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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!


Update on Medicaid expansion in LA

By Heidi Sinclair, MD, MPH
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In 2008 Governor Jindal had proposed his own “Louisiana Health First” Medicaid expansion program.  Four years later however, he had reversed course and, along with most other “Red State” Governors, was standing opposed to Medicaid expansion in Louisiana,

While the Affordable Care Act has provided many benefits beyond extending coverage to the poor through Medicaid expansion, most of the patients and families that I see and work with, live at or below the Federal Poverty Level, and therefore have been unable to obtain coverage through the ACA marketplace or exchanges.  Meanwhile, unlike some states that already extend Medicaid benefits to adults up to 133% of Federal Poverty Level, the working poor in Louisiana are generally not eligible for Medicaid at all, leaving hundreds of thousands uninsured.

The Legislative session in Louisiana is short - only from March or April until first week of June. I attended my first legislative Health and Welfare Committee Hearing in Spring of 2013.  Like most Americans, I didn’t know that these legislative committee hearings are open to the public!  Citizens are invited to fill out cards pro or con on bills being presented to be voted on during each hearing.  These cards are counted and comments included are often read into the record.  There are usually members of the public or government officials scheduled in advance to speak on the issue before the committee, but anyone present can also, on their submitted card, request to speak. I was not prepared or planning to speak that first day but I was asked to, and did. I have since been invited to present in favor of Medicaid Expansion, among other things, at other House and Senate Committee Hearings.

I joined the Campaign for Healthcare for Everyone Louisiana on meeting the Campaign Organizer, Alma Stewart, at that first legislative hearing.  There are over forty local or state-wide organizations that are endorsed members of this campaign and over one hundred organizations and five hundred individual signed on to HCEL’s initial 2013 public letter to Governor Jindal asking him to support of Medicaid Expansion. In addition to letter’s to editors and op-eds penned by members of HCEL and others, there has been editorial support for Medicaid Expansion from all of the major local newspapers. HCEL set up separate committees to focus on legislative matters, media, education and grass-roots organizing which I think has been effective in providing a “multi-pronged” approach.  As it became clear Medicaid expansion was not going to happen in 2013, HCEL developed a longer-range, eighteen month plan, with focus on making Medicaid expansion and important issue for the Gubernatorial election of 2015.  Meanwhile, HCEL continued to partner and network with other groups working in support of Medicaid expansion, meeting with legislators, promoting letter writing campaigns, organizing or participating in press conferences or interviews on radio or TV, organizing or participating in rallies and “Dying for Coverage” candlelight vigils at the capital, visiting churches, health fairs and enrollment events, etc.  In the Fall of 2014, in coordination with the American Public Health Association’s annual meeting in New Orleans, HCEL organized a Day of Action in support of Medicaid expansion and both Alma Stewart and I were invited to present at the conference as well.

Each legislative session, more and more regular people from all over the state were coming to Senate and House committee hearings to show their support for Medicaid Expansion.  The last hearing I attended required two additional over-flow rooms to accommodate everyone!

In 2015, in coordination with Dillard University, New Orleans, HCEL organized a televised Gubernatorial Candidate Forum on Healthcare in Louisiana.  Despite the legislature’s continued refusal to advance any bills in support of Medicaid expansion in Louisiana, all three Gubernatorial candidates had expressed at least willingness to consider some version.  Representative John Bel Edwards was the only candidate, however, to make Medicaid Expansion a corner-stone of his campaign. I believe Governor Edwards’ strong support for Medicaid expansion played an important role in his election and the Governor was true to his word, signing in support of Medicaid Expansion his first day in office!

Beyond HCEL, I have also been networking with Tulane students and residents who are part of Tulane University School of Medicine’s Advocacy Track as well as other physician-advocate friends and, following the lead of Tulane resident, Sarah Candler, have been involved in efforts to revive the Louisiana Chapter of the American College of Physician’s Health and Public Policy committee.

Most recently, as State Director for Doctors for America in Louisiana, I was invited to participate in Louisiana Public Broadcasting’s Public Square program on Medicaid Expansion in Louisiana and was able to bring other DFA members to participate in the discussion as well.  Meanwhile. HCEL, in collaboration with Louisiana Public Health Institute and the Department of Health and Hospitals - Office of Public Health, has also organized a state-wide Health Summit which will be held in Baton Rouge this Tuesday, March 29th.

There is still a lot of work left to do!  Louisiana is struggling with an unprecedented budget crisis and some legislators have already filed bills to block or limit expansion, despite the obvious overall fiscal benefits to the state. Dr. Rebekah Gee, the new secretary of the Department of Health and Hospitals, is optimistic however, citing support even from many conservative legislators previously opposed.  Another important point to keep in mind, is that access to health insurance does not always translate into access to care.  While Rebekah Gee and others cite “new models” of care in development and while community clinics and even private hospitals are adding new primary care positions specifically for those newly insured under Medicaid expansion, a key to attracting and retaining providers will be ensuring adequate and reliable reimbursement.  Medicaid Pay Parity, which would put Medicaid reimbursement on par with Medicare reimbursement rates, has been discussed by DHH and was part of the recommendations of Governor Edwards’ newly created Healthcare Advisory Panel.

As a member of Doctors for America, I pledge to continue collaborating with dedicated community partners and fellow healthcare advocates in working towards a more equitable, healthier future for the people of Louisiana.

DFA Louisiana Dr.'s representing at filming of LPB Louisiana Public Square Jule Asserq, Heidi Sinclair and Sarah Candler (not pictured Dr. Christy Valentine)

Dr. Heidi Sinclair is the Louisiana State Director.


 

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The next big abortion case

By Dr. Katherine Scheirman
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Next week, the U.S. Supreme Court will hear an important case regarding abortion access with far reaching implications.

The Whole Woman’s Health v. Hellerstedt case challenges a restrictive Texas law, HB2, which was designed to prevent women from accessing their constitutional right to an abortion. This law puts the health and rights of millions of women at risk.

By requiring admitting privileges in a nearby hospital and imposing prohibitively expensive and unnecessary architectural modifications, ​clinics in Texas are closing. This places a huge burden on women, including military women and families, and severely restricts their access to this important Constitutional right. 

As doctors and medical students, we know playing politics with women's health isn't just wrong, it's dangerous. That’s why Doctors for America has signed onto an amicus brief urging the Court to strike down these medically unnecessary restrictions. But, we need your help to make the physician voice heard during the oral arguments.

Raise your voice and join us in telling the Court to strike down these requirements which harm, not help, women’s health.

Here’s what you can do:

1. Rally on the steps of the Supreme Court on March 2:

March 2, 2016, 8 AM – 12 PM at the U.S. Supreme Court, Washington, D.C.
RSVP HERE
(Please note: the form does provide an option to select a bus. While we are not organizing the buses, we are aware of the option for those traveling from NY, NJ, PA, OH, VA or NC).

2. Use this tool kit to take action in your community and online.

3. Join the conversation online at #StopTheSham:

Click here to add a Twibbon to your profile picture

Click here to join the Thunderclap.

 

Dr. Katherine Scheirman resides in New York and is a retired internist and US Air Force Colonel.



 

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Flint needs you

By Dr. Alice Chen
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The Flint water crisis is a health and human rights issue. We need you to make your voice heard to help the victims of this preventable tragedy.

Nutritious food, clean air and water, safe shelter and communities. These are the most basic things our patients need to be able to be healthy and pursue their dreams. Yet, elected officials hid the dangerous levels of lead in the water until a pediatrician sounded the alarm on unusually high lead levels in children.

It's time we follow this doctor's lead and signal the alarm with leaders in Congress.

Send a letter to Congress to make sure Flint gets clean water and access to health care.

Lead poisoning is well known to cause lifelong medical and psychiatric problems for children, sapping the potential of both individual lives and entire communities. Reductions in lead poisoning rates - often against opposition from very powerful interests - is one of the biggest public health triumphs of the past century. The fact that lead poisoning has been allowed to return with a vengeance in one of the nation's poorest communities is an unconscionable tragedy that must be addressed with the greatest urgency.

Call on Congress to make clean water a priority: Provide funds to replace the lead pipes in Flint so people can drink water without being afraid it will make them sick.  And make sure people in Flint get the health care they need.

We know that even as we write, more low-income communities beyond Flint are finding that their water is not as safe as they thought. That’s why it’s so important for doctors and medical students to stand up and speak up now.

 

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Doctors for America: Exciting Work in 2015, Big Plans for 2016


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2015 has been a big year for Doctors for America and the health of the nation. This week, we launch our end-of-year fundraising drive so we can keep going strong into 2016.  We have so much to celebrate. Here are a few highlights from the year:

King v. Burwell: Doctors for America was at the forefront of the monumental King v. Burwell Supreme Court case. We made headlines and made sure the case was understood as a matter of people’s health and lives – not politics.  The Court’s decision in favor of the ACA kept 6.4 million people from losing their ability to pay for health insurance.  

Medicaid Expansion: We kept the heat on state legislators and governors to expand Medicaid in a dozen states including Utah, Texas, Florida, Maine, and North Carolina.

Supporting Key Health Issues: Through the year, Doctors for America supported efforts to renew the Children’s Health Insurance Program, prevent the defunding of Planned Parenthood, address rising drug prices, and protect the nation’s investments in prevention and low-income nutrition programs.

Celebrating our Surgeon General: We celebrated in person or on Periscope the change of command ceremony for our nation’s 19th Surgeon General, our former president and co-founder Dr. Vivek Murthy.

National Leadership Conference: We had our most highly rated National Leadership Conference ever with engaging speakers on social determinants of health, food insecurity, remaining barriers to access, racial disparities, advocacy, and physician wellness.

CDC Gun Research Ban: We made national and international news when we demanded that that Congress end the ban on CDC and NIH gun violence research – just hours before another mass shooting in San Bernardino. Our #EndTheBan hashtag made over 3.2 million Twitter impressions in just 24 hours. We brought together 68 of the nation’s leading medical and public health organizations. And, both President Obama and House Minority Leader Nancy Pelosi spoke up on the issue.

In 2016, we have exciting opportunities to keep moving forward on improving the health of the nation.

As we continue to push on expanding Medicaid, we are hearing rumblings that a couple of states are getting ready to move. We will be right there to build momentum and make the case that expansion is good for people and good for states. We are also building a new campaign on Making the Most of Medicaid, which we will roll out in the early part of the year.

We are also opening a new focus on food insecurity, which affects one in seven of our patients - even though most of us don't know it. Hunger is a health issue that impacts the ability of our patients to be healthy and to keep their chronic conditions in check. Keep your eyes out for our new Food as Medicine initiative, and let us know if you have particular expertise in this area.

We will also work to build on our momentum to remove the CDC and NIH gun research restrictions.  Plus, we have opportunities to bring physician voices to the challenges of rising drug prices, national and international policies on curbing and treating substance abuse including opioids, Supreme Court cases challenging access to abortions and contraception, payment reform efforts, and the myriad other issues that affect the lives of our patients. Of course, with the change of administration on the horizon, we will also be watching carefully to make sure the concerns of doctors and our patients are at the forefront.

Through it all, we will build new avenues to recruit, train, and support physicians and medical students to be the best advocates they can be for their patients and for a healthier America. 

Thank you to all our members and supporters for making Doctors for America possible.  

One final note, we rely on individual donations for the majority of our budget. As we close one year and open a new one, we hope that everyone can contribute whatever we can to ensure that Doctors for America can keep fighting for the health of the nation.  

Please show your support for Doctors for America with a tax-deductible donation today.

 

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Happy Thanksgiving!

By Dr. Alice Chen
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On this Thanksgiving Day, we want to share a heartfelt thank you for being a part of the Doctors for America movement. 

Thank you for coming together by the thousands from all 50 states to fight for equitable, affordable health care for all. Together, we are creating an America where everyone has the opportunity to lead a healthy and fulfilling life.

We create change because you choose action over cynicism - reading an email to get informed, signing a petition, sharing a patient story, writing an op-ed, joining a webinar, putting up a flier, running a campaign.

It is because of your efforts that the uninsurance rate in America is below 10% for the first time ever. Over 17 million more people are insured than when we first began this movement. With your continued efforts, We will get more people signed up for coverage before the end of open enrollment on January 31. We will expand Medicaid in every state and keep working until every person is covered. We will improve affordability, availability, and quality of care. And we will shine a light on social determinants like hunger and gun violence that affect our patients every day.

Did you know that Doctors for America members do all this on top of caring for over 1 million patients a month? Thank you to primary care doctors, psychiatrists, surgeons, neurologists, hospitalists, ob-gyns, anesthesiologists, cardiologists, and doctors of every specialty. To rural and urban doctors for your commitment to underserved communities. To private practice owners and tertiary care academics for improving care in every setting.

A special note of appreciation to those who are on call this weekend - caring for patients, answering their worried questions, bringing warmth and light to the sick during the holidays.

Thank you to physician administrators, researchers, innovators, and policymakers who bring a much needed clinical voice to policies and programs. To those who have committed their lives to public service and the uniformed services. To deans and medical educators for training the next generation of physicians. To retirees who have paved the way for the rest of us. To medical students whose energy and enthusiasm carry all of us forward.

Thank you to those who have donated funds to sustain our movement. Your support has been essential, and we are grateful for you.

Some of you are not doctors or medical students, but you stand with Doctors for America as our supporters and colleagues. Thank you for working alongside us to build a more just and equitable future for the health of the nation.

And thank you to Doctors for America's board members, state directors, advisors, and national campaign leaders who volunteer their time to lead our movement and to our small but mighty staff who support all of us.

On behalf of the whole Doctors for America family, may you and yours have a very happy, safe, and wonderful Thanksgiving.

Warm Wishes,

Alice Chen, MD
Executive Director

 

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Haunted by Gun Violence

By Dr. Lisa Plymate
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I am still haunted, over 30 years later, by the 18-year old woman I saw in the Emergency Room during my residency at the University of New Mexico. She had been shot in the chest, but was fully conscious when she arrived. "I'm not going to die, am I?" she asked plaintively. We worked as hard as we could on her, even cracking open her chest to massage her torn heart, but, tragically, all to no avail.

Years later, while making home visits, I encountered a 78-year old woman with severe rheumatoid arthritis who lived in subsidized housing in Richmond, VA. When I tried to coax her into at least taking walks in her first-floor apartment for exercise, she told me she wouldn't stand up after 2 p.m., because that was when the junior high kids got out of school, and "I might be shot."

Many of us have stories like these that we carry with us from our every day practices. While nothing will erase these tragedies, there is something we can do about them.

Over one thousand doctors and health advocates have signed our petition urging Congress to end the CDC ban on gun violence research. We will be delivering these signatures to Congress the week after Thanksgiving and need your help in gathering even more signatures in the final push, to reach our new goal of 2,000.

Please raise your voice and join us so we can speak up for all our patients, past, present and future, who may be impacted by gun violence. 

This is a problem we can tackle! And we need to start by supporting, not banning, gun violence research at the CDC. Let's gather more of the data we need; let's have a resource that enables us to compare the effectiveness of various interventions.

Thank you for working for our patients and our families.

Lisa Plymate is our Washington State Director and an internist/geriatrician based in Seattle Washington.

 

 

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Tell Congress: End the Ban on Gun Research

By Nina Agrawal, MD
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As physicians, we are outraged that this Nation continues to lose innocent lives from daily gun violence. Despite Sandy Hook and the continued tragedies since then, more than 89 Americans continue to die every day from gun violence

You would be shocked to know that nearly 20 years ago Congress, under intense pressure from the gun lobby, passed a law blocking the Centers for Disease Control and Prevention (CDC) and the National Institute of Health (NIH) from carrying out the necessary research to better understand how to prevent gun violence.

Most recently, in June 2015, the U.S. House Appropriations Committee voted to maintain this funding ban. The result: a significant source of funding for evidence-based, scientific research into the causes of gun violence was blocked entirely, and a signal was sent to the entire scientific funding community that chilled almost all other outside research into this critical issue.

It's time to end the ban on CDC and NIH research so we can find solutions to the gun violence crisis.

Federal scientific data has driven policy to save lives from motor vehicle accidents, sudden infant death syndrome, lead poisoning, and countless other public health crises.  It’s time to do the same with gun violence.

 Add your name to #EndTheBan on gun violence research.  

Physicians must stand together to tell Congress to remove these barriers to common sense evidence-based research and include funding annually to look into the causes of gun violence. I hope you will join us.

Physicians must stand together to tell Congress to remove these barriers to common sense evidence-based research and include funding annually to look into the causes of gun violence. I hope you will join us.

For a safer Nation,

Nina Agrawal, MD

David Berman, DO

Drs. Agrawal and Berman are pediatricians and leaders of the DFA gun violence prevention campaign.

 

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The work ahead

By Dr. Mona Mangat
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What an inspiring Doctors for America 2015 National Leadership Conference!

Passionate, dedicated doctors and medical students from across the country gathered in Washington, DC to learn and connect on how to make the world better for our patients. 

A movement that began 7 years ago is now 16,000 physicians and medical students strong. During that time we played a critical role in the passage of the Affordable Care Act (ACA) and then spent the past several years protecting the law against repeal and defunding attempts.

We have made tremendous progress on expanding access to care and we will continue to fight to expand Medicaid and protect the ACA. Yet, we know access alone is not enough. Too much of what happens outside the clinic walls is outside of our control.

There are still too many Americans who don’t have safe places to walk because of gun violence in their communities, too many children who don’t have access to the food they need to aid their developing bodies. These are the pressing problems facing our patients and communities across the country. These are the challenges physicians must join with community leaders to tackle to ensure we build a healthy America for everyone.

That’s why I am so excited to share with you DFA 2.0. While we honor and respect our history, we are evolving as an organization to meet the pressing health challenges that lie before us. We have a new mission, vision and guiding principles that you can view on our website.

I hope you will join us in the year ahead to continue to address access to care and Medicaid expansion as well as, food insecurity, racial disparities, mental health, substance abuse, drug pricing, gun violence, health innovation, physician well-being, organizing skills, and more.

Change happens because doctors and medical students like you take leadership into their own hands. Whether you care about an existing campaign or a new issue we haven't tackled or listed here, we want to hear from you and help you create the change you want to see.

For a healthier America,

Mona Mangat, Chair
Alice Chen, Executive Director

 

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A message from Stan Brock - See you in October

By Stan Brock
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I am honored to be joining you on October 10th for this year’s National Leadership Conference in Washington, DC as a guest speaker.

At Remote Area Medical (RAM), we are partners in putting patients over politics to improve access to care and help people live healthier lives.

In my travels across the country and around the world, I have witnessed too many people living in fear of sickness and injury simply because they have little or no access to basic medical care. RAM responds to this need by providing free, quality dental, vision, and medical care to those who cannot afford it. In less than 24 hours we turn fairgrounds, schools, jungles, and arenas into mobile medical centers. We are steadfastly committed to stopping pain and ending needless suffering.

I look forward to joining you at the upcoming conference as we celebrate and discuss the pressing work ahead to improve impoverished patients’ access to care.

Register now to attend the 2015 National Leadership Conference.  

See you in October,

Stan Brock
President and Founder
Remote Area Medical ®

P.S. There will also be showing at the conference of Remote Area Medical the movie. You will not want to miss it. Watch the trailer here.

 


 

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Here’s to 50 years

By Dr. Alice Chen
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Fifty years ago today, President Lyndon B. Johnson signed Medicare and Medicaid into law. Together, they cover nearly one out of every three Americans – that’s more than 100 million people.

The Affordable Care Act has continued to open up the doors of care to millions more. However, leaders in 19 states have refused to expand Medicaid leaving nearly four million people without access to care. We have not forgotten about them.

Today, we delivered signatures from physicians and medical students across the country urging these governors to put down their partisan opposition and close the coverage gap. Our message: no matter how long it takes, we will stand up and speak out until everyone is covered.

Since Doctors for America began, we have fought to make sure our patients have access to the care they need.  

When Congress threatened to cut billions of dollars from Medicaid in 2011, thousands of us spoke up to keep the program going. When the Supreme Court ruled in 2012 that states had the option of whether to expand Medicaid, we worked together to tell state leaders that it is not acceptable for people to die for lack of care when the federal funds are already there and available to give them the care they need.

Like any program, Medicaid has its strengths and weaknesses, but it is working and remains a lifeline to care for millions of women, children and families. That is why we will not be silent until it is expanded in every state and strengthened for all.

Today, let's celebrate 50 years of progress through Medicare, Medicaid, CHIP, the Affordable Care Act, and the hard work you put into making sure the most vulnerable among us have the resources they need to live a healthy life.  Post on Facebook, have a celebratory dinner, put up a sign, visit a senior center, or simply take a moment to appreciate how far we've come as a Nation in the past 50 years.

Let us redouble our efforts to make sure everyone in America has access to affordable, high-quality health care and the foundational resources they need to live a healthy life.  

 

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