Monday, August 17, 2015
Monday, July 20, 2015
A TIME FOR UNITY
by Paul Gibbs
When I first decided to make Entitled to Life, I started to meet with people who were working to support Medicaid expansion or what was just then becoming known as Healthy Utah. The 2014 Utah general legislative session had just ended, and a straight up Medicaid expansion hadn't even made it to a vote. One of the first people with whom I met asked me a question that took me completely by surprise: "What's the purpose of your documentary? Is it to express angry at the legislature for not passing Medicaid expansion? Or is it to raise awareness and try to support getting the best possible plan through?" I had to do some serious thinking about that. But I decided that the second option was by far the more productive. That's what I've tried to stick to since.
The reason I tell this story now is because we're at a very important turning point. A week ago statements from House Speaker Greg Hughes and House Majority Leader gave most of us the impression that a plan which would cover up to 138% of the poverty level and bring back the maximum possible amount of Utah tax money from the federal government was no longer a serious possibility. Now, the so-called Gang of Six (including Hughes and Dunnigan) has announced an agreement for the "framework" of a plan which does just that. We don't know much about the details at this point, and a lot of questions have to be answered. But there's no denying this is a huge step in the right direction. Now, pending those details, we have to ask ourselves some important questions as well.
The plan isn't going to be a straight up expansion of traditional Medicaid. It's not going to be exactly the same as Healthy Utah. But from what they're telling us, it's closer to both than I frankly thought had any chance of happening at this point. Real coverage for up to 138% fpl and getting back the maximum federal funding has always been the goal. That's what the "Utah Cares" plan we so disliked failed to do. And they can't exactly bring back the controversial work requirement that's already by rejected by the Obama administration. And with the support of Hughes and Dunnigan, this plan has a real chance of passing. I've made my frustrations with Hughes and Dunnigan very clear in the past. I couldn't have much more strongly disagreed with their approaches during the 2015 legislative session, and nothing I was seeing or hearing from them between now and then changed my mind. But if the details of the new plan are workable (and I join most of my fellow activists in being optimistic that they are), I'll happily consider the two of them allies. Anger over past issues will serve no purpose and distrust and antagonism will be counterproductive. If we're working toward the same goal, I'm happy to work with them.
At this point there will be no purpose served by dividing into camps and opposing each other to fight over the plan which best suits our respective pure ideologies, or in worrying about what we call the plan or who gets credit. It is necessary to unite in the common effort to get this past both houses of our state legislature, where the Allen Christensen's and Jake Anderegg's are likely to be no more friendly than before . Any confusion or disunity will be potentially disastrous. But by working together, we can help influence compromise and positive change. It's important that we remember that neither Dunnigan or Hughes have stated an absolute ideological refusal to accept
federal funding, and therefore this doesn't constitute an out of
character change of position from them which would give reason to be suspicious. If they really have found a
solution that silences their fears about sustainability while bringing back the federal funds and providing quality coverage, that will be hard for House Republicans to fight against, especially with the backing of Dunnigan and Hughes. The people many of us thought of us as the biggest obstacles a week ago may very well turn out to be crucial to getting this through. The irony may be equally poetic and frustrating, but what really matters is getting this passed.
For anyone who wonders why, given what I'm saying here, I didn't join with those who supported Utah Cares as "better than nothing" or "the best we can get", the reason is that plan plain and simple didn't get the job done. But in 2014, I moved from holding out for straight expansion to supporting Healthy Utah because it did, and it appears now that this plan may very well do the same. And if burying the hatchet with Jim Dunnigan and Greg Hughes helps that happen, then I won't give it a second thought. If the details bear out that this plan offers quality, comprehensive coverage to up to 138% fpl, we need to support it and get the job done. What we needed to do now is push the Gang of Six to give us those details, to be sure that this is real and comprehensive coverage that doesn't fall back on PCN or some other weak and inadequate form of coverage. And, as they've given us no timeline for announcing these details or calling a special session, we need to keep up the pressure that this be done quickly. As we just saw with the untimely death of Carol Frisby, a cancer patient who didn't get the care she needed soon enough, people waiting for this don't have the luxury of time, and therefore these legislators have no right to ask for it either. That's how we can stay involved, and where continued pressure serves a purpose. We don't have all the answers yet, and just as legislators kept insisting they needed to know the details of Healthy Utah, we need to know the details of this. But it's crucial that we
hear them with clear and open minds, not a cynicism that tells us this plan is bad just because of our past feelings toward or experiences with some of the legislators who support it. Some people are going to feel I'm being naive for even considering the idea that Dunnigan and Hughes may now be allies. But all that kind of thinking has the potential to do is kill a solution before it even comes to a vote. I'll take bipartisan hope over partisan cynicism any day.
As I've said in the past concerning Governor Herbert, there will be a time and place to hold people accountable for not acting sooner. But just as we've been asking our opponents to choose between their politics and the needs of tens of thousands of people, we need to be prepared to the same thing. It doesn't matter whether this is victory for Democrats or Republicans. What matters is a victory for poor and sick people.
hear them with clear and open minds, not a cynicism that tells us this plan is bad just because of our past feelings toward or experiences with some of the legislators who support it. Some people are going to feel I'm being naive for even considering the idea that Dunnigan and Hughes may now be allies. But all that kind of thinking has the potential to do is kill a solution before it even comes to a vote. I'll take bipartisan hope over partisan cynicism any day.
As I've said in the past concerning Governor Herbert, there will be a time and place to hold people accountable for not acting sooner. But just as we've been asking our opponents to choose between their politics and the needs of tens of thousands of people, we need to be prepared to the same thing. It doesn't matter whether this is victory for Democrats or Republicans. What matters is a victory for poor and sick people.
Thursday, July 16, 2015
THE HIGH COST OF WAITING
by Paul Gibbs"How much of human life is lost in waiting?" Ralph Waldo Emerson's question takes on new meaning when viewed through the lens of the Healthy Utah/Medicaid expansion debate. Human lives are being lost because Utah legislators insist on delaying action.
On Tuesday June 4, 2014, at the premiere screening of Entitled To Life, Dr. Raymond Ward (now a GOP House Member from Bountiful) announced that Emily Young, one of the patients he spoke of in the film, had passed away. Emily was 43 years old and had not been able to receive the need treatment for breast cancer because she was uninsured. Emily would have been covered by either straight Medicaid expansion or Healthy Utah.
On Wednesday, July 15, 2015, Rep. Ward informed Utah House Speaker Greg Hughes that Carol Frisby, a colon cancer patient Hughes had met with, had passed away, also unable to receive the care she needed. The fact that we're still experiencing exactly the same problem over a year later is not only heartbreaking, it perfectly illustrates the cruelty of the continual delays which seem to actually be embraced both by Hughes and House Majority Leader Jim Dunnigan. While Dunnigan keeps asking Utahns for patience and saying it's good to have some time, innocent people are dying simply because they have low incomes. And while Emily and Carol put a human gace on the issue, they're far from alone. Harvard Medical School estimates that 316 Utahns per year will die due to lack of coverage without medicaid expansion or Healthy Utah. Considering this debate has drug on for three years, that means that as many as 948 people have have died while it stretches out. If we really are forced to wait until the 2016 legislative session, as now seems a distinct possibility, then it is statistically likely that well over 1,000 people will have died because we waited. It's unthinkable that legisators can live with that figure, but apparently they can. While UtahPolcy.com's account indicated that Hughes was disturbed by the news of Carol Frisby's death, I hold out little hope that it will mark a significant change in his or Dunnigan's approach. They and every other legislator are (or at least should be) aware of the real human faces of the coverage gap. I know this because I'm one of the many people who has brought those faces to them. At this point it would take considerable effort to avoid knowing, though likely some legislators have gone to that effort. I mam quite sure Speaker Hughes is legitmately upset by this tragedy. As I've said many times before, I believe the opposition to Healthy Utah is guilty more of denial than heartlessness. And perhaps this will illustrate the problem in a personal way which makes an impact. But no matter what the reason for the delay, no matter what the motivations of the people who are delaying, the undeniable fact is that people in Utah are dying because the aren't getting the medical care they need. That cost is far too high.
Read Rep. Ward's Deseret News Op-ed
Tuesday, July 7, 2015
MISSING THE POINT
by Paul Gibbs
Today yet another economic study was released which showed that Healthy Utah's approach to closing the coverage gap and solving Utah's Medicaid expansion problem was a no-brainer. What else can you call a plan which returns $500 million from the federal government every year, grows our state's economy by $874 million, and gives us 6 times the dollar value of the rival plan? Sadly, a no-brainer seems to be beyond the grasp of Utah House Speaker Greg Hughes and House Majority Leader Jim Dunnigan, who quickly issued a press release making it clear that they consider Health Utah off the table.
While Hughes and Dunnigan are fond of stating that this is no longer a debate between Healthy Utah and Utah Cares, this argument is a silly and condescending insult to the intelligence of Utah voters: it's abundantly clear that these plans represent the two different approaches to closing the gap, and one works and one doesn't. Whatever they're considering has to more closely resemble one or the other of these two plans. The new data underscores the point that any plan which doesn't do what Healthy Utah does isn't a real solution. So the so-called "Gang of Six" continues to meet behind closed doors, with Hughes and Dunnigan claiming to work for a solution to the problem. But what sense does it make to claim you are working to solve a problem, and at the same time dismiss what expert economic evidence objectively shows us is the solution?
Since the end of the 2015 general legislative session, we've been told a plan couldn't proceed until the Supreme Court ruled in the King v. Burwell case. Well, they ruled. Now Dunnigan is shifting the focus to the 2016 election, stating: "If we get a Republican president I think they would give us more flexibility." Does this mean he expects 53,000 people to keep waiting? And what happens if, as every poll tells us is the likely outcome, a Democrat is elected President? What then will become the excuse to wait? Hughes and Dunnigan keep talking about "flexibility", but both economic science and public opinion keep telling us that this flexibility is not needed or wanted. Healthy Utah solves the problem, and every other approach which has been discussed (short of a straight up expansion of Medicaid under the Affordable Care Act ) is at best the equivalent of a Band Aid over a gaping wound from a sawed-off shotgun.
To claim comparing Healthy Utah and Utah Cares is not relevant brings the debate down to a new level of absurdity, which frankly shouldn't be possible at this point.
Speaker Hughes and Rep. Dunnigan's actions and attitudes simpy don't make sense if they are concerned about the needs or wants of the people of Utah. Real leadership requires doing your job, not coming up with new reasons to delay doing it. And in the meantime, 53,000 of Utah's working poor are left with nothing to but wait and pray that they'll still be able to be helped when (and if) help finally comes.
Today yet another economic study was released which showed that Healthy Utah's approach to closing the coverage gap and solving Utah's Medicaid expansion problem was a no-brainer. What else can you call a plan which returns $500 million from the federal government every year, grows our state's economy by $874 million, and gives us 6 times the dollar value of the rival plan? Sadly, a no-brainer seems to be beyond the grasp of Utah House Speaker Greg Hughes and House Majority Leader Jim Dunnigan, who quickly issued a press release making it clear that they consider Health Utah off the table.
While Hughes and Dunnigan are fond of stating that this is no longer a debate between Healthy Utah and Utah Cares, this argument is a silly and condescending insult to the intelligence of Utah voters: it's abundantly clear that these plans represent the two different approaches to closing the gap, and one works and one doesn't. Whatever they're considering has to more closely resemble one or the other of these two plans. The new data underscores the point that any plan which doesn't do what Healthy Utah does isn't a real solution. So the so-called "Gang of Six" continues to meet behind closed doors, with Hughes and Dunnigan claiming to work for a solution to the problem. But what sense does it make to claim you are working to solve a problem, and at the same time dismiss what expert economic evidence objectively shows us is the solution?
Since the end of the 2015 general legislative session, we've been told a plan couldn't proceed until the Supreme Court ruled in the King v. Burwell case. Well, they ruled. Now Dunnigan is shifting the focus to the 2016 election, stating: "If we get a Republican president I think they would give us more flexibility." Does this mean he expects 53,000 people to keep waiting? And what happens if, as every poll tells us is the likely outcome, a Democrat is elected President? What then will become the excuse to wait? Hughes and Dunnigan keep talking about "flexibility", but both economic science and public opinion keep telling us that this flexibility is not needed or wanted. Healthy Utah solves the problem, and every other approach which has been discussed (short of a straight up expansion of Medicaid under the Affordable Care Act ) is at best the equivalent of a Band Aid over a gaping wound from a sawed-off shotgun.
To claim comparing Healthy Utah and Utah Cares is not relevant brings the debate down to a new level of absurdity, which frankly shouldn't be possible at this point.
Speaker Hughes and Rep. Dunnigan's actions and attitudes simpy don't make sense if they are concerned about the needs or wants of the people of Utah. Real leadership requires doing your job, not coming up with new reasons to delay doing it. And in the meantime, 53,000 of Utah's working poor are left with nothing to but wait and pray that they'll still be able to be helped when (and if) help finally comes.
Monday, June 15, 2015
THUMBS DOWN TO "OPEN LETTER"
by Paul Gibbs
Arguing with opponents of Healthy Utah (or any similar variation of Medicaid expansion which brings back the maximum possible amount of Utah taxpayer money from the federal government) is a lot like arguing with people who insist we never landed on the moon. Every one of their arguments has been effectively shot down over and over again, but they don't stop clinging to them. This has never been more true than the recent open letter from four right wing groups: the Sutherland Insitute, the Eagle Forum, the Libertas Insitute, and Americans For Prosperity. It's full of the same old stereotypes about "able bodied" people who don't want to work, and offers nothing new to the discussion. But aside from the fact that it's pretty laughable to expect anyone to be impressed by four virtually interchangeable ideologically based groups joining together in opposition when literally dozens of diverse groups have come together in support, there is one specific argument that needs to be countered: charges that Healthy Utah and/or Medicaid puts Utah "under the thumb" of the federal government.
The scary specter of Big Brother is a favorite target of opponents who like to make cries of "government tyranny", but who really is advocating putting us under a government's thumb? Not only have the aforementioned dozens of groups voiced support of Healthy Utah, multiple polls show that an overwhelming majority of even conservative Utahns support Healthy Utah. In fact, every poll not commissioned by a right wing group like Sutherland shows that. Aren't we supposed to be a government by the people, for the people and of the people? How is a legislature which fails to listen to its voice (not to mention the needs of tens of thousands of uninsured citizens) not putting the people "under their thumb"? The point of state's rights isn't just to give state governments freedom to do whatever they want regardless of the needs and will of their citizens, but by advocating rejecting Healthy Utah, that's what these groups are asking for, intentionally or not. Freedom and democracy are not about moving power to the hands of a state government whose administration seems more friendly to your politics and therefore more ideologically palatable, and then letting a small but vocal minority over ride the will of the majority of people. State's rights are meant to protect the people of those states and their voice, not just to give their governments detached autonomy to choose an ideological course.
Yes, these groups have the right to have their say and be heard, and nobody is suggesting otherwise. But even with four of them, they represent a very small contingent compared to those voicing support, and it hardly adds credibility to bring four of them together when anyone of sound mind would expect them to agree. It reminds me of a scene in the film The Ladykillers, when one member of a group of criminals planning a heist insists he deserves a larger share of the loot, then points out that his wife agrees "so it's not just one person's opinion."
Don't be fooled by what plays like a pretty desperate attempt to set the debate back to before studies were done and polls were taken. Support Healthy Utah.
Arguing with opponents of Healthy Utah (or any similar variation of Medicaid expansion which brings back the maximum possible amount of Utah taxpayer money from the federal government) is a lot like arguing with people who insist we never landed on the moon. Every one of their arguments has been effectively shot down over and over again, but they don't stop clinging to them. This has never been more true than the recent open letter from four right wing groups: the Sutherland Insitute, the Eagle Forum, the Libertas Insitute, and Americans For Prosperity. It's full of the same old stereotypes about "able bodied" people who don't want to work, and offers nothing new to the discussion. But aside from the fact that it's pretty laughable to expect anyone to be impressed by four virtually interchangeable ideologically based groups joining together in opposition when literally dozens of diverse groups have come together in support, there is one specific argument that needs to be countered: charges that Healthy Utah and/or Medicaid puts Utah "under the thumb" of the federal government.The scary specter of Big Brother is a favorite target of opponents who like to make cries of "government tyranny", but who really is advocating putting us under a government's thumb? Not only have the aforementioned dozens of groups voiced support of Healthy Utah, multiple polls show that an overwhelming majority of even conservative Utahns support Healthy Utah. In fact, every poll not commissioned by a right wing group like Sutherland shows that. Aren't we supposed to be a government by the people, for the people and of the people? How is a legislature which fails to listen to its voice (not to mention the needs of tens of thousands of uninsured citizens) not putting the people "under their thumb"? The point of state's rights isn't just to give state governments freedom to do whatever they want regardless of the needs and will of their citizens, but by advocating rejecting Healthy Utah, that's what these groups are asking for, intentionally or not. Freedom and democracy are not about moving power to the hands of a state government whose administration seems more friendly to your politics and therefore more ideologically palatable, and then letting a small but vocal minority over ride the will of the majority of people. State's rights are meant to protect the people of those states and their voice, not just to give their governments detached autonomy to choose an ideological course.
Yes, these groups have the right to have their say and be heard, and nobody is suggesting otherwise. But even with four of them, they represent a very small contingent compared to those voicing support, and it hardly adds credibility to bring four of them together when anyone of sound mind would expect them to agree. It reminds me of a scene in the film The Ladykillers, when one member of a group of criminals planning a heist insists he deserves a larger share of the loot, then points out that his wife agrees "so it's not just one person's opinion."
Don't be fooled by what plays like a pretty desperate attempt to set the debate back to before studies were done and polls were taken. Support Healthy Utah.
Thursday, May 21, 2015
OUTSIDE INTERFERENCE
by Paul GibbsOne thing I have never found myself thinking during our extended campaign for Medicaid expansion/ Healthy Utah/Whatever the next solution is called is "You know what Utah really needs? Another right-wing foundation that cares more about ideology than facts getting involved in this." But we keep getting them anyway. The latest is a new chapter of Americans For Prosperity, a the principal political advocacy group established by the billionaire Koch brothers, two of the more controversial figures in American politics. The the group is just barely getting started, they've already listed Medicaid expansion as one of the issues they plan to target.
What's so troublesome about this development is that it means yet another non-Utah run, ideologically based group getting into this fight to serve a political agenda rather than to do what's best for the people of Utah. We've already seen the Florida based Foundation For Government Accountability run a campaign here which was based on stock photos and stock arguments. About the only thing the seemed to bother to learn uniquely about Utah was the name of the Governor they were picking a fight with. It's one thing to have Utah legislators whose idea of how to solve this problem differs drastically from the majority of Utah's citizens. It's another to have outsiders who have no stake in Utah try to mess up healthcare for tens of thousands of people as part of an agenda to mess with Obamacare, regardless of the cost.
Can anybody reasonably doubt that the conservative voice is being heard? Sure, opponents such as Rep. Jake Anderegg (R-Lehi) love to act as if their voice isn't getting a chance to be heard on this, but if the voice in favor of Healthy Utah is louder, it's only because there are so many of us, from such a wide variety of of political, religious, medical and business backgrounds, speaking as part of a true grassroots effort and echoing the voice of the majority of Utahns. No matter what groups like the FGA or Americans For Prosperity want us to believe, this isn't grass roots activism, and it isn't the voice of the people of Utah. The Koch brothers modus operandi is to spend so much money that the voices of two people with an ideological axe to grind are louder than the united, informed and educated voices of concerned citizens. We can't allow that to happen in Utah. Our voices have to be louder, and we can't stop talking.
Saturday, May 16, 2015
WHY WE HATE PCN
by Paul Gibbs
Recently Utah House Majority Leader Jim Dunnigan, creator of the proposed "Utah Cares" plan and a member of the six person committee devising a new plan for Utah's coverage gap population, made the point that those of us who have been critical of Utah Cares have focused almost exclusively on the less "robust" coverage provided Utah's Primary Care Network (PCN), and not on the high quality coverage his plan would offer to a large number of the people being helped. On one level, Rep. Dunnigan has a solid point: we absolutely have focused on PCN. However, I think that Rep. Dunnigan is conviently brushing aside the fact that the competing proposal, Healthy Utah, and any solution most of us are pushing for, would give that high qulaity coverage to everyone getting this assistance. Taken in full context his defense loses its power. And because PCN remains among the discussed possibilitess for coverage, it's important to keep talking about its inadequacies.
So, what exactly is wrong with PCN? Why do we hate it so much? Why do so many people (and the people I've heard this from have been doctors and nurses) refer to it as "Pretty Crappy Network" or "Practically Covers Nothing"? The reason is that PCN is very limited in the coverage it provides. To quote their own website, the network covers:
• Visits to a primary care provider
• Four prescriptions per month
• Dental exams, dental x-rays, cleanings, and fillings
• Immunizations
• Eye exam; no glasses or contacts
• Routine lab services and x-rays
• Emergency room visits (restrictions apply)
• Emergency medical transportation
• Birth control methods
Those things it does not cover include:
Prescription eyeglasses, contact lenses, MRI’s, CT Scans, Dexa Scans, outpatient hospital services, specialty care, pregnancy related services, mental health services, occupational therapy, physical therapy and chiropractic services (emphasis added by me).
First, let's talk about those restrictions to Emergency Room care. The website description is as follows: If you feel you are having a life-threatening medical emergency, PCN will cover an ambulance ride (ground or air) to the nearest hospital. But, in order for PCN to pay for the ER visit and visit with ER provider, the final diagnosis must be an “approved” medical emergency. Even if your primary care provider tells you to go to the ER, the final diagnosis must still be approved by PCN . . . PCN does not cover MRI’s or CT Scans even if it is during an approved ER visit. Also, if a specialist is called into the ER to visit you, that service will not be covered. For example, if you have an injury and you were seen by an orthopedic specialist along with the ER doctor, then you must pay for the orthopedic specialist.
This is highly problematic and goes beyond the obvious intention to prevent unecessary ER use. For example, in February of this year my father went to the emergency room because of symptoms which he thought may have been a heart attack. Thankfully they weren't. Had he been under PCN coverage, he would have been left worrying whether this vist would be deemed a legitimate emergency (to avoid confusion for those who know me, the accident which lead to me father's untimely death a month later was completely unrelated, and insurance coverage was in no way a factor).
Now let's deal with some of the other issues. Coverage for Pimary Care visits is great. Nobody is disputing that. But lack of specialty care and important tests like MRIs or CT scans is obviously an enormous drawback. Essentially PCN will help you with smaller issues, but not the big stuff.
Let me give you two real life examples of the difficulties created here: My cousin Ben is on PCN, and it will let him visit a doctor, but it won't help him with removal of the 45 lb. growth on his leg which makes it nearly impossible for him to walk, let alone work. It won't help with the rental of the C-PAP machine he needs to care for his potentially fatal sleep apnea.
My chronically ill friend Clare Richardson describes her experience with PCN this way: PCN was great for the most minimal possible needs: doctor visits were $5, blood tests covered, prescriptions were $5, it paid for one eye exam a year (not frames/lenses) and very basic dental (cleanings/fillings). When it comes to hospital stays, emergency rooms, or any further testing, you are out of luck. PCN didn't help me with a basic medical procedure like ingrown toenail removal, for example, and I have been unable to see specialists that could help me because specialists absolutely are not covered under PCN . . . . PCN is truly, absolutely the bare minimum that Utah can do for its citizens, and when you are on PCN, you feel that each time you turn around. You're better off than you would have been, but you're not healthy. If you are a chronically ill person, PCN places you in stasis. This far and no further.
Part of Dunnigan's defense was that the far more complete Medicaid coverage qould have gone to the lower income "most needy" people under the plan, and I have no doubt that something similar will be true of any plan which involves PCN. Again, to a degree that's a solid point. But it places an awfully high burden on the rest, people who still have low incomes (otherwise they wouldn't be eligible). The great irony here is that this concept, championed only by conservative members of our legislature, inherently goes against some of the more prominent pieces of conservative dogma we've been hearing it recent years: it penalizes people for having higher incomes, and it "rations" healthcare.
Our criticism of PCN is not based on trying to emphasize the negative. We appreciate that it's better than nothing. But it's not a real solution, and shouldn't be a part of the compromise between the members of the committee. Solving this Medicaid expansion issue requires solid, comprehensive coverage, and not just for the poorest of the poorest of the poor. PCN should not be a part of the discussion.
So, what exactly is wrong with PCN? Why do we hate it so much? Why do so many people (and the people I've heard this from have been doctors and nurses) refer to it as "Pretty Crappy Network" or "Practically Covers Nothing"? The reason is that PCN is very limited in the coverage it provides. To quote their own website, the network covers:
• Visits to a primary care provider
• Four prescriptions per month
• Dental exams, dental x-rays, cleanings, and fillings
• Immunizations
• Eye exam; no glasses or contacts
• Routine lab services and x-rays
• Emergency room visits (restrictions apply)
• Emergency medical transportation
• Birth control methods
Those things it does not cover include:
Prescription eyeglasses, contact lenses, MRI’s, CT Scans, Dexa Scans, outpatient hospital services, specialty care, pregnancy related services, mental health services, occupational therapy, physical therapy and chiropractic services (emphasis added by me).
First, let's talk about those restrictions to Emergency Room care. The website description is as follows: If you feel you are having a life-threatening medical emergency, PCN will cover an ambulance ride (ground or air) to the nearest hospital. But, in order for PCN to pay for the ER visit and visit with ER provider, the final diagnosis must be an “approved” medical emergency. Even if your primary care provider tells you to go to the ER, the final diagnosis must still be approved by PCN . . . PCN does not cover MRI’s or CT Scans even if it is during an approved ER visit. Also, if a specialist is called into the ER to visit you, that service will not be covered. For example, if you have an injury and you were seen by an orthopedic specialist along with the ER doctor, then you must pay for the orthopedic specialist.
This is highly problematic and goes beyond the obvious intention to prevent unecessary ER use. For example, in February of this year my father went to the emergency room because of symptoms which he thought may have been a heart attack. Thankfully they weren't. Had he been under PCN coverage, he would have been left worrying whether this vist would be deemed a legitimate emergency (to avoid confusion for those who know me, the accident which lead to me father's untimely death a month later was completely unrelated, and insurance coverage was in no way a factor).
Now let's deal with some of the other issues. Coverage for Pimary Care visits is great. Nobody is disputing that. But lack of specialty care and important tests like MRIs or CT scans is obviously an enormous drawback. Essentially PCN will help you with smaller issues, but not the big stuff.
Let me give you two real life examples of the difficulties created here: My cousin Ben is on PCN, and it will let him visit a doctor, but it won't help him with removal of the 45 lb. growth on his leg which makes it nearly impossible for him to walk, let alone work. It won't help with the rental of the C-PAP machine he needs to care for his potentially fatal sleep apnea.
My chronically ill friend Clare Richardson describes her experience with PCN this way: PCN was great for the most minimal possible needs: doctor visits were $5, blood tests covered, prescriptions were $5, it paid for one eye exam a year (not frames/lenses) and very basic dental (cleanings/fillings). When it comes to hospital stays, emergency rooms, or any further testing, you are out of luck. PCN didn't help me with a basic medical procedure like ingrown toenail removal, for example, and I have been unable to see specialists that could help me because specialists absolutely are not covered under PCN . . . . PCN is truly, absolutely the bare minimum that Utah can do for its citizens, and when you are on PCN, you feel that each time you turn around. You're better off than you would have been, but you're not healthy. If you are a chronically ill person, PCN places you in stasis. This far and no further.
Part of Dunnigan's defense was that the far more complete Medicaid coverage qould have gone to the lower income "most needy" people under the plan, and I have no doubt that something similar will be true of any plan which involves PCN. Again, to a degree that's a solid point. But it places an awfully high burden on the rest, people who still have low incomes (otherwise they wouldn't be eligible). The great irony here is that this concept, championed only by conservative members of our legislature, inherently goes against some of the more prominent pieces of conservative dogma we've been hearing it recent years: it penalizes people for having higher incomes, and it "rations" healthcare.
Our criticism of PCN is not based on trying to emphasize the negative. We appreciate that it's better than nothing. But it's not a real solution, and shouldn't be a part of the compromise between the members of the committee. Solving this Medicaid expansion issue requires solid, comprehensive coverage, and not just for the poorest of the poorest of the poor. PCN should not be a part of the discussion.
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