Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!
Christopher Newport University (CNU) released a poll yesterday and boy have the headlines about it been misleading. A writer at Slate started with the headline “Polls Show Democrats Losing Medicaid Debate in Virginia” while many local news outlets exclaim “Majority Oppose Virginia Medicaid Expansion.” The Slate writer did a good job of addressing some problems with his own headline in the piece, but the headline is hard to ignore.
What gives? A poll by the same University in February showed a very different result. The April poll - 53% of those polled do not want “Medicaid expansion” while 41% support expansion. The February poll showed 56% polled SUPPORTED expansion while 38% were against expansion. To this observer’s eyes, this is quite the dramatic change in 2 months, and focusing on the topline difference it appears 15% of Virginias changed their minds in the last 2 months.
I want to focus on the poll, which can be seen in its entirety here. Many polling items are ignored by the headlines, as are differences in the wording of the questions from February to April diminishing their apples-to-apples comparison. The most glaring omission from the headlines and stories is the wording of the questions. Virginians clearly do not want to see Medicaid expansion if the federal government does not pay its share. This was true in the February poll, and now is more pronounced in the April poll. This demonstrates the power of the negative propaganda of Medicaid expansion opponents. Their claim is that the federal government cannot afford expansion, and will fail to meet its statutory obligations to supply the funding to Virginia. This false, yet common claim is poisoning the debate and it is disappointing that CNU chose this wording to its questions.
Also ignored, and I feel the most dramatic, is that 71% of respondents say that Republicans and Democrats should compromise! Why is this not getting headlines? I would think the compromise that emerged from the Virginia Senate, “Marketplace Virginia,” should have had a much more prominent place in this poll. If Republicans and Democrats in the VA Senate have already come up with a compromise proposal, how to Virginians feel about that?
Unfortunately, this is all about the political horse race and ignores the 400,000 Virginians who should be newly eligible for Medicaid under the Affordable Care Act. It ignores the majority of newspaper editorial boards, economists, health care advocates, hospitals, physicians and even health insurance plans that strongly support expansion.
I think it’s media malpractice to run these headlines when a mere 806 out of 8.2 million Virginians were polled, and the questions give credence to the false arguments of expansion opponents. I would love to see pollsters ask respondents what alternative they suggest to Medicaid expansion - should Virginians simply be left without health insurance coverage? I would also like to see a focus on patients, not politics, as we have an opportunity to improve the lives of millions left in the coverage gap due to the ideological intransigence of expansion opponents. Refusing Medicaid expansion is masochism, pure and simple. Refusing expansion hurts taxpayers, job seekers and most of all the human beings who should be given the chance to have health insurance coverage.
As we celebrate the 7 million and counting Americans with new coverage, it is important to remember the window hasn’t closed for everyone still seeking coverage.
I volunteered at an enrollment event on March 31 in Dublin, California and I can tell you personally of the many people who tried to enroll, wanted to enroll, and were unable to finish before the deadline. In addition, I have been corresponding by email and phone with patients, friends, colleagues, and community members all across the state with similar stories. Luckily for them, and for many people you may know, there is an opportunity to finish their enrollment.
The Special Enrollment Periods allow people to enroll in health coverage outside of the Open Enrollment Period, if they previously tried to enroll but couldn’t through no fault of their own. Those who tried to enroll in health coverage any time before midnight on March 31 and didn’t finish, can still get coverage for 2014 -- but they must act quickly.
Patients must finish enrollment by April 15 to get coverage for 2014. If they enroll by April 15, their coverage will begin May 1.
WHO ELSE WILL QUALIFY THE FOR
SPECIAL ENROLLMENT PERIODS?
- Exceptional circumstances
- Misinformation or misrepresentation by a non-Marketplace enrollment assister
- Enrollment error
- System errors related to immigration status
- Display errors on Healthcare.gov
- Medicaid/Marketplace transfers
- Error messages which stopped your application
- Unresolved casework
- Victims of domestic abuse who were not allowed to enroll
- Other system errors that kept you from enrolling
And don't forget Medicaid patients and those who have a qualifying life event like getting married, having a baby, moving to a new area, or losing other health coverage can enroll all year round!
Additional materials from HHS:
Patients must request a Special Enrollment Period and can do so by dialing the Marketplace Call Center at 1-800-318-2596 or visiting Healthcare.gov/marketplace/ to make the request in their state-based Marketplace. It's important to check with your state exchange as some states have different deadlines.
We will continue to share information with you as it becomes available. Please continue to share your feedback on what's working with special enrollment periods and as you see newly uninsured patients.
Carolyn is a Preventive Medicine Resident at the University of California San Diego and the State Director of California Doctors for America.
“7 million is a lot of people. For those of you who don't see patients, you should know that every day I am seeing new patients who have not had coverage for a long time. Today alone I saw three new families who had been uncovered for three years. And there is a small business benefit. I am hiring two docs.” – Dr. Zee Beams, pediatrician, mother of four, DFA deputy field director 2009-2010
I still remember him. Grizzled face, red cracked lips, shaky hands, propped up in bed so he could breathe a little more easily, scrolling through his Blackberry to check in with his clients even as – unbeknownst to all of us – he was in the final days of his life.
David was my patient seven years ago. He lost his health insurance, and he didn’t know where to turn when his Crohn’s disease went bad. By the time he got to the hospital, he had kwashiorkor – he was starving to death and had heart failure, kidney failure, anemia. We tried so hard to save him, but we failed. He died in Los Angeles – just minutes away from the opulence of Beverly Hills where Bentleys and Ferraris are standard.
That day, I decided I had to tell his story. I didn’t know how or where to tell it – but I knew his story wasn’t unique. I knew that I couldn’t quietly practice medicine in a system where tens of thousands of people like David die every year.
In the 5 years I’ve been a part of the Doctors for America movement, I have now told David’s story to millions of people because he is no longer here to tell it. I have told his story because I knew that we could change the future for people like him – that we had to change the future.
Today, thanks to people like you, David’s story is being replaced with the stories of families who have coverage for the first time in years. More than 7 million people signed up for health insurance through the marketplaces. When you add in Medicaid expansion, young adults on their parents’ plans, and those who signed up directly through insurance companies, that number could be as high as 20 million.
The world has changed for the better for millions of people because doctors and medical students and concerned citizens stepped beyond the halls of our hospitals and clinics, sacrificed family time on nights and weekends, took a risk and told your stories, chose to believe that together we could make things better.
In 2009, when people said doctors were too busy and too risk-adverse to get involved, we spoke by the thousands from every corner of the country. In 2010, when the health reform bill looked doomed in Congress, we marched on Washington. In 2012, when political fighting threatened to sink the fledgling law, we organized a bus tour through the South to talk to real people in real communities. In 2013, when a flawed rollout of enrollment had many people speaking of disaster, we thought about our patients who needed coverage and kept moving forward.
Whether you put your name on a petition, held up a sign at a rally, shared your patient stories in the local paper, contributed funds, recruited colleagues to the cause, or stepped up as a leader – you have been a part of building a movement and changing the future of health care for the nation.
There is much work to do in the months and years to come. We have learned so much along the way – from our successes and failures, triumphs and missteps. I know that we can build and expand our efforts to achieve even more together – to raise that bar to 100% coverage, to coordinate our care and focus the health care system squarely on patients, to lead our communities to preserving health in the first place.
But today, in this moment, I hope you will join me in celebrating the progress we've made together in the pursuit of better health and better care for all our patients.
With gratitude and solidarity,
Alice, on behalf of your Doctors for America family
P.S. Here are just some of the highlights from the Coverage is Good Medicine and the impact we have had across the country.
With the open-enrollment period closing in a few short weeks, we all need to know what that means for our patients. As a second year medical student, I felt like I knew something about the policy changes implemented in the ACA, but I had no idea what to say if a patient or family member asked me how to sign up. After sitting in on a presentation by a Doctors for America Illinois State Director, Dr. Ram Krishnamoorthi, I was amazed at how simple the process was. I wanted everyone to know! So, as part of the effort to educate students and providers about the Affordable Care Act, I partnered with doctors from the University of Chicago to create an ACA pocket reference card.
Stick it in your white coat and learn what you need to know about the ACA. Learn how to screen patients for health insurance, answer basic questions, and point them in the right direction!
To give you a sense of the card’s success to date, here is a short story about how a University of Chicago student used the pocket card.
"Just wanted to let you know that one of the MS1s (Lola) ran up to me today to tell me that she used the pocket card with a pregnant patient with several health complications who is totally eligible for coverage but didn't have any. Quote:
"The card works just like you said. I called the number and now a Navigator is coming to the shelter next week! They know so much. I'm really glad that you had that meeting."
It is crunch time now and there are so many people out there, just like this one, who need encouragement and information about how they can get covered! Print out the pocket reference card and share it with your patients! Use this to answer your own questions and get educated!
P.S. We are working on pocket cards for specific states. If you would like to partner in this process, please email email@example.com. Also, don't forget to sign up for the DFA National Leadership Conference, I will be there too!
Aaron Silver is a medical student of the Loyola Stritch School of Medicine and a member of Illinois Doctors for America.
Remember our widely successful nationwide “Patients Over Politics” Bus Tour of 2012? Well, we’re on the road again -- hitting cities across Florida with some of the highest rates of uninsured on a “Coverage is Good Medicine” bus tour to raise awareness for the new health benefits available during the final months of open enrollment.
Along the way, we will be holding enrollment fairs and partnering with local organizations, elected leaders, and navigators in Tampa, Orlando, Jacksonville and Tallahassee to help answer questions about the new health law and get Floridians covered during the final weeks of open enrollment.
Here are the Coverage is Good Medicine enrollment tour dates. We need your help making this tour a success by 1) coming to an event to talk with the uninsured and 2) sending uninsured people you know to these events to get covered!
Saturday, February 22 (morning): Tampa Enrollment Fair with Tampa Mayor Bob Buckhorn and Representatives Betty Reed and Janet Cruz.
Saturday, February 22 (afternoon): Orlando Enrollment Fair with Planned Parenthood, National Congress for Black Women, City Commissioner Samuel B. Ings and State Representatives Bruce Antone, Joe Saunders and Victor Torres.
Saturday, March 1: Jacksonville Enrollment Fair with Rep. Mia Jones and Dr. Vanessa Cullins of Planned Parenthood.
- Wednesday, March 5: Tallahassee Enrollment Rair on the FAMU campus with Mayor John Marks and Rep. Alan Williams.
We are thrilled to be partnering with Enroll America, Florida CHAIN, Planned Parenthood, MomsRising, National Congress for Black Women, Protect Your Care and Organizing for Action to help get more Floridians enrolled.
Working together we will help save lives and put more Floridians on a path to healthier, a more financially secure future!
See you on the road,
P.S. Can't join us in person? Follow along with us on twitter: @drsforamerica! And contribute today to help us continue this important outreach all across the country -- only 41 more days left until the end of open enrollment
Mona Mangat is Chair of Doctors for America and a Allergist-Immunologist based in St. Petersburg.
Back in September 2013, I met with first year medical students at the University of Chicago Pritzker School of Medicine to discuss the ethics of student run free clinics. What could first year students ethically contribute to patient care in free clinics—when they hadn’t even learned how to listen to a heart yet and every pertinent question they asked would have to repeated with an attending? In the discussion, I shared the argument that the most ethical thing first year medical students could be doing in the clinics was getting patients OUT of the clinics. Patients connected to health insurance could get ongoing care with a dedicated provider.
Students at the University of Chicago Pritzker School of Medicine decided to take on the challenge of connecting patients with health insurance. A team led by MS2 Lauren Hobbs and MS1 Margaret Wang took on the task of preparing to train medical students to teach patients about their health insurance options. Along with Loyola law student Rachelle Sico, they supported the creation and dissemination of a pocketcard on Screening for Health Insurance Status. Loyola University medical student Aaron Silver was the main creator of the card, with content and editing support from internist Dr. Ram Krishnamoorthi, and myself.
It is an awesome card that I am proud to be able to share with healthcare providers.
The card is broken into four segments:
1. Why is insurance important?
2. How do you screen?
3. Frequently asked questions about the Affordable Care Act
4. Income qualification table for Medicaid and subsidies
1. Being uninsured or underinsured puts you at increased risk of bankruptcy, stress, and death from cancer. Over 50% of personal bankruptcies are from medical costs. People without health insurance are five times more likely to die from cancer. Not having health insurance slows specialty appointments and expensive imaging, delaying care. An estimated 26,000 people die each year from a lack of health insurance.
2. Health care providers can screen with a series of three simple questions: do you have health insurance? Are you happy with what it covers? Are you happy with the cost? A no answer to any of these means you should recommend patients check out their options either on the federal or state exchanges. Healthcare.gov, or in Illinois, GetCoveredIllinois.gov. They can also call hotlines to find out how to get connected to a navigator. In Illinois, 1-866-311-1119.
3. Pretty much everyone must have coverage by March 31, 2014 or pay a fine. The exceptions are undocumented immigrants, and people who are too poor to qualify for subsidies on the exchanges in the states where Medicaid did not expand. About half the states did expand Medicaid. You can check on healthcare.gov if yours did. On the exchanges, patients can buy bronze, silver, gold or platinum plans, with different co-pays and deductibles. No matter what the plan, no individual needs to pay more then $6350 each year on out-of-pocket in-network medical costs, and for families no more than $12,700.
4. As for income qualifications: lots of people qualify for subsidies. Medicaid covers people up to 138% of the poverty line (up to approximately $15,000) except in the states that did not expand Medicaid coverage. People who are making up to four times the federal poverty line receive subsidies. To sign up, people must have proof of their last year’s income and proof of their identity with a social security number.
The goal is to make checking health insurance status a routine part of every clinic visit, getting as many people signed up as possible in the next two months.
Social History: Do you smoke? Drink? Have health insurance? Are you happy with what it covers, and the cost?
We introduced the Health Insurance Status Screening pocket cards to about 30 medical students on a Monday. On Thursday, student organizer Lauren sent the following message:
Just wanted to let you know that one of the MS1s ran up to me today to tell me that she used the pocket card with a pregnant patient with several health complications who is totally eligible for coverage but didn't have any. Quote:
"The card works just like you said. I called the number and now a Navigator is coming to the shelter next week! They know so much. I'm really glad that you had that meeting"
Good work team! We made a difference :)
I believe the students are making a difference. And I encourage you to also—whether you’re a student or a practicing physician, check out the card, familiarize yourself with the basics, start screening your patients for health insurance status and refer them to healthcare.gov no matter what state you are in, and train your colleagues to do the same.
We can make a difference in patients’ lives, providing the most ethical care possible by connecting them with the health insurance they need.
I'm not going to sugar coat it: ACA outreach in Oklahoma is tough. But being uninsured is tougher.
One of my friends, in her late 50s, had been unable to afford health insurance for years, due to very high costs because of a minor pre-existing condition. Her job did not offer insurance, and she lived for years hoping she would make it to 65 so that she could get Medicare. Thanks to the ACA, her new affordable insurance started on Jan 1, and she is now scheduled for her first preventive care visit and mammogram in many years.
People here are proud of the fact that Oklahoma is the “reddest” state in the Union, and it’s been hard to find anyone brave enough to speak out in favor of the Affordable Care Act – but the partners I have been able to find are amazingly courageous people that I would never have met any other way. I’ve driven all over Oklahoma, from Tahlequah to Durant, speaking to groups of citizens and on country radio shows (where I once had to pause for a hilarious commercial for barbed wire.) We held a “Coverage is Good Medicine” poetry reading in a packed theater, and I have spoken at several conferences for agencies that work with the poor.
The stakes could not be higher in this state, where over 600,000 people, most of them working poor, are uninsured, and we rank near the bottom in most major health categories. Sadly, our governor has shown total opposition to the ACA, including rejecting federal funds to provide coverage to our lowest-income adults. With states like Utah now expanding Medicaid, I believe we have reached a tipping point. We are winning the battle, so it’s critical that we keep fighting for our patients.
Open enrollment ends in a little over 60 days. Help win the future for your patients. Take two minutes and put up this flyer. Then email it to 5 doctors and medical students and ask them to join you in reaching thousands by posting it in their community sometime in the next two weeks. Be sure to take a photo and share it with us!
Together we can make a difference,
Dr. Katherine Scheirman is the Oklahoma State Director of Doctors for America and a retired US Air Force Colonel.
It’s January 10, 2014, and civilization has not collapsed due to the menace of the Affordable Care Act (a.k.a. Obamacare). While this persistence of social order is not a surprise to me, many of the most vocal opponents of the ACA might be left wondering what happened to the cataclysmic predictions that have yet to come true (death panels! Death spirals! Government run healthcare!).
Seeing as the law has been more fully in effect for only 10 days, I am quite confident new problems, unforeseen consequences, and hiccups will arise, but the ACA is the law of the land that will thrive with tweaks and course corrections just like other significant reforms in the past.
I find it valuable, at this moment, to take a tally of all that has changed since the ACA was passed, and I have had a lot of fun learning these numbers:
- 9,781,525 -Americans who newly have health insurance since 2010 (almost 10 million people!)
- 2.4 Million - newly insured through the federal and state-based health insurance exchanges
- 4.5 Million - newly enrolled in Medicaid in states that chose to expand their program
- 3.1 Million - young adults under the age of 26 are covered through their parents health insurance
- 40 Million – Americans who could be eventually covered once the ACA reaches all who are uninsured and eligible
- ZERO – Americans who can be discriminated against due to a pre-existing medical condition
- ZERO – the out of pocket costs for qualified preventive health services, which 105M Americans used in 2011 and 2012
- $1.1 Billion – dollars refunded to consumers from insurance companies for over-charging
- 360 - new Accountable Care Organizations, providing care to 5.3 million Medicare beneficiaries
- Hundreds, if not thousands, of new Patient Centered Medical Homes
- 236 – Community Health Centers expanded by the ACA extending care to 1.25 million more patients.
- $8.9 Billion – the total amount seniors have saved on drug costs since the ACA passed
- $5000 – the annual savings my family will realize in 2014 thanks to the Small Business Exchanges!
- 3.2% - the annual rate of growth in Medicare spending, the lowest in decades, (the cost curve is bending) and the first time it is BELOW growth rates for our national GDP.
- 23 – the number of states NOT expanding Medicaid, leaving 4.8 Millions Americans without health insurance who were intended to be covered by the ACA
- 298 – days until Election Day. Just sayin’. If you want to see the successes of the ACA built upon, if you want to see the nearly 5 million people eligible for Medicaid gain the coverage that was intended in the ACA, and if you want to see a more high quality and high value health care system, think carefully about how you vote.
The Affordable Care Act is the most significant overhaul to our private, for-profit, health care system since the inception of Medicare. It’s easy to lose sight of the benefits of the law when the media is focused on broken websites (getting better every day) and Americans getting cancellation notices. It may also be easy to forget that our health care system has been broken for quite a while, and it will take a while to right this ship. But I have said before, and I will say again and again, the ACA is going to help ALL Americans have higher quality and less costly health care in the decades to come.
In 2013, thousands of doctors, medical students, and other supporters came together to make a huge difference. Your stories, actions, and support have helped the Doctors for America movement lead our nation toward better health and access to affordable, high quality health care for everyone.
HIGHLIGHTS OF WHAT WE DID TOGETHER IN 2013…
GETTING PEOPLE COVERED: COVERAGE IS GOOD MEDICINE
In this historic time for health care coverage, here’s some of what YOU have done to help get people covered:
Since October 1, over 1 million Americans have signed up for coverage through insurance marketplaces, Medicaid, and CHIP. As a trusted voice in a confusing time, our outreach is making a difference!
SPREAD THE WORD IN NATIONAL AND STATE PRESS
Many Doctors for America members shared perspectives from the front lines of health care in national outlets like MSNBC, FOX News, CSPAN, AP, Kaiser Health News, McClatchy, NPR, CBS News, Huffington Post, Daily Kos - plus numerous statewide publications like the Tampa Bay Times, San Antonio Express News, Charlotte Observer, and the Dayton Daily News.
RACED FOR COVERAGE
Our Docs Run pilot ballooned into a national Race for Coverage! 156 doctors, medical students, and supporters have run, biked, walked, hiked, and even read poetry to raise awareness of new coverage options. These individuals including teams in Texas, Florida, California, and Massachusetts got in shape, had fun, and raised much-needed funds to spread the word on ACA enrollment.
MOVED STATES TOWARD MEDICAID EXPANSION
ADVOCATED TO PREVENT GUN VIOLENCE
4,000+ doctors, medical students, nurses, and other health care professionals in all 50 states signed our petition for common sense gun rules. Vice President Joe Biden took notice and asked us to present our recommendations to his Task Force on Gun Violence.
Your stories and voices helped move President Obama to issue key executive orders: 1) allowing the CDC to conduct research on gun violence, 2) making sure insurance plans cover mental health the same way they cover medical care.
GAINED NEW SKILLS AND CONNECTIONS AT THE 2013 NATIONAL LEADERSHIP CONFERENCE
This year’s conference was our biggest yet. U.S. Senator Sherrod Brown of Ohio talked about the impact Doctors for America has had on advancing health reform. Surgeon General Regina M. Benjaminled us through the Electric Slide and Wobble. Wendell Potter, former Vice President of Corporate Communications at CIGNA shared insights on messaging. And conference attendees shared questions and perspectives from the front lines with leading policymakers and Administration officials.
2014: LET'S SEAL THE DEAL AND GET AMERICA COVERED!
Tens of millions don’t even know that they can now get covered. Five million low-income people live in states that have not yet expanded Medicaid. Let's get America covered in 2014 so we have a strong foundation for transforming health care in our clinics and communities in the years to come. Make a year-end tax-deductible donation today!
Today, we remember the lives lost in Newtown one year ago and those lost every day in communities across the country.
As we keep the Newtown families in our hearts and prayers, let us continue our resolve to use our unique position as America's healers to put an end to these tragedies.
As a pediatrician, I am disheartened that 7 children still die every day from gun violence in our country, and that gun injuries cause twice as many deaths as cancer and 5 times as many deaths as heart disease.
Gun violence is an urgent public health crisis and as physicians on the frontlines of health care delivery it is our obligation to take action to keep children and families safe by talking with our patients about guns.
We have included some helpful resources from The Center to Prevent Youth Violence and the American Academy of Pediatrics to make talking about guns with your patients easier. And you can also read more about our gun violence prevention campaign and how you can get involved.
Gun violence is everyone’s business. When a child dies needlessly, it is everyone’s responsibility to do something about it.
We work every day to protect our patients from deadly diseases like heart disease-- it's time to do the same for gun violence.
Please join me in preventing the loss of more young lives and keeping children safe.
Dr. Nina Agrawal is a pediatrician in New York and a DFA Campaign to Prevent Gun Violence Coordinator.