When Did We Forget About the Patients?

When Did We Forget About the Patients? - Hal Scherz - Townhall Finance Conservative Columnists and Financial Commentary - Page 1  

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With each passing day, more is discovered about the Affordable Care Act (ACA, Obamacare) confirming all of our worst fears about this law. The majority of discussion regarding Obamacare has been concentrated on issues involving implementation, such as state health insurance exchanges or Medicaid expansion.

It has also focused on the crushing financial implications of the law, such as the 18 new taxes created by the ACA, or the dramatic rise in healthcare insurance premiums, or the projected $2.7 trillion price tag. This narrative is understandable because the majority of people doing the reporting are pundits, talking heads and policy wonks.

The missing piece in this narrative is the havoc that this law is creating in the lives of so many patients. Despite minimal implementation of the ACA thus far, the effects on many patients is already devastating- something very much under-reported.

Last month we learned that cancer clinics were turning away Medicare patients as a result of cuts brought about by the sequester. The cuts would result in a decrease in Medicare reimbursement to these private clinics by as much as 28%. This has forced these clinics to find alternative treatment facilities for these patients, which in some cases may be thousands of miles away from their homes. This is tantamount to a death sentence for some patients, for whom travel is not possible because of both economic and health reasons.

The creation of high risk pools for patients with pre-existing or expensive medical problems was touted as one of the achievements of Obamacare (Pre-Existing Condition Insurance Plan, PECIP). It has never lived up to its expectations. The predictions were that by this time, over 1 million people would be participating, but it stalled at about 100,000 because this coverage was more expensive than anyone had anticipated. And further enrollment was halted because the money ran out. Now it appears that the shortage of funds may jeopardize the continued coverage for those patients currently enrolled.

The GOP leadership in the House of Representatives, sensitive to the needs of these patients, introduced HR 1549, which would transfer money from other ACA programs into the PECIP. President Obama however, threatened a veto if this bill reached his desk. He apparently has little concern for these patients and if it means that they need to be sacrificed in order to proceed with continued implementation of the law, then this may be the price that needs to be paid. Try telling that to the patients though.

Next21View Full Article Hal Scherz Dr. Hal Scherz is the Founder and President of Docs4Patient Care. Most Recent Articles Bradley has 3-stroke lead after 2 rounds at Nelson 'Sonic' video games coming to Nintendo UN panel: Sanctions delaying NKorea nuke program Tech, labor brandish dueling studies in U.S. immigration fight Ferguson praises 'amazing' Beckham's longevity Charges filed against man in Nevada killing spree Pa. coffee run leads to hatchet hitchhiker arrest Venturi, US Open champion and CBS analyst, dies Sign-Up to receive Updates from TH Join the Debate 12 Comments So Far Login in to Post Your Comments Newest First Oldest First sbrown Wrote: May 13, 2013 1:33 PM 2014 will be even more interesting. Many major elements of Obamacare are supposed to kick in. The states have, for a variety of smart or apathetic reasons, not been active in setting up the state insurance exchanges. Perversely this may protect a swath of Americans for a few more years, if their employers continue to carry health insurance as opposed to paying the fine and telling their employees to go to the exchanges for insurance. Login to Reply Flag as Offensive

Post Comment dheath Wrote: May 11, 2013 6:12 AM I went for my annual physical this week, to the same doctor I have been going to for years. They have always had the nurse take my blood pressure, do an EKG, and then take care of the medical questions. However, now the medical questioning has become so burdensome, that they went streight to the questioning and forgot to do the EKG. Later, my doctor reminded them that they needed to do that. He is a Libertarian. If you think you can trust either of these parties, any of these parties, you need to think again. It is time to get the brightest together and form the right party along the lines of the Tea Party Principles, get on the ballot in all states, put out principled candidates and get the job done. If you haven't read or... Login to Reply Flag as Offensive

Post Comment Maximus2 Wrote: May 10, 2013 3:41 PM Inarticulate , Sarah? No she was right on! Perhaps the columnist should have talked to some more Doctors, however he wrote a good piece and hit what is all wrong with Obama care except for the fact that health care for seniors with problems will be dropped over board to save his agenda to insure illegals and totally destroy the best healthcare system In the World. Login to Reply Flag as Offensive

Post Comment mshreve Wrote: May 10, 2013 2:06 PM WHO screamed when 720 BILLION was STOLEN from Medicare to help fund Obamacare. Certainly NOT the AARP. Sequestration resulted in an DECREASE in the INCREASE of spending only. 415 BILLION was cut from PROVIDER payments. Login to Reply Flag as Offensive

Post Comment mshreve Wrote: May 10, 2013 2:05 PM WHO screamed when 720 BILLION was STOLEN from Medicare to help fund Obamacare. Certainly NOT the AARP. Sequestration resulted in an DECREASE in the INCREASE of spending only. 415 BILLION was cut from Login to Reply Flag as Offensive

Post Comment Bluebonnet Wrote: May 10, 2013 1:36 PM Remember, this bill was "deemed" passed by Nancy Pelosi, still not knowing what was in the bill. How unconstitutionally corrupt, arrogant and stupid is that?!!
And, speaking of health care, the pharmaceutical companies donate heavily to members of Congress. Why don't we know more about what is in these drugs that cause deadly side effects? Do statin drugs cause diabetes? A real winner for pharma. Which drugs cause pancreatic cancer? What named drugs causing heart attacks are still allowed on the market? The accusations are there. Where is the follow-up and data? 10,000 deaths before one drug was removed. Now 80,000 deaths thought from another. Why can't staph be eliminated from hospitals? You see, the health care bill and... Login to Reply Flag as Offensive

Post Comment None1257 Wrote: May 10, 2013 1:00 PM This is real simple to understand. When you decided that you wanted someone else to pay for our needs and wants, you also gave them the right not to pay. Login to Reply Flag as Offensive

Post Comment Ronald E Wrote: May 10, 2013 10:08 AM The mission of a physician hasn't changed. We are trained for years to do whatever we can for others to the best of our ability. I will never sell out to bureaucrats who haven't had my 11 years of medical training. If that means dropping all government and private insurance plans, so be it. We are trained to think independently and practicing medicine is a complex interaction that can't be reduced to a cookie-cutter approach.
The ACA will wreak havoc on American medicine, including the unwarranted transition to electronic records that are not ready for prime time.
We have always been patient-centric, though others don't seem to think so.
Login to Reply Flag as Offensive

Post Comment ryoung292 Wrote: May 10, 2013 9:27 AM Welcome to "Logans RUN!" Login to Reply Flag as Offensive

Post Comment Charles52 Wrote: May 10, 2013 8:55 AM ObamaCares real name should be POPULATION CONTROL CARE. That is because it was nothing but a major political lie drafted by lawyers for the benefits of lawyers who are politicians and there was never any intentional benefit for people. Pelosi said it all when she gleefully said " let's pass the bill, then we can find out what is in it". That tells us what politicians thinks about what they do...pass junk they know nothing about, then leave the thing open to amendments as time goes on and there in lies the real disasters. obamacare was never intended to lower cost, nor to protect people, but more to contol people, except politicians who were exemted because they know upfront it was a disaster....for them. Login to Reply Flag as Offensive

Post Comment lgoldhammer Wrote: May 10, 2013 7:25 AM The health care solution is simple: go back to what we were doing before there was a health care problem. Go back to major medical care insurance that is used as insurance was intended: for an unplanned major medical problem with big price tags like surgery or disease. In 1984 I joined the Navy. Before going in it cost me $25 to go to the OB/GYN. I was only making $5-6/hour and could afford to pay this out of pocket. In 1988 when I got out of the service and called for an appointment they wanted $150. I was still making only $5-6/hour, but I couldn't afford to pay a doctor a whole weeks salary to be seen. What had happened in those 4 years to make medical care unaffordable? HMO's. I still only had Major Medical insurance, and... Login to Reply Flag as Offensive

Post Comment Ann Anon Wrote: May 10, 2013 7:55 AM A lot of us feel the way you do but the Politicians do not feel that way. Don't vote for incumbents. Congress needs new blood. Login to Reply Flag as Offensive

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Why the Obamacare Medicaid Expansion Is Bad for Taxpayers and Patients

Medicaid needs reform, not expansion. This federal–state health care program provides health care to over 60 million Americans and consumes a growing portion of state and federal budgets. Research shows a long history of Medicaid enrollees having worse access and outcomes than privately insured individuals.[1] Due in part to low reimbursement, one in three doctors refuses to accept new Medicaid patients.[2] Despite access issues, Medicaid spending continues to grow. In 2010, total federal and state spending on Medicaid exceeded $400 billion.[3]

Instead of reforming Medicaid, the Patient Protection and Affordable Care Act (Obamacare) expands eligibility to all individuals earning less than 138 percent of the federal poverty level (FPL).[4] The Medicaid program is already struggling to provide care to its core obligations—a diverse group of low-income children, disabled, pregnant women, and seniors. Adding more people further exacerbates Medicaid’s underlying problems.

The expansion of Medicaid fuels a larger trend under Obamacare: government coverage supplanting private coverage. By 2021, 46 percent of all Americans will be dependent on the government for their health care. Of this group, 86.9 million will be on Medicaid/Children’s Health Insurance Program (CHIP), followed by 64.3 million on Medicare and 23.4 million enrolled in government exchanges.[5] This will push U.S. health care closer to a government model.

The Temptation of Medicaid Expansion

Obamacare provides additional federal funding to the states for this new expansion population. Starting in 2014, the federal government would pick up 100 percent of the benefit costs for the newly eligible population for three years. Thereafter, this enhanced federal funding would gradually decline to 90 percent in 2020.

Obamacare also directed states to expand eligibility or risk forgoing all of their federal Medicaid dollars. The Supreme Court, however, ruled on behalf of 26 state plaintiffs that this “all-or-nothing” proposition was coercive. To rectify this, the Court essentially made the expansion optional, meaning that a state could reject the expansion but not lose its existing Medicaid funding.

Today, governors and state legislators are weighing this option as they develop their budgets for the coming year. Proponents use a variety of unrealistic arguments in support of the Medicaid expansion:

It provides states with an influx of new, generous federal revenue. This will cause states to spend money that they otherwise would not have spent. Moreover, due to the structure of Obamacare, states will likely have to absorb many currently eligible but not enrolled individuals as well as those who lose their existing employer coverage. These effects would add to the cost.[6]It will result in savings as the cost of uncompensated care declines with expanded coverage. Heritage data analysis shows that in the first few years, when federal funding is at its peak, states may see some savings. Over time, however, in the majority of states, Medicaid spending will accelerate and dwarf any projected uncompensated care savings.[7] These savings are also contingent on states enacting legislation to further reduce uncompensated care funds (Disproportionate Share Hospital [DSH] payments) on top of the $18 billion of federal cuts enacted under Obamacare. Heritage analyst Ed Haislmaier predicts that “governors and state legislators should expect their state’s hospitals and clinics to lobby them for more—not less—state funding to replace cuts in federal DSH payments.”[8]
Finally, contrary to the theory that expanding Medicaid would cause the number of uninsured to decline and reduce the need for uncompensated care, a similar expansion in Maine found the opposite effect. In Maine, uncompensated care increased, and the number of uninsured in the targeted population (those below 100 percent of FPL) saw limited change.[9]Rejecting the expansion will mean that other states get more. The federal share of Medicaid is based on a formula calculation and actual expenditures. Rejected funds do not go into a general fund for redistribution to other states. The fewer states that expand, the less the federal government spends. States that draw down on these new federal funds fuel the fiscal crisis in our country.

The Trade-Off Dilemma

Committing to an expansion creates a dilemma for the states. To control Medicaid spending, states typically fall back on predictable techniques to manage costs, such as limiting reimbursements to health care providers and limiting services, which ultimately limits access to care. These Medicaid cost controls, however, go only so far. Today, Medicaid consumes over 23 percent of state budgets, surpassing education as the largest state budget item.[10] As Medicaid spending continues to rise, other important state priorities such as education, emergency services, transportation, and criminal justice are squeezed.

Finally, if states resist balancing among spending programs, the alternative is generating more revenues with tax increases. But higher taxes come with a steep price: They reduce economic growth. With most states still experiencing anemic growth, tax increases on top of already higher taxes at the federal level are not an appealing option.[11]

Fueling the Country’s Fiscal Crisis

Any positive assumptions about Medicaid expansion also assume that federal funding remains unchanged. With deficits running over $1 trillion a year, the country’s fiscal future is in need of reform. Federal spending on health care entitlements, including Medicare and Medicaid, is the largest driver.[12]

Even this Administration recognizes that such entitlement spending, including Medicaid, is unsustainable. The President’s fiscal year (FY) 2011 budget outlined several Medicaid reform policies, including setting an across-the-board blend rate for federal reimbursement and limiting the states’ ability to leverage provider taxes for the state share of matching funds. Although the Administration attempts to distance itself from its own proposal, any serious efforts toward entitlement reform must include Medicaid.

In spite of this fact, several Democrat and Republican governors that support Medicaid expansion condition their support on federal funding remaining untouched. In essence, pro-expansion governors are telling Washington, “don’t touch entitlement spending.” This reliance on federal revenues exacerbates the country’s fiscal challenges and could also affect states’ own fiscal health. Recently, Moody’s cited Missouri’s reliance on the federal government, including Medicaid funding, as adversely affecting its credit rating outlook.[13]

Setting Good Policy

There are several recommendations that the states and Congress could adopt to help mitigate the crisis that Obamacare has exacerbated:

Reject the Medicaid expansion. Greater dependence on federal dollars tangles the states in bad fiscal policy and bad health care policy. States that reject the expansion avoid relying on unsound federal revenues, stretching an already thin program beyond its means and adding millions to a failing program.  Scale back existing eligibility where possible. Some states have allowed Medicaid to grow beyond its original intent by moving middle-class families into a welfare program. To restore Medicaid as a safety-net program, states should review eligibility levels, scale back eligibility where possible, and restore the program’s focus on its core Medicaid functions.Advance a separate, state alternative. Instead of using a flawed Obamacare model, states should put in place an alternative. States should develop a state solution tailored to the specific needs of this new population rather than placing them in a one-size-fits-all Medicaid option.[14] A non-Medicaid, state-based approach, especially for this targeted population, would give states the control to design policies best suited to addressing the needs of their citizens without onerous Medicaid constraints. Congress should eliminate the federal enhanced Medicaid match. To avoid the argument that states rejecting Medicaid are leaving federal dollars on the table, Congress should level the playing field by removing the new, enhanced federal dollars. This would remove/minimize the temptation of excessive and unsustainable federal funding and restore fiscal constraint at the federal level. States would still be able to expand eligibility but would have to do so with the traditional (non-enhanced) federal matching rate. If Congress ignores this opportunity to restrain federal spending, it could “block grant” the enhanced federal dollars to the states to develop their own state-specific approaches, including alternatives outside of Medicaid.

Alternate Solution Needed

Medicaid is already spread too thin. Adding a new and complex population to this program does not solve its challenges; it only makes them worse. States should resist, and Congress should remove, this temptation. Both should begin to lay out a better and more sustainable alternative than a failing government health program to care for the less fortunate.

—Nina Owcharenko is Director of the Center for Health Policy Studies and Preston A. Wells, Jr., Fellow at The Heritage Foundation.

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Studies Show: Medicaid Patients Have Worse Access and Outcomes than the Privately Insured

Abstract: Academic literature has consistently illustrated that Medicaid patients—adults and children—have inferior access to health care, and notably poorer health outcomes, than privately insured patients. Due to the program's low reimbursement rates, more and more doctors are refusing to even accept Medicaid. As a result, it is becoming increasingly difficult for Medicaid patients to find access to primary and specialty care physicians. When Medicaid patients are admitted to hospitals, they are often admitted with more serious conditions than those with private insurance. By further expanding this broken program, Obamacare will only exacerbate the situation, continuing to harm many low-income Americans who have no option other than Medicaid. Policymakers should reform Medicaid to allow Medicaid patients access to private insurance in a consumer-driven market.

Established as a fundamental component of President Lyndon Johnson's Great Society, Medicaid is a jointly funded federal and state program that pays for health care for low-income individuals. The academic literature has consistently illustrated that Medicaid patients have poorer access to care, and poorer health outcomes, than privately insured patients. By further expanding this broken program, the Patient Protection and Affordable Care Act - Obamacare - only exacerbates the situation. Policymakers should reform Medicaid to provide consumers with greater access to private insurance in a consumer-driven market.

Medicaid typically pays physicians 56 percent of the amount that private insurers pay.[1] Given these low reimbursement rates, more and more doctors are refusing to accept Medicaid.[2] As a result, it is becoming increasingly difficult for Medicaid patients to find primary care doctors and specialists. When Medicaid patients are admitted to hospitals, they are often admitted with more serious conditions, and in some cases, with a higher level of co-morbidity, than privately insured patients. The peer-reviewed academic literature clearly illustrates Medicaid's problems for children as well as for adults.

Medicaid undermines care for millions of children. Consider, for example, children with asthma, one of the most common chronic diseases affecting children in the United States. A 2001 study published in the Journal of Health Care for the Poor and Underserved compares hospital care for children with asthma who are covered by Medicaid to children with asthma who are covered by private insurance in California, Georgia, and Michigan.[3] The authors found slightly longer length of stay and significantly poorer outpatient care for the children on Medicaid. In terms of outpatient care, the authors specifically found that pediatric Medicaid patients were more likely than privately insured patients to be discharged on subpar medication routines. The authors also found that Medicaid patients generally lacked a consistent source of outpatient care, unlike privately insured patients. These issues with outpatient care suggest that these children are more likely to be re-admitted for hospitalization at a subsequent time in the future.

Adequate access to care is also a serious problem for children on Medicaid. A 2004 study published in Pediatrics examined children’s access to specialty surgeons in Southern California.[4] The researchers surveyed specialty surgeons throughout southern California and found that the surgeons are generally less inclined to accept patients enrolled in Medi-Cal (California’s version of the Medicaid program). The surgeons cited difficult paperwork, administrative burdens, and poor reimbursement rates as reasons for not wanting to take on these patients. The authors consequently caution policymakers about expanding this program, noting that coverage through Medi-Cal does not necessarily signify meaningful access to health care. The authors also suggest that expanding Medi-Cal may in fact exacerbate the existing problems of limited access to care.

Another study published in 2005 in Urology found similar problems with boys’ access to urologic care.[5] The authors surveyed a simple random sample of urologic offices located throughout California in order to determine the offices’ attitudes toward Medi-Cal recipients. Of the offices they found that were willing to see pediatric patients, the authors found that 96 percent of these offices would accept privately insured patients. They also found that only 41 percent of these offices would accept Medi-Cal patients. Three-quarters of the offices that refused to accept Medi-Cal patients were unable to even recommend offices that would.

Furthermore, a recent study published in the New England Journal of Medicine examined pediatric access to specialty clinics in Cook County, Illinois.[6] Sending out research assistants posing as mothers and making phone calls to a random sample of specialty clinics, the study found a significant disparity between access to specialty care for privately insured children and children on Medicaid as well as the publicly funded Children’s Health Insurance Program (CHIP). Specifically, the researchers noted more denials of appointments as well as longer waiting times for Medicaid and CHIP patients than for privately insured patients.

These studies suggest that children on Medicaid lack access to the kind of care that privately insured patients enjoy. As long as the program in its current form remains in place, these problems will persist.

Children are not the only ones Medicaid is failing. A number of academic studies have also pointed out the disparities in health outcomes between adult Medicaid recipients and those who are privately insured.

A 1993 study published in the New England Journal of Medicine found that breast cancer patients in New Jersey were often diagnosed with more advanced stages of the disease and had higher risks of death if they received their insurance coverage through Medicaid instead of private insurance.[7] These findings have been corroborated by a number of subsequent studies looking at a variety of serious illnesses:

A 2000 study published in Cancer examined health outcomes of breast cancer patients in Florida. The study found that, as a result of later diagnoses, Medicaid patients have higher mortality rates than patients who are covered by commercial fee-for-service insurance.[8] A 2000 study published in the American Journal of Public Health that examines colorectal cancer treatments and outcomes found that Medicaid patients not only had higher mortality rates, but were also less likely to receive cancer-directed surgery, than patients using commercial fee-for-service insurance.[9] A 2001 study published in Cancer compared health outcomes for a variety of cancers for patients in Michigan. The study found that Medicaid patients had significantly higher rates of occurrence as well as higher risks of death for breast, cervix, colon, and lung cancers compared to non-Medicaid patients. The study also found that Medicaid patients had a higher risk of being diagnosed with these cancers at later stages.[10] A 2003 study published in the Archives of Internal Medicine that compares health outcomes for colorectal, lung, prostate, and breast cancer in Kentucky for a variety of insurance classifications also found similar results. For all four illnesses, the authors found that survival rates are markedly higher for privately insured patients than for Medicaid patients.[11]

Most recently, a 2010 study in the Journal of Hospital Medicine found similar results for non-cancer-related illness. In this study, the authors examine the relationship between insurance status and health outcomes for myocardial infarction, stroke, and pneumonia patients.[12] The authors statistically analyzed a nationally representative hospital database and noticed, even after adjusting for factors such as age, gender, income, other illnesses, and severity, higher in-hospital mortality rates for Medicaid patients than for privately insured patients. Additionally, even after adjusting for these factors, the study found that Medicaid patients hospitalized for strokes and pneumonia also ran up higher costs than the privately insured, as well as the uninsured.

A number of academic studies over the years have illustrated that Medicaid patients have consistently had poor access to care and that Medicaid fails to meet important needs:

A 1992 study in the Journal of the American Medical Association examined hospitalizations in Massachusetts and Maryland.[13] The study found that Medicaid and uninsured patients were statistically more likely than privately insured patients to be hospitalized for avoidable conditions such as pneumonia and diabetes. A 2007 study in Health Affairs examined access to specialty services for patients who receive primary care from community health centers.[14] The study found that Medicaid recipients have significantly more difficulty accessing specialty care than privately insured patients. A 2012 study in Health Affairs examined physicians’ willingness to accept new patients. Using survey data from a nationally representative sample, the study found that nearly one-third of physicians nationwide will not accept new Medicaid patients. Doctors in smaller practices, as well as doctors in metropolitan areas, are among the least inclined to accept new Medicaid patients.[15] The authors’ results suggest that this reluctance may largely be a consequence of Medicaid’s poor payment rates to doctors.

Given these findings in the peer-reviewed literature, it is not surprising that Medicaid patients often arrive at emergency rooms in poor, and in many cases, untreatable condition. In fact, research has shown that Medicaid and CHIP patients end up in emergency rooms even more frequently than uninsured patients.[16]

As the academic research has consistently suggested, Medicaid’s so-called safety net cripples the very people it is designed to help. To fix the broken safety net, Congress should consider the following.[17]

Repeal Obamacare and its Medicaid expansion. One of Obamacare’s greatest pretenses is that it improves access to health care. The new law attempts to achieve this goal by dumping millions more patients into the broken Medicaid system. Recent Heritage Foundation research has statistically illustrated the debilitating effect that Medicaid expansion will impose on state governments.[18]

Some proponents will likely argue that Obamacare addresses access issues by providing additional federal funding to increase physician reimbursement to Medicare levels. However, this additional federal reimbursement is only temporary and solely applies to primary care physicians. As a result, it is only a matter of time until state budgets become more burdened and a lack of access to meaningful health care becomes even more of a problem nationwide.[19]

Maximize access to private health insurance for Medicaid beneficiaries. The best approach to improving access and outcomes would be to integrate the success of private health insurance into the Medicaid system. Some states, such as Florida, have pursued reforms in the past decade by giving Medicaid patients a choice of private managed care plans. A five-county pilot version of the program flattened Medicaid costs and had been saving the state slightly under $120 million annually. Additionally, the program overall noted greater access to care, higher degrees of patient satisfaction, and a marked improvement in health outcomes.[20]

The Heritage Foundation’s Saving the American Dream proposal goes further. It recommends transitioning non-disabled Medicaid beneficiaries out of the failing Medicaid program and into private health insurance and integrating private, patient-centered models into Medicaid to better serve the disabled and frail elderly.[21]

Medicaid is a prime example of government’s inability to outperform—or even keep up with—the private sector. Academic research has consistently illustrated that the program is associated with poorer access to care and poorer health outcomes than private insurance. With the right reforms, however, lawmakers can significantly expand Medicaid patients’ access to private health insurance and put low-cost, high-quality care back in the hands of those truly in need.

—Kevin D. Dayaratna is Graduate Fellow in the Center for Health Care Policy Studies at The Heritage Foundation.

[1] Robert E. Moffit, “Obamacare: Impact on Doctors,” Heritage Foundation WebMemo No. 2895, May 11, 2010, http://www.heritage.org/research/reports/2010/05/obamacare-impact-on-doctors.

[2] Sandra Decker, “In 2011, Nearly One-Third of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help,” Health Affairs, Vol. 31, No. 8 (August 2012), pp. 1673–1679, and Alyene Senger, “Don’t Expand Medicaid—One-Third of Doctors Are Already Opting Out of It,” The Heritage Foundation, The Foundry, August 9, 2012, http://blog.heritage.org/2012/08/09/dont-expand-medicaid-one-third-of-doctors-are-already-opting-out-of-it/.

[3] Nancy Merrick, Robert Houchens, Sandra Tillisch, and Bruce Berlow, “Quality of Hospital Care of Children with Asthma: Medicaid Versus Privately Insured Patients,” Journal of Health Care for the Poor and Underserved, Vol. 12, No. 2 (2001), pp. 192–207.

[4] Edward Wang, Meeryo Choe, John Meara, and Jeffrey Koempel, “Inequality of Access to Surgical Specialty Health Care: Why Children with Government-Funded Insurance Have Less Access than Those with Private Insurance in Southern California,” Pediatrics, Vol. 114, No. 5 (2004), pp. e584–e590.

[5] Andrew Hwang, Margaret Hwang, Hui-Wen Xie, Brian Hardy, and David Skaggs, “Access to Urologic Care for Children in California: Medicaid Versus Private Insurance,” Urology, Vol. 65, No. 1 (2005), pp. 170–173.

[6] Joanna Bisgaier and Karin V. Rhodes, “Auditing Access to Specialty Care for Children with Public Insurance,” New England Journal of Medicine, June 16, 2011, pp. 2324–2333, http://www.nejm.org/doi/full/10.1056/NEJMsa1013285 (accessed November 7, 2012).

[7] J. Z. Ayanian, B. A. Kohler, T. Abe, and A. M. Epstein, “The Relation Between Health Insurance Coverage and Clinical Outcomes Among Women with Breast Cancer,” New England Journal of Medicine, July 29, 1993, pp. 326–331.

[8] R. G. Roetzheim, E. C. Gonzalez, J. M. Ferrante, N. Pal, D. J. Van Durme, and J. P. Kricher, “Effects of Health Insurance and Race on Breast Carcinoma Treatments and Outcomes,” Cancer, Vol. 89 (2000), pp. 2202–2213.

[9] R. G. Roetzheim, Pal Nazneen, E. C. Gonzalez, J. M. Ferrante, N. Pal, D. J. Van Durme, and J. P. Kricher, “Effects of Health Insurance and Race on Colorectal Cancer Treatments and Outcomes,” American Journal of Public Health, 90 (2000), pp. 1746–1754.

[10] C. J. Bradley, C. W. Given, and C. Roberts, “Disparities in Cancer Diagnosis and Survival,” Cancer, Vol. 91 (2001), pp. 178–188.

[11] K. McDavid, T. Tucker, A. Sloggett, and M. P. Coleman, “Cancer Survival in Kentucky and Health Insurance Coverage,” Archives of Internal Medicine, Vol. 163 (2003), pp. 2135–2144.

[12] Omar Hasan, E. John Orav, and LeRoi Hicks, “Insurance Status and Hospital Care for Myocardial Infarction, Stroke, and Pneumonia,” Journal of Hospital Medicine, Vol. 5, No. 8 (2010), pp. 452–459.

[13] Joel S. Weissman, Constantine Gatsonis, and Arnold M. Epstein, “Rates of Avoidable Hospitalization by Insurance Status in Massachusetts and Maryland,” Journal of the American Medical Association, Vol. 268, No. 17 (1992), pp. 2388–2394.

[14] Nakela L. Cook et al., “Access to Specialty Care and Medical Services in Community Health Centers,” Health Affairs, Vol. 26, No. 5 (2007), pp. 1459–1468.

[15] Decker, “In 2011 Nearly One-Third of Physicians Said They Would Not Accept New Medicaid Patients, But Rising Fees May Help.”

[16] John O’Shea, “More Medicaid Means Less Quality Health Care,” Heritage Foundation WebWemo No. 1402, March 21, 2007, http://www.heritage.org/research/reports/2007/03/more-medicaid-means-less-quality-health-care.

[17] Nina Owcharenko, “Medicaid Reform: More than a Block Grant Is Needed,” Heritage Foundation Issue Brief No. 3590, May 4, 2012, http://www.heritage.org/research/reports/2012/05/three-steps-to-medicaid-reform.

[18] Drew Gonshorowski, “Medicaid Expansion Will Become More Costly to States,” Heritage Foundation Issue Brief No. 3709, August 30, 2012, http://www.heritage.org/research/reports/2012/08/medicaid-expansion-will-become-more-costly-to-states.

[19] Edmund F. Haislmaier and Brian Blase, “Obamacare: Impact on States,” Heritage Foundation Backgrounder No. 2433, July 1, 2010, http://www.heritage.org/research/reports/2010/07/obamacare-impact-on-states.

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Democratic Senator Touts Bill To Allow Patients Involuntarily Committed For Mental Illness To Purchase Guns

Sen. Mark Pryor (D-AR) hinted on Tuesday that he would oppose a Democratic initiative to expand background checks to all gun purchases, but reiterated his support for an NRA-backed measure that would permit individuals deemed mentally ill or incompetent to purchase firearms more freely. Pryor is part of small group of Democrats in red states who have not endorsed universal background checks, even though the measure is supported by a majority of residents.

“You know, I’m a Second Amendment guy, everybody knows that. People in our state are very strong believers in the Second Amendment and the right to gun ownership,” Pryor told “The Alice Stewart Show,” which airs on KHTE 96.5 The Voice. The conservative Democrat then highlighted his co-sponsorship of an NRA concocted proposal that would reduce the number of records in the existing background check system by removing prohibitions against individuals who were involuntarily committed to mental institutions.

Pryor emphasized removing records from the National Instant Criminal Background Check System, rather than broadening the requirement:

PRYOR: I do support improving the background check. I want to make sure that when we put data in the background check that we have the right kind of mental health data. We need integrity in that data to be in there and we also need a process where people can get their names out of there when the time is right. Either they got their name wrongly in the first place or they’ve gone through some issue or whatever and that’s behind them and they need to get their name out of the database. So I support a bipartisan bill on that, in fact I think it’s endorsed by the NRA, so I’m not like totally opposed to every single thing. I try to be reasonable on this.

Pryor, along with Sens. Lindsey Graham (R-SC), Mark Begich (R-AK), Dean Heller (R-NV), and Jeff Flake (R-AZ), has introduced the NICS Reporting Improvement Act (S. 480). The Act clarifies that mentally ill people are prevented from obtaining firearms but defines that term narrowly, so as to allow patients who had been treated for mental illness to pass a federal background check and purchase guns.

For instance, federal law prohibits people who are ordered by a court into involuntary treatment, found to pose a danger to themselves or others, or lack the mental capacity to enter into legal contracts from buying weapons — even though individuals can petition to have their rights restored in 22 states. The bipartisan NICS Reporting Improvement Act would allow these people to purchase weapons immediately after being released, unless it can be proven that they pose an “imminent” danger.

Since the shooting at Virginia Tech, the number of mental health records in NICS has grown from 200,000 to 1.2 million, though “millions of records identifying seriously mentally ill people and drug abusers as prohibited purchasers are missing from the federal background check database because of lax reporting by state agencies,” a report from Mayors Against Illegal Guns found. Pryor’s bill would keep even more mentally ill individuals out of the system.

“I doen’t listen to [New York City Mayor Michael Bloomberg] on these issues, I listen to Arkansas,” Pryor said. A recent poll found that 84 percent of Arkansans support expanding background checks to all firearm purchsases.

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Why the Obamacare Medicaid Expansion Is Bad for Taxpayers and Patients

Medicaid needs reform, not expansion. This federal–state health care program provides health care to over 60 million Americans and consumes a growing portion of state and federal budgets. Research shows a long history of Medicaid enrollees having worse access and outcomes than privately insured individuals.[1] Due in part to low reimbursement, one in three doctors refuses to accept new Medicaid patients.[2] Despite access issues, Medicaid spending continues to grow. In 2010, total federal and state spending on Medicaid exceeded $400 billion.[3]

Instead of reforming Medicaid, the Patient Protection and Affordable Care Act (Obamacare) expands eligibility to all individuals earning less than 138 percent of the federal poverty level (FPL).[4] The Medicaid program is already struggling to provide care to its core obligations—a diverse group of low-income children, disabled, pregnant women, and seniors. Adding more people further exacerbates Medicaid’s underlying problems.

The expansion of Medicaid fuels a larger trend under Obamacare: government coverage supplanting private coverage. By 2021, 46 percent of all Americans will be dependent on the government for their health care. Of this group, 86.9 million will be on Medicaid/Children’s Health Insurance Program (CHIP), followed by 64.3 million on Medicare and 23.4 million enrolled in government exchanges.[5] This will push U.S. health care closer to a government model.

The Temptation of Medicaid Expansion

Obamacare provides additional federal funding to the states for this new expansion population. Starting in 2014, the federal government would pick up 100 percent of the benefit costs for the newly eligible population for three years. Thereafter, this enhanced federal funding would gradually decline to 90 percent in 2020.

Obamacare also directed states to expand eligibility or risk forgoing all of their federal Medicaid dollars. The Supreme Court, however, ruled on behalf of 26 state plaintiffs that this “all-or-nothing” proposition was coercive. To rectify this, the Court essentially made the expansion optional, meaning that a state could reject the expansion but not lose its existing Medicaid funding.

Today, governors and state legislators are weighing this option as they develop their budgets for the coming year. Proponents use a variety of unrealistic arguments in support of the Medicaid expansion:

It provides states with an influx of new, generous federal revenue. This will cause states to spend money that they otherwise would not have spent. Moreover, due to the structure of Obamacare, states will likely have to absorb many currently eligible but not enrolled individuals as well as those who lose their existing employer coverage. These effects would add to the cost.[6]It will result in savings as the cost of uncompensated care declines with expanded coverage. Heritage data analysis shows that in the first few years, when federal funding is at its peak, states may see some savings. Over time, however, in the majority of states, Medicaid spending will accelerate and dwarf any projected uncompensated care savings.[7] These savings are also contingent on states enacting legislation to further reduce uncompensated care funds (Disproportionate Share Hospital [DSH] payments) on top of the $18 billion of federal cuts enacted under Obamacare. Heritage analyst Ed Haislmaier predicts that “governors and state legislators should expect their state’s hospitals and clinics to lobby them for more—not less—state funding to replace cuts in federal DSH payments.”[8]
Finally, contrary to the theory that expanding Medicaid would cause the number of uninsured to decline and reduce the need for uncompensated care, a similar expansion in Maine found the opposite effect. In Maine, uncompensated care increased, and the number of uninsured in the targeted population (those below 100 percent of FPL) saw limited change.[9]Rejecting the expansion will mean that other states get more. The federal share of Medicaid is based on a formula calculation and actual expenditures. Rejected funds do not go into a general fund for redistribution to other states. The fewer states that expand, the less the federal government spends. States that draw down on these new federal funds fuel the fiscal crisis in our country.

The Trade-Off Dilemma

Committing to an expansion creates a dilemma for the states. To control Medicaid spending, states typically fall back on predictable techniques to manage costs, such as limiting reimbursements to health care providers and limiting services, which ultimately limits access to care. These Medicaid cost controls, however, go only so far. Today, Medicaid consumes over 23 percent of state budgets, surpassing education as the largest state budget item.[10] As Medicaid spending continues to rise, other important state priorities such as education, emergency services, transportation, and criminal justice are squeezed.

Finally, if states resist balancing among spending programs, the alternative is generating more revenues with tax increases. But higher taxes come with a steep price: They reduce economic growth. With most states still experiencing anemic growth, tax increases on top of already higher taxes at the federal level are not an appealing option.[11]

Fueling the Country’s Fiscal Crisis

Any positive assumptions about Medicaid expansion also assume that federal funding remains unchanged. With deficits running over $1 trillion a year, the country’s fiscal future is in need of reform. Federal spending on health care entitlements, including Medicare and Medicaid, is the largest driver.[12]

Even this Administration recognizes that such entitlement spending, including Medicaid, is unsustainable. The President’s fiscal year (FY) 2011 budget outlined several Medicaid reform policies, including setting an across-the-board blend rate for federal reimbursement and limiting the states’ ability to leverage provider taxes for the state share of matching funds. Although the Administration attempts to distance itself from its own proposal, any serious efforts toward entitlement reform must include Medicaid.

In spite of this fact, several Democrat and Republican governors that support Medicaid expansion condition their support on federal funding remaining untouched. In essence, pro-expansion governors are telling Washington, “don’t touch entitlement spending.” This reliance on federal revenues exacerbates the country’s fiscal challenges and could also affect states’ own fiscal health. Recently, Moody’s cited Missouri’s reliance on the federal government, including Medicaid funding, as adversely affecting its credit rating outlook.[13]

Setting Good Policy

There are several recommendations that the states and Congress could adopt to help mitigate the crisis that Obamacare has exacerbated:

Reject the Medicaid expansion. Greater dependence on federal dollars tangles the states in bad fiscal policy and bad health care policy. States that reject the expansion avoid relying on unsound federal revenues, stretching an already thin program beyond its means and adding millions to a failing program.  Scale back existing eligibility where possible. Some states have allowed Medicaid to grow beyond its original intent by moving middle-class families into a welfare program. To restore Medicaid as a safety-net program, states should review eligibility levels, scale back eligibility where possible, and restore the program’s focus on its core Medicaid functions.Advance a separate, state alternative. Instead of using a flawed Obamacare model, states should put in place an alternative. States should develop a state solution tailored to the specific needs of this new population rather than placing them in a one-size-fits-all Medicaid option.[14] A non-Medicaid, state-based approach, especially for this targeted population, would give states the control to design policies best suited to addressing the needs of their citizens without onerous Medicaid constraints. Congress should eliminate the federal enhanced Medicaid match. To avoid the argument that states rejecting Medicaid are leaving federal dollars on the table, Congress should level the playing field by removing the new, enhanced federal dollars. This would remove/minimize the temptation of excessive and unsustainable federal funding and restore fiscal constraint at the federal level. States would still be able to expand eligibility but would have to do so with the traditional (non-enhanced) federal matching rate. If Congress ignores this opportunity to restrain federal spending, it could “block grant” the enhanced federal dollars to the states to develop their own state-specific approaches, including alternatives outside of Medicaid.

Alternate Solution Needed

Medicaid is already spread too thin. Adding a new and complex population to this program does not solve its challenges; it only makes them worse. States should resist, and Congress should remove, this temptation. Both should begin to lay out a better and more sustainable alternative than a failing government health program to care for the less fortunate.

—Nina Owcharenko is Director of the Center for Health Policy Studies and Preston A. Wells, Jr., Fellow at The Heritage Foundation.

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When Did We Forget About the Patients?

When Did We Forget About the Patients? - Hal Scherz - Townhall Finance Conservative Columnists and Financial Commentary - Page 1  

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With each passing day, more is discovered about the Affordable Care Act (ACA, Obamacare) confirming all of our worst fears about this law. The majority of discussion regarding Obamacare has been concentrated on issues involving implementation, such as state health insurance exchanges or Medicaid expansion.

It has also focused on the crushing financial implications of the law, such as the 18 new taxes created by the ACA, or the dramatic rise in healthcare insurance premiums, or the projected $2.7 trillion price tag. This narrative is understandable because the majority of people doing the reporting are pundits, talking heads and policy wonks.

The missing piece in this narrative is the havoc that this law is creating in the lives of so many patients. Despite minimal implementation of the ACA thus far, the effects on many patients is already devastating- something very much under-reported.

Last month we learned that cancer clinics were turning away Medicare patients as a result of cuts brought about by the sequester. The cuts would result in a decrease in Medicare reimbursement to these private clinics by as much as 28%. This has forced these clinics to find alternative treatment facilities for these patients, which in some cases may be thousands of miles away from their homes. This is tantamount to a death sentence for some patients, for whom travel is not possible because of both economic and health reasons.

The creation of high risk pools for patients with pre-existing or expensive medical problems was touted as one of the achievements of Obamacare (Pre-Existing Condition Insurance Plan, PECIP). It has never lived up to its expectations. The predictions were that by this time, over 1 million people would be participating, but it stalled at about 100,000 because this coverage was more expensive than anyone had anticipated. And further enrollment was halted because the money ran out. Now it appears that the shortage of funds may jeopardize the continued coverage for those patients currently enrolled.

The GOP leadership in the House of Representatives, sensitive to the needs of these patients, introduced HR 1549, which would transfer money from other ACA programs into the PECIP. President Obama however, threatened a veto if this bill reached his desk. He apparently has little concern for these patients and if it means that they need to be sacrificed in order to proceed with continued implementation of the law, then this may be the price that needs to be paid. Try telling that to the patients though.

Next21View Full Article Hal Scherz Dr. Hal Scherz is the Founder and President of Docs4Patient Care. Most Recent Articles Braves 5, Dodgers 2 Commuters warned of traffic mess for up to 1 week 2 FBI agents killed in training accident in Va. Jennifer Johnson wins Mobile Bay LPGA Classic Obama walks a fine line with Myanmar president's landmark visit Spurs rout Grizzlies 105-83 in West finals opener Official: Va. driver likely had medical condition AP CEO calls records seizure unconstitutional Sign-Up to receive Updates from TH Join the Debate 12 Comments So Far Login in to Post Your Comments Newest First Oldest First sbrown Wrote: May 13, 2013 1:33 PM 2014 will be even more interesting. Many major elements of Obamacare are supposed to kick in. The states have, for a variety of smart or apathetic reasons, not been active in setting up the state insurance exchanges. Perversely this may protect a swath of Americans for a few more years, if their employers continue to carry health insurance as opposed to paying the fine and telling their employees to go to the exchanges for insurance. Login to Reply Flag as Offensive

Post Comment dheath Wrote: May 11, 2013 6:12 AM I went for my annual physical this week, to the same doctor I have been going to for years. They have always had the nurse take my blood pressure, do an EKG, and then take care of the medical questions. However, now the medical questioning has become so burdensome, that they went streight to the questioning and forgot to do the EKG. Later, my doctor reminded them that they needed to do that. He is a Libertarian. If you think you can trust either of these parties, any of these parties, you need to think again. It is time to get the brightest together and form the right party along the lines of the Tea Party Principles, get on the ballot in all states, put out principled candidates and get the job done. If you haven't read or... Login to Reply Flag as Offensive

Post Comment Maximus2 Wrote: May 10, 2013 3:41 PM Inarticulate , Sarah? No she was right on! Perhaps the columnist should have talked to some more Doctors, however he wrote a good piece and hit what is all wrong with Obama care except for the fact that health care for seniors with problems will be dropped over board to save his agenda to insure illegals and totally destroy the best healthcare system In the World. Login to Reply Flag as Offensive

Post Comment mshreve Wrote: May 10, 2013 2:06 PM WHO screamed when 720 BILLION was STOLEN from Medicare to help fund Obamacare. Certainly NOT the AARP. Sequestration resulted in an DECREASE in the INCREASE of spending only. 415 BILLION was cut from PROVIDER payments. Login to Reply Flag as Offensive

Post Comment mshreve Wrote: May 10, 2013 2:05 PM WHO screamed when 720 BILLION was STOLEN from Medicare to help fund Obamacare. Certainly NOT the AARP. Sequestration resulted in an DECREASE in the INCREASE of spending only. 415 BILLION was cut from Login to Reply Flag as Offensive

Post Comment Bluebonnet Wrote: May 10, 2013 1:36 PM Remember, this bill was "deemed" passed by Nancy Pelosi, still not knowing what was in the bill. How unconstitutionally corrupt, arrogant and stupid is that?!!
And, speaking of health care, the pharmaceutical companies donate heavily to members of Congress. Why don't we know more about what is in these drugs that cause deadly side effects? Do statin drugs cause diabetes? A real winner for pharma. Which drugs cause pancreatic cancer? What named drugs causing heart attacks are still allowed on the market? The accusations are there. Where is the follow-up and data? 10,000 deaths before one drug was removed. Now 80,000 deaths thought from another. Why can't staph be eliminated from hospitals? You see, the health care bill and... Login to Reply Flag as Offensive

Post Comment None1257 Wrote: May 10, 2013 1:00 PM This is real simple to understand. When you decided that you wanted someone else to pay for our needs and wants, you also gave them the right not to pay. Login to Reply Flag as Offensive

Post Comment Ronald E Wrote: May 10, 2013 10:08 AM The mission of a physician hasn't changed. We are trained for years to do whatever we can for others to the best of our ability. I will never sell out to bureaucrats who haven't had my 11 years of medical training. If that means dropping all government and private insurance plans, so be it. We are trained to think independently and practicing medicine is a complex interaction that can't be reduced to a cookie-cutter approach.
The ACA will wreak havoc on American medicine, including the unwarranted transition to electronic records that are not ready for prime time.
We have always been patient-centric, though others don't seem to think so.
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Post Comment ryoung292 Wrote: May 10, 2013 9:27 AM Welcome to "Logans RUN!" Login to Reply Flag as Offensive

Post Comment Charles52 Wrote: May 10, 2013 8:55 AM ObamaCares real name should be POPULATION CONTROL CARE. That is because it was nothing but a major political lie drafted by lawyers for the benefits of lawyers who are politicians and there was never any intentional benefit for people. Pelosi said it all when she gleefully said " let's pass the bill, then we can find out what is in it". That tells us what politicians thinks about what they do...pass junk they know nothing about, then leave the thing open to amendments as time goes on and there in lies the real disasters. obamacare was never intended to lower cost, nor to protect people, but more to contol people, except politicians who were exemted because they know upfront it was a disaster....for them. Login to Reply Flag as Offensive

Post Comment lgoldhammer Wrote: May 10, 2013 7:25 AM The health care solution is simple: go back to what we were doing before there was a health care problem. Go back to major medical care insurance that is used as insurance was intended: for an unplanned major medical problem with big price tags like surgery or disease. In 1984 I joined the Navy. Before going in it cost me $25 to go to the OB/GYN. I was only making $5-6/hour and could afford to pay this out of pocket. In 1988 when I got out of the service and called for an appointment they wanted $150. I was still making only $5-6/hour, but I couldn't afford to pay a doctor a whole weeks salary to be seen. What had happened in those 4 years to make medical care unaffordable? HMO's. I still only had Major Medical insurance, and... Login to Reply Flag as Offensive

Post Comment Ann Anon Wrote: May 10, 2013 7:55 AM A lot of us feel the way you do but the Politicians do not feel that way. Don't vote for incumbents. Congress needs new blood. Login to Reply Flag as Offensive

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Georgia May Allow Mental Health Counselors To ‘Involuntarily Commit’ Patients

A Georgia Senate health committee has unanimously passed a bill “that would allow licensed professional counselors to involuntarily commit to an institution for 72 hours patients who appear to be mentally ill and a danger,” the Atlanta Journal Constitution reports.

While doctors and psychologists in Georgia already possess the authority to involuntarily commit mentally ill patients they deem to be a “danger,” licensed counselors do not share that power. The bill — SB 65 — looks to change that, with supporters arguing that the additional authorities will ease the burden on Georgia’s mental health institutions:

Giving licensed professional counselors the authority to involuntarily commit patients would fill a need and ease the strain on Georgia’s mental health system, promoters of SB 65 testified Tuesday. Georgia has roughly 4,800 licensed professional counselors.

“We need more investment in our mental health services,” Sen. Nan Orrock, D-Atlanta, told members of the Senate Health and Human Service Committee. “This is one piece of the puzzle.”

The bill is under discussion at a time when Georgia is struggling to provide more community-based mental health services, including mobile crisis teams, as part of a 2010 agreement with the U.S. Department of Justice that stemmed from an investigation into the abuse and death of patients in state mental hospitals.

The history of mental health institutionalization in America is fraught with controversy, but advocates for the mentally ill generally agree that community-based mental health services are medically preferable — and more humane — than institutionalized services. The fact that SB 65 was spurred by Georgia’s dearth of community-based practices suggests that the bill is simply treating a symptom of Georgia’s mental health woes, rather than addressing the issue’s root cause — namely, that the state does’t have nearly enough funding allocated for its mental health care system.

While the temporary institutionalization of mentally ill Americans who might be a danger to themselves or others is a relatively uncontroversial status quo, such laws may add to existing stigmas about mental health care and dissuade Americans with violent thoughts from seeking the care they need. For example, New York’s sweeping new gun safety law was met with reticence by mental health professionals for what some perceived to be draconian provisions requiring care providers to “report” potentially violent patients to a state board.

But Georgia’s law goes even further than that, adding institutionalization to the powers that a doctor has over patients. That’s pretty significant for the over half a million Georgians suffering from a severe mental disorder, as studies have shown that over a third of the mentally ill do not seek care due to social stigmas and the fear of being committed.

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Arizona Bill Requires Hospitals To Screen Immigration Status Of Uninsured Patients

Hospitals would need to check the immigration status of uninsured patients under a new bill introduced by an Arizona lawmaker. Rep. Steve Smith’s (R) H.B. 2293 would require hospital staff to “reasonably confirm” patients’ status during check-in or treatment, and immediately report those who do not have the required papers to immigration officials.

Smith claimed it is a hospital’s civic duty to check immigration status:

“I would hope if you witnessed somebody who is not lawfully present in this country taking advantage of, getting, acquiring any benefit or social service or something that they’re not entitled to, or something they’re abusing or neglected, I would hope somebody would pick up the phone and go, ‘Maricopa police, Buckeye police, I think — I’m not sure — but I think this is happening.”’

The Arizona Hospital and Healthcare Association has already rejected the attempt to turn hospitals into another front for immigration enforcement: “When does this begin or end?” a spokesman said. “What other industry should be screening their customers for citizenship verification?” The National Coalition for Immigrant Women’s Rights and National Latina Institute for Reproductive Health also called the measure “unconscionable” and legalized “harassment.” With roughly 19 percent of Arizona’s population lacking health insurance, the bill could deter many immigrants and their children from seeking care, as well as burden hospitals.

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Current Flu Season Is ‘Wreaking Havoc’ On ERs, Forcing Hospitals To Turn Away Sick Patients

Health care professionals warned that the 2012-2013 flu season would be worse than usual, with both a higher incidence of the infection and earlier onset of the flu. The numbers so far have confirmed their predictions — as ThinkProgress reported on Monday, well over half of U.S. states have been experiencing severe influenza activity.

And now Fox News is reporting that emergency rooms in states particularly hard hit by the flu — such as Illinois — are being forced to turn away sick flu patients. 11 Chicago-area hospitals alone are being forced to turn away sick Americans in the face of a particularly nasty flu season and the resulting patient burden:

This year’s predominant flu (76 percent) is very similar to a type that caused a severe season in 2003-2004, when the flu shot wasn’t a good match and there were more than 40,000 associated deaths, said Dr. Marc Siegel, a member of the Fox News Medical A Team. [...]

Melaney Arnold, spokeswoman for the Illinois Dept. of Health, said nearly 150 people have been admitted to intensive care units with the flu this season, and five have died.

Northwestern Medical Center in Chicago is one example of a hospital on bypass status. So if you’re in an ambulance because you have the flu, this hospital will have to turn you away. That doesn’t mean people can’t walk in there and still get treatment if they’re OK to do so, but it’s going to be a long wait.

The Advocate Good Samaritan Hospital in Downers Grove, Ill., reported that its emergency room has up to a three-hour wait, and a Good Samaritan doctor described the situation as “chaotic.”

“It’s not like you can just see them and out the door they go. They’re here for a while unfortunately, getting treatments,” said Dr. Tom Mullin of Good Samaritan. “Most of them we can fortunately discharge them home and treat them as an outpatient. But, it’s wreaking havoc on every emergency department in the city and the suburbs, I’ll tell you that.”

While it’s impossible to completely control an ever-mutating pathogen such as the influenza virus, flu vaccinations have proven to be the number one way to fight the pandemic. Unfortunately, a meager 37 percent of Americans have received their flu shots this year, keeping with low historical averages.

Americans’ reticence towards vaccinations has been a vexing dilemma for public health officials, driven largely by misinformation regarding vaccine safety and fact-free smear campaigns claiming that vaccines such as the HPV shot can result in sexual promiscuity and autism. Access is certainly another part of the equation. Fortunately, Obamacare has expanded free preventative health care services such as vaccinations to make them available to the Americans who previously couldn’t afford that care.

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