Add This To The “Legacy” Too

medicallogoIn today’s New York Times, we learn the following (here)…

NASHVILLE — Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.

For those in poor urban neighborhoods and isolated rural areas, including Indian reservations, the clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases.

As a crucial component of the health safety net, they are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care.

OK, so this got me to thinking, and I wondered (among other things) what Bushco has done concerning “medically underserved areas.”

And it didn’t take me long before I found my answer; this tells us, among other things, that Dubya and his pals tried to implement rule changes last June, that would…

…change how the Department of Health and Human Services designates areas as medically under-served or short of primary care doctors. Those designations bring in federal dollars for new clinics and enable clinics and hospitals to recruit doctors through special programs for under-served areas.

And even if a clinic is declared a safety net center in a community that no longer is designated as a shortage area, there’s no clear understanding of how much, if any, of its funding it would receive.

That’s exactly the predicament of the Fremont-based Community Health Services. Sandusky County (Ohio), where Fremont is located, is now considered a primary care shortage area but won’t be if the proposed rules are enacted.

“They (federal officials) told us recently, it wouldn’t affect our financing,” said Joe Liszak, chief executive of Community Health Services, which offers dental, primary care and pediatrics at several locations. But Liszak said there’s no guarantee.

However, Liszak said he was told it would affect their ability to recruit physicians through a special program that allows foreign doctors to stay in the U.S.

The clinic relies heavily on those doctors, who are required to work for three years to get permanent residency, to treat the growing number of uninsured and Medicaid patients that private local doctors refuse to take. Federally qualified health centers take all comers, regardless of ability to pay, and are subsidized by the government to be the safety net provider.

Officials have twice extended the period for public comment on the proposed changes, which now will continue through June. The first was granted after outcry from public health officials and a few strongly worded letters from U.S. senators requesting the extension. The second was granted last week.

And I should also note that, in the story, Diana Espinosa, deputy associate administrator for health profession (?) at the Health Resources and Services Administration (HRSA), said, “those worrying (about the changes) are doing so needlessly,” even though Peter Shin, associate research professor at George Washington University’s School of Public Health and Health Services, said, “Our recommendation is to withdraw this rule . . . and start negotiated rule making so everyone knows.”

And fortunately, that’s what happened; as noted here…

“The proposed regulations would have jeopardized the ability of community health centers to provide care to underserved populations nationwide,” said Julio Bellber, president and CEO of the RCHN Community Health Foundation. “The input of hundreds of respondents across the country, coupled with the thorough and timely research by the (Geiger Gibson/RCHN Community Health Foundation Research Collaborative), was crucial in leading the HRSA to this important decision.”

So before we heap too many plaudits on Dubya for actually not screwing up something (even though he tried his best), let’s add this episode to the proverbial record also (even more ridiculous that the changes weren’t negotiated for something as complicated as making the determination that a community is underserved). Also, this tells us that the so-called “conscience” rule from His Fraudulency affects medically underserved areas also, of course, and is actually more damaging to these people because they have so few options for health care.

Update: Writer Kevin Sack should have read the following editorial from his own newspaper, which states in part that…

A parting gift to the far right, the new regulation aims to hinder women’s access to abortion, contraceptives and the information necessary to make decisions about their own health. What makes it worse is that the policy is wrapped up in a phony claim to safeguard religious freedom.

The law has long allowed doctors and nurses to refuse to participate in an abortion. (HHS Secretary Mike) Leavitt’s changes elevate the so-called right to refuse beyond reason to an increased number of medical institutions and a broad range of health care workers and services — including abortion referrals, unbiased counseling and provision of emergency contraception, even to rape victims.

The impact will be hardest on poor women who rely on public programs for their health care.

Some “legacy” that is!

Also, according to here…

The Office of Personnel Management (OPM) has completed its annual determination of the States that qualify as Medically Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2009. This is necessary to comply with a provision of the FEHB law that mandates special consideration for enrollees of certain FEHB plans who receive covered health services in States with critical shortages of primary care physicians. Accordingly, for calendar year 2009, the following states are Medically Underserved Areas under the FEHB Program: Alabama, Arizona, Idaho, Illinois, Kentucky, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, South Carolina, South Dakota, and Wyoming. For the 2009 calendar year the State of Illinois is being added.

Why do I get the feeling that that list of states is woefully incomplete?

Finally, this takes us to information on H.R. 1601, the Telehealth and Medically Underserved and Advancement Act of 2007; this is a bill that has been “referred to committee” without any further progress. Part of the intent of the bill is, “to make recommendations for coordinating federal and state efforts to increase access to health services, education, and information in rural and urban medically underserved areas.”

The sponsor of the legislation was William Jefferson of Louisiana’s 2nd U.S. House district; seeing as how he was caught with $90 grand in the freezer and subsequently voted out of office, I’ll look forward to another Democrat doing his or her best to move this bill along after the 111th Congress begins its session in a few weeks.

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