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Opinion | Now, a Medicaid program built around families and communities

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The elections of November 6th are over, and now, in Washington and in Montgomery legislators again take up the task of governing. As the leader of Alabama’s twenty-seven Republican state senators, my focus is on working with other lawmakers and Governor Kay Ivey to make state government more efficient and to keep job growth strong.

Reforming the state’s Medicaid program is one of the toughest challenges we face in the coming year. Medicaid, the federally-mandated health insurance program for pregnant women, children, low-income adults, the elderly, and the disabled, is by far the largest line item in the state’s General Fund — Medicaid by itself accounts for 37% of all non-education state spending and its budget for the current year is $755 million. For context, state prisons consume 23% and the Alabama Law Enforcement Agency (state troopers) uses 2.5% of non-education spending.

The aging of America’s population as the Baby Boomers retire puts enormous stress on government-run health insurance programs like Medicaid. About 10,000 Boomers retire every day, and the U.S. Census Bureau predicts that by 2035, the number of adults aged 65 and older in America will outstrip the number of children under the age of 18. In Alabama, the population of folks aged 65 and older is expected to grow by 25% between now and 2025. This coming demographic tidal wave threatens to swamp a number of government programs, including Medicaid.

For the past five years, I have worked with Medicaid Commissioner Stephanie Azar to craft a new health care model that better serves the growing number of senior citizens in Alabama who are in Medicaid’s long-term care. Thankfully, this year Alabama received approval from the Centers for Medicare and Medicaid Services in Washington to move ahead with the Integrated Care Network (ICN). This reform will offer senior citizens on Medicaid additional health care choices and is projected to save, over the long run, tens of millions of taxpayer dollars.

Here is how the ICN will work: in October of this year, the state Medicaid agency partnered with an Alabama health care provider that will now serve the medical needs of the 23,000 senior citizens who are receiving Medicaid’s long-term care services, 70% of whom are in nursing homes. By partnering with an expert health care provider based in Alabama, Medicaid can offer its long-term patients better care — and thus allow more Medicaid recipients to stay longer in the comfort of their own home.

Medicaid recipients can still opt for a nursing home, and no benefits are changed under this new system. But by partnering with a health care provider that is an expert in managed care, Medicaid can bend the cost curve down, offer improved health care, and give more of Alabama’s senior citizens an opportunity to stay a little longer in their homes and communities.

For my wife and me, one of the greatest privileges in life is spending time with our parents — and as the years have passed, we, like so many Alabama families, have discussed the future and begun to plan for the day when our parents will need additional help. As a legislator, I think often about how the policies that I vote on will affect the lives of my friends and neighbors. The Integrated Care Network is just getting started, but I am optimistic that this reform will improve the quality of life for many families in Alabama and put Medicaid on a sounder financial footing.

Greg Reed, R-Jasper, is the Alabama Senate Majority Leader and represents Senate District 5, which is comprised of all or parts of Winston, Walker, Tuscaloosa, Jefferson, and Fayette counties.

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Opinion | Alabama doctor: We’ve lost precious time and must act now

Dr. Anand S. Iyer, MD, MSPH

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Disclaimer: The opinions expressed in this perspective are my own.

My home air conditioning unit broke this week. Worst possible time, right?

Fortunately, it was an outdoor problem, so the repair guy didn’t have to come inside.

When he approached the door to discuss the problem, I told him I was an intensive care unit doctor at one of the largest hospitals in the country who couldn’t risk any potential coronavirus exposures and asked him to stand as far away from me as possible.

He responded, “Think this whole coronavirus thing is real?”

The way that our political leaders have failed at handling this pandemic has seeped into the culture. This nonchalant attitude was modeled by Alabama’s leaders who acted like this could never happen in our state two weeks ago, by spring breakers enjoying themselves on the beaches despite pandemic warnings last week, and by my repair guy who was completely oblivious just a few days ago.

Political action was needed weeks ago when those of us in the medical community were sounding the alarm. We now have lost precious time, and the president is even considering loosening restrictions.

Meanwhile, my wife and I are planning how to isolate me away from my kids for the next several weeks, since my friends and I are anticipating placing many Alabamians on ventilators as we see severe cases skyrocket.

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Allow me to make one last plea for the state of Alabama.

Our state political leaders are doing the equivalent of sitting at the dinner table wondering if we should buy a weather radio for protection while a tornado is at the front door, and the president is about to let everyone go outside to play.

Time is of the essence. Please urge your leaders and Gov. Ivey to implement much heavier action in Alabama now. More shelter in place orders are needed across the state like what Birmingham did on Tuesday.

This is the minimum we need to give our state’s healthcare system the most essential commodity it needs right now – time.

Some people are doing great at social distancing and are taking this very seriously. I thank you for this. However, the average person is barely listening to even these simple requests.

Staying at home is the most basic way to flatten the curve. Loosen this recommendation any further as the president has suggested, and it will magnify the Alabama April 2011 tornado outbreak by several fold. Nine years later, this is our “James Spann with no suspenders,” “respect the polygon,” “once in a generation” moment, Alabama.

I urgently plead with our local and state leaders to quickly take the next steps needed to proactively protect all of us right now. Our healthcare systems need the valuable time to build capacity at a reasonable pace, figure out treatment options for this novel virus, and hammer out backup plans.

I see several other immediate priorities. At the national level, rather than waiting for corporations to pivot towards mask and ventilator making, we need to invoke and implement the Defense Production Act now to generate vital medical supplies to protect those of us on the frontline and our patients.

The outpouring of community support for making masks is amazing. We are grateful, but the federal government could make them to scale. My colleagues across the US are unsafely reusing masks, especially N95 masks that are supposed to be reserved only for those of us on the very front of the frontline. Please don’t hoard these masks. Rather, donate them to your local hospital.

At the state level, our leaders should ensure that rural and small-town hospitals, such as the ones in my hometown of Anniston, are adequately prepared with the supplies and communication structures needed to identify and ration critical needs and workforce. I know many aren’t ready. As the virus spreads quickly throughout the state, hospitals in rural Alabama will most surely run out of supplies unless we act quickly to help them. The federal government isn’t stepping up at the moment.

Finally, and at the very least, we need our leaders to be highly visible on television continuously urging citizens to stay at home every day. Other countries that have successfully controlled the pandemic have made this a priority and a natural part of all messaging that is being delivered. We should do the same.

Things will get bumpy in the next month, but we in the medical community are here to guide and protect you through this as best we can, Alabama.

I echo the urgency and recommendations of Dr. Anthony Fauci and Surgeon General Jerome Adams.

Please stay at home unless absolutely necessary.

Take care and be safe, Alabama.

Dr. Anand S. Iyer, MD, MSPH Pulmonologist and Intensivist, is a 2003 graduate of The Donoho School in Anniston.

 

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Opinion | Slowing the spread requires all hands on deck

Bradley Byrne

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As the COVID-19 coronavirus continues to change the way we live our daily lives, its important to take note of the ways this challenging time has brought our communities together.  It has been reassuring to see stories of neighbors helping neighbors in communities in Southwest Alabama and beyond.  As we continue to treat this unprecedented challenge with the seriousness it deserves, let’s not forget to help our neighbors as best we can.  Whether dropping off supplies to senior citizens or supporting local businesses, we all can do something for others in our community.

As expected with increased testing, the number of confirmed cases in Alabama has risen.  The first coronavirus aid bill passed by Congress included more than $4 billion to make diagnostic tests more broadly available, and more test kits are on the way to Alabama.  It is important to remember that approximately 90 percent of tests are coming back negative, and most who contract the coronavirus show no or mild symptoms.  To slow the spread, it is critically important we all continue practicing social distancing, keeping our hands washed, and using common sense.

Your federal government is continuing to work aggressively. Vice President Pence and the coronavirus task force have exhibited outstanding leadership.  On March 16, with the consultation of medical professionals on the task force, President Trump instituted a “15 days to slow the spread” initiative to encourage Americans to stay home, avoid gatherings greater than 10 people, choose takeout rather than dine in, and avoid travel and social visits whenever possible.  The more we encourage others to follow these guidelines, the sooner we can “flatten the curve.”

This problem truly requires an “all hands on deck” solution.  President Trump has called for the private sector to help, and the response has been encouraging.  Some automobile manufacturers are working to transition from cars to ventilators.  Just this week, Governor Ivey announced an anonymous donation of 100,000 masks to the state.  Even my colleague in Congress, Denver Riggleman from Virginia, has transitioned his family’s distillery from making bourbon to hand sanitizer to supply to those in need.  This is the kind of response Americans have always had during a crisis.

Our governor has shown strong leadership.  She declared a state of emergency to mobilize all the state’s resources necessary to address the coronavirus.  With this declaration, small businesses across Alabama negatively impacted by the coronavirus pandemic are eligible for assistance under the Small Business Administration’s Economic Injury Disaster Loan program.  She authorized the Alabama National Guard to activate up to 100 guardsmen if needed.  Following the federal government’s actions moving the filing deadline for federal taxes from April 15 to July 15, Governor Ivey did the same for state taxes.  And she has continued to follow the best guidance from medical professionals to combat the spread of the coronavirus.

There are important state resources available to Alabamians that you should know about.  The Alabama Department of Public Health established a toll-free hotline at 1-888-264-2256 to answer questions regarding testing locations and options. Their website is a great location for information, updates, and guidance specific to the state.  Additionally, the Alabama Department of Labor announced that workers who are unable to work due to the coronavirus are eligible to apply for unemployment benefits.  If you are eligible, you can file online at the department’s website or call 1-866-234-5382.  As always, the Centers for Disease Control maintains an excellent resource for information at www.coronavirus.gov.  

We are far from out of the woods, but we are making great progress.  Thank others for their sacrifices and work for others, especially our medical professionals and first responders.  I’ll continue keeping you updated on new developments from Washington.  Americans are resilient and strong, and we will get through this.

 

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Opinion | Former industrial workers are among the high-risk groups for COVID-19

Gregory A. Cade

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The novel coronavirus has been rapidly spreading worldwide, affecting everyone’s lives more than we’d have expected – from stress and anxiety, having to practice social distancing and therefore isolate inside the house to the illness itself. And it’s with good reason that most people are concerned about it, as the disease can have serious complications and even become deadly for the ones who find themselves being in the groups with a high risk.

For former industrial workers, the risks of developing severe complications if infected with COVID-19 are high, especially if they have been exposed to various toxins that could have potentially damaged their lungs and left them with respiratory diseases. One of the most common work-related diseases is asthma, the occupational development of it accounting for 15% of adult on-set cases, followed by COPD that can develop from the inhalation of fumes, dust, and gasses. Industrial workers are also at risk of developing pneumoconiosis as a result of exposure to silica or coal and asbestosis, lung cancer as a result of asbestos exposure.  All of these are a huge risk factor as the novel coronavirus seems to attack the respiratory system. Simply put, if there is already a respiratory disease that has weakened the body’s system, especially the lungs, chances are that it will be extremely difficult to fight off an infection attacking an already weakened organ and in some cases even fatal.

Being a new virus, there is still a lot of things that remain unclear about it to doctors and scientists. Until this point, there have been only a few months to study its effects, which isn’t nearly enough to be able to have a complete image and conclusive statistical information on how the virus attacks and how it be better treated to lower the mortality rate and render it less of a risk to those already vulnerable. It appears though, that around 80% of cases are suffering only mild or moderate symptoms, 15% suffer a more severe form that requires hospitalization and around 5% of the cases end up in a critical state and need intensive care. The data gathered until now shows that the virus has a mortality rate of around 3.2%, mostly amongst older adults (over the age of 70) which additionally have one or more chronic diseases.

Alabama Industrial Workers Exposed to Toxic Chemicals 

Up until the 80s, various toxic chemicals were widely used for manufacturing products in a number of industries. Alabama is amongst the states where many manufacturers opened up sites with 10 asbestos sites for commercial use and 9 naturally occurring asbestos known sites. As the protection equipment was often inadequate, many industrial workers were exposed to inhaling these toxins over a long period of time and therefore, running the risk of developing serious diseases. The most common types of toxins that industrial workers might have been exposed to are:

  • Polychlorinated biphenyls (PCBs), which might have endangered people who have worked in manufacturing insulation materials as well as in power plants as this type of chemical was mostly used as coolants and lubricants in transformers, electrical appliances, and old fluorescent lighting fixtures.
  • Silica, where the most severe exposure occurs as a result of working with abrasive blasting, cement, and brick manufacturing as well as steel and foundry industries.
  • Coke Oven Emission, putting to risk workers in heavy industries such as the iron and steel industry
  • Asbestos, which due to the fact that it was used in numerous products, could have potentially exposed workers from a large number of industries such as automotive, construction, industrial manufacturing, and even former navy and marines veterans.

As exposure to these chemicals means that workers would inhale them for an extended period of time, the possible health effects for most former workers that have been exposed to it are respiratory diseases such as asthma, COPD, pulmonary fibrosis, asbestosis, silicosis, lung cancer or mesothelioma. But when it comes to toxic exposure, it can take as much as 20 years for diseases to develop and even when they do, victims might be asymptomatic for a long time which means that by the time they receive a diagnosis, it’s too late. The other big problem is that in these cases, misdiagnosis is common which in light of the current pandemic could put even more people at risk, as we know that it acts as a respiratory virus, attacking the lungs. This is why it’s extremely important that former industrial workers that have a history with toxic exposure, constantly check up on their health and provide doctors with all the information regarding their occupational past, especially in the context of the current COVID-19 pandemic, as having an early diagnosis and being able to take the necessary precaution measures might even save lives.

How Can Vulnerable Groups Limit Exposure to COVID-19

It’s extremely important for people with a history of toxic exposure to limit as much as possible the potential of catching the novel coronavirus as it can cause severe complications and even be fatal. There are just a few general rules that are important to follow:

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  • Try isolating as much as possible, avoid crowded places, house visitors or having contact with a family member or caretaker that shows symptoms similar to those given by COVID-19
  • Wash your hands regularly and disinfect surfaces that are most likely to have bacteria on them such as doorknobs
  • Avoid touching your face without having your hand clean
  • Try to also maintain calm and positive throughout this time
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Opinion | Coronavirus will stretch Alabama hospitals and healthcare facilities to the breaking point

Craig Ford

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With cases of the coronavirus now being reported in Alabama, healthcare – especially in rural parts of our state – has become more important than ever.

Several years ago, our state had the opportunity to expand Medicaid at almost no new cost to Alabama taxpayers. The federal government would have funded over 90 percent of the expansion, and that comes from taxes we already pay.

Instead of reclaiming our tax dollars, state leaders at the time chose not to expand Medicaid, and so our tax dollars went to other states like New York and California.

Now we are paying the price for that shortsightedness. And let me be clear – Medicaid expansion was not just about providing health insurance to people who otherwise couldn’t afford it. Medicaid expansion was about keeping hospitals and doctors’ offices open.

What many people don’t realize is just how much of healthcare in this state is paid for by Medicaid. A majority of payments to nursing homes and pediatricians comes from Medicaid. And hospitals – especially in rural Alabama – rely on Medicaid funding to stay open.

So, even if you have good private health insurance it won’t matter if your doctor or local hospital goes out of business because they aren’t making enough money to pay their bills.

And that is exactly what is happening.

Alabama has lost 17 hospitals over the last 10 years. The most recent one was Pickens County Medical Center, located in rural west Alabama near the Mississippi line. Losing this hospital means patients lose healthcare, healthcare providers lose their jobs, and neighboring hospitals become more crowded as those patients have to obtain healthcare services from other places.

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So even if you don’t live in a rural county, you may still have to wait longer to see your doctor and pay more for it as your local hospital and doctor’s office becomes more crowded and has to take on more patients who don’t have the money to pay for the care they have to receive.

When one patient can’t pay, that cost gets passed along to all the other patients, meaning those of us who have good health insurance are still paying for the ones who don’t.

Under normal conditions this situation would still be a major problem. But now that the coronavirus has hit our state our hospitals and critical care wards, which are already stretched to the max on what they can handle, will be stretched even more thin.

Dr. Michael Saag, professor of infectious diseases at UAB, recently wrote in an editorial printed in the Birmingham News that the State of Alabama is not prepared to adequately respond to the coronavirus. He estimates that up to one-third of the entire U.S. population will eventually contract the disease, and that we may have as many as 25,000 cases here in Alabama within the next 10 weeks.

If that happens, we can expect roughly 20 percent of them to be significantly ill, and that hospitals and ICU’s can anticipate an influx of 2,500 patients statewide.

Just to give you some idea of what that means, UAB hospital only has 300 ICU beds and they are the flagship hospital in our state.

And remember that we have now lost 17 hospitals in Alabama, mostly in rural areas. So these patients will be flooding the already overcrowded hospitals in our cities and suburbs.

So what can we expect to happen here in Alabama?

Well, we can look at Italy to get a glimpse of where we are headed. In Lombardy, Italy last week, 200 patients needed to be admitted to the hospital but there weren’t enough beds. So doctors had to decide which patients had a chance of surviving and send the rest home to die.

Italy is not a third-world country. They are an industrialized nation just like us. And, just like them, we are not prepared for this disease.

This coronavirus will stretch Alabama’s hospitals and healthcare system to the maximum. Had we expanded Medicaid a few years ago, we would be in a much better position. But we didn’t and now it’s too late.

The only hope we have is to take the appropriate precautions and try to limit how quickly this virus spreads by self-quarantining, following basic hygiene practices like washing our hands, and being mindful of commonly used surfaces like door knobs, gas pumps and light switches.

If we all do our part then we can limit the impact of this disease and help our medical personnel do their jobs.


Craig Ford is the owner of Hodges-Ford Insurance and the Gadsden Messenger. He represented Gadsden and Etowah County in the Alabama House of Representatives for 18 years.

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