|Nancy Anness, a nurse practitioner and the Chief Advocacy Officer for Saint Thomas Health, consults with an uninsured patient at a Saint Thomas medical mission held Sept. 24, 2016, at Municipal Auditorium in Nashville. Anness regularly travels to Washington, D.C., to meet with members of Congress and their senior staffers to share stories of her patients and the on-going need to increase access to health care. Photo by Reiner Venegas|
As the inauguration of President-elect Donald Trump draws closer, health care providers and advocates are concerned about what the future holds for the vulnerable and medically fragile if the Republican-controlled Congress, backed by the president-elect, quickly repeals President Obama’s signature piece of legislation, the Affordable Care Act.
The coming changes could be dramatic, which might be good news to those dissatisfied with Obamacare, but it is worrisome to advocates who have dedicated their careers to helping more people gain access to health care.
Tennessee Justice Center Executive Director Michele Johnson, a parishioner at Christ the King Church, hears every day from people on the margins concerned about their health care coverage. Since the election, “our lines are ringing off the hook. People are really scared they will lose coverage,” said Johnson.
If the Affordable Care Act is dismantled, “I’m worried about the dignity of life being honored if health care goes back to being treated like a commodity, like designer jeans or video games,” said Johnson. Catholic teaching regards health care as a basic human right, and has long supported adequate and affordable health care for all.
The Affordable Care Act, with all its glitches and shortcomings, has ultimately helped millions more Americans purchase affordable health insurance and gain better access to health care. Since the ACA was enacted, Tennessee’s uninsured rate has dropped from 9.2 percent in 2012 to 5.5 percent in 2016.
Nancy Anness, a nurse practitioner and the Chief Advocacy Officer for Saint Thomas Health in Nashville, has seen first-hand the benefits of a better-insured population. More people are getting preventive care, like mammograms and annual pap smears, and better management of chronic health conditions like diabetes, she said. “It’s really good to see people get consistent care.”
Anness, a parishioner at St. Ann Church, is concerned about what might happen if Congress repeals the Affordable Care Act without a solid replacement plan in place. “We want to advocate for a smooth transition,” she said. “We want to serve as a resource for Congress and the Trump administration,” she said, “to help develop a 21st century health care system, and make sure no one remains in the gap.”
An estimated 280,000 Tennesseans still fall in the health insurance coverage gap because their income is not low enough to qualify for TennCare, Tennessee’s Medicaid program, but they make too much to qualify for financial help to buy insurance on the Marketplace exchange through the Affordable Care Act.
Health care advocates with the Tennessee Justice Center, which helps families access health care and works to reform national health policy, encounter stories from Tennesseans “in the gap” every day: working parents, students, veterans, shift and service industry workers, many with chronic health conditions but no insurance.
“We want to shape a policy that respects the dignity of these people’s lives,” said TJC’s Johnson. Too many Americans are just an illness or injury away from exorbitant medical debt or bankruptcy, she said. “Pope Francis urged new leaders not to forget the poor. They are the most vulnerable. Their lives are most at risk.”
While Trump has said that he favors keeping certain ACA planks in place, such as covering people with pre-existing conditions, he has indicated that he would eliminate one of the plan’s central features, the individual mandate. The mandate, which requires all Americans to have a health policy or pay a fine, is integrally related to other provisions, said Johnson.
All the different aspects of the Affordable Care Act and how they work together are complicated, Johnson said, and she and the TJC are working to educate citizens across the state about it. “We’re navigating complex terrain,” she said. “We want to make sure everybody in the state understands what’s at stake.”
While the issue of health care has become highly politicized, with the ACA regarded as either Obama’s greatest achievement or biggest failure depending who is polled, the Tennessee Justice Center strives to put a human face on the issue. They encourage people to share their stories so that those elected to public office can understand the human impact of their action, or inaction, on the issue. “We need to put pressure on our elected officials to lead on this issue,” Johnson said.
Anness, as part of her advocacy work on behalf of Saint Thomas and Ascension Health, regularly travels to Washington, D.C., to meet with members of Congress and their senior staffers to share stories of her patients and the on-going need to increase access to health care. Over the years, she has consistently advocated for a better health care delivery system for the nation, one that respects life, is efficient, cost-effective, and leaves no one out. “We want a plan that will give access to all people,” she said. The question is, “How can we do this in a fair, just and compassionate manner?”
Advocating for ways “to decrease costs, make health care more accessible, and offer dignity at every stage of life,” Anness offers some ideas about improving health care. One would be reimbursing health care providers based on quality of care delivered instead of a fee-for-service model. “Care should be value-based, not volume based,” she said.
She also noted that broader and more uniform implementation of electronic medical records could help prevent duplicate tests and create cost savings.
One innovative program that has helped improve health outcomes and keep costs down is Saint Thomas’ Mission Point Health Partners, an accountable care organization that uses complex data analysis to focus direct resources on high-cost and high-risk members. This “population health management” approach, for example, assists patients after their hospital discharge to make sure they have all appropriate medication, access to healthy food, and transportation to follow-up appointments. This can reduce emergency room and re-admission visits. “It’s an innovative way to save money,” Anness said, and helps ensure better health outcomes.
Mission never changes
Anness sees patients at one of Saint Thomas’ family health clinics near the hospital’s Midtown campus, many of whom have TennCare, Medicare, or still lack insurance and qualify for charity care. No matter what happens in the future regarding health care, “we will continue to be here as a safety net to take care of people,” Anness said. “Catholic health care has been a safety net in this country for hundreds of years.” Saint Thomas was established in Nashville by the Daughters of Charity in 1898, but a vibrant Catholic health ministry in the United States dates back farther than that.
Saint Thomas and its parent organization, Ascension Health, the world’s largest Catholic health system, gives special attention to those living in poverty and those most vulnerable. In the fiscal year 2016, Ascension provided more than $1.8 billion in care of people living in poverty and other community benefit programs.
Even though health care advocates are highly concerned about what might happen if the Affordable Care Act is gutted, they remain hopeful that something better might emerge from the coming shake-up. “Repeal and replace” proponents promise that a new health care plan will be better, “and we hope it will,” Johnson said. “We want to re-build something as strong as possible that reflects our values.”
“In the midst of uncertain times,” Anness said, “it’s so good to know our faith and the God we serve never changes, and our goal to have health care that leaves no one behind never changes.”