Category Archives: Vulnerable Populations
A D.C. protest without people: Activists demand PPE for health care workers on front line of coronavirus pandemic
With mandatory social distancing guidelines and stay-at-home orders in effect throughout the region, and given the grueling demands of their jobs as the deadly coronavirus continues to spread, it would have been nearly impossible to assemble 1,000 health-care workers outside Congress this week.
Instead, volunteers put up 1,000 signs to stand on the lawn in their absence.
Activists who are used to relying on people power to amplify messages and picket lawmakers have been forced to use alternative protest tactics amid the pandemic.
Half a dozen volunteers with liberal activist group MoveOn pressed lawn signs into the grass outside the Capitol as the sun peaked over the Statue of Freedom.
On each sign was a message.
Some, bearing the blue Star of Life seen on the uniforms of doctors, first responders and emergency medical technicians, reiterated a hashtag that has made the rounds on social media for weeks, accompanying posts from desperate front-line workers who say they are running out of necessary protective equipment: #GetUsPPE.
Others showed photos of medical workers in scrubs and hair nets and baseball caps. Some wore face shields and plastic visors. Others donned gloves.
One barefaced doctor in a white lab coat held up a hand-drawn sign. “Trump,” it said. “Where’s my mask?”
Health-care providers in hospitals, clinics, nursing homes, assisted-living facilities and rehabilitation centers have for weeks begged for more PPE to protect themselves and their vulnerable patients.
States and hospitals have been running out of supplies and struggling to find more. The national stockpile is nearly out of N95 respirator masks, face shields, gowns and other critical equipment, the Department of Health and Human Services announced last week.
“Health-care workers are on the front lines of this crisis, and they’re risking their lives to save ours every day, and our government, from the very top of this administration on down, has not used the full force of what they have with the Defense Production Act to ensure [workers] have the PPE they need and deserve,” said Rahna Epting, the executive director of MoveOn. “We wanted to show that these are real people who are demanding that this government protect them.”
Unlike protests that have erupted from Michigan to Ohio to Virginia demanding that states flout social distancing practices and reopen the economy immediately, organizers with MoveOn said they wanted to adhere to health guidelines that instruct people not to gather in large groups.
“Normally, we’d want everyone down here,” said MoveOn volunteer Robby Diesu, 32, as he looked out over the rows of signs. “We wanted to find a way to show the breadth of this problem without putting anyone in harm’s way.”
A large white sign propped at the back of the display announced in bold letters: “Social distancing in effect. Please do not congregate.”
The volunteers who put up the signs live in the same house and have been quarantining under the same roof for weeks. Still, as they worked, several wore masks over their face to protect passersby — even though there were few.
A handful of joggers stopped to take pictures as the sun rose.
One man, who spoke on the condition of anonymity because he is a government employee, said he supported the idea.
“I’m so used to seeing protests out here by the Capitol that it really is bizarre to see how empty it is,” he said. “But this is really impressive to me.”
By sharing images and video on social media of front-line workers telling their stories, MoveOn organizers said they hope to galvanize people in the same way as a traditional rally with a lineup of speakers.
Activists planned to deliver a petition to Sen. Chris Murphy (D-Conn.) with more than 2 million signatures urging Congress to require the delivery of more PPE to front-line workers. Murphy has been a vocal critic of the Trump administration’s coronavirus task force and its reliance on private companies to deliver an adequate amount of critical gear, such as N95 respirator masks, medical gowns, gloves and face shields, to health-care workers.
“In this critical hour, FEMA should make organized, data-informed decisions about where, when, and in what quantities supplies should be delivered to states — not defer to the private sector to allow them to profit off this pandemic,” the senator wrote last week in a letter to Vice President Pence, co-signed by 44 Democratic and two independent senators.
Organizers said the signs would remain on the Capitol lawn all day, but that the demonstration was only the beginning of a spate of atypical ones the group expects to launch this month.
Epting described activists’ energy as “more intense” than usual as the pandemic drags on.
“The energy is very high, the intensity is very high,” she said. “That’s forcing us to be creative and ingenuitive in order to figure out how to protest in a social distancing posture and keep one another safe at the same time.”
Coronavirus-wracked nursing home evacuated after most of staff failed to show for two days
“We have a large vulnerable population at any of our long-term-care facilities, and we want to make sure those people are taken care of,” he said.
Nursing homes and other long-term-care centers nationwide have been hit particularly hard by the coronavirus, which poses much higher risks to elderly people and those with underlying health conditions. In recent months, facilities have reported struggling to contain the spread of covid-19 among patients, with staff growing increasingly concerned about becoming exposed to the virus themselves due to shortages of personal protective equipment.
Riverside County officials say they do not yet know why many of Magnolia’s staff members stopped reporting for duty. As of Wednesday, Kaiser said his office had not received any complaints from the staff about working conditions at the 90-bed center, which bills itself as “one of the finest skilled nursing facilities in Riverside, California.”
But no matter how justified the reasoning may be, Kaiser said he is concerned that the employees’ actions “could rise to the level of abandonment.”
“Nationwide, all of our health-care workers are considered heroes, and they rightly are,” he said. “But implicit in that heroism is that people stay at their posts.”
Officials learned something was amiss Monday when they received a notice that the Riverside facility “had made a large staffing request for the next day which was considered an unusual event,” Kaiser said. The request came just days after testing confirmed an outbreak of covid-19 at the center.
Upon contacting the nursing home, Kaiser said he was informed that a “substantial portion” of employees had not come in for their shifts.
On Tuesday, only one certified nursing assistant out of the 13 scheduled to work showed up, which prompted facilities nearby to send more than 30 of their own nurses to the center, according to a news release from the county.
The staffing problem persisted into Wednesday morning, Kaiser said at the news conference, leaving him with no choice but to order the evacuation “to safeguard the well-being of the residents and ensure appropriate continuity of care.” According to the most recent figures, Riverside County has 1,179 confirmed cases of the coronavirus, with 32 reported deaths.
Bruce Barton, director of the county’s emergency management department, told reporters that Wednesday’s operation involved 53 ambulances as well as assistance from the fire department and police.
The Southern California county isn’t alone in its struggles to care for its vulnerable residents amid the pandemic.
Since the coronavirus reached the United States, reports of nursing homes and eldercare facilities becoming overwhelmed by outbreaks have surfaced regularly.
Last month, a senior-care center in New Jersey relocated all 94 of its residents following a covid-19 outbreak that also sickened several workers, causing critical staffing shortages. Meanwhile, the CEO of a company running several eldercare facilities in New York, the epicenter of the U.S. outbreak, started advising family members to take their loved ones home if possible, NBC News reported this month.
The Seattle Times reported Wednesday that at least 137 long-term-care facilities in Washington state had residents test positive for the virus. More than 200 deaths have been linked to them, according to the Times, about half the total fatalities in the state from covid-19.
On Wednesday, as patients from the Riverside center were still waiting to be transported, Barton issued a plea to health-care workers for assistance.
“We are in immediate need for help to care for our most vulnerable patients,” he said. “We will provide full PPE. We will pay you and provide malpractice. The facilities you work in will be clean. We have an amazing team that is working on this night and day. Please come join us.”
As coronavirus spreads, so do reports of companies mistreating workers
From nurses to retail salespeople, workers are walking off the job and facing retribution for speaking out.
She could not, however, wear her mask in the hallways, or the cafeteria or any of the hospital’s common areas, because her supervisors told her it would scare patients. “I was told if I wanted to wear a mask, I would not be working there,” she said. “So I said I’m not willing to put my life at risk, and my contract was terminated.”
Since the viral pandemic started ravaging the country in recent weeks, workers, unions and attorneys are seeing a dramatic rise in cases they say illustrate a wave of bad employer behavior, forcing workers into conditions they fear are unsafe, withholding protective equipment, and retaliating against those who speak up or walk out.
Moreno’s case was one of many that her attorney, Rachel Bussett, and her colleagues at the National Employment Lawyers Association have been inundated with as workers grow increasingly fearful of retribution from, as Bussett said, “employers who value the economy over people.”
A handful of workers at a McDonald’s outside San Francisco walked off the job to protest the lack of safety measures. So did about 50 workers at a Perdue chicken plant in Georgia, as well as workers at Instacart and Amazon, while the companies said they were taking steps to ensure their employees’ safety and well-being. (Amazon’s chief executive, Jeff Bezos, owns The Washington Post.)
Meanwhile, employees at several major retailers have circulated petitions urging the companies to close their stores and protect workers. And some workers have said they were fired outright for speaking their minds and pushing companies to look after them.
The complaints come as the virus’s toll mounts and health officials warned that extreme measures, such as lockdowns, would continue. On Sunday, health officials said social distancing guidelines would remain in place through April, and President Trump said the nation “will be well on its way to recovery” by June 1, not Easter, as he had said previously.
“This is a situation we’ve never had to deal with before,” said Heidi Burakiewicz, a D.C. attorney and a member of the employment lawyers association. “We’re doing everything we can to help these employees — not just about protecting jobs. But people’s lives are at stake, and people should never have to be faced with questions about whether they need to risk exposing themselves and their families or losing their jobs.”
The designations for “essential” businesses can vary by state but generally include supermarkets, pharmacies, hardware stores, auto repair shops and the defense industry.
Workers at a number of large retailers — such as craft stores, video-gaming shops and office supply chains — have questioned their employers’ decision to stay open despite stay-at-home orders across the country.
“It is unnecessary and unsafe to be open during a PANDEMIC,” Staples employees wrote in a petition. “We are not an essential store and corporate is fighting and begging to stay open, claiming Staples is essential and putting employees and their families at risk. Staples should temporarily close stores and pay their employees for the time being.”
Staples spokeswoman Meghan McCarrick said the company is “an essential provider of business and educational materials and products, household goods and cleaning supplies.” She said that an intensive care unit at a Baltimore hospital recently purchased ink and toner for a printer at Staples, while a hospital in Virginia bought webcams to set up remote telemedicine offices.
Last week, the Federal Bureau of Prisons turned away employees who said they had taken pain medications such as Advil, Tylenol or Motrin within four hours of reporting for work. That meant guards with balky hips or bad backs were forced to take sick leave, even if they had no fever or other symptoms of the virus, union officials said.
“You have unqualified people asking questions that are medically related,” said Sandy Parr, a union official. “They’re sending people home just because they took Motrin, which is decreasing the staff available to work — and that increases the danger.”
After guard workers complained and The Post inquired about the measure, the Bureau of Prisons said last week that it was discontinuing the practice.
Across the country, some health-care facilities are hoarding masks, goggles and gloves — forcing some workers to bring in their own, use the same equipment again and again, or go without.
“It’s in cabinets locked away, collecting dust while people need it now,” said Rebecca Reindel, the safety and health director of the AFL-CIO, who said the union has raised the issue “in every avenue we can.”
Moreno’s concern wasn’t the availability of the equipment — only her ability to use it. A contract nurse at Select Specialty Hospital, she felt she needed to wear a mask at all times, especially given that the patients she was treating were particularly susceptible to the worst effects of the virus. The hospital’s website says it provides “specialized care for patients with acute or chronic respiratory disorders. Our primary focus is to wean medically complex patients from mechanical ventilation and restore independent breathing.”
The state is under a “safer at home” order, which directs people over 65 and those with underlying medical conditions to stay home and limits gatherings to no more than 10 people, among other restrictions.
On Wednesday, however, Moreno was told her contract was being terminated because the hospital did not want her wearing a mask in common areas of the hospital, she said. But by the next afternoon, after The Post had contacted the hospital, she said hospital officials “had completely changed their tune” and decided to allow nurses to wear masks throughout the hospital and not just in patient rooms.
On Friday, she went back to work. In an email, a hospital spokeswoman said, “The nurse is still engaged with us and her upcoming scheduled shifts have been confirmed.”
The policy change “feels wonderful,” Moreno said, “because I know I will be protected and my friends and co-workers will be protected.”
Kevin Readel, another nurse in Oklahoma City, said he was fired for a similar reason — but in his case it was for insisting on wearing a mask while with patients.
He said he was told “point blank that I can’t wear a mask” because it “could cause fear and anxiety amongst the other nurses and the patients.”
He filed a suit against the Oklahoma Heart Hospital South for wrongful termination, claiming that “the hospital was more concerned about the perception of due diligence than actually performing due diligence.”
A spokesman for the hospital said he could not comment on pending litigation but said the hospital’s “entire focus is on making sure we protect the safety of our patients and health care professionals in preparation for an expected surge in COVID-19 patients. As part of our preparation, we are strictly complying with the guidelines on the personal protective equipment set forth by the World Health Organization and the Centers for Disease Control.”
Lauri Mazurkiewicz, a nurse who lives outside Chicago, grew nervous when she was repeatedly exposed to patients diagnosed with covid-19, the disease caused by the coronavirus. “This is so contagious. It’s spreading so fast. I need an N95 mask,” she said, referring to a specialty mask worn by many health-care workers.
She happened to have an N95 and began wearing it during her rounds at Northwestern Memorial Hospital, she said, but was told the hospital was prohibiting the use of N95 masks and using regular surgical masks instead.
She sent an email warning her colleagues that those masks were less effective. She was fired shortly afterward — the result, she alleged in a lawsuit against the hospital, of her attempts to “disclose public corruption and/or wrongdoing.”
A spokesman for the hospital declined to comment on the specifics of her complaint in the lawsuit, but said it is “committed to the safety of our employees who are on the frontlines of this global health care crisis.” He added that it follows “CDC guidance regarding the use of personal protective equipment for our health care providers.”
In a statement Monday, the American College of Emergency Physicians said it was “shocked and outraged by the growing reports of employers retaliating against frontline health workers who are trying to ensure they and their colleagues are protected while caring for patients in this pandemic. … Not only does this type of retribution remove healthy physicians from the frontlines, it encourages others to work in unsafe conditions, increasing their likelihood of getting sick.”
In the retail sector, employees at Michaels crafts stores said they were told the company’s shops would remain open because they serve “people who are bored at home” and double as UPS drop-off sites, according to an employee at a Phoenix store who is awaiting results for a coronavirus test.
The worker, who spoke on the condition of anonymity, has been home with a low-grade fever, cough and chest pain but says store managers have not been supportive.
“Every time I call in sick, there’s just an incredibly disappointed sound on the other end,” she said. “This is not an essential business — nobody in the history of mankind has ever dropped dead from boredom. They need to close their doors.”
Anjanette Coplin, a spokeswoman for Michaels, said its stores provide necessary products and services for parents and small-business owners. “We want to support and remain a lifeline for the teachers, parents and small businesses who rely on Michaels and our products to enable creative learning,” she said. Michaels is offering curbside pickup and has temporarily closed locations in certain states, including California, New York and Pennsylvania.
JoAnn craft stores, GameStop, Office Depot and Guitar Center have also come under fire for keeping stores open. A spokesman for Office Depot said the company is not requiring retail employees to come to work if they are not comfortable. Guitar Center, which furloughed 9,000 workers on Monday, said it is following state and local rules regarding store closures. JoAnn and GameStop did not respond to requests for comment.
In Plain City, Ohio, workers at a TenPoint Complete call center who administer automotive surveys by phone have been instructed to report to work even after the state issued a stay-at-home order, according to one employee who spoke on the condition of anonymity because she feared reprisal.
Her work, she said, consists of calling customers to ask about their experience at the body shop.
“This is not an essential job,” she said.
TenPoint Complete did not respond to a request for comment.
Even as other department stores, such as Nordstrom and Kohl’s, have temporarily shut their doors and kept paying their workers, Dillard’s has kept locations operating where government authorities allow it, making it one of the few remaining mall-based stores to remain open despite the pandemic, employees say.
That has sparked concern from employees, social media outrage by community members and a petition drive urging it to close that alleges, “Unlike other retailers who care about the safety and well-being of their employees and the guests they serve everyday, Dillard’s is choosing to run a blind eye in order to keep money funneling into their greedy pockets.”
Some employees who work for the company expressed fear about the stores remaining open, saying that they have been offered no assurances of pay if their stores close and that they had to pay more for their health insurance as their hours were cut.
One full-time Dillard’s employee based in Colorado, who requested anonymity to preserve her job, said that before her store closed in the middle of last week, she tried to use the vacation time she has accumulated to take off two weeks, but was told she couldn’t because the store was short-staffed. Her store has since closed because of local restrictions for nonessential businesses, and she said they were not being paid during the closure, other than for earned vacation leave. They have received little clear information about whether they would get their jobs back when the stores reopened, she said.
An employee in her 60s based in southwest Florida said she has not yet accumulated any paid time off, so if she were to get sick, she would have no paid leave. “They say you’re more than welcome to stay home, but that’s, of course, without pay,” at least for her.
She said the company has done little to directly encourage social distancing from customers making purchases. “They’re just telling us to relay to customers — politely — to stand back,” she said, but not putting up signage or tape to mark where customers should stand. “They are providing us at each register with a little small bottle of hand sanitizer. Mine has about a quarter of it left.”
In an email, Julie Johnson Guymon, a company spokeswoman, said “direct communication” with associates began Monday. In an earlier statement, she said Dillard’s is “fully cooperating with any government directives in our markets and promptly closing under those guidelines. Importantly, we are strictly following CDC guidelines for the safety of our associates and the customers who choose to visit us where open. No associate who is uncomfortable working is required to do so. We believe continuing to operate using current safety standards is the best thing we can do long term for our associates and for the economy.”
Trump Medicaid proposal sparks bipartisan warnings
Republicans and Democrats alike are warning that a recent proposal from the Trump administration could lead to billions of dollars in cuts to Medicaid, forcing states to eliminate benefits, reduce enrollment or cut payments to health providers.
In a rare sign of unity, hospitals, insurers, patient advocates and members of both political parties are on the same page in their opposition to the Trump administration’s plan, and most have urged the administration to withdraw a proposal they say would “cripple” Medicaid, the federal-state partnership that provides health care for the poor.
The proposal hasn’t received as much attention as the administration’s other efforts to reform Medicaid, such as implementing work requirements, but it could have the most damaging effect because of how far-reaching it is, experts argue.
“This is high stakes,” said Matt Salo, executive director of the National Association of Medicaid Directors, whose board urged the administration to completely withdraw the proposal.
Trump allies have also voiced their concerns.
“The Medicaid fiscal accountability rule is a concern to my governor, and the stakeholders are worried the rule as proposed could lead to hospital closures, problems with access to care and threaten the safety net,” Sen. John Cornyn (R-Texas) told Department of Health and Human Services Secretary Alex Azar last week during a hearing on the agency’s fiscal 2021 budget request.
Sen. Mark Warner (D-Va.) warned during the same hearing that the proposal could “dramatically affect Medicaid eligibility” and “wreak havoc on budgets in red states and blue states all across the country.”
The proposal would overhaul the complex payment arrangements states use to raise money for their Medicaid programs — funding that is then matched by the federal government.
The administration argues some states use questionable methods of raising funds so they can leverage more money from Washington. One approach used by states consists of taxing providers who stand to benefit from more Medicaid funds flowing into the state.
But governors and state Medicaid directors argue those long-standing arrangements are both legal and necessary as states look for ways to keep up with escalating health care costs.
The proposal would allow the Centers for Medicare and Medicaid Services (CMS) to limit the extra payments from states to providers serving high numbers of uninsured patients or Medicaid patients. Opponents say such changes could result in providers deciding not to accept Medicaid patients.
Dozens of states wrote public comments to CMS Administrator Seema Verma, urging her to withdraw the proposal, including conservative states that are typically supportive of her work.
“If the rule is finalized as proposed, it will immediately disrupt the Medicaid program in Alabama and we believe across the country,” wrote Stephanie McGee Azar, commissioner of the Alabama Medicaid Agency, who is not related to Alex Azar. She added that it would have “unintended consequences that will affect access to care in Alabama to our most vulnerable populations.”
Florida Gov. Ron DeSantis’s (R) administration warned the effect of the proposal would be “immediate and crippling.”
Meanwhile, a letter signed by state Medicaid officials in Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Illinois, Louisiana, Colorado, Pennsylvania and Washington argued the proposal would likely “force states to cut Medicaid eligibility, benefits and/or provider payments, which would have the effect of decreasing low-income individuals’ access to important health care services.”
The public comment period closed Jan. 31. CMS now needs to go through the 4,000 comments before deciding whether to finalize the rule.
Verma and her supporters argue the proposal is not intended to cut Medicaid but instead aims to improve transparency and accountability in the $600 billion a year program.
“It’s not surprising providers and the states are objecting when they are getting federal money for free,” argued Brian Blase, who previously served on President Trump’s National Economic Council, where he worked on health care issues. “They don’t want transparency and they don’t want their financing gimmicks checked.”
Blase predicted the rule, if implemented as proposed, would reduce Medicaid spending by a “very small amount.”
Verma also pushed back on opponents, criticizing a study commissioned by the American Hospital Association that estimated the rule could reduce Medicaid funding by as much as $49 billion annually.
“This proposed rule is not intended to reduce Medicaid payments, and alarmist estimates that this rule, if finalized, will suddenly remove billions of dollars from the program and threaten beneficiary access are overblown and without credibility,” she wrote in a blog post last week.
Some experts disagree with her, pointing to other actions the administration has taken on Medicaid, including work requirements.
“I think one should view this rule not in isolation, but in combination with the broader agenda of this administration on Medicaid,” said Edwin Park, a research professor at Georgetown University McCourt School of Public Policy. “Their ultimate agenda is about cutting the Medicaid program, changing the Medicaid program as it currently stands.”
State officials have complained that they were not asked for their input before the proposal was released, nor did CMS conduct a regulatory analysis of potential effects.
A nonpartisan agency that advises Congress on Medicaid policy wrote to Alex Azar advising he not implement the rule because CMS has not fully assessed the possible effects.
“The Commission is concerned that the proposed changes could reduce payments to providers in ways that could jeopardize access to care for Medicaid enrollees,” the advisory group wrote.
For example, Maine’s Department of Health and Human Services has planned to make $86 million in supplemental payments to hospitals in fiscal 2020, which began July 1.
The rule “would require significant changes to MaineCare and could force the State to cut back on eligibility or services,” Jeanne Lambrew wrote in the department’s public comment.
The administration hasn’t given any signals that it plans to back down from the proposal, despite considerable pushback from stakeholders, states and bipartisan members of Congress.
“We will work with states to help them recreate their practices in ways that are in conformity with the statute and try to be fair and equitable in all our dealings with states,” Alex Azar told lawmakers last week on Capitol Hill.
Efforts to save new moms clash with GOP’s Medicaid cuts
https://www.politico.com/story/2019/06/14/new-moms-clash-gop-medicaid-cuts-1364564
The push to address the soaring U.S. maternal morality rate is colliding with a broader, more ideological public health imperative: Republican-led efforts to scale back Medicaid.
The safety net program pays for half of all births in the nation. Democrats and many public health experts see it as a natural vessel for slowing the death toll of pregnant women and new mothers, by extending care in the crucial year following childbirth.
But concern over the potentially staggering cost has already quashed efforts in states such as Texas and left liberals in Congress glum over the prospects for a nationwide legislative fix.
“Medicaid represents the best of America and the administration’s effort to gut it would be a massive step backwards on confronting America’s maternal mortality crisis,” Sen. Elizabeth Warren (D-Mass.) wrote in an email.
The dynamic mirrors the federal response to the opioid epidemic, in which Republicans and the Trump administration support making addiction services more available while simultaneously working to shrink Medicaid, the largest single payer of behavioral and maternal health care.
Research has shown the risk of death after childbirth persists for a full year, from such factors as heart disease, stroke, infections and severe bleeding. Black and Native American women are about three times more likely to die from a pregnancy-related cause as white women, according to the Centers for Disease Control and Prevention.
Warren, along with fellow 2020 Democratic presidential contenders Sens. Bernie Sanders, Cory Booker and Amy Klobuchar, back extending Medicaid’s current requirement to cover new mothers from 60 days to one year after childbirth. Democratic proposals in the Senate from Dick Durbin of Illinois, and in the House, from Reps. Robin Kelly of Illinois and Ayanna Pressley of Massachusetts would do that along with provide states grants to improve hospital deliver practices, among other things.
But the efforts aren’t yielding GOP buy-in across the country, as conservative lawmakers keen on shrinking the program press for narrower fixes, such as increased data collection on deaths and a national standard of best medical practices. Proposals to enhance Medicaid coverage to address maternal mortality haven’t attracted a single Republican co-sponsor in Congress, with both sides at loggerheads on whether to grow or shrink the entitlement program.
“All mothers must have access to adequate care before and after delivery, and we should provide states with the tools and flexibility they need to ensure coverage of their most vulnerable populations,” Sen. John Cornyn (R-Texas) told POLITICO.
A Republican aide said GOP lawmakers are focused on getting a better picture of how many pregnant and postpartum women actually need coverage before exploring how to expand access to care. “That is a laborious process to undertake as we have to talk to both the states, stakeholders, and CMS to discern what coverage gaps exist. And we need to know the role other sources of coverage play as well,” the aide said.
Democrats say the prospect of expanding Medicaid benefits scares Republicans in an era of pitched partisan battles over health policy.
“Following the ACA and repeal Obamacare debates, health care, especially Medicaid experience, has become a hot issue — not quite a third rail but definitely hot and our GOP counterparts are a little squeamish,” a Democratic aide working on the issue said.
President Donald Trump last year signed a maternal care measure that directed millions of dollars in new spending to help states collect data on maternal mortality, but has been mum on extending Medicaid coverage to new mothers. His administration will weigh whether to allow Missouri to use its Medicaid programs to offer extended coverage to mothers struggling with addiction — but not the broader Medicaid population.
Meanwhile, the administration is aggressively pursuing an overhaul of Medicaid, finalizing proposals to allow states to apply for block grants that cap program spending and approving requests to condition benefits on work. The administration’s separate efforts to overturn Obamacare would also jeopardize federal subsidies that low-income mothers use to purchase coverage.
The focus on maternal mortality is driven by rising trend lines showing about 700 women die each year due to pregnancy related conditions a rate that’s more than doubled over the last three decades. About a third of the fatalities occur between one week and one year postpartum, according to a recent CDC report, putting the U.S. behind other developed countries for maternal health. And 60 percent of maternal deaths are preventable, with African American women and other minorities disproportionately affected.
Researchers studying the pattern say that extending Medicaid coverage would provide comprehensive benefits for chronic health conditions like heart disease, which accounts for a quarter of maternal deaths.
“The postpartum period is such a period of vulnerability,” said Houston physician Lisa Hollier, immediate past president of American College of Obstetricians and Gynecologists and chair of Texas’s Maternal Mortality and Morbidity task force. “The transition time [from pregnancy to full recovery] is one when we see unmet health needs.”
Obamacare helped boost coverage for new mothers. The uninsured rate for women who reported giving birth in the past year fell to 11.3 percent in 2016 from 19.2 percent in 2013 according to a study in Health Affairs.
The gains in states that expanded their Medicaid programs under Obamacare were especially pronounced, with the uninsured rate among new mothers falling 56 percent compared with 29 percent in non-expansion states.
But the Republican-led push to dial back Medicaid expansion has put a spotlight on controlling spending across the entire program.
Some states are exploring alternatives. Missouri’s Department of Social Services this month intends to ask the Trump administration for a waiver that would allow it to offer Medicaid coverage to postpartum women struggling with substance abuse for one year after they give birth. The move would cover about 1,500 of the 24,000 women in the state whose benefits lapse 60 days after childbirth.
The state’s Republican-controlled legislature endorsed the idea last year after killing a broader expansion of Medicaid benefits to postpartum women.
In Texas, where 382 women died within a year of giving birth between 2012 and 2015, Republican Gov. Greg Abbott this week downplayed the state’s maternal mortality rate on Twitter and said that the state was already doing enough to deal with the issue.
Last month, legislators opted to develop postpartum care services within an existing state program geared towards family planning, which will cost about $56 million over five years, instead of extending Medicaid for 12 months, which carried a five-year price tag of nearly $1 billion in state and federal funds.
Kay Ghahremani, the state’s Medicaid director disputes the cost analysis, saying it would actually save money in the long run by promoting wellness and averting potential emergencies.
“It’s the most important thing we can do for maternal health in this state,” said Ghahremani, now president of the Texas Association of Community Health Plans. “We don’t want to see a single mom die from things that are avoidable.”
HENRY KOTULA 