Archive for Health care

The Affordable Care Act

March 27, 2012

By:  Jeanne Christensen, RSM

Editor of KC Olive Branch and Justice Coordinator, Sisters of Mercy West Midwest Community

The Affordable Care Act was passed as a reform law that would require all insurance plans to cover preventive care at no cost.  This included free check-ups, free mammograms, immunizations and other basic services.  This is important because many women cannot afford these basic preventive health care services; and it saves lives and money –- for families, for businesses, for government, for everybody.  It is a lot cheaper to prevent an illness than to treat one.

It included, based on a recommendation from the experts at the Institute of Medicine, women’s preventive care should include coverage of contraceptive services such as birth control.  In addition to family planning, doctors often prescribe contraception as a way to reduce the risks of ovarian and other cancers, and treat a variety of different ailments.

Because some religious institutions, particularly those affiliated with the Catholic Church, have a religious objection to directly providing insurance that covers contraceptive services for their employees, the original bill exempted all churches from this requirement -– an exemption that eight states didn’t already have.

In February, 2012, compromise rule was enacted.  Under the compromise rule, women will still have access to free preventive care that includes contraceptive services, no matter where they work.  So that core principle remains.  But if a woman’s employer is a charity or a hospital that has a religious objection to providing contraceptive services as part of their health plan, the insurance company -– not the hospital, not the charity -– will be required to reach out and offer the woman contraceptive care free of charge, without co-pays and without hassles.

The result will be that religious organizations won’t have to pay for these services, and no religious institution will have to provide these services directly.  These employers will not have to pay for, or provide, contraceptive services.  But women who work at these institutions will have access to free contraceptive services their insurance companies pay for; and they’ll no longer have to pay hundreds of dollars a year that could go towards paying the rent or buying groceries.

Religious liberty will be protected, and a law that requires free preventive care will not discriminate against women.   We live in a pluralistic society where we’re not going to agree on every single issue, or share every belief.  That doesn’t mean that we have to choose between individual liberty and basic fairness for all Americans.

To overturn the Affordable Care Act to rid it of the contraception mandate, for which there is now a workable compromise, will endanger thousands of Americans.  Those already covered under the Affordable Care Act will lose their coverage.  This includes children up to age 26 who are now able to remain on their parents’ insurance, children with pre-existing conditions, restrictions to participation in Medicaid programs and the like.  It would further penalize the most vulnerable among us.  Many not-for-profit organizations who serve the poor support the Affordable Care Act for this reason.  Is it not our moral responsibility to provide for the most vulnerable among us?




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Happy Birthday ObamaCare!

By Mary Ellen Howard, RSM, Executive Director of the Cabrini Clinic, Detroit, MI.  This clinic is the oldest free clinic in the U.S.

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA), landmark legislation designed to provide coverage for more than half of the nation’s 52 million uninsured citizens, and to address abuses in the insurance industry.  The law is being implemented gradually.  The uninsured poor have to wait until January 1, 2014 before Medicaid will be expanded.  Until then, they will continue to defer care, or to seek it at free clinics and hospital ERs.

Since 1995, I have served as Director of the oldest free medical clinic in the nation, St Frances Cabrini Clinic of Most Holy Trinity Church.  Free Clinics are nonprofit organizations that use volunteer health professionals to provide free or low cost care to uninsured individuals.  Cabrini Clinic was founded in 1950 to provide for the primary medical care needs of Detroit’s uninsured poor families.  We have a full-time staff of five, and over 100 volunteers.  I came to the clinic following a 20-year career in hospital administration, including as CEO of two Mercy Hospitals.

It didn’t take me long, after coming to Cabrini, to figure out that free clinics were not the answer to the problem of the millions without access to healthcare in the USA, including the 200,000 uninsured persons in Detroit.  This led me to get involved in local advocacy for access, and national advocacy for changes in health policy.

In 2009, I supported President Obama’s efforts for health reform, although the resulting ACA falls far short of the single payer expansion of Medicare that I had hoped for.  ACA maintains a market-based insurance system, and does not effectively address the escalating cost of health care in this country.  Still, it promises to cover 32 million of the 52 million uninsured which deserves our support.

On January 1, 2014, Medicaid eligibility will be expanded nationally to 138% of the Federal Poverty Level (FPL) which in 2012 is $15,418 for an individual and $31,809 for a family of four.  In contrast, eligibility in Michigan is at only 35% of FPL or $3,910 for an individual and $8,068 for a family of four.  If your annual income is above that, you are too rich for Medicaid in Michigan.  ACA will also cover childless adults who formerly have been ineligible for Medicaid, regardless of poverty or severity of illness.

This year, I was awarded a fellowship from the McGregor Fund to study the effect of health reform on free clinics and their patients, and to help them through the transition.  Free clinics are in a key position to help their uninsured patients apply for the Medicaid expansion and find a new Patient-Centered Medical Home.  Given the demand for service and limited resources of many free clinics, long-range planning tends not to be a strong suit.  Through the fellowship, I hope to keep free clinics aware of developments, provide tools to assist them, and encourage them to chart their destiny in this time of change.

There are many unanswered questions about ACA.  With the Supreme Court challenge to the mandate, and with presidential candidates vowing to repeal the law, will it be fully enacted?  And if it is, where will the newly insured find care?  Will there be sufficient primary care providers who will accept Medicaid patients and Medicaid reimbursement rates?  Who will remain uninsured, and where will they find care?  Will there be a future role for free clinics in the health care safety net?

Three states have received a federal waiver to expand Medicaid coverage for their citizens in advance of ACA:  Wisconsin, Vermont, and Massachusetts.  I contacted free clinic leaders in these states to learn their experience and what can we expect when Medicaid is expanded in the rest of the nation.  They reported that no free clinics closed as a result of the expanded coverage.  In fact, volume of patients seeking care at the free clinics continued to grow.  Free clinics helped enroll their patients in these new programs, and helped them find a new Primary Care Provider (PCP).  The latter proved a challenge, due to a critical shortage of PCPs and their refusal to accept Medicaid.  As a result, several free clinics are now accepting Medicaid patients, but not billing Medicaid.  Because the population served has unstable income, they frequently go off and on Medicaid, and require navigation assistance.  Dental care and prescription assistance remain huge gaps in service which some free clinics are attempting to fill.

Who will remain uninsured under ACA?  It is estimated that only 40% of the uninsured will be eligible for the expanded coverage. The other 60% are undocumented immigrants and naturalized citizens in this country less than five years.  Some persons, otherwise eligible for Medicaid, will not be able to pull together the required documentation, e.g., a birth certificate.  Others are exempt from the mandate and will choose to remain uninsured.  And some will choose to pay a penalty rather than acquire insurance.  All of them will need care.

The future of ACA is uncertain, but one thing seems certain.  The need for free clinics will not soon disappear.  Communities will continue to need free clinics, and free clinics will continue to need the support of their communities.

Health reform is a work-in-progress.  Health care advocates must continue to work for a national healthcare system which has as its goal improved population health rather than profit.  The Affordable Care Act is a step in that direction, and we must ensure its continued implementation, while at the same time working towards “Health Care for All.”

*Cover photo attribution to LaDawna Howard, Creative Commons licensed content.

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Heathcare reform tests our commitment

Despite enactment in March of the Affordable Care Act — more commonly known as federal healthcare reform — debate and confusion about it continue.  “Healthcare reform, as currently enacted and as it will no doubt be amended, tests our country’s commitment to the common good,” says Sister Doris Gottemoeller, RSM, senior vice president of mission and values integration at Catholic Healthcare Partners in Cincinnati, Ohio. ”It is a tangible expression of our ability to work together to achieve a social good that no group or state could achieve on its own. Effective reform will encourage both personal responsibility and concern for our neighbors, especially the poor and vulnerable.”

In his 1963 encyclical” Peace on Earth,” Pope John XXIII listed healthcare among the basic rights that flow from the sanctity and dignity of human life, and today the Catholic Health Association hasn’t wavered in its commitment to reform. To read remarks by Sister Carol Keehan, DC, president, and fund further information visit here.

The Kaiser Family Foundation, a non-profit organization focusing on U.S. healthcare issues has released a nine-minute animated video entitled “Health Reform Hits Main Street” that explains the new law in simple terms. It can be viewed here.

Editor’s note:  This article was first published in the January 24th weekly newsletter of the Sisters of Mercy South Central Community.

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Health Reform: The Facts Matter

Editor’s Note:  Reprinted with author’s permission. Also posted here on Septemer 23, 2010.


By Mary Waskowiak, RSM, President, Sisters of Mercy of the Americas

It’s been six months since Congress passed health care reform, and the law has become a divisive political issue as midterm elections loom. This early anniversary is an opportunity to consider how the most historic domestic legislation passed since Medicare and Medicaid is helping families in practical ways that serve the common good.

As a Catholic sister and president of the Sisters of Mercy of the Americas, my commitment to health care reform is rooted in the unwavering belief that providing quality medical care for all is a moral priority and a fundamental tenet of a just society. Our sisters know from experience working in hospitals and clinics the profound stresses that come with sickness. Families battle with insurance companies as loved ones suffer. Time away from work puts jobs at risk. Medical bills pile up as hope fades. This is why so many Catholic sisters support health care reform. We put politics aside and respond when people are in need.

While this law will not cure the many issues at stake in a complicated health care system, the Patient Protection and Affordable Care Act has already achieved significant victories. Starting this week, insurance companies can no longer deny coverage to children with pre-existing conditions. This means that children with cancer or other acute diseases won’t be cut off from getting the care they need. The law also prohibits all health plans from placing lifetime caps on coverage. Young adults who need coverage can now remain on their parents’ insurance until they are 26, which is especially important as young people face the most difficult job market in decades. Uninsured adults who could not get coverage because of a pre-existing condition now have access to temporary high-risk pools until permanent health care exchanges are established. In addition, new health plans must cover preventive services such as blood pressure checkups, cholesterol tests and routine vaccinations. No longer will patients be charged a copayment or deductible for these services — an important victory for consumers since heart disease, diabetes and other chronic illnesses are often preventable, and research shows consumers avoid preventative care when it’s not covered.

The law also goes a long way to help mothers by establishing a Pregnancy Assistance Fund that will provide $250 million over the next decade to help pregnant and parenting women and teens with child care, housing, education and services for those victimized by domestic or sexual violence. This vital network of comprehensive support is especially critical for women who lack the resources to raise a healthy child and may view abortion as their only option in difficult situations. These robust supports are more than just sound bites in campaign speeches. These funds will make sure struggling women and families have access to baby food, post-partum counseling and parenting classes.

An honest dialogue over health care reform should be encouraged. People of goodwill can disagree in spirited, civil ways. But the facts matter and we should not let partisanship or ideology drown out the voices of those with real needs. Let’s celebrate the tremendous achievements of this important law and work together to keep building a health care system that lives

Sister Mary Waskowiak, RSM, a native of California, has served as President of the Institute of the Sisters of Mercy of the Americas since July 2005. Prior to her role as president, Mary served as councilor on the Institute Leadership Team from 1991 to 1999 and as President of the Sisters of Mercy Regional Community of Burlingame, California, from 2003 to 2005.

Mary also served as President of the Leadership Conference of Women Religious (LCWR) from 1996 to 1999, during which time she participated as official observer to the Bishops’ Synod for the Americas at the Vatican. Her prior ministry experiences include secondary education, parish ministry, seminary field education, Sisters of Mercy vocation and formation ministry, and directing Mercy Center in Burlingame.

Mary has served as facilitator and presenter for groups of women and men religious in Argentina, Chile, England, Guyana, Ireland, Peru, South Africa, the United States and Zambia.

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We Believe Healthcare is a Human Right, Not a Commodity

This article is taken from emailed information sent by the Demand Dignity Campaign of Amnesty International USA

In October 2008, President Obama affirmed that health care should be a right, not a privilege. In so doing, he echoed the values of the Universal Declaration of Human Rights and the international conventions, which hold that every human being has the right to health including health care.  Elected officials in the United States – especially President Obama, his administration, and the current Congress, but also policymakers at the state and local levels – have a historic opportunity to make good on the president’s affirmation by recognizing and treating health care as a right, and not a commodity.

Amnesty International USA believes that health care is a right, not a privilege or a commodity. At a time of uncertainty in health care reform, Congress should take guidance from these human rights principles:

1. Universality: This means that everyone in the United States has the human right to health care. Reform measures should ensure that every person has access to comprehensive, quality health care. No one should be discriminated against on the basis of income, health status, gender, race, age, immigration status or other factors.

2. Equity: This means that benefits and contributions should be shared fairly to create a system that works for everyone. Health care is a public good, not a commodity. Gaps in the health care system should be eliminated so that all communities, rich and poor, have access to comprehensive, quality treatment and services.  Publicly financed and administered health care should be expanded as the strongest vehicle for making healthcare accessible and accountable.

3. Accountability: This means that the U.S. government has a responsibility to ensure that care comes first. All players in the health care system, whether public or private, have human rights obligations, and must be accountable to the people.  The U.S. government is ultimately responsible for ensuring that both public agencies and private companies make health care decisions based on health needs, not on profit margins or other factors.

These principles are endorsed by Amnesty International, USA as well as other organizations.

Amnesty also believes that public programs are the best vehicles for making health care accessible and accountable, and they should be expanded and strengthened.  Medicare treats health care as a public good, rather than as a commodity or a privilege.  Medicaid and community health centers help ensure that all members of our society have access to care, regardless of ability to pay. These programs also fight inequities that hurt women, who face disproportionate barriers to obtaining private health coverage.        The political landscape has changed, but what we’re fighting for has not – the human right to health care.  Although President Obama has urged Congress to pass the health care legislation on the table, the future of reform remains deeply uncertain.  Last week’s special election in Massachusetts has forced Congressional leadership to chart a new course.  With current proposals in question, now is a crucial opportunity to move.  We must push for simple yet meaningful reform measures that will bring us closer to making the human right to health care a reality for all in the United States.  Support health care reform that serves the public good, not the insurance companies.   Expand Medicare, Medicaid and community health centers.

We are in an uncertain moment in the fight to reform American health care. This is not the time to wait and see.  Let’s remind our elected officials what progress looks like.  It’s time to keep fighting for health care for all.

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The long road from surviving to thriving

By Sisters Marilyn Lacey, RSM and Kathleen Connolly, RSM

Sister Marilyn Lacey, RSM, the Executive Director of Mercy Beyond Borders, wrote:  “The current debate raging around health care reform in the U.S. prompts me to reflect on the health of the women and girls in Sudan whom I have come to know through Mercy Beyond Borders. ‘What type of health insurance system would you prefer?’ is a question never asked in South Sudan. There is no debate.  Why?  Because, quite simply, there is no health insurance whatsoever. And for most of the people, there is little or no health care, either.  It is common for a woman to walk 6 or 7 days to reach a rural clinic or for a seriously injured person to ride atop a lorry jostling through the bush for 8 hours to get to a distant hospital – which may or may not have the needed personnel or medicines.”  Mercy Beyond Borders is addressing these problems.

Emma Ross, medical writer for the Associated Press, has described Southern Sudan as “one of the poorest and most neglected areas on Earth, with possibly the worst health situation in the world.”

There is, in essence, no health care system. Foreign humanitarian agencies provide nearly all of the doctors and medicine. Three surgeons serve southern Sudan, a span of 80,000 square miles (one and a half times the size of Iraq). The number of proper hospitals can be counted on one hand, and in some areas there is just one doctor for about 500,000 people. War has displaced much of the population and prevented a proper census, but experts estimate that 6 to 8 million people now live in the region.

“This really is the forgotten front line when it comes to health,” said Francois Decaillet, a public health specialist at the World Bank who has 20 years of experience in Africa. Southern Sudan has the world’s highest rate of maternal death by childbirth. Diseases which have been eradicated in most parts of the world remain stubbornly common in Sudan: guinea worm, Hansen’s disease, tuberculosis, polio.  And even now, 4 years after the signing of the peace agreement that ended the North/South civil war, gunshot wounds rank as the #1 “presenting problem” of patients appearing for clinic treatment.

What can be done?

The fledgling government of Southern Sudan is building clinics and attempting to set up an infrastructure for health care.  That will be a long process and ultimately a fruitless one unless Sudanese students themselves can train for health careers. Mercy Beyond Borders is now launching two new programs to improve the situation:

1. Nursing Scholarships and Internships:  Mercy Beyond Borders supports the academic training of young women graduating from 12th grade who wish to pursue careers as doctors, nurses, midwives or nurses’ aides at local colleges.  MBB also underwrites yearlong internships for young adults interested in nursing who need practical work in a medical clinic to qualify them for entrance into a nursing school.  Sister Angela Limiyo, recovered from the gunshot wound she suffered in a random vehicle ambush in Sudan earlier this year, has graciously offered to supervise interns willing to work with her at the remote Kuron Clinic in Eastern Equatoria, Sudan.

2. Women’s Health:  Mercy Beyond Borders began its Women’s Health Outreach workshops in villages in and around Narus during September.  Sister Kathleen Connolly works in partnership with Anna Mijji, a Sudanese woman who knows the local area and its Toposa people and can negotiate the protocols (e.g., permissions from local chiefs) essential for a successful program.  Kathleen and Anna are conducting half-day workshops to teach basic health practices to the women:  Wash your hands. Boil the water. Cover the food.  These health habits may seem obvious, but they are challenging to implement in regions where both water and firewood are scarce and burdensome to obtain each day.

Sr. Kathleen described what pure gratitude looks like.  Immediately after a torrential day-and-a-half rainstorm (the first real rain in two years, welcomed by everyone in that drought-stricken region), they conducted the first women’s health workshop in the town of Narus. This is her description:

“At first we thought the workshop might be canceled due to the rains, but no, the show went on when we learned that 30 women had assembled and were waiting for the training to begin…. We wound up walking in absolute muck twice to and from the compound and the workshop site because we underestimated the number of women who would come and I had to go back [about 1/2 mile] to get more cups and soap.

Twenty-five Toposa women came, not counting their children, and 5 more straggled in at the end.  I mimed a little scenario of what happens when you DON’T wash your hands before eating.  The women actually clapped, and I curtsied.  Two Sudanese women and I taught as a team for 45 minutes and then there were animated questions and comments… Afterwards, while we were doling out maize flour into large plastic cups for each woman, all the women spontaneously erupted into song, and after we gave each some soap they started dancing.  I wish I’d had a camcorder.  I had forgotten what pure gratitude looks like. Next week we are to go into the bush to another small village….”

Postscript:  Kathleen was bitten recently by a scorpion that had nestled in the clothes in the suitcase in her tukul.  “Never have I experienced such exquisite pain,” she wrote.  What an understatement!

For more information, please visit Mercy Beyond Borders at

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