Tag: Health Care

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Rural Hospitals and COVID-19

Anyone who knows my background would know that I’ve spent most of my life living in a big city. So, you might be asking why I’d take an interest in rural hospitals during COVID-19, and why others should take an interest in this topic as well. There are really three answers to that “why” question:

(1) many rural hospitals were in danger before the pandemic,

(2) many rural hospitals may be in even more danger of closing as a result of the pandemic, and (3) such closures would reduce access to care for many during this pandemic.

Even before COVID-19, many rural hospitals had been closing at an alarming rate. The problem has been particularly bad in poor rural areas here in the United States. The reason for this is often attributed, at least in part, to the fact that some states have decided not to opt for Medicaid expansion, a move that affects the finances of hospitals severely.[1]

With COVID-19, this situation is expected to get even worse, unfortunately, especially in the states that have not expanded Medicaid. That’s not to say that the pandemic isn’t taking a toll on other places, but that toll is expected to be particularly bad in places that have not seen this expansion.[2]

What this will mean is potentially more rural hospital closures, especially in poor rural areas.

It means that many in these places who need urgent care for anything, whether it be for COVID-19 or something else, will need to wait longer to get urgent care that they need, ranging from heart attacks to severe strokes. Furthermore, it will mean that people in the areas affected by these closures will need to travel further to get the care they need, in the process putting more of a burden on the hospitals that do survive (both hospitals that exist in rural areas and ones that do not exist in rural areas).

All of this, in turn, would affect places’ abilities to adequately address COVID-19. I am presenting a rather doomsday scenario because it does sound like a doomsday situation, unless rural hospitals get the help they need.

There are two ways forward from this crisis, as far as I can tell. First, states that have resisted Medicaid expansion should end that resistance immediately. Second, federal assistance to rural hospitals, which from what I have read has been inadequate, should be much more substantial.[3] This is not to say that the situation will be universally great even with these measures because the entire American healthcare system is feeling the strain from COVID-19. However, the measures I suggest above would hopefully slow down some of the financial bleeding many rural hospitals are experiencing.

For any of my readers who live in rural parts of the United States and may be affected by the closures of rural hospitals, you may want to do the following:

  1. See if your state has implemented Medicaid expansion. If not, put pressure on your state officials to expand Medicaid in their states.
  2. Contact your members of Congress (particularly if your member covers some rural areas) to ask them to make sure that rural hospitals are adequately addressing any future COVID-19 relief or stimulus plan.

Yes, I may be a city kid in many ways, but I also know that we need urban, suburban, and rural hospitals alike to be in adequate shape financially as they confront this pandemic. Anything less than that is irresponsible and may result in unnecessarily losses of life.

[1] This Forbes article explains how a lack of Medicaid expansion causes significant financial harm to many rural hospitals: https://www.forbes.com/sites/claryestes/2020/02/24/1-4-rural-hospitals-are-at-risk-of-closure-and-the-problem-is-getting-worse/

[2] https://www.npr.org/2020/04/09/829753752/small-town-hospitals-are-closing-just-as-coronavirus-arrives-in-rural-america

[3] https://www.thegazette.com/subject/news/health/iowa-rural-critical-access-hospitals-money-problems-coronavirus-relief-20201019. This source, which is the paper of record for much of Eastern Iowa, has been consistently covering the issue of federal assistance to rural hospitals.

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Obamacare and Race

One of the signature issues for both major political parties is health care. Many Republicans want to repeal the Affordable Care Act, also known as Obamacare, that passed in 2010. President-elect Joe Biden, who was Vice President in the administration under which Obamacare was passed, says he wants to expand it. These are two wildly differing views on what to do with our health care system.

However, given the current climate of racial unrest in the United States, as well as the potential repeal of the law being considered by the United States Supreme Court, it seems timely to talk about Obamacare from a racial justice standpoint.

So, where does Obamacare stand from a racial justice standpoint? Well, I have some good news for proponents of Obamacare, and some not-as-good news:

Reductions in uninsured rates were significant among minorities.

Among the highlights of those gains:

  • 21.8% of American Indians and Alaska Natives were uninsured as of 2018, down from 32% in 2010.
  • 19% of Hispanics were uninsured as of 2018, down from 32.6% in 2010.
  • 11.5% of Blacks were uninsured as of 2018, down from 19.9% in 2010.
  • 9.3% of Native Hawaiians or Other Pacific Islanders were uninsured as of 2018, down from 17.9% in 2010.
  • 6.8% of Asians were uninsured as of 2018, down from 16.7% in 2010.[1]

These are undoubtedly significant gains. However…

The aforementioned gains I mentioned have stalled out.

Most of the gains that occurred were between 2014, when important provisions of Obamacare were implemented, and 2016. Those gains have stalled since then, and for Blacks the rate of those uninsured has started to tick up in recent years. The Kaiser Family Foundation, which focuses on health care issues, attributes this to certain policy changes in the Trump Administration “that affected the availability of and enrollment in coverage.”[2] But whatever the reason for this stall, it has happened, and this stalling trend is one that a President Biden will need to address (assuming the Supreme Court doesn’t repeal the law).

However, the gaps in insurance by race are about more than just what’s coming out of Washington, DC. It’s also because of policies at the state level.

Many states with large Black populations have refused to expand Medicaid under Obamacare.

As a result of this, even though there appear to be modest gains in racial disparities among the uninsured overall as a result of Obamacare, the gains are not as big as many might like. Additionally, the result of this is that about half of the remaining uninsured Americans are people of color.[3] This goes to show that elections have consequences—not just federal elections, but state ones too. This is worth keeping in mind for future elections at the state level.

In spite of the issues I’ve mentioned, the racial gap among the uninsured has closed somewhat.

The rate of those without insurance has dropped among whites too, but as there were fewer uninsured whites than uninsured people of any minority group to begin with, the rate among whites of those lacking insurance dropped more slowly than among any other racial group. As such, the racial gap among the uninsured has closed somewhat, even if there are disparities that still exist.[4]

In spite of all this data I’ve shared, there are some unanswered questions.

So far, I have painted a mixed picture of what Obamacare has been like for minority groups, particularly from an insurance coverage standpoint. But there are some unanswered questions about the true impacts of the health care law, too. Here are a few such questions:

  • While the number of uninsured Americans has decreased significantly since Obamacare was passed in 2010, the number of underinsured Americans has also increased.[5] To what extent does this underinsurance issue affect people of color?
  • Is there anything about Obamacare that might, even unintentionally, contribute to the continued (if somewhat decreased) gap in the uninsured between some minorities and whites?
  • There are mixed messages about how Obamacare affected health care costs—out-of-pocket health care spending decreased, while premiums increased.[6] To what extent are people of color getting the benefit of reduced health care spending, or the drain of increased premiums?

The unanswered questions are so numerous that I may need to republish this post at some point, as a version that hopefully answers some of the questions that I’m asking here.

Over the last several hundred words, I have painted a rather mixed message on the question of Obamacare and racial justice. But where does this leave us?

For those in the United States who care about American health care, this raises some questions. For the Republicans, who are proponents of repealing and replacing the law, how does the law get repealed and replaced without erasing all the gains that people of all races, particularly minorities, have seen as a result of Obamacare? For Biden and his supporters, how can we continue making progress in increasing the number of insured Americans, and how might the issues with underinsurance and health care premiums be addressed (assuming, once again, that the Supreme Court doesn’t strike down the whole law)? And for all sides of the debate on this law, how can we ensure that every American is insured?

The last question is maybe the most important one of all, because access to affordable health care should be a human right, not just a privilege to those fortunate enough to access it.

[1] https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/

[2] Ibid.

[3] https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2020/02/19/there-are-clear-race-based-inequalities-in-health-insurance-and-health-outcomes/

[4] https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/

[5] https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca

[6] https://www.cnbc.com/2018/01/22/out-of-pocket-health-spending-dropped-after-obamacare-rolled-out.html

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Want to “Support Our Health Workers”? Here are Some Tangible Ways to Do So.

“I support our health workers.”

The above is a common refrain I’ve heard while the United States has grappled with the coronavirus.

I agree with the sentiment—I think our health workers should be supported. However, I also recognize that all too often, this refrain does not turn into action. Often, we say “support our health workers” but then act in ways that show anything but support for our health workers.

But how can we support our health workers? I propose a few suggestions:

  1. If you aren’t doing so already, wear a mask or some other protective face covering[1] and practice social distancing. These two actions are widely proven to contain the spread of the coronavirus. If people performed these two actions, we would keep our health workers from becoming overwhelmed with coronavirus patients.
  2. Assess the needs of the health workers where you live, and act accordingly. Speaking as someone who witnessed how difficult things were with the coronavirus in New York City, the needs of health workers were varied—at one point it included everything from equipment to food to funds for childcare. I can’t speak for what the needs are of health workers in places like Miami or Houston, but I strongly urge you to assess the needs of health workers where you live and act accordingly.
  3. If there are murmurs of a hospital closing down near where you live, do all you can (within reason) to protest the closure. There is a great deal of concern about the financial strain that many hospitals are experiencing as a result of the pandemic.[2] As such, there is also concern about the potential of hospitals closing. The closure of hospitals would put more strain on the hospitals that remain, and therefore the health workers who remain. As such, I urge readers to protest any proposed hospital closures in your area.
  4. Support legislative efforts to reduce the financial burdens that our health workers have. From current childcare costs to past student loan costs, there are a multitude of financial burdens that many of our health workers have to deal with. Given the stresses involved with trying to deal with the pandemic, we should try to minimize other sources of stress, such as financial burdens. This is where I would recommend actions such as urging your member of Congress to support legislation to forgive student loan debts for frontline health workers during COVID-19.[3]
  5. If you have a friend who is a health worker, listen to what they have to say. Don’t blow off your friend. Don’t minimize the experiences your friend had. Just listen to them.

These are just a handful of ways that you can support our health workers during COVID-19. Are there other ways we should consider supporting health workers? If so, please leave a comment below!

[1] I understand that some people have a difficult time with masks for health reasons. However, for many, there are other types of face covering, such as face shields, that may work better for you than a face mask.

[2] https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due#:~:text=Hospitals%20face%20catastrophic%20financial%20challenges,of%20%2450.7%20billion%20per%20month.

[3] https://www.govtrack.us/congress/bills/116/hr6720

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Addressing the Rise in Coronavirus Cases in Some States

Coronavirus cases are increasing at drastic rates in some states. Some people are alarmed with this rise in coronavirus cases, while other people (including some elected officials) downplay the increase in cases by saying out that there’s more coronavirus testing than before, and that because of more testing, there are more cases.

I’m here to say that there is reason for alarm in some places. But the reason for alarm is not because of the increase in coronavirus cases in many places, but because many places are struggling to adequately handle coronavirus cases so severe that urgent intervention is needed.

In places hard-hit by the coronavirus, the local health care systems get completely overwhelmed by coronavirus patients. In parts of Italy, the health care system got so overwhelmed that doctors had to make heart-wrenching decisions about who to try saving and who to let die.[1] In my hometown of New York, response times for emergency calls surged significantly at the height of the coronavirus, which in turn further endangered individuals already at risk.[2] In Alabama, fellow blogger Kim reported a few weeks ago that hospitals in Montgomery were so overwhelmed that they were needing to start sending patients to Birmingham, which is 90 miles away from Montgomery; this additional wait for treatment also further endangered individuals already at risk.[3] In places like these, the health care systems get so overwhelmed that lives are put at risk or worse—lives are lost. That is reason for alarm.

But, how is one to respond to the alarm? I have five words to say: wear masks and socially distance. People should do those two things, as much as possible. I know people want to give their friends a hug, and I know that the masks can feel hot during the summer, but this is not about you. It’s about others. Namely, it’s about saving others’ lives. It’s about making sure that our emergency responders, nurses, and doctors don’t get overwhelmed. It’s about making sure that the immunocompromised don’t catch the virus and end up seriously ill (or dead) because of irresponsible actions from others. If you don’t want to wear masks and socially distance for yourself, do it for others, because wearing a mask and practicing social distancing are the two best ways to do your part to limit the spread of this pandemic.

Note that I will not have a post next Monday because of the July 4th holiday the previous Saturday.

[1] https://www.bbc.com/future/article/20200428-coronavirus-how-doctors-choose-who-lives-and-dies?ocid=global_future_rss

[2] https://www.nbcnewyork.com/news/local/tracking-nycs-coronavirus-fight-from-911-call-to-er-door/2369206/

[3] https://cadburypom.wordpress.com/2020/05/22/family-fridays-9/

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Did You Get Money You Don’t Need From the Feds? Here Are Some Ideas of Where to Donate It.

Those of you who have been following the weekly updates on how I’m doing, and how my city (New York City) is doing with the coronavirus, will know that I am in a pretty stable situation professionally. As a result, I didn’t need the federal government to give me $1,200…yet I was given it anyway since many of us are receiving somewhere between $1,200 and $4,700.

If you are a person struggling to make ends meet, you need not feel guilty about using the money to help yourself financially. In fact, you’re the kind of person who was envisioned as benefiting the most from receiving the money.

However, if you are like me in that you don’t need the money, I strongly recommend that you give away the money in ways that help those less fortunate (because there are so many people less fortunate than you, in that case). However, you may be struggling to figure out how best to use the money you received to help others. In today’s post, I offer some suggestions of the types of places where you can donate your money, in no particular order:

  • Food banks: Right now, food banks are the way that many people are surviving during these times. However, food banks need financial resources as well as donations of canned and dry goods, and that’s where your donations can come in.
  • Services that deliver food to seniors and/or those with underlying health conditions: There are a lot of people who need food but can’t easily go out to get it because they fall into a population that is at risk for suffering a severe case of the coronavirus (seniors and those with underlying health conditions). That is where a service that delivers food to people can be so vital. I will likely donate some of my $1,200 to one such service.
  • Anything that helps our health care workers: I’m leaving this open-ended because there are so many ways to help our health care workers. The public hospital system in New York is accepting donations that will help support the day-to-day needs of their workers,[1] but the needs for hospital workers in New York may be different than what they are in another part of the United States.
  • Anything to support local small businesses: Many nonessential small business staff have been hit particularly hard by the coronavirus. As a result, some small businesses have started up crowdfunding campaigns to help their employees, some patrons of these businesses have looked to buy gift cards (in order to keep some sort of cash flow coming into the businesses), and some patrons of local restaurants have stepped up their support by ordering in or taking out with frequency. Regardless of the method of support, using your money to support your favorite local small businesses is money well spent.
  • Services that give support to those most vulnerable to physical, mental, and/or emotional harm during the coronavirus: This is a time when there is an elevated risk of domestic violence. This is also a time when some people in the LGBTQ+ community may be struggling while living with family who are highly rejecting of their identity. It is also a time when many people already struggling with their mental health may be struggling even more so. You may want to consider donating to an organization that helps provide support and/or services to a group of the population particularly vulnerable to harm during the coronavirus, such as one of the groups mentioned before.
  • Organizations that will help fight the spread of the coronavirus in places where health care infrastructure is poor: Okay, so for a developed country, the United States does not have a good health care infrastructure. However, this virus is poised to hit parts of the world that have health care infrastructure even worse than that of the United States. Therefore, an organization such as Doctors Without Borders, an organization that will help fight the spread of this virus in parts of the world where health care infrastructure is poor, is money well-spent.

Of course, this list, while somewhat extensive (I hope), is not comprehensive. With that in mind, if anyone here has other suggestions of types of places (or specific organizations) we should give our money to, please feel free to comment below! Hopefully, this list will provide the most fortunate among us an opportunity to think about where to donate, and might also make my readers going through hard times think about how they can best be helped during these times.

This is a “Blindly Just” post.

[1] https://www.nychealthandhospitals.org/donate/