The outcome of the Blue Wave of November is starting to be felt. The article, while from Chicago, opens with Washington State and California as examples. In case you haven’t been following, newly elected Governor Gavin Newsome is off to an incredible start. He ran on healthcare as a major issue, and is already starting to deliver.
The Peninsula Daily News (PDN) is reporting that the Trump Administration, against the wishes of hundreds of letters and testimony against it, is slashing Medicare and Medicaid reimbursal rates to clinics more than 250ft away from a central hospital. The new rule is called the “CY (for Calendar Year) 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System”
The rule announcement from July is found at
and the October 30th update is found here:
The goal of the proposed rule was to eliminate patient clinic visits to hospital clinics that charge more than non hospital clinics. The Center for Medicare and Medicaid Services (CMS) claims in it’s press release that, “Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.” They offer no proof to that claim.
The most affected facility for this on the Olympic Peninsula is Olympic Medical Center’s (OMC) offsite clinics in Sequim. Ironically the clinics serve a population that voted for President Trump in the last election and they will, if this rule is not overturned via legislation, be the most effected by it. The chart at the link below shows how various precincts voted in 2016.
The PDN is reporting that payments may be slashed up to 60%, which would apparently make these clinics financially nonviable. Medicare and Medicaid payments today are so lean that many physicians do not take new Medicaid/Medicare patients because they cannot survive on the reimbursal rates.
The outcome of this will be that seniors and the poor will have to travel further for medical care, and that some hospitals, like OMC may be forced to close their remote facilities and possibly even put their main hospitals in financial jeopardy. Hospital closings in the last decade in rural areas have reached new highs, leading to rural areas often being the most under-served areas for healthcare in the country. Forbes magazine, in 2017, had an article that researched the issue and found that “Approximately 2300 rural hospitals are in the United States. Of those, 81 have closed since 2010.” Forbes went on to show how President Trump’s proposed healthcare cuts were putting “673…at risk of closing”. The full story from Forbes is available at https://www.forbes.com/sites/bisnow/2017/07/26/obamacare-repeal-could-cripple-rural-hospitals-and-lead-to-more-closures/#6dbd6b4f42b8
It is not known how this will affect Jefferson Healthcare (JHC) as they have kept their clinics within the required 250 yard rule. They have worked around the issue by setting up their clinics in Quilcene and Port Ludlow in a different legal framework. They claim that they will be less affected.
There have been rumors from healthcare providers that other standalone clinics may be affected, those not attached to a hospital. We will track those as we hear from the community. Your comments and insights are welcome to be sent to firstname.lastname@example.org
What is happening is an ongoing push to centralize healthcare in urban centers and reduce the costs. While healthcare costs are rising, much of these costs are centered in the last years of life. Our insistence on providing all out high cost medical support to terminally ill patients, for example, rather than focusing on expanded hospice care has led to a heavy weighing of costs to end of life medical intervention. From personal experience, I can say that in some locales there seems to not be honest dialogue between patient and provider about the likelihood of a successful outcome, leading to the patient not knowing that they are essentially terminally ill and wanting to continue, under the providers suggestions, with expensive treatment that will only likely extend life a few months.
Medical providers are also, due to litigation costs, often insisting on far more tests than necessary, driving up costs. There is no easy route out of that issue, as patient expectations are not often aligned with actual healthcare scenarios and outcomes. The inability to also properly judge physician history and ratings also make it hard for patients to know when some providers have a history of malpractice.
But the slashing of medicaid and medicare costs to OMC and other hospitals like it, is a cynical ploy by the Trump Administration and Congress to do a stealth attack on these services, one which was highlighted in an article last month.
Larry Kudlow, the director of the Trump White House’s National Economic Council, recently said he wants to take aim at “entitlements” as early as “next year.” A few months earlier, House Speaker Paul Ryan (R-Wis.) said he wants to see policymakers bring the budget closer to balance by cutting “entitlements.” Rep. Steve Stivers (R-Ohio), who currently chairs the National Republican Congressional Committee, made the same argument in August.
And now Senate Majority Leader Mitch McConnell is making the identical pitch.
This all comes after slashing taxes to the wealthiest Americans and corporations earlier in the year.
It is worth remembering that this administration and previous ones have spent approx. $170M a day for 16 years funding the war in Afghanistan. We have the money to fund Medicare and Medicaid at appropriate levels. It’s all about priorities.
Just last month, our legislators from both Clallam and Jefferson counties, including some of our county and hospital commissioners and executives, traveled to Washington D.C. and met with numerous staffers, both at the White House and Congress. Some of them, such as Republican Congresswoman Jamie Herrera Butler, was not in Washington and sent out a staffer who knew nothing of the issues.
It remains to be seen if our legislators can fix this problem in Congress next year. If you want to help ensure it gets done, vote Democratic on Tuesday November 6th. Putting Democrats at least in charge of the House will allow a real debate and bipartisan approach on how this all proceeds. Representative Kilmer, who is up for re-election, along with other Democratic Representatives have been fighting hard to protect rural hospitals. These politicians are not perfect. None of them will agree with all of us all the time. That’s just not how this representative democracy works. But these Democratic politicians in our district have a track record and to elect more Republicans and expect a different outcome seems unrealistic.
Otherwise these kind of cuts are going to continue to come at us, with the outcome being far worse healthcare options for all of us, no matter who you voted for in this election. This is not “making America great again.”
The final rule will appear in the November 13, 2015 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.
Open enrollment for 2019 coverage will run from November 1, 2018 to December 15, 2018.
All counties will have 2019 exchange coverage, but 14 (up from 9 this year) will have only one insurer; average proposed rate increase is more than 19 percent
Washington marketplace highlights and updates
- 2019: All counties will have plans available; Average proposed rate increase is 19.08%
- 14 counties will have just one exchange insurer in 2019, up from 9 counties this year
- 2018 health care legislation mostly fell short; successful bill will help ensure access to exchange plans
- 243k people enrolled for 2018, a record high for Washington’s exchange
- All counties have coverage options in 2018; 9 counties have 1 insurer
- Seven insurers offering plans for 2018
- 36% average rate increase for 2018, due in large part to federal actions
- Lower silver plan rates could be implemented mid-2018 if CSR funding is allocated
What is causing AFM? This is bizarre disease is increasing in the number of cases, and apparently is happening in Washington State.
Hayden Werdal was born “perfectly healthy.” He caught a nasty cold at age 14, and now, four years later, he’s considered a paraplegic and needs a ventilator. Werdal, of Bremerton, has a rare and mysterious illness that’s left Washington families reeling. AFM is spiking, with 127 confirmed or reported cases nationwide this year, including eight in Washington. – Seattle Times
Just today, another case in Yakima:
While this is emerging, Trump has cut the budget at the Center for Disease Control. According to Politifact:
“Among other changes, Trump’s budget would cut $138 million from the program dedicated to chronic disease prevention and health promotion, cut $59.9 million from programs studying “emerging and zoonotic infectious diseases,” and $46 million from a program called “Racial and Ethnic Approaches to Community Health.” A zoonotic disease is a disease that can be transmitted from animals to people.
Remember this as you decide who to vote for. A vote for Republicans is a vote to continue cutting the one agency that might help find a cause for this emerging illness.
This profoundly broken system need massive overhaul. At least the Republicans recognize the issue and have reasonable proposals to come to a bipartisan table to address. Now if Inslee can find the money needed to get this done.
GOP state lawmakers unveil plans to improve Washington’s troubled mental-health system
It is outrageous that the Federal Government has not delivered the monies needed and promised by law to do this. While we spend billions on military gear without batting an eye, women who have been raped in our state (and elsewhere) await justice. Please let Derek Kilmer, Patty Murray Maria Cantwell and others know this needs to get done.
Nearly 6,500 rape kits sit untested statewide, Washington attorney general says
In a high spirited meeting running over three hours, Jefferson County Democrats endorsed all candidates presented on their slate. The entire list can be viewed under the tab at the top of this page, titled 2018 Elections.
The three candidates that drew the most debate were Joe Nole for Sheriff, Maria Cantwell for Senator and Derek Kilmer for House of Representatives.
The debate on Joe Nole’s endorsement came from a group of people who brought up issues that had happened under his temporary leadership as interim sheriff in the months before Dave Stanko’s election. They also discussed issues of aggressive policing, (not by Joe but by officers under his command at that point) and positions that Joe was claimed to have made. They also were in support of Sheriff Stanko. Ultimately, a series of speakers who have worked with Mr. Nole, including outgoing County Commissioner Kathleen Kler, allowed for a clear win for endorsement.
Opposition to Derek Kilmer came from what is known as the “Progressives”, who primarily were supporters of Senator Bernie Sanders. They identified a number of issues that Rep. Kilmer has not taken a stand on, or has supported. Single Payer Healthcare, bills that supported Israel to the exclusion of Palestinians, and his vote supporting the massive recent military budget (HR5515) and tax bills, which far exceeded the demands of President Trump. To be clear, many Democrats ended up supporting the bills as there were numerous items added that they requested. Representative Kilmer also has not achieved anything of substance around the expansion of the Navy airbase and it’s subsequent noise issues for the entire north Sound and Strait. He has done nothing of substance to also protect the west end of the Olympic Peninsula from being used as a Navy training ground with low flying jets over the west side of the Olympic National Park. These issues have engendered huge meeting turnouts and thousands of letters of support for him to take action. However, as of this writing, his efforts have seemed very unsubstantial. Representative Kilmer has been endorsed 100% by Planned Parenthood, Human Rights Campaign, and to a lesser degree, by the ACLU (88%) and The League for Conservation Voters (92%). His entire voting record can be viewed here:
Similar issues were raised about Senator Maria Cantwell. Senator Cantwell did vote no on the Defense Appropriations Act. Senator Cantwell has been endorsed 100% by Planned Parenthood, Human Rights Campaign, and to a lesser degree, by the ACLU (88%) and The League for Conservation Voters (91%). Her voting record can be found at
Supporters of the two argued for Democratic unity in the face of goals to take back the House and Senate, along with positive bills that both had supported. Ultimately, both easily won endorsement.