Healthcare Advocacy - News and Action

May 24, 2023

Happy Wednesday Healthcare Advocates

Please enter requests for research using the comment button at the bottom of this newsletter. Remember our advocacy educates our representatives and lets them know what we want them to do for us.

Items in work are prison healthcare (a hot mess) and rural healthcare (another hot mess).

Universal Healthcare

Last week Rep. Jayapal (WA) and Sen. Sanders submitted their Improved Medicare For All bills to Congress. They are respectively H.R. 3421 and S. 1655. These are links to Congress’ website. The official texts of the bills are not yet available at the congressional website. However, I received two notes from Lori B. who shared with me versions of the bills. Here is H.R. 3421 from Representative Jayapal’s website and Physicians for a National Health Plan (PNHP) had a version of Senator Sanders’ bill. Thank you, Lori!!!!

S. 1655

I spent this morning reviewing Sen, Sanders Medicare for All Bill and comparing it to H.R. 3421.

There are a wide range of similarities. Both cover improvements to the healthcare infrastructure, building new facilities in medical deserts, like rural America, and providing an education budget to bolster the medical workforce where needed.

The senate bill has a 4 year transition to full implementation rather than two year. January 1 after enactment allows for people 55 and above, 2nd year 45 and above etc. The house bill allows people to begin joining 18 and under and 55 and above one year after enactment.

The description of how Medicare changes over the four years is also more detailed in the senate bill. For instance, Part D (prescription) insurance will have a $1500 yearly out of pocket cap as opposed to $2000 in the transition period.

Both plans allocate the same 1% of the budget over 5 years to assist workers displaced by the new legislation - good thinking!!!

Both plans allow for additional optional insurance - like other countries do.

I will continue reviewing over the next few days.

Prison Healthcare

I have been reviewing how this works and found the overall situation appalling. About 159,000 people are in Federal custody. None of these are held in private prisons. The Federal government maintains a pharmaceutical formulary and treatment regimen for a wide variety of illnesses including mental health. It can be accessed here. As best as I can determine medical care is provided by Bureau of Prisons medical employees.

States prisons and jails are another matter. Over the 50 states the amount paid for healthcare per employee varies wildly. California leads the list at almost $19,000/prisoner/year and Louisiana is at the bottom at about $2100/prisoner/year according to the Pew Charitable Trust. At state and local levels there are copays for healthcare, usually small but remember that prisoners make little. Sometimes there are programs to waive copays if a prisoner has no funds. Recall that while work is available to prisoners the wages can be abysmally low. I’ve seen reports as low as $0.14/hour.

About 60% of state prisons and local jails use commercial medical providers for in house medical staff. There are only a few companies involved and there is an inherent problem of having a for profit company provide care. It’s that for profit thing. The less care they provide the more money they make because their contracts are usually written based on the size of the population they serve. Those companies are WellPath, Corizon, NaphCare, PrimeCare Medical and Armor Correctional Health Services. Here is a news article that details examples of medical negligence and related lawsuits by most of these companies.

In one instance a new company took over the contract for one prison and immediately hospitalizations dropped by 50% making them much more profitable than their predecessor. This is really an area that having Universal Healthcare could help.

As I read about these problems, I was curious about the amenable mortality rate. That’s the rate of death from avoidable causes if treatment was available in a timely fashion. According to the Organization for Economic Cooperation and Development, the US was recently at 88 deaths/100,000 population. So for each 100,000 people 88 die who don’t have to die. For state prisons and local jails it is much different. Reuters did an analysis of jail deaths and found that jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates. That’s a rate of 128/100,000 for comparison. Jails with healthcare provided by one of the five companies above had an additional 2.3 to 7.4 annual deaths per 10,000 inmates. That’s between 15.8/10,000 (or 158/100,000) and 20.2 /10,000 (or 202/100,000).

RECAP US population amenable mortality is at 88/100,000, public health in jail is at 128/100,000 and private healthcare in jails is between 158/100,000 and 202/100,000).

HOUSTON WE HAVE A PROBLEM. I know that 40% of individuals in jail have chronic issues like hypertension, heart problems and diabetes but these rates are just sky high and indicate that people are not getting the treatment they need in a timely fashion.

You may ask why jails/state prisons just don’t hire the staff directly and many sheriffs respond that they don’t want the headache of managing more staff in an area that is not their core competency.

I don’t have an action we can take yet, but the problem is in front of us. I will continue researching and report back.

Reproductive Healthcare Update

South Carolina’s legislature has passed new legislation reestablishing its 6 week abortion ban. This is long before most women even know they are pregnant. The governor has promised to sign it. There are now 25 states that ban abortion. Link to CNN article. Let’s reinforce the message to Congress that they need to fix this at the federal level.

ACTION

Call or email your Congressperson and Senators about this. There is a sample text below or use RESISTBOT on your phone by texting SIGN PCXZUF to 50409 to tell them:

“I am your constituent in [zipcode] and I am fed up with women being treated as less than human and capable of making their own choices in life. My doctor and I can decide what is best for me, not self-righteous elected officials who never went to medical school. I want you to cosponsor and support and pass the Women’s Health Protection Act that guarantees the right to abortion nationwide. You are either a woman or are related to one to whom you owe this. Thank you.

While I have your attention, cosponsor the Improved Medicare for All ACT. H.R. 3421 or S. 1655 whichever applies to you. Let’s make sure we can all go to the doctor and be treated. It will lower costs, cover everyone, and make the US much more competitive. Do it.”