Youth Council that has a real voice in agency matters.

“For any big push we have we get input from this community, including our youth,” she said. “We don’t want to be telling them what they need to be learning and working on if they have other things going on that need to be addressed. They discusses where we’re going with programming – if we’re hitting it or missing it.”

Last summer, participants of an NUIHC-sponsored youth group made a chaperoned road trip to Chicago and Washington D.C., where they presented cultural performances featuring traditional singing and dancing.

“A lot of our kids haven’t even been past Sioux City,” she said. “It’s giving them an opportunity to understand there’s a whole world out there and it’s very possible for them to reach and go to. They enjoyed it.

“We took them around to all the museums in D.C.  The one they enjoyed the most was the Holocaust Museum. A lot of people wondered if that was going to be too traumatic for them. But when we talked to the kids afterward, they’re so used to seeing things on the reservation, they’re so knowledgable historically of the things that have happened to Native Americans, that this didn’t affect them as it might a lot of others.

“Trauma is just such a part of their daily life that it takes so much for them to be impacted by the experience.”

The Omaha office just got grant a to do domestic and sexual violence counseling.

In everything NUIHC does, great emphasis is placed on observing Native traditions. It even occasionally hosts funeral services, most recently for Zachary Bearheels, the mentally ill man tasered and punched multiple times by Omaha police last June before dying in custody.

“We use a spiritual base,” Polk said. “We don’t deal with religion or denomination – we deal with spirituality. Religion is for people afraid they’re going to hell, and spirituality is for people who’ve been there.”

Every effort’s made to respect client requests.

“If you want to go to the sweat lodge or have a ceremony with a medicine man or go to a pow-wow, you can do that.”

“Definitely. our focus is healthcare, but the connection between cultural activities and being able to identify who you are with how those things affect your health has come more about,” Tamayo said. “We’re able to do that to address the health issues we’re working with.

“We work with Omaha Public Schools and their NICE (Native Indian Centered Education) program on addressing truancy. We help school officials understand sometimes Native students will miss school to participate in traditional practices.”

NUIHC works with OPS and other stakeholders on cultural sensitivity to Native mobility and family dynamics that find youth moving from place to place.

“That’s very important because we look at that as a protective factor so kids can feel good about who they are,’ said Polk.

Tamayo appreciates the autonomy she’s given.

“Donna (Polk) has faith in me that I understand our families’ needs and what services to give them. I have full permission. It’s like open-door mentoring. We have to be really connected and visible in the community. It’s a lot of hours.

“I’ve been in the community my whole life on and off and I know most of these families on an individual level, so being able to reach out and do what I need to do to help them is a plus.”

That help may include informal counseling-coaching to navigate the complexities of life off the Rez.

“We partner with and reach out to reservations because so many of our families migrate back and forth between urban settings and reservations. We want them to feel like they’re getting help with things wherever they go,” Tamayo said.

“They feel like they’re so far away from home and they don’t have a connection here,” Polk said. “We help get them more involved in the community so they can keep that cultural connection they may be missing in an urban setting.”

Polk feels NUIHC is sometimes out-of-sight, out-of-mind. Its $2.3 million budget depends on the vagaries of federal and foundation funds and grants. The low-key, low-profile agency isn’t exactly a household name.

“I don’t lament the fact the general public may not know us or what we do here because the people who need our services know we’re here. That’s what’s important to me. Nationally, people know we’re here. We get clients from as far away as Alaska who come for treatment.”

She’s gearing up to raise millions to acquire and renovate the South Omaha Eagles building. Plans to build the Eagle Heights recovery community are contingent on TIF financing and other funding sources.

“Our mission is to create a small community for the original inhabitants of this land. Almost every group has a community people identify with. We believe we can blend in with South Omaha. It offers the land, the vibrancy and a welcoming spirit. We will be able to increase our ability to elevate the health status of urban Indians by offering additional services, including Intensive outpatient, parenting, caregiver training-assistance, community health and outreach.”

Visit http://www.nuihc.com.

Frank LaMere: A good man’s work is never done

July 11, 2017 1 comment

Frank LaMere: A good man’s work is never done

©by Leo Adam Biga

Originally appeared in The Reader (www.thereader.com)

 

Frank LaMere, self-described as “one of the architects of the effort to shutdown Whiteclay,” does not gloat over recent rulings to deny beer sellers licenses in that forlorn Nebraska hamlet.

A handful of store owners, along with producers and suppliers, have profited millions at the expense of Oglala-Lakota from South Dakota’s nearby Pine Ridge Reservation, where alcohol is banned but alcoholism runs rampant. A disproportionate number of children suffer from Fetal Alcohol Syndrome (FAS). Public drunkenness, panhandling, brawls and accidents, along with illicit services in exchange for alcohol, have been documented in and around Whiteclay. Since first seeing for himself in 1997 “the devastation” there, LaMere’s led the epic fight to end alcohol sales in the unincorporated Sheridan County border town.

“This is a man who, more than anyone else, is the face of Whiteclay,” said Lincoln-based journalist-author-educator Joe Starita, who’s student-led reporting project — http://www.woundsofwhiteclay.com — recently won the Robert F. Kennedy Human Rights Journalism grand prize besting projects from New Yorker, National Geographic and HBO. “There is nobody who has fought longer and fought harder and appeared at more rallies and given more speeches and wept more tears in public over Whiteclay than Frank LaMere, period.”

LaMere, a native Winnebago, lifelong activist and veteran Nebraska Democratic Party official, knows the battle, decided for now pending appeal, continues. The case is expected to eventually land in the Nebraska Supreme Court. Being the political animal and spiritual man he is, he sees the Whiteclay morass from a long view perspective. As a frontline warrior, he also has the advantage of intimately knowing what adversaries and obstacles may appear.

His actions have gotten much press. He’s a key figure in two documentaries about Whiteclay, But his social justice work extends far beyond this specific matter.

“I’ve been involved in many issues in my life,” he said.

Indeed, he’s stood with farmers, immigrants, persons with disabilities, police misconduct victims, child welfare recipients. He’s opposed the Keystone XL Pipeline.

“I must have marched a hundred times in my life and not always on Native interests. If somebody’s being mistreated and I have time and they come ask me, I don’t care who it is, I’m going to go there. That’s what it’s all about. That’s what drives me in my work.”

LaMere’s fought the good fight over Whiteclay, where he sees a clear and present danger of public health and humanitarian crisis. As a Native person, it’s personal because Whiteclay exists to exploit alcohol intolerance among the Pine Ridge populace. He’s cautiously optimistic things will get better for residents, assuming the courts ultimately uphold the denial of the liquor licenses.

“We’ll see where things go from there,” he said, “but rest assured, things will never be the same at Whiteclay. The only thing I know is that the devastation will never be like it was. I truly believe that.”

Just don’t expect him to do a victory lap.

“There are no wins and losses at Whiteclay. Nobody won, nobody lost, but all of us decided maybe we should begin to respect one another and find a better way. I think we will after the dust settles.”

The state Liquor Control Commission, a district judge and the Nebraska attorney general oppose beer sales happening there again but LaMere knows powerful opposing forces are at work.

“I think Nebraskans have good sense. We know what’s right. But there’s money involved. Whoever controls alcohol at Pine Ridge-Whiteclay controls money, controls county government and until very recently even controls state government. I am unequivocal on that. I understand what’s going on here. You’re talking about tens of millions of dollars and we’re threatening that, and when you threaten that, you know, you get a reaction.”

He said he’s received threats. He and fellow Whiteclay advocate, Craig Brewer, went there the day after the sellers lost their licenses.

“There was a foreboding I had all that day I’ve never had in my life,” LaMere said. “It was strange to me. I’ve been dealing with things my whole life and never been afraid. But this time I was looking at different scenarios having to do with the volatility there and if things didn’t work right what could happen to me. Maybe it’s aging. Maybe it was the newness of the situation. I don’t know.

“We got up there very apprehensive about what we were going to encounter, maybe from the beer sellers or from those who support the sellers or maybe from their hired associates. We didn’t know what to expect, but we went up there because that’s what we do – and everything worked out. The right thing happened.”

The sellers did not open for business.

“I told a reporter we went up to look the devil in the eye and the devil wasn’t there, and I don’t think the devil’s coming back.”

He said attorney David Domina, who represents the interests opposed to alcohol, appeared the same day there in the event something amiss happened.

“It was no coincidence,” LaMere said. “We were to be there that day. A lot of prayers went with us.”

LaMere will maintain a wary watch. “I will continue there to be careful, to be apprehensive, but I’m still not afraid.”

He knows some contentious situations he steps into pose certain dangers.

“I’m a realist, I know how things are.”

He and his wife Cynthia made an unwritten pact years ago not to be at rallies or protests together to ensure they won’t both be in harm’s way.

“I do a lot of things in a lot of places and Cynthia grounds me. She critiques whatever approach I’m taking, always asking, ‘Do you have to do it?’ I’ve learned she’s protective of me. But I also hear from her on many of these issues, ‘Well, why didn’t you say that?’ because she knows Frank, what he’s committed to, and she never questions that.

“I can do something I feel good about and I’ll come home and she’ll tell me the downside that maybe I don’t always want to hear. She’ll give me a perspective I need to hear that sometimes other people won’t give me. She’ll tell me the brutal honest truth. Cynthia’s tough, engaged, committed.”

His admirers marvel at his own doggedness.

“He’s an indefatigable worker and once he latches onto an issue that he sees as a moral challenge, he does not let go, and Whiteclay is a case in point. He’s the most principled man I know,” said Nebraskans for Peace coordinator Tim Rinne.

Joe Starita said LaMere is “hard working for his causes to the point of physical and mental exhaustion.”

“He’s a man who shows up for allies when nobody else is looking,” Nebraska Democratic Party chairman Jane Kleeb said.

Setbacks and losses he’s endured have not deterred him, including a serious stroke that required extensive speech therapy, and the death of his daughter, Lexie Wakan, who was a Creighton University student.

“He’s a man who’s had hardship, yet still continues to get up and stand up,” Kleeb said. “For me, that’s what Frank’s all about – he always shows up.”

For LaMere, it’s a way of life.

“Every day’s a fight, and if you keep fighting you win because others watch that. The impact of Whiteclay will manifest itself hopefully with a win in the Supreme Court and perhaps in some young leader who cares about these things. I’ve been in a hundred struggles in my life, lost almost all of ’em, but I was never afraid, and that’s what I want people to understand.

“If you’re not afraid, people see that as a victory because you cause others to take heart, to persevere, to take action.”

He’s glad his resilience to keep agitating, even in the face of intransigence and tragedy, inspires others.

“I’ll accept that because that’s what it is – you just keep working.”

He likes to say Whiteclay’s implications are “bigger than we can ever fathom.”

“Years from now, we will understand it is way bigger than us. I got to be a bit player. The creator of all things, said, Frank, I’m going to have you see what you can do, and along the way I’m going to cause you to struggle. I’m going to knock you down, and I’m even going to take something from you, and if you keep going, maybe I’ll let you change something.

“That’s the greatest work we can do.”

Reflecting on Whiteclay, he said, “This was an emotional roller coaster for all Nebraskans.” He chalks up the recent breakthrough to divine intervention.

“There’s things happening that are so strange,” he said.

He recalled a hearing in Lincoln on LB 407 introduced by Neb. State Sen. Patty Pansing Brooks to create the Whiteclay Public Health Emergency Task Force. LaMere testified. His son, Manape LaMear, sang a sun dance song. After finishing his sacred song, Manape asked if someone from Sheridan County was there to speak.

“A big guy got up and testified,” said LaMere. “He was asked, ‘Do you have enough law enforcement to take care of Whiteclay?’ and he answered, ‘Absolutely not.’”

“This man said some things absolutely nobody expected him, maybe not himself. to say. If you’re with those (monied) interests of Whiteclay, you’re not supposed to say that, you’re going to be ostracized. But for whatever reason, he told the truth. I attribute that to the powerful prayers said that day.

“You’re watching at Whiteclay a very spiritual journey. There’s something much bigger than us that has brought us to this point – that we would make such a great change for the Oglala Lakota people. I think it’s God’s work. From that I hope things will be better.”

He’s convinced “the greatest impact will not be felt for generations,” but added, “I’ve seen immediate impact right now.”

“I believe there’s a child whose mother and father were together at home and did not drink. I believe children are feeling very good Whiteclay is not open. I believe there’s been prayers by children that their parents be sober. I believe their prayers are very powerful. I think what we’re seeing may have to do with these children and their suffering and their prayers.”

LaMere has disdain for arguments that banning alcohol at Whiteclay will only move the problem elsewhere, thus increasing the danger of drunk drivers.

“Worrying about someone driving down Highway 87 who might get hurt by a drunk driver can’t be our greatest concern. Our greatest concern has to be the health and well-being of hundreds of children crippled in the womb by fetal alcohol syndrome (FAS). I’ve called out many on this. Where are pro-life people? Where’s the church? Children are crippled in the womb tonight and nothing’s said about it because there’s money involved. That’s troubling to me.

“We’ve crippled hundreds of kids in the womb on Pine Ridge – all so somebody can get rich, wrap themselves in a flag, and talk about this model of free enterprise. We cherish that more than we cherish life. It’s ugly to hear that but that’s what we’ve done. But we’ve always been afraid to accept that.”

Attorney John Maisch, whose documentary Sober Indian, Dangerous Indian includes LaMere, said, “I would say Frank’s empathy is what drives him. Frank is in a perpetual state of mourning. Frank has lost many family members and friends to addiction. I think that is partially what drove him to tackle Whiteclay. Frank lost his daughter, Lexie, and I think that is why he’s particularly drawn to fighting for those children, whether Native children lost in our foster care system or suffering from FAS as a result of their mothers drinking on the streets of Whiteclay. He’s drawn to suffering of others because he has also suffered great loss.”

LaMere acknowledged he’s “redoubled” his efforts since losing his daughter.

“And it’s not in any way substitution,” he said. “I don’t see it that way. I look at it very simply that now I stand on the shoulders of my daughter. In all of the things I’m doing right now perhaps I’m as bold as ever, and there’s a reason for that, for that is what she would have me do. If I hedge, she’ll say, ‘Why are you doing that? That is not who you are.’ I even heard her say in her young life: ‘This is my father, this is who he is, and this is what he does, and he does this for the people.’

“All I do for the rest of my life will be done in remembrance of my daughter because she was so committed at a very young age to the things I’m still committed to.”

LaMere’s glad Nebraska may finally own up to its sins.

“At long last Nebraskans have said perhaps it’s time for us to look at this. For once I’m pleased Nebraskans are not going to merely beg the question, they’re going to look at the impact of Whiteclay and maybe we’re going to act and make some of it a little bit better.”

As LaMere sees it, the whole state’s culpable.

“We as Nebraskans are unwittingly, unknowingly responsible for it. We need to act and to mitigate some of those things we’ve helped to cause at Pine Ridge. Even after all this, I say Nebraskans are fair – fair to a fault. Sometimes it takes us so damn long to act.”

The real culprits, he said, are “those in Sheridan County” who’ve turned a blind eye.

“The beer sellers and the rest are going to have hell to pay, not from Frank LaMere, but from the Supreme Court, the Liquor Control Commission, the attorney general, all these other interests, because when they take a good, long hard look at what’s happened, there there’s no way you can reconcile that as being anything close to normal or acceptable.”

As watchdog and conscience, LaMere said he lives out a covenant he made with his creator to serve others.

“I’ve traveled a million miles, spent everything I have, taken time from my family, taken time from myself. At some point, there’s a moral authority you feel. Nobody can give it to you or bestow it on you. Once you acquire it, it means nothing unless there’s a moral imperative that goes with that. I’ve tried to achieve some moral authority and the moral imperative that goes with it.

“I hear every day in my work with different agencies the words ‘by the authority invested in me.’ Means absolutely nothing to me. Doesn’t impress me at all. I don’t care how much authority you have – if you do not use it and if there’s no moral imperative to make things better, it’s meaningless. I meet with those people all the time. They have the authority, but they don’t use it. I’m not being cynical. I have the truth on my side.”

Whiteclay offered duly elected and appointed officials decades of opportunities to act, but they didn’t. LaMere never left the issue or let authorities forget it.

“Sometimes I can go into a room with a hundred people and I have the least amount of authority-power-title, but they have to listen to Frank because he’s put time and energy into it and he’s acquired that moral authority and he uses it. He scares them. They wish he would go away. People have to listen to Frank because he never goes away and there’s nothing in it for him.

“That’s why we made some changes at Whiteclay and that’s how we’re going to make change in our society – gain that moral authority and act.”

LaMere said his greatest asset is the truth.

“Any issues of change, even Whiteclay, you stand with the truth. I’ve learned that over many years. Because once the press conferences, the conventions, the rallies are done, the arrests are made, the petition drives are over, the legislative efforts go by the wayside, the only thing that’s left is the truth. It’s very important you stand with the truth and be recognized having stood with it.

“That’s the only thing that keeps me going. I’m firm, forthright and respectful and always telling the truth. Of late, it has worked in some respects for me.”

If Whiteclay confirmed anything, he said, it’s that “nothing changes unless someone’s made to feel uncomfortable and you have to make yourself uncomfortable.” In dealing with Whiteclay, he said, he expressed his “healthy disrespect for authority.”

“Maybe it’s a character flaw,” he said, “but you can put me in a room with a hundred people and if there’s a bully, before the night’s over I’ll probably butt heads with him.”

As a young man he was active “on the periphery” of the American Indian Movement. Later in life he got close to AIM legends Russell Means and Vernon Bellacourt. The men became allies in many fights.

“I saw Native people and non-Native people be bullied simply because somebody felt they had a position of power over them and whenever I see that I naturally react to that. I don’t care what the issue is, I’ll ask, ‘Who do you think you are? Why are you doing that? Why are you treating him or her that way?’ I’ve said that. I’ve always grown up with that feeling that if somebody is being mistreated, I will always speak up for them.”

Whiteclay offered a microcosm of predatory behavior.

“When I first went to Whiteclay 20 years ago, I took one look and you could see the Natives who went there did not have a voice and were not held in high regard. The owners and residents paid little attention to them. The other thing I saw there was the lawlessness and the mistreatment of vulnerable people being taken advantage of. I saw it and so could everybody else. Then I saw how nobody acted, so I thought perhaps I should give some voice to them.”

The still unsolved murders there of Little John Means, Ronald Hard Heart and Wilson Black Elk weighed on him. The alcohol-related illness and death of others haunted him.

“The alcohol coming out of Whiteclay has killed scores of Lakotas and we’re still waiting for that one white man or white woman, God forbid, who dies on the road between Rushville and Whiteclay.’

The documentary The Battle for Whiteclay shows LaMere at a hearing railing against “the double standard” that overlooks Native deaths.

“It means we feel there’s two classes of citizens here in this state. Would we allow the things in Whiteclay in western Omaha or southeast Lincoln? I don’t think so. Scores of our people … victimized, orphaned, many of our people murdered. God forbid that one young white woman, one white man, die at Whiteclay tonight. We’d shut the damn thing down in the morning, and the pathetic thing about that is we all know that’s the truth.”

LaMere feels that double-standard still exists.

“We want everything at Whiteclay to be just right, but we cannot even take care of the clear and simple. There’s one thing you know you can do under the law – you can shut them down, and they’ve done that, and they’re having problems keeping them shut.”

He refuses to be patronized because he’s learned from experience that playing the game doesn’t get results.

“You’ll pat me on the head and say, Frank, you’re a great guy, I appreciate what you’re bringing to us, but I know in the back of your mind you don’t want to change anything. You’ll even give me a permit to march or picket. But I bet you won’t do that for 20 years. You can handle a year and then say – this damn guy never goes away, perhaps we should sit and listen to him.”

LaMere regrets the one time he took things for granted.

“I made a mistake many years ago. I raised the issue of Whiteclay. We got a lot initiated with then-Gov. (Ben) Nelson. He put together groups of officials from Sheridan County, Pine Ridge, state agencies, and we talked about the lawlessness issues up there. So we got something in the works a long time ago and I appreciated that process. I made the mistake though of thinking it’s a no-brainer. I thought all I have to do is bring this back to Lincoln and Nebraskans will change it.

“I was too hopeful. Many Nebraskans would change it but those in power did not. Where there’s money involved, nothing is a no-brainer. People are going to weigh the money and the impact. Those with influence and monied interests are probably going to win out. That’s what I watched. Whiteclay is perhaps the poster child for greed, not in Neb. but maybe in the whole nation. It ranks up there with Flint (Mich.).”

For too long, he said, the attitude about Whiteclay was, “We know what we’re doing but it’s going to cost us money, it’s going to cost me to do my job in the public trust. Just leave it the way it is.” Because the problem was allowed to persist, he said, “Whiteclay will go down in our history as something we tolerated and that we will forever be ashamed of, and we’re only going to understand that when the Supreme Court makes that final decision to shut ’em down. Then we’re going to take a look at what we’ve truly done.”

Meanwhile, LaMere won’t rest easy. When well-meaning people offer condolences about Lexie and lament her unfulfilled promise, he said he accepts their sympathy but corrects them, saying, “There’s no unfulfilled promise – it’s more for you to do, it’s more for me to do.

“That’s how it is. That keeps me going. That’s the way I’ll be until I’m not here anymore.”

Read more of Leo Adam Biga’s work at leoadambiga.com.

Who’s Going to Pay? Before and After the Affordable Care Act

March 16, 2017 Leave a comment

There’s nothing like getting current, though it’s hard to do when you write for a monthly. Still, in this cover story I wrote for the March 2017 issue of The Reader (http://www.thereader.com) I think I mostly managed to stay relevant to the topic of health care coverage in America, the forces pushing and pulling for and against the Affordable Care Act and what the ACA has meant in terms of gains and what its repeal and replacement would mean in losses. For the piece I spoke to local professionals on the provider and insurer sides of the equation for their take on how we got here and where we might be heading. The story went to press with us knowing Congress was working to repeal and replace Obamacare, though no one knew what that entailed, and then just about the time our story got published that plan was unveiled. As you know by now, the proposed new plan was met with disdain from all quarters, especially consumer rights groups and elected officials, even conservative Republicans, who heard loud and clear from constituents that they they oppose the called for cuts that would cause many people to lose insurance. As the push back continues, town halls and debates ensue, and presumably negotiations, revisions and compromises will get made. Meanwhile, America still can’t get its health care system to work equitably and efficiently.

 

Who’s Going to Pay? Before & After the Affordable Care Act

©by Leo Adam Biga

Appeared in the March 2017 issue of The Reader ((http://www.thereader.com)

One accident, one illness could be catastrophic. Not just medically, but also financially.

Families stood to lose almost everything in medical bankruptcies when health insurance companies rejected those with pre-existing conditions and capped their policies with lifetime limits.

Uncovered costs helped health care expenditures soar, more than tripling in the last 20 years according to the federal National Health Spending Report. In 2015, the federal government was the largest payer of health care, covering 37% of the total cost through its two programs Medicaid and Medicare.

The curve was starting to bend.

According to the Kaiser Family Foundation, health insurance costs increased 63% from 2001 to 2006 and 31% from 2006 to 2011. That number dropped to 20% from 2011 to 2016.

Part of the reason was the Affordable Care Act and a landmark shift in how health care was being offered. Through a series of tax increases targeting high-income earners, the ACA was able to fund experiments in in- novation while subsidizing the cost of bringing almost 30 million Americans into the health insurance system.

With the end of Obamacare at the top of the national conversation, The Reader talked to the major stakeholders about life before and potentially after the Affordable Care Act.

It’s not just the $2 billion in federal revenues Nebraska passed up for health insurance, or the 275,000 Nebraskans with pre-existing conditions that could be denied health insurance, according to the Kaiser Family Foundation. It’s not even the estimated 165,000 Nebraskans that would lose health insurance, an increase of 111% of the uninsured, according to the Economic Policy Institute, leading to almost 3,000 jobs lost and $400 million in federal health care dollars gone that we subsidize.

It’s also about the way we take care of each other.

Quality of Health Care Over Quantity

America treating healthcare as a commodity helps explain its high delivery and coverage expense. Characterized by historic lack of incentives to drive prices down, providers and insurers dictate terms to consumers. Subsidies to assist low income patients who can’t pay out of pocket get passed along to other consumers. But affording care and its coverage is a burden even for the middle classes.

Amid runaway costs and coverage gaps, America’s clunkily moving from a volume to a value-based system as part of long overdue healthcare reform. The Affordable Care Act was passed in 2010 after contentious bipartisan debate. The statute’s full roll-out began in 2014.

Nebraska Medicine CEO Daniel DeBehnke said, “The tipping point that brought the ACA forward is really the unsustainable growth in our country’s healthcare costs.”

The calculus of people not being able to afford care translates into real life implications. Untreated chronic diseases worsen without treatment. Early diagnoses are missed absent annual physicals or wellness checks.

Championed by President Barack Obama, who promised reform in his campaign, the ACA’s enacted consumer protections and mea- sures holding providers account- able for delivering value.

Nebraska Methodist Health System CFO Jeff Francis said organizations like his have “con- tracts and monies at risk for hit- ting certain quality items, not just with Medicare, but with some of our commercial insurers as well, Five or ten years from now,” he added, “we’ll probably have more at risk financially from a quality and outcome standpoint. Recent federal legislation changed the way physicians get paid by CMS (Centers for Medicare and Medicaid Services). Starting in 2019 they’re having potential penalties depending on whether they’re hitting certain quality metrics or not.”

He said the stick of such punitive measures works.

A new Standard in American Health Care

Aspects of Obamacare, such as the individual mandate and public health exchanges, have detractors. Federal lawsuits challenging it have failed. But its intact survival is in jeopardy today. A chief critic is President Donald Trump, who with the Republican controlled Congress vowed to repeal and replace, though that’s proving more daunting in reality than rhetoric. On February 16, GOP leaders shared a replacement plan with tax credits for buy- ing insurance and incentives for opening healthcare savings accounts, but no details for funding the plan or its projected impact on the insured and uninsured.

Debehnke said, “I don’t think there’s any question, regardless of where you land politically, there are components of the current ACA that require tweaking. Even Democrats will tell you it wasn’t exactly perfect – nobody said it was going to be perfect. It was understood there were going to need to be changes as things move along.”

There’s widespread consensus about the benefits accruing from the ACA. New subsidies allowed millions more people nationwide and tens of thousands more in Nebraska to be insured, in some cases getting care they deferred or delayed. Insurers cannot deny coverage for pre- existing conditions or cancel coverage when someone gets sick. Plans must cover essential care and wellness visits. Adult children can remain on their parents’ insurance until age 26.

Francis said, “A lot of good things have come out of this. We’re focusing on well- ness, we have fewer uninsured, we’re having better outcomes for patients. I think there’s satisfaction with the improvements. I just think there’s disagreement with how it’s occurring or being done.”

“You can’t believe the difference it’s made by setting minimum standards for health insurance,” said One World Community Health Chief Medical Officer Kristine McVea, “so that things like child immunizations and mammograms are covered.”

Since the ACA’s adoption, uninsured 18-to 24-year-olds in Nebraska dropped from 25.5 percent in 2009 to 12.4 percent in 2015, according to the Kids Count in Nebraska Report.

McVea said, “At One World people get assistance in enrolling for health insurance. Counselors guide them through the market- place. People are really becoming more savvy shoppers. Improved health literacy has been a result of this process, you can really compare for the very first time apples to apples in terms of different plans. That has been a tremendous boon to clients.”

Not everyone included – Nebraska drops the Kick- back

Healthcare disparities still exist though. In Omaha 24% of adults living below the poverty line

lack health coverage while 3% of adults with medium to high in- come are uninsured. Some 36% of Hispanic adults, 15% of black adults and 5% of white adults are uninsured in the metro, ac- cording to numbers reported by The landscape, a project of the Omaha Community Foundation.

McVea said, “The poorest of the poor are not eligible for the marketplace at all because that part of the Affordable Care Act carved them out thinking states would cover them with Medicaid. Well, Nebraska’s elected not to expand Medicaid, so there’s this whole gap of people not insured. Then there’s prob- ably another tier who do get assistance through the marketplace, but considering the economic pressures they’re under, even with the assistance, it still falls outside their reach to get good healthcare.”

The Kids Count Report found 64 percent of uninsured Nebraska children are low-in- come — likely eligible for but not enrolled in Medicaid or Children’s Health Insurance program (CHIP).

Past Nebraska Medical Association president Rowen Zettermen said, “In Nebraska we have somewhere in the neighborhood of 60,000 to 90,000 uninsured people that would have otherwise been eligible for Medicaid expansion. you find the highest percentage uninsured rates in rural counties. We still have 20 some million uninsured in this country. A number may have insurance but they’re underinsured for their various conditions. Ideally, everybody should be able to establish a healthcare proposition with their physician, nurse practitioner or physician’s assistant to access care whenever they need it.”

Then there are federal DSH monies to fund Medicaid expansion the state foregoes because the legislature’s voted against expansion. Gov. Pete Ricketts opposes it

as well. Disproportionate Share Hospital payments are subsidies paid by the federal government to hospitals serving a high percentage of uninsured patients. Nebraska hospitals write off uncompensated care cost while getting no money back for it.

Zetterman said, “We could expand Medic- aid and take advantage of the roughly $2 to $2.5 billion that’s failed to come into the state. It would have paid salaries for more people in physicians offices and a variety of things that would be taxed and bring in more revenue.”

DeBehnke of Nebraska Medicine said, “Being a large hospital health system that takes all comers, we have a Medicaid percentage of our business. We would be better off in a Medicaid expanded state. We would like to see more coverage for the working poor. That’s what Medicaid expansion is – providing coverage to the working poor. Those who don’t currently qualify for it would under an expansion.”

Proposed federal community block grants could expand coverage. DeBehnke cautioned, “We just have to be sure there’s good control around how those dollars are used and they actually go for healthcare coverage. Expanding coverage to all people is really the key.”

Nebraska State Senator Adam Morfield is the sponsor of lB 441, which would expand Medicaid in Nebraska. The bill is scheduled for a March 8 Health and Human Services Committee hearing.

The care-coverage-income gap may be more widespread than thought. Kids Count Report findings estimate 18.5 percent of Nebraskans are one emergency away from financial crisis.

Preventative Care is Long-Term Savings

Having coverage when you need it is a relief. Insurance also motivates people to get check-ups that can catch things before they turn crisis.

“A woman having symptoms for some time didn’t have any insurance and she waited

before she sought care,” McVea said. “By the time she came to us for diagnosis she already had a fairly advanced stage of colon cancer. She’s undergone chemo- therapy and surgery and is now living with a colostomy. That didn’t have to happen. We see things like that every day – people who’ve let their diabetes and other things go to where they have coronary artery dis- ease, and that’s not reversible. We’re trying to get them back to the path of health with treatments, but they’ve lost that opportunity to maintain a high quality of health.”

Zetterman said, “There’s good data to show patients with cancer who don’t have insurance tend to arrive with more advanced disease at the time of initial discovery because they come late to seek care.”

That pent-up need is expressed more often, McVea said, as “people have insurance for the first time or for the first time in a long time.”

“We’ve seen a lot of people come in as new patients saying, ‘I know I should have come in a long time ago, and I’ve just been putting it off.’ Many are middle-aged. They’ve been putting off chronic health conditions or screening tests or other things for years. We see people come in with diabetes or high blood pressure that’s out of control and within three months we get them to a point where everything’s in control, they’re feeling better, they have more energy, they’re feeling good about their health. We’ve maybe given them advice about diet and exercise and ways they can keep themselves healthy.”

More positive outcomes are prevalent across the healthcare spectrum.

“I would say overall the average patient is having a better experience and outcome now than they were five years ago,” Nebraska Methodist’s Jeff Francis said.

One World’s CEO, Andrea Skolkin, said, “We’ve been able to reach more people living on limited income so our services have been able to expand both in terms

of numbers of patients we care for as well as types of services and locations.” One World opened two new satellite clinics with help from ACA generated monies. “As we’ve opened new clinics we’ve seen a number of people that had never been seen or delayed being seen with very complex

medical and sometimes mental health issues – and it’s more costly. We grew from about nine or ten percent of patients with insurance to close to 15 per- cent. For newly insured patients it’s meant some peace of mind.”

Fewer insured people, Higher Costs

She and her community health center peers favor more afford- able coverage to increase the numbers of those insured.

Zetterman said high premiums and co-pays present obstacles that would be lessened if everybody got covered. “The financial burden on the individual patient and family for health- care right now is too high.”

DeBehnke said, “A lot of the

burdens of those premiums in terms of high deductibles and other things have been shifted to families. There has to be some degree of subsidization if we’re going to make this all work. Regardless of where we land with this, the financial burden on the individual patient and family for health- care right now is too high.”

For the poor, the last resort for care continues to be the ER.

“If you’re uninsured the one place you can go in this country is to the emergency room of a hospital because the laws say you cannot turn anyone away from there,” said Zetterman. “As a consequence the uninsured make use of the ER because it guarantees they’ll get cared for – at least at that moment. The ER is the most expensive place to go for things that could otherwise be handled in a healthcare office.”

Zetterman said America’s handling of its social contract and safety net means “we cost shift in the healthcare environment to pay for things.” “In Nebraska, where we didn’t expand Medicaid,” he said, “we cost shift from private insurance and healthcare providers to people who have private insurance. They help pay for the uninsured-underinsured. We’ve estimated that to be well over a billion dollars. We can’t control costs reliably until everybody is in the system with some kind of a paid healthcare benefit. That can include all the current federal and state programs as well as commercial insurance that’s out there.

“Once we no longer cost shift to pay for healthcare we can begin to address the questions where are we spending our money and why are we spending it in those areas. Then we have a chance to control the growth of healthcare costs.”

Skolkin said, “A lot of hands in the pot helps add to the cost. There’s a lot of system inefficiencies, particularly in billing and credentialing, that could be made a lot of easier. That would save resources.”

DeBhenke said, “As the healthcare industry, we have not been engaged to the degree we need to be to actually decrease overall cost of care because frankly from a pure financial standpoint it’s not been in our best interest. The health systems, providers and other organizations have to really get be- hind this whole idea of providing value, of decreasing overall total cost of care while improving outcomes for patients. That’s got to work in parallel with legislative and subsidization levels at the federal level.”

He said until there’s more buy-in from “young invincibles” – 20-somethings in good health – to broaden or balance the risk pool and thus reduce payouts, costs will be a problem.

“Certainly the pricing needs to be attractive to those individuals to broaden the pool. And frankly the benefits associated with products on the exchange need to be attractive so those individuals feel comfort- able and actually want to have coverage. Those least likely to go to the marketplace and buy individual health insurance plans are exactly the people we want to do that to broaden the pool. Healthy individuals that don’t utilize healthcare much soften the financial blow.”

Repeal Without replace is A mess, Why not repair?

The ACA’s meant adjustments from all healthcare stakeholders. Opponents have resisted it from the start and that fight continues. In early January the Republican-led Senate began reviewing ACA to try and garner enough votes to repeal it through the budgetary reconciliation legislative process.

“Unfortunately President Trump has focused on what he’s going to take away without have a plan in place,” said Kristine McVea, “I think that’s been harmful. There’s a lot of fear and uncertainty among our patients. These are people who struggled without health insurance who finally got a chance at taking care of their health and are now very afraid of the possibility that’s all going to be taken away. We hear this every day from people coming into the marketplace and coming into see us for care, I think the capricious statements made by this administration have fueled that.”

More recently, talk of flat-out repeal has given way to amend or modify in acknowledgment of the gains made under ACA and the difficulty of dismantling its far-reaching, interrelated tentacles, absent a ready-to-implement replacement. The political fallout of taking away or weaken- ing protection people have come to rely on would be severe.

“Once leadership has really started to

dig into what it would mean to repeal this outright and try to replace it they’re finding it is not a simple thing to do and the health and coverage of millions of people are at stake,” said James Goddard, an attorney with the public advocacy group Nebraska Appleseed. “So things are slowing down with the recognition they need to be careful with this, and of course they do.

“I think the change in the way it’s being discussed is a reflection of the reality that this is a dramatic thing you’re discussing altering and they need to do it the right way. Much of the ACA hangs together and one thing relies on another and if you start pulling pieces of it apart, you have the potential for the whole thing to fall down.”

Zetterman said he and fellow physicians favor a cautionary approach.

“Most of us would say the Affordable Care Act should be maintained and improved. There are dangers in taking it away and replacing it because it’s now in so many different places.”

Nebraska Appleseed attorney Molly McCleery said total repeal would affect many. “Initial Congressional Budget Office projections show 18 million people would lose coverage, and then in the out years, 32 million would lose coverage – both private and public. The Urban Institute’s state-by- state impact study found 200,000-plus Nebraskans with a pre-existing condition would be impacted if that consumer protection would be taken away.”

Jeff Francis said, “The new ‘r’ word I’m hearing is repair. The consensus seems to be to keep what’s popular and working and change what’s not.”

EDITOR’S NOTE: Details of the recently proposed GOP replacement had not been released as of this printing.

Daniel DeBehnke said of the current climate, “I think it’s extremely confusing because it’s complicated. It’s like a balloon – you poke in one area and something bulges out in another. I think people are frustrated, and rightly so, they pay a lot for healthcare. It’s not just as simple as I-pay- a-lot-for-my-healthcare, ACA is bad, let’s get rid of it.’ There are layers of complexity. We may not like exactly how things are funded or how some components are dealt with. We may not agree totally with all the tactics to get there, but at the end of the day we’ve got more people covered.

I don’t think anybody has the appetite to change that back.

“We just have to figure out how to incrementally lessen the financial burden while maintaining the real goal – more people covered and providing value for the money being spent.”

He said the best course of action now for providers is to “just take really good care of patents and decrease unnecessary utilization and duplication of services,” add- ing, “It’s what everybody wants anyway.”

Fixing the marketplace

Meanwhile, on the insurers’ side, some carriers have left public health exchanges after incurring major losses. This state’s largest healthcare insurer, Blue Cross Blue Shield, opted out of the volatile marketplace.

“Since we started selling on the ACA marketplace we’ve lost approximately $140 million,” executive vice president Steve Grandfield said. “We have a responsibility to all our members to remain stable and secure, and that responsibility was at risk

if we had continued to sustain losses. The public marketplace is unstable, which has driven increased costs and decreased com- petition and consumer choice. The higher premiums go, the more likely people, especially healthy people, drop their coverage. That means the majority of people remain- ing on ACA plans are sick, with increasingly higher claims, which drives premiums up even further.”

He cited instances of people gaming the system by buying plans when they need care, then dropping them when they longer need it.

Granfield said Blue Cross supports a well modulated ACA overhaul.

“It’s important to put in place a smooth transition. We would like to see regula- tory authority for insurance returned to the states, including rate review and benefit design and closing the coverage loopholes that lead to higher consumer costs.”

He has a long wish-list of other changes he wants made.

The leaders of two major Nebraska health provider systems say they haven’t seen any impact from the BCBS defection because there are many other insurers and products on the market. The executives were not surprised by the move given the fluid healthcare field.

Nebraska Methodist’s Jeff Francis said, “There were a lot of unknowns. I think it takes several years through the insurance cycle to be able to correct those kinds of unknowns, especially the way the federal government handles the bidding and setting of rates That’s why you won’t see craziness or changes in the rates in the years to come because they now have several years of experience with this new population and they’re then able to price accordingly.”

Daniel DeBehnke of Nebraska Medicine said, “Regardless of what happens in Washington, if the exchanges are kept in place there will be some changes made either in the pricing or pool that will help organizations like Blue Cross perhaps get back in that business.”

Quality Health Care Starts with Collaboration

Collaboration is key for containing costs in a system of competing interests. More U.S. healthcare decisions are happening outside silos.

Francis said, “A big change in the last 10 years is opportunities to work more collaboratively. In the past it would have been much more stand-alone. Now the hospitals and physicians are working more closely. Nebraska Methodist is part of an account- able care organization – Nebraska Health Network, along with Nebraska Medicine and Fremont Health. We recognize the importance of learning better practices from each other so we can pass that along to make healthcare better for the community and for employers paying for their employees insurance.”

One result, he said, is “less antibiotics pre- scribed by our family doctors at Nebraska Medicine and Methodist Physicians Clinic.”

Breaking the chains and being set free

December 28, 2016 Leave a comment

A dear friend asked me to share this personal witness for those of you afflicted with addiction or who have a friend or loved one caught in the struggle. The hope is to cast some light in the darkness. Addiction can be an isolating thing and with the ice storm shutting us in and everything down, the loneliness, the temptation, the internal conflict can be overwhelming, So, for those needing it, please heed these words and let go of all that fear and anger, of all that hopelessness and despair, to know, receive and accept the love that is in you and that is inherently you. There is no lack in you, except maybe surrender and faith. Anyone fighting the good fight will understand what the title of this message “Breaking the chains and being set free” refers to, but it is in fact applicable to so much of our human condition. The thing to know is that once the shackles are shed, all you need do is follow the light and let your spirit fly free. That’s when you can soar to the sun. The freedom starts by acknowledging you have a problem, that you can’t lick it alone and that you accept the healing gift of a higher power to break the chains holding you down. It’s all in how you think and what you do. But true freedom only comes from getting out of your head and getting in touch with your heart. And, so, with no further ado, I present my friend’s call to the heart on this cold winter’s night. May it warm you and light the way out of the dark.

 

 

Breaking the chains and being set free

The time has come to part ways.

A long time ago, you saw the gaps in me and made me believe you filled the void when nothing else could.

That was a lie, of course, but I didn’t know it then. I didn’t know it for a very long time.

Like a lost child, I sought comfort wherever I could find it.

Even when I discovered the truth, I found it hard to say goodbye.

You are such a bedeviling creature and I am such a slave to your seductive charms. You go right for my weaknesses and unless I am careful I succumb every time.

You are the ultimate illusionist. Even though I know better by now, if I find myself tired. angry, afraid, depressed or lonely, you will still appear to be the answer, the relief, the escape I desire – unless I am honest with myself and willing to see through the mask.

I know now what I seek is love of God and love of self, not lust. I seek wholeness and unity of mind, body, spirit, not betraying oaths for momentary pleasures that only splinter me. What you offer is a mirage, not even a temporary fix, but merely a distraction to numb the pain. In the end, you don’t fill me or complete me, you empty me and keep me shattered in pieces.

Like a fool, I sought to purchase love, solace, oneness. These things cannot be bought or sold. They can only be claimed as rightful, divine-endowed parts of me.

But I would not believe that I was God-worthy. I would not accept that I was created from love, by love, for love.

Feeling loveless is no way to live. Nothing good comes from the desperation and despair that follows.

In spurning God, I let a hole in my heart fester. Like the seducer you are, you are always eager to fill that void, though in reality you can’t.

You are the Pandora of the fabled box. Once I open that chest of alluring pleasures, your stream of temptress guises are too many and enticing to avoid. One or more is sure to envelop me if I let things go that far.

You are the mythic siren calling me and your bewitching powers cast a spell that pulls a veil over reality, obscuring moral bounds. so that I fall back into your wiles again, suddenly grown blind to the truth, willing to risk all, to cross boundaries, to betray myself and others.

In the haze of your intoxicating pull, it’s as if all sound judgment is rendered powerless.

You make it seem as if I have no will to resist and in fact by the time I do entertain your delights, I am in your control.

With some perspective, that we call sobriety, I now know that I always have a choice.

It begins by admitting that I have a problem but also by believing that it need not define me. It is a part of my nature. It is a chronic affliction that thrives under certain conditions. If I am in a vulnerable state of mind, heart and soul, then I am at risk. It doesn’t mean I will act out, it just means that is when I am most susceptible, therefore that’s when I need to be most vigilant.

Those of us who identify as afflicted this way find that recovery, even in our darkest, lowest times, is always freely offered and within our grasp. The solution is surrender to a Higher Power of our choice. Whatever name you give it, healing flows from this wellspring of love that is the source of all life.

This disease feeds on negative energy. Recovery springs from positive energy.

Recovery is the conscious, intentional act of walking out of the darkness and into the light. It is a choice that must be made over and over again. It means bravely facing life one day, one action, one decision, one thought, one feeling at a time. It requires basking in the glow of life, with all its intensity or boredom, its anxiety and discomfort, its pain and pleasure, rather than hiding in the gloom of shadow and looking for some artificial high.

Man in despair

I am not cured. There is no such thing as a cure where this is concerned. I am, however, informed, armed with tools, working a program, taking steps and slowly making progress. There are stumbles along the way. I sometimes take wrong turns. I sometimes relapse. Been there, done that.

I am getting too old for this shit.

The longer it is with me, the more rewiring my brain requires. A lifetime of bad habits and patterns in my thinking and reacting must be unlearned and new, healthier ones put in their place. It’s like an old dog learning new tricks.

Starting over at 58 is not a good picture or prospect, but it’s a lot better than dying alone or being a sullen mess feeding on chaos and misery. That’s where this leads if left unchecked. Ruined relationships, losing your spouse, your family, your home, your livelihood, your name, your health, even your freedom.

Did I mention losing your mind? You see, this affliction is a form of insanity. Despite my best intentions and full recognition of right and wrong, I am liable to turn a blind eye and throw everything away I say I cherish for a fix. I’m liable to lie and cheat, to break promises, vows, oaths. I’m liable to sabotage goals and plans.

I have been lucky so far. Nothing lost. Except peace of mind. Except causing various people in my life untold pain. Making amends is a lifetime project.

The past can hold me hostage if I let it. This problem can enslave me if I empower it.

Revealing my truth in this forum feels awkward but right. It is a public testimony. It is a declaration. It is a prayer. This disease is all about secrets and rituals, about holding onto old wounds and hurts and getting stuck in the muck and mire. Recovery is all about honesty and transparency, about housecleaning, about moving forward and freely. Telling my story, my truth, symbolizes my saying goodbye to something I don’t need anymore. I therefore let go of the crutch and the anesthetic of addiction. I let go of the fear, resentment and self-pity that lead me to seek these false supports and cause me to become dependent on them.

Mark this as my release – release from the bonds and chains that held me captive. I hereby claim that release for myself. I hereby resolve to choose freedom, sobriety, serenity.

I am scarred but not broken. I am healing. I am free.

 
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