Tennessee may become the first state in the country to take advantage of the Trump administration’s enthusiasm for block-granting Medicaid – a radical change to the federal-state health program for low-income people created in 1965.
Under recently passed legislation, Tennessee will within six months seek a waiver from CMS to have a block grant – a lump sum of money along with more state flexibility on how to run Medicaid. Continue reading
President Trump says he wants to encourage the formation of “association health plans” that would better enable small employers to band together to purchase more affordable health insurance in the large-group market. On Jan. 4, the Department of Labor published for public comment a proposed rule for such entities, also known as small business health plans.
What will these health plans, which typically would organize under the umbrella of a trade group or other association, look like? Continue reading
Photo: Don via FlickrNashville cemetery statue
Last week we posted an update on mental health coverage under the Affordable Care Act, so let’s follow up with a look at what’s going on in Tennessee, courtesy of Holly Fletcher at The Tennessean.
Tennessee is among the 19 states that have not taken up Medicaid expansion under the ACA. This summer a Tennessee legislative task force put forth a proposal for a partial expansion program, with the first stage focusing in large part on people with mental illness or substance abuse disorders. If approved – which isn’t certain – it could later be expanded, but only if it meets cost and quality objectives. As Fletcher reported, that’s not so easy. Gov. Bill Haslam, a Republican, last year tried to enact a market-based version, only to be blocked by a more conservative legislature, as one commentator noted in the newspaper. Continue reading
In The Tennessean (and USA Today), Tom Wilemon has assembled a series of reports on what he calls “the diabetes hot zone,” “a cluster of predominantly African-American, inner-city neighborhoods where diabetes rates soar to more than double the Davidson County average.”
After establishing the outlines and perils of the hot zone in his first piece, Wilemon follows up by looking into the scarcity of transplants and pervasiveness of dialysis in the area.
Although organ transplants can occur between races, matches are more difficult to achieve for blacks. Transplant recipients must have similar genes in their immune systems to those of the donor. Otherwise, the body will reject the organ.
Whites account for 68 percent of all organ donors, while African-Americans account for only 14 percent, according to the U.S. Organ Procurement and Transplantation Network. Although the number of blacks and whites waiting for a kidney in 2011 was about the same, whites received just over half of kidney transplants that year, while blacks received less than a third.
Finally, he examines the causes of the diabetes epidemic and, in the process, wading deep into the “soul food” versus “fast food” debate.
Wilemon is a 2012-13 AHCJ Regional Health Journalism Fellow and wrote this story with support from USC’s Annenberg School of Journalism.
The Healthy Memphis Common Table is an effort to help patients and providers take charge of improving the city’s health. It includes the results of about 24,000 patient ratings of 430 local primary care doctors, all conducted by the nonprofit Consumers’ Checkbook.
Manoj Jain, M.D., M.P.H., (bio) is on the table’s advisory committee and he, as part of its mission to publicize the effort, wrote a three-part series in the The (Memphis) Commercial Appeal on the results and potential of the survey. The first installment is the one with the broadest appeal, as it discusses survey results and consequences.
In the second installment, Jain profiles a highly rated doctor and includes his own musings on what makes a physician great. Jain then wraps up the series with anonymous profiles of two poorly rated doctors and further musings on how their ratings might be improved. Interestingly, Jain’s suggestions almost always focus on non-clinical factors such as office staff quality and communication skills.
In The New York Times, reporter Kevin Sack visits Nashville, Tenn. to tell stories from the front lines of health bankruptcy, stories which he folds into larger discussions about health care reform. Apart from compelling anecdotes, Sack’s most interesting angle was that bankruptcy is equivalent to a painful insurance safety net for many Americans.
The old Davidson County courthouse in Nashville, Tenn. Photo by Brent and MariLynn
“This has really become the insurance system for the country,” said Susan R. Limor, a bankruptcy trustee who calculated that 13 of the 48 Chapter 7 liquidation cases on her docket one recent afternoon included medical debts of more than $1,000.
Under Chapter 7, a debtor’s assets are liquidated and the proceeds are used to pay creditors; any remaining debts are discharged, and filers are left with a 10-year stain on their credit ratings.
“You can’t believe how many people discharge medical debts,” Ms. Limor said. “It’s a kind of trailing indicator of who’s suffering in this economy.”
Sack writes that proposed health care reform bills in both houses seek to solve the medical bankruptcy epidemic by expanding Medicaid eligibility, subsidizing health insurance and capping annual out-of-pocket medical costs.
AHCJ Immediate Past President Trudy Lieberman adds another anecdote to the mix in a post on CJR.org, this one based on an engineer from rural Illinois. Despite a relatively good health plan from his employer and the relatively good health of his wife and children, he was forced to declare medical bankruptcy earlier this decade and now the bills are mounting again. Lieberman carefully chronicles the man’s expenses, teasing apart premiums, deductibles and everything else, then comes to the conclusion that proposed health care reforms won’t do him much good.