ModernHealthCare.com, an online healthcare news agency, named their “100 Most Influential People in Healthcare - 2013.” On the list are the expected big name players like the Secretary of Health and Human Services, Kathleen Sebelius (No. 1) and President Obama (No. 3).
Governor Jan Brewer's (No.14) successful push to restore Medicaid eligibility as supported by Arizona voters in 1996 and 2000, and expand Medicaid as allowed by the ACA landed her high on the list.
“I think she looked at the data and looked at what would happen if they didn't expand Medicaid,” says Dr. Dan Derksen, director of the Center for Rural Health at the University of Arizona in Tucson. “She built a coalition and moved this through and should be basically commended for a job well done.”
Remarks at the 40th Annual Arizona Rural Health Conference
By HRSA Administrator Mary K. Wakefield
August 21, 2013
Thank you, Dr. (Dan) Derksen, and all of you for the opportunity to join you today for this 40th annual conference. It’s wonderful to be part of this 40th anniversary gathering.
|L to R: Dr. Mary Wakefield and Dr. Dan Derksen|
I also want to acknowledge another HRSA employee that some of you know, Dr. John Moroney, who leads our regional office that includes Arizona. John is a great contact, incredibly knowledgeable and as a team that works with him. He’s easy to spot in a crowd because he’s so tall.
Well, this first-of-its-kind conference was founded by Andy Nichols, even before there was a State Office of Rural Health here in Arizona. Having known Andy personally, I am well-acquainted with his health policy work. The field of rural health in this state owes much to him and many of us across the country do as well. What I observed about Andy was his forward thinking and his fearlessness, willing to take on any challenge. For example, he was the first person to champion promotores, recognizing and helping the rest of us understand the profound impact they could have in their communities. He supported their training and their recognition as legitimate and important members of the health care team. For a host of reasons, it’s a particular honor to deliver the lecture that bears his name.
I also want to acknowledge the University of Arizona’s Center for Rural Health for the leadership you’ve demonstrated over your 30-plus years of existence. And congratulations to the Center staff, who were recently honored for their work by the National Rural Health Association. As a result of your collaborations -- with state, federal, clinical practice and research partners – residents of Arizona’s rural areas and border region have access to care they might very well otherwise be without.
We can take a moment to think about how much has changed in rural health care in the wake of that first gathering 40 years ago and since the Arizona Center for Rural Health came into being a few years later. The convening of the conference then and the establishment of the Center are moments in time that align with some of the first major policy actions taken to address shortages in rural health services. Consider some of the key developments from that era, 30 to 40 years ago, that have had a very significant impact since then on the health of rural communities, including:
- The considerable growth and reach of Medicare and Medicaid;
- The creation of the Community Health Center Program and the National Health Service Corps; and
- The passage of the Rural Health Clinic Act in 1977.
Over this same period of time, Arizona was ahead of the game in seeing rural health as a critical public policy issue, and you became a significant model for much of the rest of the country.
In the succeeding years, we’ve seen other important programs and initiatives with relevance to rural health, including the focus on policy through:
- At the Federal level, the creation of a Federal Office of Rural Health Policy and State Offices of Rural Health program in each of the 50 States, an infrastructure that we almost take for granted today, but that is new enough that I remember when very little of that infrastructure existed, and where it did it was quite limited.
- We’ve seen over the past couple of decades a focus on workforce around an increased emphasis on Federal training programs for primary care providers in medicine and nursing.
- And a focus on stabilizing health care infrastructure through the creation of the Critical Access Hospital program.
These and other accomplishments have provided a strong, substantive foundation for our current work. They are building blocks that remain essential to improving access to health care across rural communities.
And now, we find ourselves standing at a very historic time in the evolution of health care delivery in this country as we complete the implementation of the Affordable Care Act. When the Health Insurance Marketplace opens for business October 1, we’ll begin the next phase of important work -- expanding insurance coverage to millions of uninsured Americans.
I think Andy Nichols would have loved to see this happen. I remember hearing that when he served in the Arizona legislature he would introduce a universal coverage bill at the beginning of every session, so clearly he recognized the importance access to of health insurance coverage.
In my remarks today, I’d like to focus on what Andy cared about and what we at HHS and HRSA care about, too, and that is making sure that every American can access health care – which begins with affordable, accessible health coverage.
To that end, job one for us in HRSA right now is completing the implementation of the Affordable Care Act. And I would say to you as someone from a rural area and as someone actively engaged in standing up provisions of the ACA, I personally think that nowhere is this implementation more important than in rural America.
As many of you are aware, the insurance market has never worked that well for rural families and rural communities, where folks are more likely to have to buy coverage in the individual or small group market and pay more for that coverage, if they could get it at all.
And, I share the belief of President Obama and HHS Secretary Kathleen Sebelius, which is this: In America, where you live shouldn’t determine your chances for a healthy life. That’s a principle that I think we should all be able to agree on.
The full implementation of the ACA will improve the situation for everyone by providing needed common-sense reforms to the insurance market and by expanding coverage. But already the law has resulted in more health care choices, better benefits, a check on rising costs, and higher quality care.
In a speech just last month, President Obama clearly articulated how the ACA has changed health care in America for the better, in rural areas and around the country.
- He reminded us that 3.1 million previously uninsured young Americans between the ages of 19 and 25 have now gained health insurance coverage by remaining on their parents’ plan – this includes an estimated 394,000 young adults living in rural areas and in Arizona 69,000 young adults right here, previously uninsured – now insured – because of the ACA.
- The President reminded us that the ACA eliminated life-time coverage limits on caps that affected almost 16 million rural Americans. Already, more than 2 million Arizonans, including 769,000 women and 570,000 children are free from having to worry about lifetime limits on their insurance coverage, that perverse practice of denying insurance coverage just when an individual may very well need it the most.
- And, in July, he also reminded us that the law has increased access to affordable prescription drugs for 6.6 million seniors by reducing the Medicare Part D “donut hole,” saving seniors over $7 billion on prescription drugs. In Arizona, that added up to savings of nearly $123 million on prescription drugs for people on Medicare thanks to the ACA, with many of those Medicare beneficiaries residing in rural Arizona.
So what’s next for the ACA and what does it mean for rural America and rural health?
Estimates from a RAND study project that 5.5 million rural Americans who would otherwise be uninsured will gain coverage by 2016 through the expansion of Medicaid eligibility and the creation of Health Insurance Marketplaces. That’s 5.5 million rural Americans who will gain health insurance coverage!
At HHS, our team recently took a look at the data on uninsured Americans, at those people who will have new insurance options when the Health Insurance Marketplace opens October 1. The research found that:
- Right now, more non-elderly people are uninsured in rural areas than in urban settings, and the rural uninsured across the nation tend to be poorer than their urban counterparts. The rural uninsured non-elderly are also more likely to be older than 35 and working.
- The research also confirmed that rural residents per capita are more likely to benefit from the Medicaid expansion than the uninsured in urban areas.
So why are these findings important to all of us in this room? Well, first, on a per-person basis, rural Americans are in greater need of and stand to benefit more than those in urban and suburban areas from the expansion in insurance coverage. Second, the demographics of this population reflect a population that faces some serious challenges -- and we’ve got a chance over the coming months to really help them.
As the Health Insurance Marketplace opens this fall, we see a real opportunity to improve rural health on two key fronts. First, we’ll be able to get more of the rural uninsured covered, some for the very first time in their lives. Second, this will help rural hospitals and clinics improve their bottom lines. By seeing more patients with health insurance, their uncompensated care and bad debt will be reduced.
And these facts – improved health of rural families and improved financial health of rural providers – are personally important to me because I come from a rural town just a bit north and east of here, Devils Lake, North Dakota, population 7,000. And I worked in that local rural hospital starting in high school, and I knew early on what it meant for people not having to drive 95 miles for health care. And furthermore, living in a rural community means you know your neighbors. When you talk about the uninsured in your community, they’re not faceless numbers. They’re people you know. They work in your stores downtown. Their kids are in classrooms with yours. They live next door or a block over.
So now let me take a minute and talk about those people we know, and how the new Health Insurance Marketplace will affect them. Because this is so important to their health and the economic health of their communities, and because of its importance, each of us has a role to play in making sure that affordable health coverage is within reach for every American.
In Arizona, about a million people, 947,000 to be exact, or about 18 percent of your state’s population, are uninsured and eligible for coverage through the Marketplace. I’m sure that all of you know a few people who fall into that group.
Beginning October 1st, they’ll be able to sign up for health insurance through the Marketplace. Enrollment will open that day in Arizona and in every state, with coverage that begins January 1, 2014. And while each state will have its own set of insurance options, each of the state plans will be accessible through one website: healthcare.gov.
Here, at healthcare.gov, rural consumers and others will get a clear picture of what they are paying for before they make a choice. Here, consumers will be able to make apples-to-apples comparisons of plans. Here, they’ll be able to learn, with a single application, if they or their family members qualify for a no-cost or low-cost plan – or a new kind of tax credit that lowers monthly premiums right away. We recognize that computer access may be limited in some rural areas: I mention this so you know that folks can also submit a paper application if they prefer.
All state plans must cover an essential set of benefits, including hospital visits, doctor visits and prescription drugs; and now, discrimination based on gender or pre-existing conditions, like diabetes or cancer -- because of the ACA -- is against the law. And many, many families and small business owners will qualify for a break on monthly premiums.
For a lot of people, the Marketplace will be a whole new way to shop for health insurance.
Right now, we’re counting down to coverage. So I’m asking you today to help us educate rural America about the new coverage options that will be available. You can partner with outreach workers and Navigators who will be on the ground in many of your towns and communities. Or you can work with your local health centers: last month we announced $150 million in supplemental funding to boost health centers’ efforts to help enroll the uninsured in underserved areas.
Just last Thursday, we announced $67 million in funds for Navigators in the 33 states with a Federally-facilitated or State Partnership Marketplace. The Navigators will help consumers learn about their Marketplace and find coverage. In these grants, we’re asking Navigators to work with individuals with limited English proficiency, people with a full range of disabilities, and vulnerable, rural, and underserved populations. Specific to Arizona, yesterday we highlighted grants worth more than $2 million to four Navigator organizations and their partners.
We’re also getting ready to provide supplemental funding of just over $1 million to up to 52 Rural Health Outreach grantees to help enroll eligible folks in their communities for coverage.
Those funds will help us, but more needs to be done to make sure we reach every eligible rural person. We need you to help spread the word that “now’s the time to get ready.” We need you to engage your networks and your communities to help ensure that no one who is eligible is left out, left behind, or left on the sidelines. Our collective effort is critical because surveys tell us that many of the people who stand to benefit most from access to health insurance may not know what they are eligible for.
That reminds me of a quote I saw recently in my local paper in Devils Lake from an old friend of mine, a rural health care administrator who said this about the importance of getting the word out. He was quoted as saying: “The only thing worse than not having insurance is being eligible for insurance but not knowing about it.” I think that about sums it up when it comes to getting the word out. How true is that?
So we have to change that situation, particularly for rural Americans, who, as I indicated earlier, in many respects have the most to gain from affordable coverage. Right now, as Secretary Sebelius says, it’s “all-hands-on-deck time” in rural America and across the nation. Yes, this work is a challenge, but it’s an opportunity to recalibrate access to health care for our neighbors and our communities and perhaps even for some of our own family members.
There are terrific resources you can use when colleagues, patients, friends, and neighbors come to you with questions about enrolling in health insurance through the Marketplace. And you can guide people to places that have additional answers.
- Urge patients and friends to go to healthcare.gov to learn about the Marketplace and what will be available October 1st. In Spanish, it’s CuidadoDeSalud.gov. It’s straightforward information about what people need to do to sign up.
- Get the word out through social media. If you have a Facebook account or a Twitter account, connect to HHS social media channels through hhs.gov. Then repost and re-tweet the information you find there and as that site is updated.
- For providers, one site to visit is marketplace.cms.gov. How many of you have been to this website? There you can download infographics that you can post on your websites; videos you can run in your waiting rooms, patient rooms, classrooms, board rooms and community meeting rooms. It also has quick visual links called “widgets” that you can put on your e-newsletters, agency websites and consumer sites. And HRSA is about to add our own website with a “toolkit” of useful resources for providers. We’ve pulled all our information and guidance to providers and put it in a central location to make it as easy as possible to get the knowledge you need. We expect it to be ready to post later this month at our existing ACA website. So if you’re a provider, keep an eye out for that.
These next few months are the culmination of the most significant advance in health care policy that I personally have seen in my lifetime. It’s a game-changer, and we’re right at the point of fully engaging it. Every eligible Arizonan deserves to be insured, and in partnership we can make that happen!
So, that’s the message on enrollment. But that’s just part of the important work of the ACA. We are so concentrated right now on outreach, enrollment and education that it’s easy to overlook the other important elements of the ACA, elements that also are changing the way we deliver health care in the United States – especially care to underserved populations and communities, and I want to talk for a moment about those other provisions of the law that we’ve been working on as well.
The scope of our work at HRSA underwent a massive expansion when the ACA invested billions of dollars in four key HRSA programs: two programs that were expanded – health centers and the National Health Service Corps, and two that were brand new – the Home Visiting program and the Teaching Health Center program. I’ll say just a word about these four programs.
With health centers and NHSC, ACA funds followed investments in two programs of these programs through the 2009 Recovery Act, so the combined impact has been strongly positive in terms of increasing access to care for underserved people.
I’m sure that many of you are intimately familiar with the value of services provided by NHSC clinicians -- these physicians, dentists, psychologists, advanced practice nurses and others who agree to spend at least two years working in an underserved community or site in exchange for federal loan repayment or scholarship assistance. Well, thanks to the support provided through ACA and the Recovery Act, the number of NHSC loan repayors and scholars nationally has more than doubled since 2008 to about 8,000 clinicians.
How has Arizona benefited from just this one provision of the ACA? Well, today Arizona has 274 NHSC clinicians, with 234 of them (85 percent) supported by ACA funds. Of the total number, 86 (almost a third) are physicians. Particularly important for rural Arizona, 166 of the 274 NHSC clinicians in the state are serving in rural areas.
Of course, many of these clinicians --in Arizona and around the country -- work at HRSA-funded health centers. Thanks mostly to the ACA – which invested $11 billion over 5 years to expand health center sites and services – health centers have added 4 million patients since the beginning of 2009. They now serve more than 21 million people each year. Today, some 1,200 health center grantees operate almost 9,000 clinics in every state and U.S. territory.
Arizona has added 2 health center grantees since 2009 (the number is now 16) and the volume of patients in Arizona’s health centers has grown by nearly 19 percent during that time.
And since about half of all health centers across the nation are located in rural areas, the boost that the health center expansion has given to health care in rural America is real – and it’s growing. As a result of the Recovery Act and now the ACA, health centers located in rural areas of the country provided care to just over 7.6 million patients last year; that’s an increase of more than 20 percent since 2009. Think of that!
Health centers also help provide needed rural jobs. Data show that rural health centers employ more than 50,000 people; that’s up by 28 percent since the start of 2009.
So you can see that the impact of the ACA investment in health centers has been positive in increasing access to care, in expanding the range of available services provided, and in creating needed jobs -- in rural America and the entire country.
As I mentioned earlier, the ACA didn’t just expand HRSA’s existing portfolio, it also added to it by assigning our agency responsibility for implementing and overseeing two new programs.
The first initiative made one of the most significant investments in Maternal and Child Health in a lifetime, by creating the Home Visiting program. This five-year, $1.5 billion investment enables nurses, social workers and others to visit pregnant women, young children and their families in high-risk communities. There, they provide evidence-based counseling and intervention services known to have improved health outcomes. In fiscal year 2013, Arizona reports almost 11,000 home visits to date.
The positive outcomes of evidence-based models used in home visits include: improved parental capacity; improved school readiness; reduced maternal depression; and better healthy child development. Studies show that every $1 invested in home visits returns $9.50 to society. It’s an important program – talk with your state health department about the needs you see for families and at-risk communities to participate in this program.
The ACA also established a new Teaching Health Center Program to expand medical and dental residencies in community-based training sites. I’m told that the Wright Center for Graduate Medical Education and AT Still University of Health Sciences’ School of Osteopathic Medicine are supporting family medicine residents through this program.
Research indicates that teaching health centers produce primary care physicians who are three to four times more likely to provide care for underserved populations in community settings than physicians primarily trained in hospital settings. So, the ACA is not just focused on preparing more providers, we’re also focused on harnessing training opportunities that reflect an important new orientation for the next generation of health care providers. Some of the Teaching Health Center training sites serve rural populations, like those in West Virginia, Washington and Kentucky.
Let me shift gears for a moment here. With the current focus on expanding health insurance coverage, people may not be aware of the ACA’s strong emphasis on encouraging individuals, families and communities to take proactive preventive measures to maintain good health. And the law also encourages better ways to organize the delivery of health care to improve quality and lower costs.
Many of you are health care clinicians and you know that a lot of the health problems sick patients present with could be wholly prevented, or at least markedly mitigated, through investments in disease prevention activities like screenings, health and wellness promotion, and patient education. And these activities are a big part of the ACA.
For women, for example, the ACA requires most private health insurance plans to cover recommended prevention and wellness benefits such as mammograms, screenings for cervical cancer, regular well-baby and well-child visits, and domestic violence screening with no cost-sharing.
Men also have access with no out-of-pocket cost-sharing to potentially life-saving screenings that are covered for all adults: colonoscopies, flu and pneumonia shots, alcohol misuse screening and counseling, cholesterol checks, immunizations, and more.
For rural populations with historically high rates of uninsurance and lower incomes, these preventive screenings, that many of us take for granted because of our insurance coverage and our incomes, will – in many cases – provide the first opportunity for many rural folks to access these very important services.
I also mentioned that the ACA drive toward better ways to organize care. To follow that important work, I urge you to stay up with the ongoing efforts of the Innovation Center at the Center for Medicare and Medicaid Services. Our colleagues at CMS are making important investments, funded by the ACA, that test new models for paying for and organizing care which not only improve outcomes but also help to control costs. Rural providers are a key part of these activities, whether it’s the rural health centers taking part in the Patient-Centered Medical Home demonstration or the many rural communities funded under the ACA-supported Innovation Challenge.
More vital work in this field has been taken on by the Partnership for Patients, which seeks to improve quality and reduce patient harm on a national level, and I’m pleased to say that we have a high level of rural participation in that effort. When it comes to quality and patient safety rural providers can lead.
At the core of the Partnership for Patients are 26 Hospital Engagement Networks, which link with nearly 3,700 hospitals across the country to identify best practices and solutions to reducing hospital- acquired conditions and readmissions.
Dozens of hospitals in Arizona are members of the Hospital Engagement Networks. They run from some of the biggest hospitals in the Phoenix area to at least two Critical Access Hospitals: Page Hospital in Page and Copper Queen Community Hospital in Bisbee.
As I close, let me return our attention to the task closest at hand, the start of health insurance enrollment in just 40 days, by recalling what President Obama said earlier this month at a press conference: that millions of Americans are going to have a chance to benefit from the gains that come from getting access to health care.
We’ve got a wonderful opportunity to really improve health care in rural communities by reaching out to help as many uninsured Americans as possible sign up for health insurance.
Thank you for inviting me to be here today and for the important work that you do every day and for what you do going forward to ensure that your neighbors and friends in your rural towns have full access to health care because they have access to health coverage.
Trying to educate Arizonans about their health care options as Medicaid and health insurance exchanges get underway can be particularly challenging in rural areas, according to Dr. Dan Derksen.
He leads the Center for Rural Health at the University of Arizona’s Zuckerman College of Public Health and is the director. Derksen’s center is leading the 40th annual Arizona Rural Health Conference Tuesday and Wednesday in Prescott.
Posted: Aug 20, 2013 7:15 AM MSTUpdated: Aug 20, 2013 7:15 AM MST
Happening today, local experts are heading to Prescott to talk about the Affordable Care Act.
Under discussion will be the future of healthcare for Arizonans, with Dr. Dan Derksen focusing on public health policy.
The work Dr. Derksen is conducting looks at how to reach out to those who will soon go from uninsured to being eligible for coverage. This is what he will be talking about at the Arizona Rural Health Conference today and tomorrow.
Almost one-fifth of Arizona's total population, some 1.2 million people are uninsured. Most of those people will be able to buy a subsidized health insurance plan soon.
The open enrollment marketplace starts on October 1, and expanded Medicaid coverage on January 1.
Researchers looked at Arizona as it expanded Medicaid coverage a decade ago; those experts found that expansion led to fewer deaths and better overall health.
Whether the same is true again depends on how many people get coverage. The hope and goal is that after two years about 600,000 people will go from uninsured to insured.
Copyright 2013 Tucson News Now All rights reserved
Today we just posted to the web a series of community forums we will be hosting across the state to provide a broad overview of HEA Plus, the transition of certain populations (like KidsCare II and childless adults) and to answer questions about all of the moving parts. While Linda and her team have been leading an incredible effort, we in OIR are focused on ensuring that the public feels comfortable that HEA Plus will feel familiar and will provide them an enhanced consumer experience. We are also ensuring providers, advocates and others that assist the public that HEA Plus is the best tool that will bring real time results with accuracy and certainty.
Please feel free to send people the link of the forums and our Medicaid Moving Forward page where they can stay updated. If you have a group that seems to need additional assistance, please just contact me and we can work together to provide you that support in collaboration with Linda and her team.
Thanks and please let me know if you have any questions.
Community Forums schedule: http://www.azahcccs.gov/publicnotices/Downloads/MedicaidCoverage/MMFCommunityForums.pdf
Continue to check the AHCCCS Medicaid Moving Forward webpage regularly for the latest information at: http://www.azahcccs.gov/publicnotices/MovingForward.aspx.
Affordable Care Act May Cover Half of AZ's Uninsured by 2015
Story by Luis Carrión, Arizona Public Media, NPR
August 12, 2013. Listen at:
More than half of Arizonans now without health insurance will be covered by the Affordable Care Act by 2015, say officials of a rural health center.
Arizona has 1.2 million residents without health insurance, said Dan Derksen, director of the Center for Rural Health at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.
"Arizona is right around the bottom five states in terms of percentage of population that is insured," Derksen said. "It’s especially true for percentage of uninsured children."
The state’s recent restoration and expansion of Medicaid coverage, along with implementation of the Federal Heath Insurance Marketplaces beginning Oct. 1, will significantly reduce the number of people living without coverage, Derksen said.
"How many people that are eligible actually enroll in these new marketplaces, or are covered by Medicaid, depends on how well we do with the outreach," he said, "how well we set up on-site assistance to help people that are uninsured sign up for what they’re eligible for and how well we do in getting the information out especially in rural areas, especially in tribal communities."
Derksen said the 40th annual Arizona Rural Health Conference in Prescott later this month will focus on implementation of the Affordable Care Act in the state.
Dr. Mary Wakefield, the Health Resources and Services Administration (HRSA) Administrator will attend and give the keynote address at the Rural Health Conference
Contact: Gerri Kelly, (520) 626-9669
Aug 5, 2013
Tucson, Ariz.− The Center for Rural Health at the University of Arizona Mel and Enid Zuckerman College of Public Health, will hold the 40th Annual Rural Health Conference Aug 20-21 at the Prescott Resort & Conference Center, in Prescott, Ariz.
Dr. Wakefield will deliver the Andrew W. Nichols Rural and Border Health Policy Memorial Lecture on Wednesday, August 21 at 8:00 a.m. She will discuss the Federally Facilitated Health Insurance Marketplaces under the Affordable Care Act.
“We are delighted and honored to have Dr. Wakefield join our annual meeting,” said Dan Derksen MD, the Walter H. Pearce Endowed Chair and newly appointed director of the Center for Rural Health at the UA Zuckerman College of Public Health. “Between Medicaid restoration and expansion, and the implementation of the Marketplaces in Arizona, the state could see more than half of its uninsured covered by ACA provisions by 2015.”
The Rural Health Conference attracts a statewide audience of health care providers, academic, county and community health professionals, administrators, policy makers, and state and local leaders. This year’s gathering is notable for the milestone of its 40th anniversary and the focus is on implementation of the Affordable Care Act in Arizona.
For registration information, admission, directions to the conference and the agenda, please visit www.crh.arizona.edu or contact Center for Rural Health: Rebecca Ruiz, firstname.lastname@example.org, 520.626.2243.
The Center for Rural Health at the University of Arizona Mel and Enid Zuckerman College of Public Health was named 2013 Outstanding Rural Health Organization in the U.S. by the National Rural Health Association. Home to the Arizona State Office of Rural Health, the CRH partners with other state agencies and organizations to improve the health and wellness of rural underserved populations through service, research and education.
Her leg inexplicably purple, painful and double its size, University of Arizona student Aimee Snyder cried herself to sleep, desperate to avoid going to an emergency room.
She wouldn't have health insurance coverage for 28 more days. Just hold on until then, she told herself.
A healthy athlete in her 20s, Snyder had no idea that her pain was from a clot that spanned from her abdomen to her knee, blocking the return of blood from her left leg. Smaller clots were breaking off and had lodged in the blood vessels of her lungs, causing several pulmonary embolisms that put her at risk for sudden death.
Snyder was one of about 1.2 million Arizonans who do not have health insurance. And it's not unusual for people who are uninsured to forsake medical care because of cost, but that mentality can be deadly.
If the federal Patient Protection and Affordable Care Act works the way its supporters predict, such behavior could change. Health experts predict the state's number of uninsured could drop 50 percent in the next two years as a result of the law.
One of the reasons for an anticipated drop in uninsured in Arizona is that childless adults, who have been frozen out of the state's Medicaid program, will be allowed back on Jan. 1. Medicaid is a government insurance program for low-income people.
Medicaid in Arizona is AHCCCS, the Arizona Health Care Cost Containment System. The end of the state's freeze on childless adults is expected to add about 300,000 people to its rolls, provided an effort to repeal the expansion does not force a referendum.
That's not soon enough for Snyder, who was denied Medicaid before she got sick.
Money before health
In the summer of 2011, Snyder resigned from her teaching job to pursue a master's degree. In the shuffle of moving, securing a teaching-assistant job and starting classes, she missed the deadline to enroll in the UA's student health plan. She asked if she could pay a late fee and enroll. The answer was no. She would have to wait until the following semester.
Her income level was low enough to qualify for Medicaid. But Snyder learned that due to budget cuts, the state had frozen Medicaid enrollment for adults without children.
Snyder, then 28, weighed her options. She could enroll in the student plan in January. Private insurance was expensive and the choices were overwhelming. She was young, healthy and fit. She rode her bike up Mount Lemmon, ran marathons and had no history of health problems. What was another four months? It seemed like a low-risk decision.
She was wrong.
Two weeks after she rode 111 miles in El Tour de Tucson in November 2011, Snyder started having shortness of breath and thought it was anxiety from the end of her first semester in graduate school.
A week passed and the shortness of breath continued. Then on Dec. 7, the last day of classes, her leg went numb and began to swell. It got worse throughout the day and Snyder tried to ignore it. She had a lot to do and besides, she had no health insurance. An emergency-room visit could cost thousands of dollars that she couldn't afford. Quitting teaching and going back to school was a big enough financial decision. She had student loans and feared crushing debt. She went home and elevated her leg. The pain was terrible and she felt helpless.
By the next morning she had a talk with herself. She was a public-health student, after all. She needed to take control. What would she recommend to someone in her situation?
At 2 p.m. Dec. 8 she was sitting in a local El Rio Community Health Center clinic. Clinic workers helped her sign up for the Pima County Access Program (PCAP), which is not health insurance but for a yearly fee provides access to local health providers at discounted rates. PCAP's enrollment has increased by about 41 percent since the Medicaid freeze, officials with the program say. Snyder joined PCAP for $40 and paid a $30 co-pay to be triaged.
Medical staffers at El Rio were alarmed at Snyder's condition. They wanted to call an ambulance. She needed to go to a hospital right away. Snyder resisted.
The doctors pushed back. There is no price tag on life, they said.
Snyder agreed and went to Carondelet St. Joseph's Hospital, but she still couldn't help thinking about money. She declined the ambulance and drove herself. Once in the emergency room, she was flagged as a priority and doctors told her they needed to do surgery to scrape the clots out of her poor veins and place a filter below her heart to protect her lungs.
Snyder recoiled. But she was terrified by what the doctor said next - she was at a high risk of death if she didn't have surgery. And even if she survived, her leg would never return to normal.
Throughout her six-day hospital stay, Snyder asked for minimal treatment, stressing to doctors that she didn't have health insurance. She had the surgery, recovered and ran a half-marathon two months later.
Eventually she found out that she has a congenital condition called May-Thurner syndrome, in which the left iliac vein is compressed by the right iliac artery, increasing the risk of deep-vein thrombosis blood clots. She believes her athletic life and healthy diet contributed to both her survival and fast recovery.
Snyder knows she could have died from delaying seeking medical attention and says in retrospect she's ashamed she was putting money before her health. She is grateful that her doctors at St. Joseph's did not listen to her pleas to minimize treatment.
But she's certainly not the only American who has avoided medical care because of the cost.
About one person dies in Arizona every day because of a lack of insurance, says Dr. Dan Derksen, a physician who is section chair of public-health policy and management at the UA's Mel and Enid Zuckerman College of Public Health. He is not familiar with Snyder's case, but says it rings familiar.
"Sadly, this story plays out across the country for 49 million uninsured Americans," he said. "As a family physician, there are tragic consequences for the uninsured who have to delay necessary care because they don't have money."
Derksen, who helped draft a portion of the Affordable Care Act, noted the word "affordable" in the legislation. The idea is to reduce health-care spending that often spikes because of delayed care, which makes treatment more expensive. Deep-vein thrombosis if caught early is often treated on an outpatient basis with medication - far cheaper than Snyder's treatment, which was surgery and hospitalization.
After the Medicaid freeze on childless adults began in 2011, uncompensated care in Arizona hospitals skyrocketed, particularly in rural areas where there is a higher concentration of uninsured people, Derksen said. He said what's so often missed in the health-care debate is that the costs of delayed care accrue to the entire system. Studies have shown that people on Medicaid have better health outcomes than people who are uninsured.
About 18 percent of Arizonans are uninsured, says the Kaiser Family Foundation, which bases its numbers on U.S. Census data. It's one of the highest uninsured rates in the country. Texas has the highest - 24 percent.
"The U.S. pays twice per capita what any other developed country pays for health care, yet has worse population health outcomes," he said. "The evidence shows that getting the uninsured covered - through Medicaid, or by health insurance purchased in the new marketplaces - will improve health outcomes. The underpinning of the Patient Protection and Affordable Care Act is affordable health care."
Gov. Jan Brewer surprised many when she announced she would support expanding Medicaid, thus lifting the freeze on childless adults, earlier this year. Her decision caused friction with many fellow Republicans.
The Legislature passed the expansion, but not without contentious debate.
"The good news in that is that Arizona has the potential, because it is moving forward with Medicaid expansion, to have one of the highest percent decreases of uninsured in the country," Derksen said. "It will make a huge difference for people here to have coverage."
Mountain of debt
Two years after her health crisis, Snyder is still paying off costs of her care. Without the Pima Community Access Plan (PCAP), however, she'd be facing much more crushing debt. The cost of a six-day stay including a night in the intensive care unit at St. Joseph's resulted in an eight-page bill for $107,000. Under PCAP terms and its agreement with local hospitals, Snyder needed to pay 10 percent - $10,700, and the hospital absorbed the rest of the cost.
Snyder did not have $10,700 and says she's fortunate her family was able to give her the money.
One month after her hospital stay, Snyder went back in for surgery to remove the filter under her heart. Though she was by then enrolled in the UA's health plan through Aetna, she had a $1,000 deductible and a 20 percent "co-share," so Snyder was on the hook for another $3,000.
She has a clear pink plastic folder of more than 30 bills ranging from $400 to $3,000 that continued to come in the mail for months after her hospital stay. The bills were for each service contracted through the hospital, like radiology, vascular specialists, anesthesiology and X-rays. She added those bills to her student loans.
She recently earned her master's degree and will continue her studies in a doctoral program. But she'll focus on maternal and child health, not the payer system.
"Insurance-policy mumbo jumbo and run-around makes me angry," she said. "Especially when it's adding confusion to my personal medical and financial decisions."
Individuals who have felt overwhelmed and confused about buying private insurance should have some relief when open enrollment in an Arizona insurance "marketplace" through the Affordable Care Act begins Oct. 1.
The marketplace can be accessed online or by phone, or with the help of trained people who will be at health clinics and other places closer to enrollment. The marketplace will screen individuals and send them to Medicaid or to the private insurance market. It will act a bit like Expedia does with airline flights, sorting out individuals' preferences and showing options that will range from bronze to platinum plans. Some Americans will be eligible for federal subsidies for their health insurance.
Contact reporter Stephanie Innes at email@example.com or 573-4134. On Twitter: @stephanieinnes
(http://www.trivalleycentral.com) Opinions may differ on the number of healthy food choices available in Florence, but a local group is working to measure it objectively.
Elizabeth Kizer of Florence was awarded a grant from the Arizona Area Health Education Center (AHEC) to measure the availability of healthy foods in Florence using a valid and reliable survey measure called NEMS, or Nutritional Environment Measurement Survey.
She completed an online training through the University of Pennsylvania to become a certified NEMS rater.
Early last month, she trained six coalition members who volunteered to help in this project, she told the Town Council in an update of the group’s activities.
Over the last several weeks, group members surveyed all of the stores and restaurants in town to measure the availability of healthy foods, affordability of healthy foods, preparation methods used, facilitators and barriers to healthy choices, differences in adult and kid’s menus, and signs and promotion materials.
The NEMS surveys are completed from the vantage point of a consumer, filled out based on what a consumer sees in a food establishment. “This will allow us to establish a baseline measure of the ‘health’ of our food environment,” Kizer told the Town Council last week.
Kizer is working with a coalition of 56 local residents for more healthy food choices in Florence. The group wants increased access to fresh produce and whole grains at reasonable prices, and restaurants to support healthy choices.
Kizer wrote recently on a University of Arizona blog that many things can make healthy eating and active lifestyles difficult choices, especially in rural areas.
By now most of the Arizona community will have heard of the loss of the 19 brave firefighters from Prescott, AZ who perished in the Yarnell Hill Fire in Yavapai County. Please join us in expressing our deep sympathy and sorrow to their families and friends. Our thoughts and prayers also go out to the many Yarnell residents who, in addition to grieving for the loss of the fallen heroes, also lost homes and businesses to this devastating and deadly wildfire.
If you'd like to help the families who lost loved ones or those who lost their homes, below are some ways you can do so.
- The American Red Cross Grand Canyon Chapter is accepting monetary donations to help provide food, water and beds to evacuees staying at shelters at Yavapai College and Wickenburg High School. To donate, go to http://www.redcross.org/az/phoenix/ways-to-donate. Donations also can be made by calling 800-RED-CROSS (800-733-2767).
- To make a donation to the 100 Club of Arizona's Survivor Fund in memory of the Granite Mountain Hotshots, go to: http://www.100club.org/web/100CLUB/GetInvolved/Fund.aspx. Eighteen of the 19 firefighters who died were members of the Granite Mountain Hotshots. The 100 Club is a charity that helps the families of fallen police officers and firefighters.
- To make a donation with your smartphone to either the Red Cross or the 100 Club, text the word "FIRE" to 411923, 620620 or 411987. A response will be sent with links to both.
- The United Phoenix Firefighters Association and Prescott Firefighter's Charities have established a relief fund to handle donations to benefit the families of the fallen firefighters. Individual or corporate donations can be made at any Chase Bank. Make checks out to: United Phoenix Fire Fighters Association Account, Account #987218757. For more information, call 602-277-1500.
- The Arizona Community Foundation is matching donations to its Disaster Relief Fund up to $100,000 to go toward long-term relief for displaced families.
Cover Arizona is an information and resource web site designed for those professionals and volunteers who will help consumers enroll in the federally-facilitated health insurance marketplace.
The Cover Arizona website is a collaborative effort engaging more than 200 non-partisan, non-profit organizations and their partners throughout the state of Arizona.
Dan Derksen, MD, professor and chair of the Public Health Policy and Management section of the Mel and Enid Zuckerman College of Public Health, has been appointed to the Walter H. Pearce Endowed Chair and director of the Center for Rural Health.
“We’re very fortunate to have a distinguished teacher and researcher with such a strong record of health policy, rural health and administrative success to lead our nationally recognized Center for Rural Health,” said Iman Hakim, dean and professor of the UA Zuckerman College of Public Health. “The depth of Dr. Derksen’s knowledge during this monumental time of change in the nation’s health care system makes him the ideal person to lead the Center.”
Derksen joined the College of Public Health in 2012. His health services research interests include covering the uninsured, enhancing access to quality care, reducing health disparities, and implementing community and team-based health services for rural, underserved and vulnerable communities and populations. He serves on the American Academy of Family Physicians Commission on Governmental Advocacy and the American Hospital Association’s Governing Council Section on Rural or Small Hospitals. His leadership roles have included directing New Mexico’s Area Health Education Centers (AHEC), the faculty practice plan, and the Office of Rural Outreach.
He graduated from the UA College of Medicine in 1984, and did his family medicine residency at the University of New Mexico (UNM) where he worked as a faculty member for 25 years.
In 2011 Governor Susana Martinez appointed Derksen to Director of the New Mexico Office of Health Care Reform where he submitted the state’s health insurance exchange establishment proposal funded by CMS (Centers for Medicare and Medicaid Services).
Derksen completed a Robert Wood Johnson Health Policy Fellowship in 2008 with U.S. Senator Jeff Bingaman. He researched and drafted federal legislative provisions to improve the nation’s supply and distribution of the health workforce that were included in Title V of the “Patient Protection and Affordable Health Care Act.”
After returning from Washington, D.C., Derksen was president of the New Mexico Medical Society in 2009 and worked on medical homes legislation for the state’s Medicaid programs, signed into law (HB 710) in 2010. He served as President of the New Mexico Academy of Family Physicians (2000) and the Greater Albuquerque Medical Association (2003).
The Center for Rural Health, which is located within the Mel and Enid Zuckerman College of Public Health at the University of Arizona, is home to the Arizona State Office of Rural Health. The center partners with other state agencies and organizations to improve the health and wellness of rural underserved populations through service, research and education. It was recently named the 2013 Outstanding Rural Health Organization in the U.S. by the National Rural Health Association.
June 26, 2013
Neil MacKinnon, PhD, professor in the community, environment and policy division of the Mel and Enid Zuckerman College of Public Health, has been appointed dean of the James L.Winkle College of Pharmacy at the University of Cincinnati. “It is with both sadness and great pride that I wish Dr. MacKinnon well in this next venture,” said Iman Hakim, dean and professor of the UA Zuckerman College of Public Health. “His strategic vision and strength in the areas of interdisciplinary collaboration and community engagement have gained national prominence for the Center for Rural Health. I have every confidence that he will make an excellent leader as Dean of the Winkle College of Pharmacy.”
MacKinnon joined the College of Public Health in 2011 and held the Walter H. Pearce Endowed Chair. From 2011-2012 he served as section chair of Public Health Policy and Management. He held additional appointments as professor in the UA College of Pharmacyand School of Government and Public Policy. He alsoserved as director of the Center for Rural Health, which houses the Arizona State Office of Rural Health. The center partners with other state agencies and organizations to improve the health and wellness of rural underserved populations through service, research and education. It was recently named the 2013 Outstanding Rural Health Organization in the U.S. by the National Rural Health Association.
Prior to joining the faculty at the College of Public Health, MacKinnon was the associate director for research and professor at the Dalhousie University College of Pharmacy in Halifax, Nova Scotia. He also has practiced in community and hospital pharmacy settings.
MacKinnon earned his undergraduate pharmacy degree at Dalhousie University. He completed a master’s degree in hospital pharmacy and an administrative hospital pharmacy residency at the University of Wisconsin Hospital and Clinics. He also received a doctorate and fellowship training at the University of Florida followed by a mid-career fellowship in 2007-2008 with the Commonwealth Fund in New York City under the mentorship of Stephen Soumerai, ScD, professor of population medicine at Harvard Medical School.
A past president of the Canadian Society of Hospital Pharmacists, MacKinnon has edited two books, Seamless Care: A Pharmacist’s Guide to Implementing and Evaluating Programs (2003) and Safe and Effective: The Eight Essential Elements of an Optimal Medication-Use System (2007). In 2010, he co-authored the Canadian national bestselling book Take as Directed: Your Prescription for Safe Health Care in Canada with Rhonda Church, MD, a family physician. His research interests include the quality and safety of health care, the role of the pharmacist, health policy and health issues among underserved populations. He has published more than 150 scientific papers.
Please join us on Monday, July 8th from 3-5 p.m. as we bid Dr. MacKinnon a fond farewell. The reception will be held on the third floor of Drachman Hall in the Bridge Conference Rooms.
Contact: Gerri Kelly at 626-9669
PAGE, Ariz. (Feb. 25, 2013) –Page Hospital has been recognized for demonstrated excellence in leadership and innovation in the area of quality patient care.
According to the National Rural Health Resource Center, Page Hospital has demonstrated its leadership and innovation among the nation’s rural hospitals. The National Rural Health Resource Center works in cooperation with the Department of Health and Human Services, Health Resources and Services Administration and the Office of Rural Health Policy.
“Page Hospital is well-managed, provides high quality patient-centered care, and operates in a unique rural environment,” the association said in a written announcement about the recognition.
In 2002, Page Hospital was one of Arizona’s first hospitals to receive critical access hospital designation from the Centers for Medicare and Medicaid.
Public reporting to the CMS Hospital Compare program, participation in the Medicare Beneficiary Quality Improvement Project, and demonstrated excellence in quality initiatives with documented outcomes has provided evidence to the high-level of care at Page Hospital.
Among the data reported, Page provides information on pneumonia, heart failure, surgical care and patient satisfaction scores. The hospital is accredited through The Joint Commission, and quality outcomes and operational performance rates high compared to peers.
Page Hospital is a quality hospital providing excellent patient care by excellent people, said Chief Executive Officer Sandy Haryasz.
“Last year was an outstanding year for Page Hospital,” she continued. “We offered new services, won national quality recognition, passed The Joint Commission accreditation with flying colors, opened Banner Health Clinic, and upgraded technology. Consistently Page Hospital performs well with the Banner Health strategic initiatives and 2012 was no different.”
About Page Hospital
Page Hospital is a 25-bed critical access hospital that serves Northern Arizona. Built in 1958, the hospital provides a range of medical services that include emergency services, surgery, medical imaging, obstetrics, cardiopulmonary, acute care and rehabilitation. It is part of Banner Health, a nonprofit hospital and healthcare system that covers seven states and is based in Phoenix.
Located five hours north of Phoenix, five hours east of Las Vegas, and adjacent to the Navajo Nation, the hospital was founded to serve workers who built the Glen Canyon Dam. Page Hospital’s service area includes the city of Page with about 7,500 residents, and surrounding frontier regions: north into Utah, east into the Navajo Nation, and south to Flagstaff. To the west is the Grand Canyon, and the hospital is an essential part of the region’s healthcare safety net for more than 3 million tourists.
ADHS has launched a new website called the AZ Hospital Compare website which (for the first time) provides an online searchable database to help Arizonans make educated decisions about their healthcare. The new website will allow patients and their families to explore the care and outcomes, costs and charges of Arizona’s licensed hospitals. The transparency that the site provides regarding outcomes will no doubt improve hospital performance as well.
For example, expectant mothers will be able to look for a hospital that excels in uncomplicated newborn deliveries or lower C-section rates. Patients planning a knee replacement or shoulder surgery can learn how much they would be charged at one hospital versus another and find out how hospitals compare when it comes to healthcare associated infections from surgeries. The online tool also helps healthcare professionals, policy makers, and legislators to develop and implement important health policies and best practice guidelines that will increase the quality of health care, while reducing costs.
The site uses data from 2011 inpatient discharges collected from all Arizona licensed hospitals. The website contains complete supporting documentation on the methodology used and integrated processes like the quality indicators and the cost-to-charge ratios. This website has the potential to be a positive step towards transparency in Arizona hospital care.