healthcare policy

John Dingell and the Pursuit of Healthcare for All

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This photo shows former President Obama signing the Affordable Care Act. What you might not notice is the gentleman sitting in the right-hand corner of this photo. That was former Congressman John Dingell Jr., who represented much of Washtenaw County for many years. Dingell--who died yesterday--introduced a health care bill into Congress every year from his start as a legislator until the passage of the ACA, and he served for 59 years. Thank you, Congressman Dingell, for your devotion to healthcare for all.

A Little Bit of History

John Dingell’s father (also John Dingell!) was in Congress before John Dingell. John Dingell Sr. began cosponsoring a national health insurance bill (what we would now call “single-payer” legislation) and fighting for universal health care when the issue was less about cost and more about health care as a right. John Dingell Sr. was also active in the fight for social security.

John Dingell Jr. enjoyed the world of twitter, and here is a bit of history—in Dingell’s own words.

John Dingell Sr. is at the back wtih the mustache as President Franklin Delano Roosevelt signs the Social Security Act into law.

John Dingell Sr. is at the back wtih the mustache as President Franklin Delano Roosevelt signs the Social Security Act into law.

When John Dingell Sr. died, John Dingell Jr. ran for his congressional seat and took up the mantle, introducing a single-payer bill into Congress every year. But John Dingell Jr. was practical, and also worked for extending health care incrementally when the opportunities arose.

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John Dingell Jr. said the honor was given to him because the speaker had been great friends with Dingell’s father, and Dingell’s father had worked hard to make Medicare a reality. Note the gavel at bottom left.

John Dingell Jr. said the honor was given to him because the speaker had been great friends with Dingell’s father, and Dingell’s father had worked hard to make Medicare a reality. Note the gavel at bottom left.

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John Dingell Jr., July 8, 1926 – February 7, 2019

We thank John Dingell for his relentless support of health care through his entire career and for his dedication to working for the people of the United States.

Read more details about John Dingell’s role in fighting to extend health care to all here.

John Dingell’s NYTimes Obituary

From the Detroit Free Press:

John Dingell: In love with his life, in awe of his luck

Barack Obama: John Dingell made life better for Americans

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Welcome Immigrants—Opposing Public Charge Rules Changes

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UPDATE: Over 200,000 comments were received while the public comment period was open. No changes can be made until the regulating body (Department of Homeland Security) responds to every comment. Then they can publish a final rule, which could incorporate changes based on comments received—or they could decide not to publish a rule. After the rule is published there is a waiting period before it takes effect.

Today—in fact—any day—is a good day to tell the world that you welcome immigrants to the United States. The Washtenaw Health Plan and Washtenaw County Health Department have submitted comments opposing the changes in "public charge" regulations. Comments could be submitted until December 10th, 2018.

What Is The Issue?

The Trump administration has published a proposed rule that would force many immigrants and their families to choose between accessing essential public services and keeping their families together. 

There are many reasons why immigrants may be denied permanent residence (aka a “green card”) or not be allowed to enter the United States. Public charge is one of those reasons. Under current laws, the government considers someone a public charge if they are found likely to become primarily dependent on government programs.

Currently, “public charge” is considered very narrowly—an immigrant can only be found to be a public charge if they use cash assistance (like TANF or SSI), or institutionalized long-term care (like living in a nursing home) through Medicaid.

The government is considering changes that would dramatically expand who is considered a public charge. making it much harder to get a green card or visa. These changes include:

  • Expanding the benefits that could classify you as being a “public charge” and

  • Assessing your income differently—meaning that your income would only be viewed positively if you made at least 250% of the poverty level (nearly $63,000 for a family of 4).

  • Adding assessments of age, health, education and skills. Children and seniors could be assessed negatively.

In addition to what the public charge proposed rule actually says (and at this point it is only a proposal), it can also have a “chilling effect,” and make people afraid to access any services, even ones that are not included in the rule. If the “public charge” rule is ­finalized in its proposed form, this would mark a significant and harmful departure from long standing immigration policy. The proposal would make -- and has already made -- immigrant families afraid to seek programs that support their basic needs. These programs help them stay strong and productive, and raise children who thrive. With about one in four children having at least one immigrant parent, this issue touches millions and is critical now and for our nation’s future. And that’s why taking action is so important!

According to the Michigan Immigrant Rights Center, at this point, “If you are applying for a green card within the U.S., the rules have not changed, and there is no reason for you or anyone in your family to stop receiving non-cash benefits (like Medicaid and food stamps) that they are eligible for.”

What Can I Do To Make A Difference?

When the federal government proposes a rule, they have to request comments. We have until December 10, 2018 to submit comments. Your voice matters!

The best way to comment is to go online to the federal public charge comment portal at regulations.gov. Click on “comment now” and either enter your comment in the text box (must be fewer than 5000 characters) or upload your comments as a PDF.

Any comments are good, but it’s best if:

  1. You write comments in your own words.

  2. You share research, experiences, and/or the stories of people you know (friends, relatives, community members). You can even include web links or upload supporting materials (research, or your resume, if you are a content expert).

  3. Look to the Michigan League for Public Policy for some great information about the positive economic impact of immigrants in our communities; use that information in your comments. Talk about why we value immigrants in Michigan!

  4. Talk about the role that access to benefits has played in your life, or the lives of people you know.

More details about comments can be found here.

In fact, there’s even a toolkit with specific comment suggestions. However, don’t worry too much about it, short comments are ok too!

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What Else Can I Do?

Use email, phone calls, and social media to get your friends and family to submit comments. (Hint: Share this post!)

You Are In Good Company

If you comment, you are in good company. Not only did the Washtenaw Health Plan submit a comment, but:

And special, special thanks to our partners at the Michigan Immigrant Rights Center for their knowledge, support, and advocacy. Read more about their campaign to Protect Immigrant Families here!

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Medicaid work requirements: A prescription for problems

“We’ll call you with the results on Monday.”

If you’ve ever left your doctor’s office after hearing those words, then you’re familiar with the dread. Minutes become hours, hours become days, and the worst fears tend to enter your mind no matter how hard you try to suppress them.

Waiting for that call is excruciating. But a law being proposed in Lansing would make it a lot worse for many in our state.

Michigan’s Senate Bill 897 is ethically, logically and morally wrong; it threatens the healthcare of hundreds of thousands of Michiganders. And it’s going to cost us a boatload.

The bill comes on the heels of a change at the federal level that allows states to request waivers to enforce work requirements on Medicaid recipients.

First, let’s look at what Medicaid is. Medicaid is healthcare. It was designed to help sick people get well and to help healthy people stay that way. And it does a pretty great job. Michiganders with low incomes are able to sleep at night knowing that they can receive healthcare through Medicaid and Michigan’s expanded Medicaid program, the Healthy Michigan Plan. Since its creation in 1965, that’s what Medicaid has been: A healthcare plan.

Now, let’s look at what Medicaid is not. Medicaid is not a jobs program. Jobs programs help train workers, eliminate barriers like transportation and childcare issues, and work with local governments, community members and businesses to find solutions to problems in workforce development. By all means, let’s invest in solid jobs programs!

But some in the Michigan Legislature think we need to complicate the health plan by adding layers of bureaucracy and obstacles with work requirements. Here are a few logical truths to counter the myths being used to push work requirements:

  1. Most Medicaid recipients who can work are already working. Those who don’t work are students, caregivers, retired or in poor health.
  2. Michiganders enrolled in Healthy Michigan are doing better at work and are able to find work because they have healthcare. It’s not a big stretch: Being healthy makes it easier to thrive in the workplace. But it doesn’t work the other way around. Being at work doesn’t suddenly cure health problems.
  3. Medicaid recipients, employers, doctors and state employees will be burdened with paperwork, red tape and additional hurdles. These complications will strain the state and cause many struggling Michiganders to lose coverage.
  4. It’s going to cost us. Kentucky, which recently implemented work requirements, reports that just setting up the infrastructure to track work requirements will cost nearly $187 million in the first six months alone.
  5. Work requirements are potentially illegal. Under the act that created the Medicaid program, certain parts of the Medicaid Act can be waived, but new eligibility criteria cannot be imposed—in this case, the criteria of work in order to qualify for Medicaid. Legal challenges have already begun in Kentucky that could have repercussions on any states pursuing work requirements. Michigan lawmakers should wait and see how that case unfolds.

I’m obviously urging you to take action on this issue. But I’m also asking you to start talking about it. Talk to your friends, your neighbors, your family. Help them to understand what Medicaid is and what it is not.

I also hope you’ll listen. Over the years Medicaid has helped millions of Michiganders, from those going through a rough patch to those struggling with chronic health problems or terminal illness. It is likely that someone you love or know has benefited from Medicaid. Take the time to listen to how it helped them temporarily or on a long-term basis. And encourage them to share their story to make a difference.

If you have a personal story about how Medicaid and having reliable healthcare has enabled you to work or look for work, please share it!  Click here. 

If you have a personal story about how Medicaid and having reliable healthcare has enabled you to work or look for work, please share it!  Click here. 

Healthy people are better able to work, but working people do not automatically become healthy. Let’s stop discussing unnecessary plans like this and instead focus on the real things Michigan residents need to work and provide for their families, including Medicaid and other assistance programs, job training, adult education, high-quality child care, reliable public transportation, and more.

Added April 4th, 2018 by Gilda Z. Jacobs  

By Gilda Z. Jacobs, president & CEO of the Michigan League for Public Policy since 2011

April 4, 2018 

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Ten Reasons To Oppose Medicaid Work Requirements

Printable pdf of this blog post here.

You may have heard that there are some proposals in the Michigan legislature to require individuals on Medicaid to work in order to continue to qualify for Medicaid  (Proposed in March 2018: Senate Bill 897 and House Bill 5716). The Washtenaw Health Plan and Washtenaw County are opposed to any efforts to impose work requirements on Medicaid recipients. Here's why: 

1. Most people on Medicaid are already working.

Those who are not working, are most likely to be found taking care of young children, elderly relatives, to be living in high unemployment areas, or to be in poor health themselves. The vast majority of individuals in Medicaid are in households with at least one working person (Kaiser Family Foundation, 2016). 

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In December 2017, a team of University of Michigan researchers did extensive research on individuals in the Michigan Medicaid expansion, called the Healthy Michigan Plan, population.

  • Nearly half the individuals are working (48.8%)
  • 5% are students
  • Nearly 5% are home taking care of children
  • 11% reported being unable to work because of their health
  • Over one fourth are out of work, many of them because they are in fair or poor health. Three-quarters of those who were out of work reported having a chronic health condition.

NOTE: This study was the first peer-reviewed study from the formal evaluation of Michigan's expansion, called the Healthy Michigan Plan. The evaluation, funded by a contract with the Michigan Department of Health and Human Services, was required under Michigan's federal waiver. 

As Renuka Tipirneni, lead author of the study notes, "'Is it worth the cost to screen and track enrollees when only a small minority isn't working who are potentially able to work?"

2. The Medicaid expansion has helped improve individuals' health.

Health improvements mean it is more likely that they will be able to work--now or in the future. 

According to the UM IHPI study, "In all, nearly half of the newly covered Michiganders said their physical health improved in the first year of coverage, and nearly 40 percent said their mental or dental health got better. Those who said their health improved also had the most chance of experiencing an effect on their work life. As a group, they were four times more likely to say that getting Medicaid coverage helped them do a better job at work. And those who felt their health had improved, but were out of work, were three times as likely to say that their coverage helped them look for a job."

3. Work requirements can worsen (or externalize) other problems. 

For instance, a person with epilepsy who loses access to seizure medications could have a seizure while driving and have a car accident. The cost, then, is to the individual (who is injured by the car accident and seizure), to the costs to the insurance system, and potentially to other individuals involved in the car accident.

4. Work requirements cost the system more.

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Work requirements drive people to more expensive care. Rather than a person getting preventive care, and a prescription, from a primary care doctor for an easily treated problem like high blood pressure, they are more likely to end up in the emergency room, where they know they will not be turned away. Rather than getting a free flu vaccine, they are more likely to get the flu--ending up infecting others, requiring time off work, and perhaps risking a hospitalization. 

5. Work requirements place a huge administrative burden on Department of Health and Human Services (DHHS) staff.  

DHHS staff already struggle under enormous caseloads. The administrative burden of this additional work is significant. The true number of people who could work but aren't is small. Yet requiring people to show that they are working, or cannot work, requires a lot of time on the part of DHHS staff.

Paperwork photo by Tom Ventura

Paperwork photo by Tom Ventura

6. Work requirements place a huge administrative burden on individuals with Medicaid.

In addition, they are likely to affect many others. For instance, if one person in a family does not return proof they are working, others in the family may be wrongfully cut off. This policy is another bureaucratic obstacle intended to keep poor people from getting healthcare.

7. We are in the midst of an opioid epidemic and a surge in suicides.

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Mental health and substance use disorder services are essential; suicide is preventable. Work requirements make it difficult for individuals getting mental health or substance use treatment to continue to get treatment. In 2015, the State of Michigan's Prescription Drug and Opioid Abuse Task Force report recommended " exploring ways for the State to increase access to care, including wraparound services and MAT [Medication-Assisted Therapy], as indicated by national and state guidelines for treatment. (p. 20)" Work requirements would surely reduce access to care. 

8. Work requirements put physicians and nurses in an untenable position.

Physicians take the Hippocratic oath, to do no harm, but if people are cut off of Medicaid and physicians are unable to get paid for patient visits, their organizations will find it financially untenable to take care of these patients. That is one reason that the American College of Physicians, the American Academy of Family Physicians, the American Congress of Obstetricians and Gynecologists, the American Osteopathic Association, the American Psychiatric Association and the American Academy of Pediatrics have taken a position against Medicaid work requirements. Read their statement here.

9. Work requirements threaten the health of people with disabilities.

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As the IHPI study indicates, many individuals who have Medicaid and are not working are doing so because they are in poor or fair health. In the experience of staff at the Washtenaw Health Plan, in many cases the access to health care allows people to either a) get better, and start working or b) get the necessary evidence from competent physicians to show that they are disabled. Without Medicaid, many individuals would not be able to collect the medical evidence to prove that they are disabled. In 2016, the Kaiser Family Foundation found that 36% of people on Medicaid who are not working are disabled.

10. The Washtenaw Health Plan and the Washtenaw County Health Department believe that healthcare is a human right.

We oppose efforts to reduce access to coverage, and believe in healthcare for all. The Washtenaw County Board of Commissioners agrees with us. Read their resolution here

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WHP Staff Profile: Krista Nordberg

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Meet our Queen of Enrollment and Outreach!

Have a policy question about Medicaid? Need to know the best way to make sure an entire family has health care? Want to understand the difference between QMB and SLMB, or SSI and SSDI? The go-to person in the WHP office is Krista Nordberg. 

Krista Nordberg has spent the last 25 years working as an advocate for people's rights through the legal system as a lawyer and legal advocate.  She has provided legal representation and assistance for low-income clients in the areas of housing, consumer and family law.  As the Assistant Director of the Counsel Advocacy Law Line she supervised a team of attorneys who performed legal intake services, case reviews and advice for 12,000 clients per year.  While working for Legal Services of South Central Michigan (LSSCM), Krista worked as a Staff Attorney (Ann Arbor) and Managing Attorney (Lansing).  

Since 2007, Krista has been the Director of Enrollment and Advocacy Services at the Washtenaw Health Plan.  She has trained and nurtured various staff members and AmeriCorps Community Resource Navigators (for example, Haley Haddad, Amber Wells, Michael Randall and Will Cheatham), all of whom have progressed in their careers with a strong sense of advocacy. 

Since joining the WHP as an AmeriCorps member, Krista has acted as a phenomenal mentor, showing me how important it is to be passionate about your work. Krista continues to be inspirational as I build my career and daily I strive to be as kind and dedicated as her.
— Haley Haddad, Americorps 2012-2013
Krista rocks the orange safety vest as she has people check in at a fire safety drill. 

Krista rocks the orange safety vest as she has people check in at a fire safety drill. 

As our Queen, I mean Director, Krista leads the fight for healthcare coverage for all through the Washtenaw Health Plan. Krista is known for sharing enrollment policy updates, answering questions from case managers across the county, providing leadership and collaborating with Michigan Department of Health and Human Services for Medicaid enrollment and advocacy,  leading a staff trained as Certified Application Counselors for the Marketplace, and--in general--spreading the message that healthcare matters. 

Krista is a once in a lifetime kinda boss. One that takes you in and adopts you, coaches you and gets you ready to fly. I owe so much to my experience under her leadership and I am a better public servant because of it.
— Michael Randall, Americorps 2014
Krista and her daughters, Lucy and Sally.

Krista and her daughters, Lucy and Sally.

Krista has won the Washtenaw County Manager of the Year, the NAACP Distinguished Lillian D. Wald Civil Rights Award and she was a Commissioner on the Human Relations Commission for City of Ypsilanti.  But she doesn't want you to know about those awards.  Awards, in her opinion, are not as important as people getting healthcare, human rights and justice! 

And she dances! Krista loves salsa and travels to dance in California, Cuba or anywhere there is a good rueda.  She has two wonderful, smart daughters and lives in a tiny house with a cat, Logan. 

What stands out about Krista is that she is a fierce advocate, and she combines that with a strong sense of compassion. Clients are always asking for her by name, because she helped them before, and they know she will help them again.
— Ruth Kraut, WHP Program Administrator

-M. Buhalis

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Six Things I Learned about Healthcare While Working at the WHP

Editors Note: This post was written by a wonderful summer intern, Madeline Higgins, as a reflection on her work over the summer. Madeline is a student in the MPH program at the University of Michigan School of Public Health, and we are sure she will go on to do great things!

I was lucky to intern at the Washtenaw Health Plan this past summer, where I got to observe the services that WHP provides and work with a new program involving Community Health Workers. Meanwhile, the federal government was attempting to greatly reduce the Affordable Care Act, which had the potential to negatively impact the health of residents in Washtenaw County. While I learned many facts, protocols, and systems, the items listed stick out most in my memory.

 

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1. There is a significant gap in understanding of the reality of healthcare and policy impact from federal legislators.

I believe this stems from decision makers finding information that enforces their current worldview instead of looking at fact-based data. While watching and reading about the legislative process for healthcare reform, I was struck by the lack of listening and understanding from both sides of the aisle. While everyone utilized individual stories to demonstrate their points, there was little conversation about population-level health outcomes. After reading reports and statistics which utilized a population health framework, it is obvious to me that overall, the Affordable Care Act has positively impacted health in the US.

 

2. You can work minimum wage full time and not qualify for Medicaid (as a single individual household).

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I learned this towards the end of my time with WHP. I hadn’t done the math before, and it was hard for me to imagine living on the minimum wage in the Ann Arbor area in regards to housing costs, let alone health care. To me, this further demonstrates the need for a livable minimum wage.

 

 

3. Pre-existing condition protections help us all.

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At some point in our lives, we are likely to experience some health setback where we utilize the healthcare system. It is advantageous to us all to include people with pre-existing conditions in the insurance pool because one day that could be us!

 

 

4. Everyone has questions about healthcare- and it is important to find places to get good information.

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The Washtenaw Health Plan is a great place to ask for help! No matter your insurance plan, there seem to be terms and deadlines that won’t make a lot of sense until you ask an expert or seek reliable resources. I also wrote a blog post this past summer about reliable resources regarding health care access, and it totally changed the way that I look for information about health.

 

5. People who do direct service work can (and must) also do policy advocacy.

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Washtenaw County is organized and ready for action! I sat in on many meetings where people were putting their heads together to make sure they had the right information to talk to colleagues, legislators, and their clients about how federal policy change (for example, reduction in SNAP benefits) is detrimental to our community. This is vital to both keeping their jobs but also elevating the health status of the Washtenaw County population.

 

6. Above all, if healthcare was treated like a human right, the tone of this conversation would be very different.

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People at the WHP recognize that healthcare is more complicated than having access to insurance. Health is about access to nutritious foods, opportunities to relax, space to exercise, and of course the occasional donut from Dom’s. Working in the county government showed the interconnectedness of the systems that comprise of people’s access to health. I believe if we are more inclusive to people’s needs we can work together to improve the health of Washtenaw County.

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