LINCOLN, Neb. – El plan de Nebraska para expandir la cobertura de salud de Medicaid a unos 90,000 residentes para el 1o de octubre de 2020, está recibiendo críticas. El Departamento de Salud y Servicios Humanos (“Department of Health and Human Services”) dice que el retraso es necesario para hacer actualizaciones tecnológicas y corregir contratos con proveedores.

Los defensores de la salud están lanzando una alarma por la propuesta del Departamento de Salud y Servicios Humanos de Nebraska (“Nebraska Department of Health and Human Services”) para ampliar Medicaid. Molly McCleery, directora del programa de atención a la salud “Nebraska Appleseed”, dice que la fecha propuesta del primero de octubre de 2,020 sería un retraso de 23 meses después de que los electores hayan obtenido la cobertura ampliada.

La ampliación de cobertura en otros estados se llevó a cabo en un tiempo entre 8 y 12 meses, y McCleery dice que Nebraska necesita moverse rápido para asegurarle la cobertura de salud a unos 90 mil residentes que ganan demasiado para calificar en el Medicaid regular, pero no tanto como para comprar pólizas comerciales.

“Esto les exigiría esperar unos dos años más luego de que los electores aprueben iniciativa que les dé acceso a la atención. Son gente que trabaja todos los días, y experimenta las dificultades financieras y las personales por no tener seguro de salud.”

McCleery dice que el retraso, junto con una propuesta para eliminar la cobertura retroactiva, también impacta a los proveedores, que frecuentemente no son compensados por la atención que brindan a pacientes que no tienen seguro ni pueden pagarlo.

McCleery dice que el plan para crear dos niveles de cobertura también impondría barreras innecesarias a la cobertura. Los funcionarios estatales dicen que el retraso es necesario para reforzar la capacidad técnica para la inscripción, para presentar reclamaciones y para modificar contratos con los proveedores.

McCleery está de acuerdo en la importancia de modificar contratos y actualizar la tecnología. Pero argumenta que esos retos no son exclusivos de Nebraska, y quiere ver que la administración del Gobernador Pete Ricketts ofrezca resultados más oportunamente.

“Queremos asegurarnos, como hace el departamento, de que cuando esto se termine esté bien hecho. Creemos que puede hacerse más rápido, pero además bien hecho.”

McCleery destaca que sin cobertura mucha gente retrasa su atención hasta que su condición empeora, lo que puede derivar en costosas visitas a la sala de emergencias. Agrega que el retraso daña también a la economía estatal, refiriéndose a la investigación realizada por la Universidad de Nebraska en Kearney (Carney).

“Calcularon que podríamos ver la creación de 10 mil empleos y atraer billones de dólares en fondos federales. Y todo eso está esperando a que demos un paso hacia la expansión.”

La Propuesta de ampliación está disponible para consulta (en inglés), en https://bit.ly/2IaK6Bk - La investigación, en https://bit.ly/2UpnO5s


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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.

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.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.