Dr. J. Nadine Gracia visits AIHFS

In May, we were fortunate to have some time to meet with Dr. J. Nadine Gracia who is the  Deputy Assistant Secretary for Minority Health.  Our Chief Executive Officer, Ashley Tuomi, attended the Mayor’s Summit on Health Equity, where she also got the opportunity to meet with a small group of other minority leaders in Detroit and Dr. Gracia. Dr. Gracia then took time out of her busy schedule to come here to American Indian Health and Family Services for a tour. We are very grateful for her time and were happy to show her all of the great things that happen here at AIHFS.

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Supreme Court upholds subsidies in King v. Burwell

So what does this mean?

For those of you how haven’t been following this issue let me start with what this case was about.

When the Affordable Care Act was originally written, the thought was that all of the states would manage their own exchanges. In reality that is not what happened. There are currently 34 states who do not operate their own exchanges and rely on the federal exchange to provide coverage to their constituents.

Those who have been challenging the Affordable Care Act found a part of the law that would have completely undermined the intent of the Affordable Care Act. The part of the law that they challenged was that it was written that subsidies are only available to those who enrolled in a state exchange. According to them, those in the 34 states who enrolled in plans through the marketplace would not be eligible for the subsidies that made coverage affordable. It’s estimated that it would be about 6 Million people who could have been affected by this.

Today the Supreme court voted 6-3 to uphold the subsidies and the interpretation of the Internal Revenue Services that individuals in all 50 states should be able to access these subsidies.

Vote Breakdown:

Roberts filed the opinion with Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan joining

Scalia filed a dissenting opinion with Thomas and Alito joining

The decision was based on the fact that they had to read the law in context and not just plain language. It was determined that in context the words “an Exchange established by the State under [42 U. S. C. §18031]” is ambiguous. Due to the ambiguity, the Supreme Court had to look at the phrase in the greater context of the Act. They also found that other parts of the law would not make sense if this phrase was defined as plain language.

When looking at the greater context of the Act the Supreme Court had to reject the interpretation of the petitioners because “it would destabilize the individual insurance market in any State with a Federal Exchange, and likely create the very “death spirals” that Congress designed the Act to avoid”.

It would have removed the subsidies from the states that didn’t operate their own exchanges and many of those individuals would have been exempt from the coverage requirement because the insurance would not have been affordable. These two facts would have also had a negative impact on the state exchanges as well since they would have struggled to operate in this environment.

So why should we care? Michigan is one those states that participated in the federal exchanges. As some of you know American Indian Health and Family services has played an important role in enrolling both tribal members and non-tribal members through the Marketplace and Healthy Michigan. If the Supreme Court had not upheld the subsidies, most of the individuals that we enrolled in the marketplace would no longer be able to afford coverage and would become uninsured again.

If you would like to read the filing please visit here

Day 5: Building On 20 Years of Success

We started off the week talking about the health care disparities that exist in the United States, and while they paint an ugly picture, the last 20 years have shown us that there have been improvements and that we will continue to see improvements. In order to see those improvements, we need to continue to fight for change and to play an active role in change.

For those of you reading these posts this week, how do you think you can be a part of the changing landscape of health care? What is the number one change that you would like to see and what do we need to make that change?

Excerpt from the American Public Health Association:

Let’s celebrate our accomplishments and talk about what it will take to become the Healthiest Nation in One Generation!

2015 marks the 20th anniversary of APHA coordinating National Public Health Week! The accomplishments of the public health community over the last two decades are significant. To become the Healthiest Nation in One Generation: experts need to support the integration of public health and primary care; policy decision makers need to understand and support funding for both a strong public health workforce and prevention programs proven to advance health; both national and local policy decision makers need to expand the consideration of health implications in all the policies they create; and the general public needs to make healthy choices for themselves and demand that everyone has an equal opportunity to make those same choices.

Facts & Stats:

Some of the greatest public health achievements of the 20th Century – according to the CDC (and we agree!) include:

• Healthier Mothers & Babies – Infant and maternal mortality rates have decreased in the U.S. Environmental interventions, improvements in nutrition, advances in clinical medicine, improvements in access to health care, improvements in surveillance and monitoring of disease, increases in education levels, and improvements in standards of living contributed to this remarkable decline.
• Immunizations – Today, U.S. vaccination coverage is at record high levels! National efforts to promote vaccine use among all children has helped eradicate Smallpox and dramatically decrease the number of cases of Polio, Measles, Hib and other diseases in the U.S.
• Motor Vehicle Safety – We’ve seen a huge reduction in the rate of death attributable to motor vehicle crashes in the United States, which represents the successful public health response to a great technologic advancement (the motorization of America). The response has spanned government, public health and driver and passenger behavior.
• Family Planning – Increased contraception use, public health education and other factors mean that, today, Americans face fewer unintended pregnancies and are far more likely to achieve desired birth spacing and family size.
• Tobacco as a Health Hazard – During 1964-1992, approximately 1.6 million deaths caused by smoking were prevented thanks to substantial public health efforts.
• Decline in Deaths from Heart Attack & Stroke – Still the country’s top killers, the public health community has helped achieve remarkable declines in deaths from both diseases: since 1950, deaths from cardiovascular disease have declined 60 percent, and stroke rates have declined 70 percent.

(For more visit http://www.cdc.gov/about/history/tengpha.htm)

What’s next? Together we can create the healthiest nation in one generation.

We have a lot of challenges to overcome, but it all starts with a simple first step:

Sign the pledge to show your commitment.  Ask others to sign as well because the more people who sign, the more influence we have to drive change.

Sign the petition to ask our leaders to do their part.  It will take change at both the local and national level to ensure our communities make a positive impact on our health.

See below

Day 4: Building Broader Communities

Public Health involves us coming together as a community to create change. Very little happens when we do work as an individual, but when we come together in coalitions we can impact the health of our communities. When looking to build these coalitions, think outside of the box and go beyond your normal partners. Sometimes the unlikeliest partner will actually be the best partner that you could have.

The examples below show how partners that cross many sectors can create wonderful change

Facts & Stats:

• Individual workers, unions, employers, government agencies, scientists, state labor and health authorities, and others have worked together to make a significant difference in workplace conditions and safety, vastly reducing workplace injuries and death.
• Fighting Big Tobacco to reduce the prevalence of tobacco use in the U.S. would not have been possible without the combined efforts of a broad coalition of government officials, public health groups, scientists, economists, and educators. Scientific evidence proved the relationship between disease and tobacco use / environmental exposure to tobacco. Funders and advocates spread this information to the public, and fought for nonsmokers’ rights. Government officials and agencies (together with advocates and voters!) passed tobacco taxes, restricted smoking in public spaces, and limited how tobacco companies could advertise.
• Public health action, together with scientific and technologic advances, have played a major role in reducing and in some cases eliminating the spread of infectious disease, and in establishing today’s disease surveillance and control systems.
• Reducing death and injury attributable to motor vehicles has required an all-hands-on-deck approach. In 1966, passage of the Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the federal government to set and regulate standards for motor vehicles and highways, and many changes in both vehicle and highway design followed that mandate. Drivers and passengers also changed their behaviors, in part thanks to significant public health and safety campaigns. Governments and communities recognized the need for motor-vehicle safety, which prompted programs by federal and state governments, academic institutions, community-based organizations, and industry.

(For more visit http://www.cdc.gov/about/history/tengpha.htm)

What’s next? Together we can create the healthiest nation in one generation.

We have a lot of challenges to overcome, but it all starts with a simple first step:

Sign the pledge to show your commitment.  Ask others to sign as well because the more people who sign, the more influence we have to drive change.

Sign the petition to ask our leaders to do their part.  It will take change at both the local and national level to ensure our communities make a positive impact on our health.

Day 3: Building Momentum

We have learned that health is not an individual issue. What we are most recently learning (sometimes the hard way) is that health is not just an issue for the medical world, the government, and those interested in public health. Health is an issue that everyone has to be concerned about and this includes entities within the government, non-profit and community settings, and even the for profit world. Below are some great momentous activities that have been going on.

I’m particualry excited about the decision of cvs to stop selling tobacco products. That was a huge step for them to take and a huge risk since tobaccos sales are a big part of these pharmacy and wellness stores. It makes sense that a store focused on health and wellness would stop selling products that are the exact opposite of health and well-being. I think that there are other things that they could be looking at as well, but this was a huge step and I hope the Walgreens, Rite Aids and other stores of the world will catch up as well.

Debates around the Affordable Care Act have brought added attention to prevention and public health. As a result, we’re beginning to see a broad range of influential organizations taking important steps in line with creating the Healthiest Nation. Yet, as we celebrate the gains we’ve made, a key challenge will be to expand and build upon this momentum.

Facts & Stats:

• At APHA, we’ve developed a strategic plan for the public health community to help America become the Healthiest Nation in One Generation!
• Robert Wood Johnson is re-positioning the foundation’s work behind the goal of “creating a culture of health.”
• In 2014, the American Planning Association – the organization of professionals who help communities plan for growth and change – for the first time dedicated a full day of their annual meeting to health.
• The First Lady Michelle Obama’s Let’s Move! initiative is gaining traction in addressing childhood obesity & raising a healthier generation of kids.
• Even in the for-profit sector we see companies seeking a better balance between their profits and the health of their customers:
  • CVS Health has stopped selling tobacco products and has expanded their programs to help people quit.
  • Sixteen major food and beverage companies reduced the calories in the products they sold by 6.4 trillion calories.

What’s next? Together we can create the healthiest nation in one generation.

We have a lot of challenges to overcome, but it all starts with a simple first step:

Sign the pledge to show your commitment.  Ask others to sign as well because the more people who sign, the more influence we have to drive change.

Sign the petition to ask our leaders to do their part.  It will take change at both the local and national level to ensure our communities make a positive impact on our health.

Day 2: Starting from Zip

So I got a little behind in posting each day this week, but this is still very important information. There is a lot of work going on in the U.S. in terms of life expectancy and zip codes. I would love to do some of this research in Michigan and specifically with the metro area. Although knowing this data doesn’t automatically solve problems, its a great place to start awareness and create the buy-in that is necessary to make changes on a large scale.

If you take a lot at the links below you can see that Wayne County has over 9,000 years of potential life lost before 75 in 100,000 people. Compare this to just over 5,000 in Washtenaw County.

Facts & Stats:

• In the area served by the Washington, D.C. metro system, communities only 12 miles from each other can have a nine year difference in life expectancy! (Source: RWJ Commission to Build a Healthier America graphic via APHA website)
• In the U.S. there is a 13% difference (9 years) in life expectancy between states.
• Use these great resources to find specific data for how your county and state rank!
  • Find your state in the America’s Health Rankings report.
  • Find your county in the County Health Rankings and Roadmaps report.

What’s next? Together we can create the healthiest nation in one generation.

We have a lot of challenges to overcome, but it all starts with a simple first step:

Sign the pledge to show your commitment.  Ask others to sign as well because the more people who sign, the more influence we have to drive change.

Sign the petition to ask our leaders to do their part.  It will take change at both the l

National Public Health Week- Raising the Grade

Today is the first day of National Public Health Week (#NPHW). I will be sharing posts and information regarding the daily themes.

Today’s theme is raising the grade. It’s sad to think that the U.S. is so far behind the curve in terms of health care yet we have the highest medical expenditures (17.9 of the Gross Domestic Product expenditures). In this case high spending does not equal quality.

Below is some information from the American Public Health Association regarding our current status.

What does the data reveal about America’s health?

The U.S. doesn’t have the top health care system – we have a great “sick care” system. We have great doctors, state-of-the-art hospitals and we’re leaders in advanced procedures and pharmaceuticals. But studies consistently show that despite spending twice as much, we trail other countries in life expectancy and almost all other measures of good health. This holds true across all ages and income levels. So what is missing?  We need a stronger public health system that supports healthy communities and moves us toward preventing illness, disease and injury.

Facts & Stats:

We’ve seen some improvements!

In 2013:

• Smoking continued its decline from 19.6% to 19.0% of the adult population.
• Immunization coverage increased from 64% to 67.1% of adolescents aged 13 to 17 years.
• We have many successes like increasing life expectancy, reducing infant mortality and declining cardiovascular deaths – but other countries are succeeding faster than we are.

And yet, compared to peers in other countries, people in the U. S. have…

• Shorter lives – Over the past 25 years U.S. life expectancy has grown, but at a slower rate than in other countries. Studies consistently show we have a lower life expectancy than comparable countries.
• Adverse birth outcomes – we have the highest infant mortality rate, low birth weights, the highest rate of women dying due to complications of pregnancy and childbirth and children are less likely to live to age 5.
• Highest rates of injury and homicides – deaths from motor vehicle crashes, non-transportation injuries and violence occur at much higher rates than in other countries.
• Heart disease – the U.S. death rate from ischemic heart disease is the second highest; at age 50 Americans have a less favorable cardiovascular risk profile and adults over age 50 are more likely to develop and die from cardiovascular disease
• Obesity and diabetes – For decades the U.S. has had the highest obesity rates across all age groups and adults are among the highest prevalence of diabetes.
• Chronic lung disease – Lung disease is more prevalent and associated with higher mortality.
• Disability – Older U.S. adults report a higher prevalence of arthritis and activity limitations.
• Adolescent pregnancy and sexually transmitted disease – our adolescents had the highest rate of pregnancies and are more likely to acquire sexually transmitted diseases.
• HIV and AIDS – we have the second highest prevalence of HIV infection among 17 peer countries and the highest incidence of AIDS.
• Drug related mortality – we lose more years of life to alcohol and other drugs than people in peer countries even when deaths from drunk driving are excluded. In fact the President’s 2014 National Drug Control Strategy noted that drug induced overdose deaths now surpass homicides and car crash deaths.

What’s next? Together we can create the healthiest nation in one generation.

We have a lot of challenges to overcome, but it all starts with a simple first step:

Sign the pledge to show your commitment.  Ask others to sign as well because the more people who sign, the more influence we have to drive change.

Sign the petition to ask our leaders to do their part.  It will take change at both the local and national level to ensure our communities make a positive impact on our health.

ACA Updates

Its been awhile since I have been on here but I do have some important updates related to the ACA Marketplace. IF you currently have a marketplace plan there is important information regarding the 2015 year. There is a great infographic available that will give your steps to staying covered.

5-steps-to-staying-covered

You should also be getting notification of renewal options in the mail. If you have questions you can call us, set up an appointment or email our Navigators
Just a reminder that members of U.S. Federally recognized tribal members can enroll at anytime. For others the open enrollment period starts on November 15th for coverage that will start on January 1st, 2015.

Health Insurance Glossary

There are so many different terms that thrown around and I found this great glossary of terms that I thought I would share with you.

Affordable Care Act: A set of health care reforms passed by Congress and signed into law by President Barack Obama in March 2010. The foal of this law, which is more formally called the Patient Protection and Affordable Care Act and more informally nicknamed Obamacare, was to make affordable quality health care accessible to more Americans. It also aims to give both the insured and uninsured new patient protections to make coverage more fair and easier to understand.

COBRA: Stands for Consolidated Omnibus Budget Reconciliation Act. It allows workers the right to stay on their employer’s health insurance plan for a certain period of time, though they may be required to pay the entire cost of their coverage.

Deductible: A specific amount of money that you must pay before your health insurance will start paying on a health-care claim you have made. This is an out-of-pocket cost. Typically, if you have an HMO, it does not have a deductible (but the trade-off is you are limited to doctors/care providers within that HMO’s “network”).

“Donut Hole”: In Medicare Part D, which covers prescription drugs, most plans have a coverage gap, which is often referred to as the “donut hole”, where coverage is cut off after spending a certain amount and then starts up again after you’ve reached a new threshold of cost. The Affordable Care Act eliminates this gap in coverage by 2020.

Employer-based plans: Insurance plans that are provided by your employer and partially covered by them. This is the type of insurance plan most Americans have.

Employer Mandate: The requirement that businesses with more than 50 full-time employees must offer health insurance to their employees and their dependents under the age of 26, starting in 2015.

Health Insurance Marketplace: The online marketplace where you can search for and purchase health insurance. Also called Health Care Exchange, HIX, Obamacare Exchanges, and Health Benefits Exchange. It’s available at Healthcare.gov

Healthy Kids: A free health insurance plan for children under age 19 and pregnant women. Income requirements do apply.

Individual Mandate: The requirement that all Americans have health insurance in 2014. Those who do not comply face a fine (Some exceptions apply, i.e. Members of federally recognized tribes and others who are eligible for Indian Health Services).

Medicaid: Federal Health care program provided to people whose household income below 133 % of the federal poverty level (Not all states expanded Medicaid, but Michigan did).

Medicare: Federal health care program provided to those age 65 or over and younger people with disabilities.

Medicare Advantage: Medicare benefits provided by a private insurance company.

MIChild: a low-cost health insurance plan for children under age 19. Income requirements do apply.

Minimum essential coverage: The level of health care coverage that all Americans are required to have in 2014 or pay a penalty (some exceptions apply)

Out-of-network: A health care provider with whom your insurance company has not negotiated a rate of payment. See a doctor “out-of-network” can cost you more than seeing a doctor “in-network”.

Out-of-pocket: Expenses you have to pay yourself, above and beyond your insurance premiums. Typically includes copays and deductibles.

Pre-existing condition: A health issue that you already had that would sometimes disqualify you from getting insurance, or would cause your premiums to be increased. Under the new health care reform, insurance companies can no longer discriminate against those with pre-existing conditions or levy additional fees.

Premium: The rate you are charged for having active insurance. It is influenced by various factors and may be paid annually or in smaller installments over the year.

Primary Care Provider: A doctor, nurse practitioner or physician assistant who is the primary person you go to about your health care and is your go-to medical advisor.

Subsidies:Tax credits to help those who earn less than 400% of the federal poverty level buy insurance

Thank you to Health Care Reform + You Magazine for these definitions

Are you a kroger shopper?

If you shop at Kroger you can register your card to benefit American Indian Health and Family Services. We currently have 19 households supporting our organization, so last quarter we had a little over 100 donated to our organization just from these individuals shopping at kroger.

Please register your cards and pass on to family and friends

http://www.krogercommunityrewards.com

Search for American Indian Health and Family Services or Organization # 91936