DENVER – Los profesionales de la medicina, entre ellos un médico de Colorado que conoce Medicaid como paciente y además como doctor, están muy preocupados por las propuestas de recortar casi 1 trillón de dólares al programa de salud, lo que podría significar que unos 22 millones de estadounidenses pierdan su cobertura.
La Asociación Médica Americana, la Asociación Americana de Hospitales, la Asociación Americana de Cardiología y otros grupos nacionales se oponen a los planes tanto de la Casa Blanca como del Senado sobre revocar y reemplazar la Ley de Cuidado Asequible, Affordable Care Act.
Los esfuerzos por llevar a cabo este plan se encuentran detenidos por ahora, pero los médicos del estado están preocupados por lo que el Senado de los Estados Unidos propondrá luego del receso del 4 de julio.
Dale Terasaki, médico residente de segundo año en el Campus Médico Anschutz (“Anschutz Medical Campus”) de la Universidad de Colorado, conoce bien el Medicaid ¬como paciente y también como doctor.
“Se trata de gente real, hablamos de que ahora tienen nueva cobertura con la expansión de Medicaid. Yo era uno de ellos. Realmente deberíamos partir del progreso que hemos hecho con la Ley de Cuidado Asequible (ACA). La gente está beneficiándose ahorita, mientras hablamos.”
Siendo estudiante de medicina, a Terasaki le diagnosticaron una condición cardiovascular delicada que requería cirugía de corazón. La expansión de Medicaid evitó que se endrogara con una deuda de más de 100 mil dólares.
Dice que su experiencia como beneficiario de Medicaid le permitió apreciar mejor este programa de salud y le dio una nueva perspectiva de lo que sus pacientes tienen que pasar.
Quienes apoyan la Ley del Senado de los EEUU llamada ley de Reconciliación de una Mejor Atención, dicen que el gobierno no debería meterse al negocio de asegurar pacientes y que las nuevas propuestas reducirán el déficit federal.
Ahora que Terasaki es parte del programa de residentes de la Universidad de Colorado, cuenta con una buena cobertura y no tiene que preocuparse por una potencial bancarrota en caso de otra emergencia de salud. Opina que si la expansión de Medicaid es retirada, los impactos tendrán largo alcance y tanto hospitales como clínicas se verán de nuevo forzados a pagar por atención no cubierta cuando se aparezca en sus salas de emergencia gente que no cuente con seguro de salud.
De acuerdo al Instituto de Salud de Colorado (CHI), el estado podría perder 15 billones de dólares en fondos de Medicaid para 2030.
“Ha sido un gran activo para los hospitales y para nuestra capacitación en residencia. Sacar a la gente, sólo quitándole dinero a un programa que han visto que funciona –y sigue funcionando para millones de americanos–, personalmente creo que no es la solución.”
De acuerdo a la encuesta de NPR y PBS NewsHour, sólo el 17 por ciento de los americanos está a favor del plan del Senado de revocar y reemplazar el Obamacare.
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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.
Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.
Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.
"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."
Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.
Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.
"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."
Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.
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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.
Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.
"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained
Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.
Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.
"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.
Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.
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New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.
The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.
"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.
Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.
Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."
"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.
Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.
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