Tag Archives: heller

Embattled Bill Entangled Senator

While the Russians are in, or not in, meetings which are, or aren’t important, and which do or don’t offer trade-craft dangles — there’s a Senate version of the health insurance bill as egregious as its predecessors.  The hold music of the morning on Senator Dean Heller’s DC office phone is a static infused version of The Battle Hymn of the Republic while a person waits for an opportunity for leave a message for the Senator urging opposition to the health care insurance bill.

There’s a reason no one likes this bill — it puts insurance corporations back into the bifurcated market  with high premiums for those older and lower premiums (with higher co-payment and deductible out of pocket expenses) for younger, or less affluent, customers.  It puts state budgets at extreme risk. It slashes Medicaid funding (in conjunction with the proposed budget), thus placing services for children and the elderly in peril.

Senator Heller is described as being wedged into a hard place — between the desires of the hard right (and perhaps the bounteous coffers of Sheldon Adelson) and the hopes of his constituents and the Governor who want reasonable access to affordable health care insurance.

“Heller, in other words, has backed himself into a corner. Either he honors the concerns he raised just a few weeks ago, or reverses course and completes a very public betrayal – the year before his re-election campaign.” [NBC]

It’s time to offer Senator Heller a way out of this box — encouraging his continued opposition to the health insurance bill — call 202-224-6244; or 702-388-6605; or 775-686-5770.

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It Ain’t Over Until The Fat Golfer Sings

Senator McConnell’s Secret Health Insurance Shop is still working, with the Lobbyists/Elves seeking a way to offer goodies acceptable to the wavering and the wanton.  Keep calling!  and if you’d like more information to substantiate your comments there are some excellent sources.

Kaiser Family Foundation:   Your one stop center for research and analysis on health insurance issues.  Definitely a “bookmark this” recommendation.  Today, KFF notes that before the implementation of the ACA individual insurance plans for health care did not cover delivery and maternity care  in 75% of the policies; 45% of the policies didn’t cover substance abuse treatment; and 38% failed to cover any mental health care services.

If terms like “risk adjustment,” “re-insurance,” and “risk corridors” seem like something written in Minoan Linear A, the KFF has an excellent summation of these technical terms in easily understood American English.

There are also some analytical pieces on the impact of Republican suggestions for health care insurance “reform” as they relate to rural health care in the following:

Human Rights Watch — Senate Health Care Bill A Swipe At Rural United States.

MSNBC/Scarborough – Rural Health Care Would Be Savaged By This Bill.

There’s a narrative going around that Democrats haven’t brought anything to the table, which depends on whether we’re taking the long or short term view.  In the short term this would be true — because the McConnell Secret Health Insurance Shop didn’t invite any Democratic participation,  for that matter there seems to have been some Republican Senators who were left in darkness.  The longer view would note some of the following:

Senator Franken’s “Rural Health Care Quality Improvement Act of 2016” (pdf) S. 3191 (114th Congress) was introduced in July 2016 and “died” in the Senate Finance Committee.  The bill would have amended two titles of the Social Security Act to improve health care in rural areas of the United States.

There is Representative Jan Shakowsky’s CHOICE Act, H.R. 635, which would establish a public option under the ACA.  See also S. 194, Senator Sheldon Whitehouse’s CHOICE Act.  There’s Rep. Gene Green’s HR 2628 to stabilize Medicaid and the Children’s Insurance program.  Rep. John Conyers introduced his form of “single payer” in his Medicare for All bill, HR 676.  On the topic of making pharmaceuticals more affordable:  Senator Sanders – Affordable and Safe Prescription Drug Importation Act S. 469.  Senator Klobuchar has a bill “… to allow for expedited approval of generic prescription drugs and temporary importation of prescription drugs in the case of noncompetitive drug markets and drug shortages.” S. 183. Rep. Kurt Schrader introduced H.R. 749 to increase competition in the pharmaceutical industry.  Senator Ron Wyden introduced S. 1347, RxCap Act of 2017.

Senator Klobuchar has also introduce a bill supporting Alzheimer’s caregivers in S.311.  Rep. Derek Kilmer’s bill, H.R. 1253, seeks to improve access to treatment for mental health and substance abuse issues.   This is by NO means an exhaustive list of what can be gleaned from Gov.Track, but it does illustrate that the Democrats are not without suggestions — negotiating drug prices for Medicare, stabilizing the current system, public options, single payer — it’s just that these bills won’t get out of Republican controlled committees and they didn’t make it into Senator McConnell’s Secret Shop.

Indulge in no victory dance, we’ve seen this movie before … don’t believe that some minor blandishment won’t be enough to lure Senator Heller from his current position …don’t think that the products of McConnell’s Secret Shop have stopped coming off their assembly line.

Senator Heller can be reached at 202-224-6224;  702-388-6605;  775-686-5770

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Filed under Health Care, health insurance, Medicaid, Medicare, nevada health, Pharmaceuticals, Politics, public health

48 Hours: The Health Care Bill

If a person hasn’t found the reason to call Senator Heller’s office and advise him to vote NO on the Republican version of a health care bill, consider the following:

(1)  One in three residents of skilled nursing facilities in Nevada are supported by Medicaid. Now, apply a simple calculator test — if a person was born in 1946 (the beginning of the Baby Boom) he or she will hit 80 in 2026.  In short, the Baby Boomers will be in the age range to need such care just as the major cuts to Medicaid kicks in.  About 65,000,000 children were born in this country between 1945 and 1961.  Cuts to the Medicaid program in this context is essentially create a crisis which we could easily have avoided.

(2) The Republicans are fond of focusing on “premium increases.”  That’s only a part of the story.  Anyone can devise insurance policies with low premiums — raise the deductibles, cut the coverage, increase co-pays,  insert lifetime benefit limits, and Voila! lower premiums.   The problems begin when a person tries to use the insurance — the reason the person bought the policy in the first place — “We’re so sorry, but this policy doesn’t cover immunizations. Or, mammograms, or prostate cancer screening, or the expenses related to the birth of your first child…”

(3) Speaking of lower premiums,  if a person has insurance from an employer then there should be no surprise when the coverage decreases compliments of the waivers included in the Senate bill — “We’re sorry, but we no longer cover wellness screenings for men and women, maternity care, or other elements that used to be included as Essential Benefits.” If a person thought that employer sponsored policies were “safe” from “reforms,” please think again.

(4) This isn’t a health care bill, it’s a tax cut bill.  Those whose income is in the top 0.1% level would receive a lovely $250,000 tax savings gift in 2026. Those earning more than $875,000 (top 1%) would get tax savings of $45,500.  [CNN]  All this at the expense of working Americans.

(5) The buzz word “patient centered” is nonsense.  At bottom, it’s a euphemistic way of saying “You are On Your Own.” A person can “choose” to buy what he or she can afford — and for lower income Americans this means lower coverage and higher out of pocket expenses.  The problem with applying classic market principles to health care is that much of what is covered isn’t a matter of Choice.  No one chooses to be in a traffic accident, any more than a person chooses to get cancer or have a heart attack.   The Republican argument seems to boil down to “live a perfect life and make excellent choices” and you are ‘worthy’ of having insurance.  This argument only works IF a person has no familial risk factors, IF a person isn’t exposed to other people (who might have an infectious disease), and IF a person can afford to build a residence in which there are no places to fall and no way to have an accident with a garage door.  In short, it’s fantasy land.

The next few hours are crucial — that’s right — HOURS. Please call Senator Heller’s office at 702-388-6605;  or 775-686-5770; or 202-224-6244.  Your health care services are at stake.

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Filed under Health Care, health insurance, Heller, nevada health, Nevada politics, Politics

Caring for Grandma on the I-80 Corridor

Republican “reforms” of Medicaid, which seem to be composed of stalling funding until the program can be gutted in 2025, could easily have a negative impact on those families trying to find skilled nursing care for elderly relatives along the I-80 corridor in northern Nevada.  As noted in the previous post, health care facilities in northern Nevada have service areas of miles and miles of miles and miles.  The euphemistic term “remote rural” is especially pertinent in this instance.  These may be the “cow counties” but they do include a significant number of individuals over the age of 65.

By The Numbers 

Pershing County (Lovelock) has a total population of 6,560 of which 14.8% are over 65, and 11.1% of those are disabled individuals under the age of 65.  Humboldt County (Winnemucca) population of 16,842 includes 11.9% over 65 and 8.3% under 65 disabled. Lander County (Battle Mountain) has 5,702 people, of whom 13% are over 65 and 6.5% are disabled.  Eureka County (Eureka) is a small entity with 1,917 people of whom 12.9% are over 65, and 6.6% are disabled.  More populous Elko County (Elko) with 52,168 people has an over 65 population of 10.0% and 8.4% disabled individuals.  Churchill County (Fallon) has a population of 24,198 of whom 18.7% are over 65 and 6.5% are disabled.

For the sake of this analysis, let’s assume that the families would like to find skilled nursing facilities for their elderly relatives closer to home than securing similar residences in the Reno/Sparks/Carson City area.  That means finding skilled nursing facilities in the towns listed above.  Elko County has such a unit with room for 110 residents, Fallon has a facility with a capacity for 74 residents.  Lander and Eureka counties are served by a facility in Battle Mountain with a capacity of 18.  Pershing county has one facility with a capacity of 25 residents, and Winnemucca has a skilled nursing facility for up to 26 residents. [Links]  We’re speaking in numbers at present, but it’s important to remember that those numbers are specifically associated with real people, and very real families who are seeking affordable quality care for those individuals.

The cost of skilled nursing care will vary with the level and type of medical or rehabilitative services required, however we can generally assume that the monthly price tag for SNF care in Nevada is about $8,213.  Drilling down a bit deeper, the reported minimum cost per month for Skilled Nursing Care in a semi-private room is about $3,346; the median is $7,128; the maximum is $8,425.  Private rooms come at a minimum of $4,106, a median cost of $8,213, and a maximum cost of $15,452.  [SNF]  At this point another reminder is appropriate — these aren’t price tags, the numbers represent what a family might have to pay for care specific to the needs of their elderly relatives.

And now we return to the numbers.  In the State of Nevada 1 out of every 7 persons over the age of 65 is covered by Medicaid. Medicaid covers 3 out of every 5 nursing home residents. [KFF]  Consider for just a moment what would happen to the fiscal solvency of the residential facilities listed above in the rural counties if Medicaid is cut, then “reformed” into block grants (which can be further cut by Congressional action) and finally all but reformed out of existence by Republican representatives.

Mythology

Let’s work on some of the elements of Republican mythology commonly associated with their efforts to slash the Medicaid program.

(1) It was only originally intended to cover the “really poor.” Republicans have an interesting way of defining “poverty.”  Several reports of recent memory decry the fact that people on various welfare programs have CARS (to get to work) and REFRIGERATORS (which come with most furnished apartments.)  Left to their own devices it’s easy to imagine that unless a person is naked, living rough in the bush, and starved into semi-consciousness the individual wouldn’t qualify as “poor” by some Republican standards.  That said, Medicaid isn’t really a welfare program — it’s essentially a health insurance program.  One way to extend this health insurance coverage was to apply income eligibility standards for publicly subsidized health insurance — for the low income families, for the aged and for the disabled.

(2) The states can do better because they are closer to the problems.   There’s a reason we have a federal system — there are some tasks which the states are not capable of adequately addressing.  Providing health insurance coverage for millions of Americans working at low wage jobs, who have disabled family members, who have aging family members, and have children in need of health care services is one of those objectives best addressed by federal resources.  Imagine if someone said the states can best determine what security is best for them?  Should we block grant the Defense Department budget, send it to the states and let them decide how to fund the elements of their National Guard?  This sounds ridiculous, and doesn’t the Constitution require government prioritization of our mutual defense? Yes, and it also provides that our government provide for our “general welfare.”

(3) We’re really not cutting anything.  No? When the inflation rate for the medical sector exceeds that of the other sectors of the economy, and budgeting or funding proposals don’t meet or exceed that inflation rate the end result is a cut.  It’s not mathematics, it’s just old fashioned arithmetic.  There’s also something disingenuous about continually clamoring for tax cuts (especially at the state level) and then offering that the states should pick up more of “their share” of program expenses.  Finally, it’s always easier to cut funds from “block grants” than it is from specific program budgets.  Yes, the Republicans intend to cut Medicaid; if it’s done slowly or quickly is beside the point — at some date the result will be the same.   Program cuts will affect those real people in those real skilled nursing facilities, both the staff providing the services and the residents who depend on them.

Senator Dean Heller should be aware of these issues, and if he isn’t perhaps he should receive some phone calls this week.  702-388-6605;  775-686-5770; 202-224-6244.

*And we still haven’t discussed the benefits of Medicaid supported home health care programs!

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Filed under Health Care, health insurance, Heller, Medicaid, nevada health, Nevada politics, Politics

Rural Nevada Health Care and the Great Bamboozle AHCA

The state of Nevada consists of 110,567 square miles of miles and miles and miles.  271,985 people live in those miles and miles and miles out of a total population of  2,940,058.  A quick poke at the calculator shows a state in which 93% of the population is urban, while most of the real estate is rural.   This situation poses some easily apparent problems for health care services and the delivery thereof.

Rural health services must literally cover wide spans of territory in which there is a small population.   There is one hospital in Battle Mountain (Lander County, NV) to serve a total population of 5,702.  There is one hospital in Winnemucca (Humboldt County, NV) serving a total population of 16,528.  There is one hospital in Lovelock (Pershing County, NV) with a total population of 6,753.  There is one hospital in Elko (Elko County, NV) serving a population of 48,818.  Two conclusions can be reasonably drawn from this quick view of the northern tier of rural counties: (1) In none of these areas can a hospital draw upon “economies of scale” in terms of hospital services.  The obvious example may be that an expectant mother will usually require the same obstetric services in Battle Mountain, as in Winnemucca, as in Las Vegas or Reno.  (2) These rural hospitals serve populations which are generally not as affluent as in urban areas;  the rural per capita income lagging slightly behind urban areas. [RH] This places the northern tier of counties in a predicament similar to other western states:

“In the rural West, many farmers, ranchers and other agricultural workers are self-employed, so they can’t get coverage through an employer. Hence, a higher percentage of agricultural employees are covered by Medicaid (11 percent) than in non-agricultural industries (8 percent). Before the ACA was enacted in 2010, workers in the agricultural sector had fewer options, so many remained uninsured. But under the Obama-era plan, many states expanded Medicaid, increasing the percentage of those covered. Under the AHCA, that expansion would be significantly scaled back, according to the Joint Economic Committee report.”

Thus, the National Rural Health Association issued this warning:

“Though most rural residents are in non-expansion states, a higher proportion of rural residents are covered by Medicaid (21% vs. 16%). Congress and the states have long recognized that rural is different and thus requires different programs to succeed. Rural payment programs for hospitals and providers are not ‘bonus’ payments, but rather alternative, cost effective and targeted payment formulas that maintain access to care for millions of rural patients and financial stability for thousands of rural providers across the country. Any federal health care reform must protect a state’s ability to protect its rural safety net providers. The federal government must not abdicate its moral, legal, and financial responsibilities to rural, Medicaid eligible populations by ensuring access to care.”

In short,  cuts to the Medicaid program will disproportionately affect rural health care providers serving rural populations.

But, but, but, sputter the advocates of the Republican offering — We’re Giving People A Choice — you can buy what you want!  Not. So. Fast.

“Though some provisions in the modified AHCA bill improve the base bill, NRHA is concerned that the bill still falls woefully short in making health care affordable and accessible to rural Americans. For example, the modified bill contains a decrease in the Medical Expense Deduction threshold from 10% to 5.8% in an attempt to assist Americans between the ages of 50 and 64 who would see their premiums skyrocket under the current plan. However, this deduction is not a credit and therefore would be of little use to low income seniors that are in very low tax brackets or do not pay income tax at all. Additionally, the new amendments to freeze Medicaid expansion enrollment as of Jan. 1, 2018, and reduce the Medicaid per-capita growth rate will disproportionately harm rural Americans.”

Well, that didn’t go well.  What about that “get what you want argument?”  The first question might well be — What can you afford?  The annual earnings of a farm or ranch owner (manager) in Nevada is reported at an annual mean of $91,970.  However, the range runs from 10th percentile $39,850 to 90th percentile $150,410.  The annual mean wage for a farm or ranch worker is $34,520. [BLS]  Nevada’s reported average annual mean for farm and ranch workers is slightly higher at $36,480. [DETR download] Now we have a problem — 138% of the federal poverty level is $16,374 for a single person or $33,534 for a family of four.   Our hypothetical average annual mean earnings for a farm or ranch worker isn’t eligible for Medicaid expansion enrollment, but has an income well below the Nevada average household income average of $52,431, or 63.96% of the annual average household income level.

How to market an insurance policy this hypothetical average family could afford?  Either offer a comprehensive insurance plan and provide premium assistance to make up the difference between what the premium costs and what the family can reasonably afford — or there’s always the Junk Insurance option.   Consumer Reports offered some excellent advice concerning what constitutes Junk Insurance — aka “affordable plans” —  watch out for fixed benefit indemnity plans, and medical discount cards.  Another Consumer Reports bulletin specified the elements of Junk Insurance, your insurance plan could be very hazardous to your physical and financial health if it contains: Limited benefits; Low overall coverage limits; unrealistic “affordable” premiums; No coverage for important health care services; Ceilings on categories of care; No limits on out of pocket costs; Random catches — like covering hospital care after the second day, when it’s known that the first day is usually the most expensive.

The problem at this juncture for rural Nevadans is that those in the agriculture sector may or may not have earnings allowing them to enroll in Medicaid.  If “yes” then a reduction in Medicaid — whether it happens now or just after the 2020 elections — will have a negative impact on many citizens in the northern tier of “cow counties;” similarly, a return to the Bad Old Days pre-ACA makes those who are certainly less than affluent vulnerable to the offerings of Junk Insurance, which is fine as long as they don’t mind paying for a product which will not cover their medical expenses at the time they actually need it.  Exacerbating this issue is the fact that jobs in agriculture (farming and ranching) are listed by Forbes as the 4th most dangerous occupations in the country.

There’s no way to bestow a bright face to the Republican tax cut disguised as a health insurance ‘reform’ bill in terms of what happens to rural Nevadans and their health care providers.  Those it doesn’t cut out completely it leaves vulnerable to incomplete and almost useless “catastrophic coverage” plans — which for too many policy holders leaves them facing health care costs well beyond their ability to pay for out of pocket.  If there were a recipe for increasing the “uncompensated care” costs for local hospitals and clinics this is definitely IT.  Rural hospitals and clinics, already stretched to meet costs, would be especially at greater risk — and we haven’t even touched on the topics of long term care for the aging or home health care services which prevent individuals from having to reside in more expensive residential care facilities in rural areas.

NOW is the time to contact, and continue to contact, our Senators (Heller and Cortez-Masto) and urge their opposition to this assault on medical care for northern Nevada citizens and their health care providers.

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Filed under Health Care, health insurance, Heller, Medicaid, nevada health, Nevada politics, Politics

Disinformation Dismay

Perhaps Representative Mark Amodei (R-NV2) would like to apply his talent for taking simple GOP talking points and putting them through the Amodei X600 Syntax Degenerator to the Trumpian version of why it was necessary to take the US out of a VOLUNTARY climate improvement agreement? Vox explains the 5 biggest bits of disinformation in the Rose Garden jazz concert and diplomatic disaster. Want more fact checking? Politifact provides more.

And, we hear that Senator Dean (Moderate in Name Only) Heller (R-NV) wants to get to “yes” on replacing the Affordable Care Act with some GOP approved insurance scheme that actually replaces affordable health insurance with a major tax cut for those who enjoy an income level in the top 2%.  How do we get to “yes” with this scenario?

“However, under the AHCA, currently under consideration in the Senate, the tax credit will be a flat rate based on age. Korbulic said a 40-year-old making $30,000 a year could see a more than $400 increase in premiums because of the flat rate, but a person over the age of of 60 making the same amount could see a $6,000 jump in premium costs.”

“I think you’re looking at a scenario where consumers are going to have less affordable access, and so that will likely mean they’re going to be priced out of the market,” Korbulic said. “

Meanwhile, the Trump Chicken put in an appearance at Senator Heller’s Las Vegas office. Senator Heller has a relatively predictable pattern. (1) Publicly announce “concern” or “trouble” with Republican legislation.  (2) Receive some nebulous assurance that the result of the Republican legislation won’t be the obvious. (3) Revert to standard GOP platitudes and clichés like “free market,” “freedom,” “personal choice,” and “individual responsibility,” and then (4) Vote right along with the GOP leadership as he had intended to all along.  (Examples?  SCHIP votes.  Financial Reform.)  There’s no particular reason to believe his performance on this matter will be any different.

Representative Amodei emerged from hiding to explain his chances for a statewide office are slim to none.   There is no indication yet in these parts that the tag team of Heller and Amodei will conduct town hall meetings with constituents in any populated area of the Silver State with lights, cameras, and real questions.

 

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Filed under Amodei, ecology, Health Care, health insurance, Heller, Politics

All Quiet on the Humboldt

When last we heard from Rep. Mark Amodei (R-NV2) it was in early May at which time he smoothly flipped his vote on the disastrous ACA replacement bill, with a convoluted explanation that “it” wouldn’t hurt Nevada…and then came the CBO scoring.  The District 2 Congressional representative has kept his head down like a ground squirrel in his burrow by the side of the highway.  This prevents him from dashing into the roadway, or as constituents might call it — holding an in person town hall meeting.

Tossing statistics about like so much confetti doesn’t remove the cold fact that the bill for which Amodei voted cuts $839 Billion with a B from the Medicaid expansion.  Cue the GOP lament that there are “able bodied” people who benefit from the Medicaid program, a program initially meant to serve the desperately poor.  The expansion aided people who may not be homeless without a tent but who were certainly desperate in terms of their ability to afford health insurance for themselves and their families.  These are the people who waited until the medical situation was so dire expensive emergency room treatment was required; who used the emergency rooms as a form of walk in clinic for the lack of any more available alternative; who went without any medical attention whatsoever — 48,000 who died according to the Harvard study because health insurance was unaffordable.

Representative Amodei may not have believed the ACA replacement bill would have profound impacts on Rural health services, but other politicians from other states have pointed this out with remarkable clarity.

Missouri, for example, refused the Medicaid expansion, and the results aren’t positive, as described by Missouri Senator Claire McCaskill:

“Well, we have, first, more than 2 million Missourians live in rural areas of our state. And 41 percent of our state’s hospitals are in rural areas. We know that they are under particular stress right now, particularly in states like Missouri that have refused the money that has been offered them for their Medicaid program under the Affordable Care Act. We know that there’ve been 78 rural hospitals closed, including three in Missouri. We know that 74 percent of those hospitals were actually in states that refused to accept the Medicaid money that was offered by the federal government back to the federal taxpayers in those states.”

Arkansas which accepted the Medicaid expansion also has some issues related to its rural hospitals:

“The ACA’s crafters essentially made a deal with hospitals: The ACA cut Medicare reimbursements, but the reduction in uncompensated care through the Medicaid expansion helped offset some of those cuts. Without that offsetting boost, some of the state’s smaller rural hospitals might not be able to survive. A hospital like Baxter — the fifth most Medicare-reliant hospital in the nation, according to Moody’s, thanks to the community’s significant proportion of retirees — would be forced to make dramatic cuts in services without the Medicaid offset. “The expansion of Medicaid through Arkansas Works is one of the key components that’s been able to help us through the change in the ACA,” Peterson said. “Not just Baxter, but it helps all of rural Arkansas.”

What is true of Missouri and Arkansas is true for rural health care in general:

Of the more than 11 million people who have gained Medicaid coverage through the ACA expansion, nearly 1.7 million live in rural America, according to new CBPP estimates (see Appendix Table 1).  The expansion population is more rural than the population as a whole: rural residents make up 12.1 percent of the population of expansion states but 14.1 percent of expansion enrollees in these states.  In at least eight expansion states, more than one-third of expansion enrollees live in rural areas: Alaska, Arkansas, Iowa, Kentucky, Montana, New Hampshire, New Mexico, and West Virginia.

The Medicaid expansion has been a lifeline for rural areas in other ways.  The ACA coverage expansions, especially the Medicaid expansion, have substantially reduced hospital uncompensated care costs: uncompensated care costs as a share of hospital operating budgets fell by about half between 2013 and 2015 in expansion states.[8] Reductions in uncompensated care and increases in the share of patients covered by Medicaid have been especially important for rural hospitals.

Nevada hasn’t been immune from the problems associated with a lack of access to affordable health insurance and uncompensated care:

“Rural residents are themselves a public health challenge, as they are generally older, more isolated and less likely to be covered by insurance than their urban counterparts. They’re also more likely to smoke, suffer from obesity and hypertension and die from complications of diabetes.

But preventive care that could head off medical emergencies is hard to come by in many areas. Nevada’s rural and “frontier” counties – a term used for the state’s most-remote and sparsely populated regions – and reservations face severe shortages not just of doctors and primary care services, but also nurses, EMTs, dentists and substance abuse and mental health professionals. And in some areas, the numbers are dwindling, despite efforts to reverse the trend.”

 

And so, there are rural hospitals in Representative Amodei’s district — Elko, Lovelock, Battle Mountain, Yerington, Winnemucca, Ely, Fallon and others — wondering what effects will be felt if the GOP adopts the framework in the House bill for which Amodei voted.   Residents in Tonopah watched as their hospital closed in August 2015, an unfortunate testament to the perils of privatization.  The question which might, and should be raised, to Representative Amodei in some town hall (should he ever emerge) is how does the Republican version of health care insurance “reform” protect rural hospitals from financial pressures endangering rural hospital administration.

Ah, but all this is “old news” now that the Representatives voted on an unscored bill in their haste to get something, anything, done and have tossed the blazing ball into the lap of the Senate — in which we might expect Senator Dean Heller to lament the inadequacies of the measure to the Heavens, and then vote along with Senate leadership for the final (probably dismal) result.

Let’s guess that Senator Heller will announce his ‘profound misgivings and questions’ and then after consultations with some officials, reverse his position and do what he has always done — vote against any augmentation of health insurance affordability for his constituents (see his votes on SCHIP on multiple occasions.)

And so it remains — all quiet on the Humboldt — as Representative Amodei and Senator remain quiet (unless we count Heller’s scripted telephone town hall) on an issue of profound significance to District 2’s health care service providers.

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Filed under Amodei, health insurance, Heller, Medicaid, Medicare, nevada health, Nevada politics, Politics, public health, Rural Nevada