Michigan Disability Resistance

http://bit.ly/2IkJLc1

Safety-net health systems play an essential role in the US health care system by providing care to low-income and vulnerable populations, including the uninsured and individuals with Medicaid. Even after coverage expansions under the Affordable Care Act (ACA), about 27 million Americans remain uninsured and millions more underinsured, for whom safety-net health systems play a major role in providing inpatient, emergency, and ambulatory services.

The financial viability of safety-net health systems may be increasingly in peril given the recent elimination of the individual mandate penalty—which the Congressional Budget Office estimates may lead to 13 million additional uninsured people by 2027—and cuts to disproportionate-share hospital (DSH) payments. DSH payments offset the cost of caring for low-income patients. Although the Centers for Medicare and Medicaid Services (CMS) did recently signal a year-on-year increase of $1.6 billion in Medicare DSH payments, anticipating an increase in uninsured patients, overall DSH funding is set to fall by $44 billion in the coming decade. Many of the most affected hospitals are in weak financial condition. The recently passed budget bill delays cuts until 2020 but increases the annual reduction thereafter: $4 billion in 2020, followed by $8 billion per year through 2025.

Growing financial challenges faced by safety-net health systems should concern not just system administrators and low-income patients but also neighboring hospitals and state governments, for which safety-net systems help defray the costs of uncompensated and undercompensated care. When uninsured patients receive care, health systems often bear the cost: In 2016, hospitals alone provided $38.3 billion in uncompensated care, and by some estimates, government funding offsets only 65 percent of such costs. While policy debates focus on overall insurance coverage, less attention is paid to heterogeneous effects of coverage changes when considering the varying payer mix across providers. Hospital margins on average have risen to 30-year highs, driven by commercial prices, but hospitals with fewer commercially insured patients face a different reality.

Recent years have brought a wave of hospital closures, especially in rural and suburban areas where hospitals are struggling financially. What happens when a safety-net health system closes? Evidence suggests that the total demand for uncompensated care in a health care market does not change and that there is nearly complete spillover of uncompensated care to remaining hospitals. Each newly uninsured individual is associated with a $900 increase in uncompensated care annually, and some recent Medicaid disenrollment has likely resulted in even larger per capita uncompensated cost growth.

http://bit.ly/2IgBgys

The Disability Rights Movement is a global movement for equal opportunities and rights for people across the disability spectrum. It includes access and safety in physical environments, buildings and transportation; “equal opportunities in independent living, employment equity, education, and housing; and freedom from discrimination, abuse, neglect, and other violations.” (wikipedia)

The Disability Rights Movement started in the 1960’s in the United States; encouraged by the civil rights movement. Through nonviolent protests, sit-in’s and “silent armies” that worked behind the scenes, Americans with Disabilities Act (ADA) and Individuals with Disabilities Education Act were created, then Section 504 of the ADA was enacted

Section 504:

“Section 504 of the 1973 Rehabilitation Act was the first disability civil rights law to be enacted in the United States. It prohibits discrimination against people with disabilities in programs that receive federal financial assistance, and set the stage for enactment of the Americans with Disabilities Act. Section 504 works together with the ADA and IDEA to protect children and adults with disabilities from exclusion, and unequal treatment in schools, jobs and the community.” – DREDF

Section 504 essentially gives teeth the ADA. It was won through protest, and these videos below are wonderful tools in understanding both how important Section 504 is for people with disabilities, and how hard-won it was.

The videos speak to the power and resourcefulness of the disability community:

The Power of 504, Part 1:

http://bit.ly/2If1cKZ

Before I decided to specialize in psychiatry, I assumed a person in need of mental health care would have the same access to treatment one has for medical conditions like kidney stones, pneumonia or seizures. Instead, mental health patients and their providers face a mountain of bureaucratic obstacles that other patients are spared.

http://bit.ly/2wx2krR

After a devastating horse-riding accident in January 2017 landed him in the hospital for about 30 days, requiring trauma care and hospital-based therapy, Jeff Woodard considered himself lucky.

The bills amounted to hundreds of thousands of dollars. But Woodard’s employer-sponsored health insurance limited his out-of-pocket maximum payment to $5,000. He reached that “within like a day,” he recalled.

His retired parents relocated from their small town in Massachusetts to help Woodard, now 27, who lives just outside of Denver, through his recovery. With their support, and regular outpatient therapy, he returned to working full time in just two months.

But he didn’t expect another set of payments to haunt him and his parents for nearly a year, ultimately going to collections, and threatening to weaken his credit rating for years more.

While medical bills are a leading source of personal bankruptcy in the United States, a far more common problem is the widespread damage they do to people’s credit. Almost 40 percent of adults younger than 65 reported a lower credit score because of medical debt, according to the most recent Commonwealth Fund analysis, based on 2016 data.

That means greater difficulty with transactions such as financing mortgages, taking out student loans or purchasing cars.

In Woodard’s case, his parents had been deliberate in making sure that all the care their son received was within his insurance network. But it turned out that the trauma doctors at the in-network hospital were not. They were employees of Aspen Medical Management, a Colorado Springs, Colo., physician staffing firm that employs physicians and contracts them out to hospitals.

That generated about $3,000 worth of out-of-network surprise bills, sent directly to Woodard. United Healthcare had paid Aspen the standard rate for in-network care, and Aspen expected Woodard to come up with the rest.

Stunned, Woodard complained to his insurer and Aspen, and filed paper appeals. His parents hectored Colorado lawmakers and filed complaints with both the hospital and various state agencies. But as notices from Aspen and then collections agencies piled up, with threats to report a delinquent bill to credit bureaus, his worry grew.

“I was planning on refinancing my mortgage,” he recalled, a change that he said would have saved him $15,000. “But if I got a bad hit to my credit score, it wouldn’t save me any money. I was paranoid about that.”

Woodard’s persistent appeals succeeded, and his debt was settled just days before it was set to hit his credit report.

“I was going to write [Aspen] a check, but my parents insisted I didn’t,” he said. “I was incredibly lucky — and it sucked.”

When contacted by Kaiser Health News, an Aspen spokeswoman said the company had no comment, declined to provide her full name and then hung up.

http://protestapa.com/