Post Hospital Issues: Hospitalization-Associated Disability

In a recent article in the San Francisco Chronicle, Dr. Edgar Pierluissi brings to light an issue that many people are unaware of. It is an interesting “paradox” as Pierluissi puts it that seniors can be in no better place than a hospital for identifying, treating and monitoring illnesses, but that hospitalization “accounts for about half of all new-onset disability and worsening of existing physical disability in people older than 70.” The onset of disability or worsening of existing conditions is called “Hospitalization-Associated Disability.” <img alt=”elderinhospital.jpeg” src=”” width=”275″ height=”183″ align=”left” hspace=”10″ vspace=”10″ /

Causes of Hospitalization-Associated Disability
Elderly patients encounter numerous hazards during hospitalization.There are physical hazards such as bed or pressure sores, adverse drug reactions, and bowel or bladder dysfunction. Psychological hazards include confusion and depression. These hazards alone or combined can contribute to new or increased disability and a loss of independence according to Pierlussi. Doctors, patients, and relatives fear that an individual enters the hospital for treatment of an illness, but leaves disabled and no longer able to live alone.

Many elderly patients are unable to exercise in hospitals either due to the illness or due to existing disabilities. Other patients are unable to exercise because they were put on bed rest by their doctor. This lack of exercise leads to a rapid loss of muscle strength for people over the age of 70. The article in the Chronicle states that patients over the age of 70 “lose more than 15% of their muscle strength with 10 days of bed rest.”

This is an alarming statistic. Hospitalization-associated disability sets in quickly and can have a devastating impact.

Improvements: “A.C.E.”

A.C.E. stands for Acute Care for Elders. San Francisco General Hospital adopted A.C.E. as a way to prevent hospitalization-associated disability in elderly patients. There are four basic features to the ACE approach as outlined by Pierlussi:

(1) Interior designs that make hospital units easier for older adults to use
(2) Patient centered care
(3) Early planning for discharge
(4) Careful daily review of medications and procedures

Pierlussi points out that the “heart of the program” is feature (2); Patient centered care. San Francisco General uses teams of providers consisting of therapists, doctors, pharmacists, dieticians, social workers and nurses to assess and assist the patients in a number of ways. The rehab therapists make sure patients are exercising in one way or another. The pharmacists work to make sure the correct medications and dosages are being administered while the dieticians ensure that patients receive a healthy diet while hospitalized. These same team members also work to establish goals for each patient to keep the patients psychologically engaged and to monitor progress. The care goes beyond the hospital since the team also develops a post hospitalization plan for each patient. ACE has worked to send more patients home rather than directly to nursing facilities; a chief concern for this program.

Where to go from here?
Our elder neglect attorneys are always looking for ways to help educate elders and their loved ones on ways to avoid mental and physical disabilities that can result from neglect or abuse. Every hospital does not have an ACE unit. The article points out and we agree that patients and their loved ones can take actions similar to that of an ACE unit. Patients and their families should take an active role in discussing the hospital’s plans for performing tests, administering meds, monitoring progress and crafting a plan for post discharge. Family members should help patients feel more at ease or at home in the hospital to help minimize the mental strain a foreign surrounding creates. Family members need to understand the dangers faced by newly discharged patients.

It is important to prevent a patient from developing new disabilities or from losing a sense of independence while hospitalized and then later when recovering at home. At this later stage of life, physical and mental disabilities can become permanent much more quickly than in earlier stages.

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Firm At Center of Meningitis Outbreak Had Similar Problems in 2004

News about the pharmaceutical compounding firm at the center of the latest meningitis outbreak continues to pour in. As we reported, well over a hundred cases of meningitis have already been identified in various states across the country as a result of steroid injections that were tainted, allegedly by the pharmaceutical compounding company. Over 17,000 vials of the product were sent into the marketplace, according to various reports. Of that group, at least 13,000 may have been used in different clinics, including in Illinois. Those who received the drugs are at risk of developing a rare and dangerous fungal meningitis. Several cases have already resulted in deaths.

Past Problems
This week the Tennessean reported on new information related to past problems that the very same company had a few years ago involving meningitis contamination.

The report indicates that eight years ago the company was implicated in an individual’s meningitis death. The man’s widow filed suit claiming that the steroid injection in his back caused the meningitis and ultimately led to his death. The man died in early 2004, and the subsequent lawsuit was settled the following year. As is commonplace with many negligence settlements, the terms of the agreement were confidential.

In addition, according to state records, complaints were also lodged against the company in 2002. Eventually that complaint led to a consent decree in 2006 that required the company to undergo a full inspection of its compounding procedure. That prior inspection was done in conjunction with the state and the U.S. Food and Drug Administration.

Illinois Meningitis Outbreak
Local residents are likely wondering if they or someone they know might be affected by this outbreak. It is important to note that at least three clinics in our area have acknowledged that they gave patients injections of the epidural steroid at some point between July and September of this year. Those clinics are three APAC Centers for Pain Management. One is at the Thorek Hospital Professional Building in Chicago. Another is the APAC in Lincoln Park. And the third is in the Prairie Medical Building in Westchester, Illinois.

All patients who show any symptoms of the meningitis are advised to seek medical help immediately. Several people have already died as a result of this situation, and so it is critical to act promptly. Some common signs include stiff neck, headache, nausea, and sensitivity to light. In addition, stroke related signals may also be caused by the fungal meningitis, such as slurred speech and mobility problems on one side of the body. Importantly, you do not have to show all of these symptoms—even one or two are cause for alarm. The prudent step is always to visit with medical professionals to ensure you receive quick treatment if necessary.

In addition, be sure to protect your legal rights in the aftermath of this incident. The injury attorneys at our firm are working with those affected to ensure they are compensated for any losses they incur and to demand that the compounding firm be held responsible.

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Recognizing Risks Before a Knee or Hip Replacement

Many seniors in Chicago and throughout Illinois face mobility problems. To help, full knee and hip replacements are often recommend by medical professionals to ease various ailments that affect those joints. When successful, the replacements can offer welcome relief to seniors who have spent years faced with pain and movement issues.

However, like all medical procedures, it is absolutely critical for community members to understand the risks of each operation. All medical treatment has some risk, and that is why it is critical for patients to be informed about their options before going forward. Of course, at the end of the day it is up to the patients to decide if they want to go ahead or not. But just because the patient has the ultimate say does not mean that doctors and medical professionals are not without some obligation to provide accurate information about those risks, taking them into account when making recommendations to the patient.

Failure to Identify Risks
A recent article from the American Medical Experts touched on this subject. The authors noted how some medical professionals often fail to recognize the risks–that failure can sometimes be a breach in the basic standard of care owed to medical patients. The key for legal purposes is identifying whether a complication following a procedure could or should have been prevented.

For example, one of the most common complications faced by seniors–including many nursing home residents–is peri-operative infections. This refers to infections that arise during an operation, though it often describes things that occur during admission, anesthesia, surgery, as well as recovery.

The article notes that these infections related to hip and knee replacements are serious, “resulting in significant morbidity, including pain, loss of function, and potential removal of the prosthesis.”

They go on to note that certain factors make that infection more likely. It is critical for medical professional to take those increased risks into account to try to prevent the infection–failure to do so may be a sign of malpractice. When it comes to knee and hip replacement operations, those factors which increase the risk include obesity, extended operation time, smoking, cirrhosis, prior infection, and others.

The authors note that for legal purposes the standard of care for these operations requires the primary surgeon–not just the referring primary care physician–to determine those risks factors. Once identified, the doctor needs to discuss these risks with the patient, explaining how they influence the probability of a post-operative infection. Negligence might be at issue if that discussion does not happen and if complications develop. The medical patient has the right to be fully informed in these cases–making their ultimate choice based on full and accurate information provided to them by their medical professional.

The bottom line lesson for local residents is that there are time when an infection following one of these surgeries could and should have been prevented. Malpractice is not always at play following these complications, but there are certain occasions when the patient suffers because doctors did not properly take risk factors into account.

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What Is Fungal Meningitis?

Yesterday we discussed the latest news related to the meningitis outbreak connected to a now-recalled spinal steroid injection. We noted that over a hundred people have already been infected with fungal meningitis as a result of the steroids, eight have died, and thousands may be at risk of exposure.

The Centers for Disease Control and Prevention explain that the contamination has been identified as originating at a pharmaceutical compounding center in New England. From there over 17,000 vials were sent to 23 states between July and September, including Illinois. A press release from the Illinois Department of Public Health noted that three APAC Centers for Pain Management facilities provided the affected spinal steroid shots to patients. They include: clinics at the Thorek Hospital Professional Building in Chicago, the Prairie Medical Building in Westchester, and the APAC Lincoln Park.

It is critical for those patients who may be affected to follow appropriate medical advice. In addition, it may be important to seek out legal help if you are affected. Serious injury, and even death, is possible with contamination, and so it is critical to act in a timely fashion to ensure accountability and redress.

Fungal Meningitis
Since learning about this situation, many have began investigating what exactly fungal meningitis is and how to recognize it. The CDC website on the illness provides some helpful context. According to the site, fungal meningitis is not contagious. Instead it is usually acquired by the spread of fungus internally, with the fungus having been introduced directly into the central nervous system.

Meningitis itself refers to an inflamed protective membrane covering the brain. With fungal meningitis, the inflammation is caused by a fungus–instead of a virus or bacteria. Fungal meningitis is very rare overall, as most cases of meningitis are connection to other pathogens.

In most cases, those with weakened immune systems are most at risk –like those with diabetes, cancer, or AIDS. Many seniors also have weakened immune systems, which may mean that the danger posed by the infection is higher.

The CDC lists a string of signs and symptoms which indicate that one might have the infection. These include stiff neck, nausea/vomiting, headache, fever, and a sensitivity to light. In addition, some reports have suggested that the meningitis may be connected to “stroke-like” symptoms, such as slurred speech or numbing to one side of the body.

As the string of recent deaths indicate, the meningitis is not something to be taken lightly–it can be quite serious. However, treatments are available to help fight the fungus. In most cases, the CDC notes, the treatment involves a prolonged series of antifungal medications. Those with weaker immune systems often need longer treatments in order to fully beat back the condition.

Right now the CDC is coordinating a multi-state investigation to get to the bottom of this specific problem. Recent releases from the Center note that some of the patients have had strokes connected to the meningitis–several of those proved fatal. In addition some of the infected patients were found with a fungus that is commonly found in the environment without causing meningitis.

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Health Officials Warn of Meningitis Outbreak — 13,000 May be Affected

Besides facing basic day-to-day life challenges as a result of various age-related medical conditions, senior residents face increased long-term consequences from medical issues that affect people of all ages. There is a reason that seniors are the first ones urged to get flu shots then they become available–because contracting the flu can have more serious long-term consequences on seniors than other community members. Their bodies are often less able to fight back against the condition.

It is for that reason that local seniors and their family members should take notice of a new national health crisis that is making news across the country this week–a meningitis outbreak. According to a story on the issue from Reuters today, health officials are scrambling to get a handle of the situation which ultimately may affect thousands of people across the country.

Thus far, the U.S. Centers for Disease Control and Prevention notes that at least 105 cases have been identified in the last few days–every day seems to bring a few more cases. Sadly, at least eight people have died already as a result of the situation.

The Cause
The first step for those addressing the problem is to raise awareness of the outbreak so that those who might be affected receive the treatment that they need to deal with the deadly problem.

But officials are already honing in on the underlying cause of the outbreak. As usual, negligent practices by a large company placing thousands at risk may be at the bottom of it. Unfortunately, attorneys working on cases like this know all too well how the drive for profits often pushes businesses (or individuals) to cut corners and otherwise risk the lives of those who are counting on them. It is that same dynamic that is at play in so many nursing homes, where care is substandard as a result of skewed profit-motives by owners and operators.

In this meningitis cause, officials have traced the problem back to a pharmaceutical company in Massachusetts. This is a “compounding pharmacy” which means that it takes medications made by others and makes them into specific doses for use in various capacities.

According to reports there are three lots of a steroid–methylprednisolene acetate–that were exposed to the rare form of meningitis. The drug is a painkiller that is primarily used in the back. It is used by medical professionals in a wide range of cases. From June to September of this year the company allegedly shipped over 17,600 vials of the steroid to dozens of facilities across the country. The steroid has since been recalled, but not before at least 13,000 patients were exposed to the dangerous drug.

Calls for Investigation into the Meningitis Outbreak
Naturally, many outraged community members, health officials, and patient advocates have called for detailed investigations into the company involved in this situation Unsurprisingly, investigators have already noted that the business faced various complaints in the pat for their practices which might have placed patients at risk.

In Chicago and throughout Illinois it is critical for seniors–and all citizens–to be on the lookout for possible signs or symptoms of meningitis. It is important to talk with medical professional immediately if you suspect that you or someone you know might have been affected by this situation. In addition it is critical to seek the counsel of an experienced lawyer to help with the legal end of the ordeal. The attorneys at our firm are standing by to help all those harmed receive fair redress.

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“Retalitory Discharge” Claims Against Nursing Home

Virtually all those who work closely on elder care issues agree that “front line” care workers are the most important individuals affecting the quality of care that residents receive in long-term care facilities. These are the dedicated employees who work day in and day out directly with seniors. They do the actual work–helping to groom, dress, feed, and transport seniors. They also provide the activities, social interaction, and basic medical care that the residents need. Lawyers, advocates, and others universally agree that a large, trained, dedicated cadre of direct line care workers is one of the best ways to ensure seniors receive the care they are entitled at these facilities.

Unfortunately, that is not always the case. In fact, it often is not the case. And it is usually not because the care workers are not dedicated, hard-working individuals. Instead, the problems are usually rooted in nursing home owners and operators trying to maximize profits by cutting staffing levels, compensation, and resources to those care workers. In many ways, when large-scale disputes at these facilities arise, the residents and direct-line care workers are on the same side–fighting for a better balance between resources committed to ensuring quality care and profits for the facility.

This antagonistic relationship between front line nursing home care workers and management sometimes boils into employment law litigation. This is particularly true when care workers stick up for residents and are punished as a result.

Retaliatory Firing Claim
For example the Madison-St. Clair Record recently reported on a new claim by a former nursing home employee in Illinois who claims that she was fired about reporting concerns about neglect at the skilled nursing facility. The complaint that the former employee filed in the case notes that, on the very day that she filed a neglect complaint with the Illinois Department of Health, she was fired by the facility.

Of course, it is important to get a full understanding of all of the issues in this particular case before making any judgments about the merit of the employment claim. Those details will undoubtedly be brought to light as this particular case unfolds.

However, the situation is a reminder of the complex issues involved in many nursing home neglect cases. Rarely is it as simple as one employee intentionally abusing a resident. Instead, quality of care problems can typically be traced back to facility owners and operators misplaced priorities. Too often the most well-intentioned caregivers are simply incapable of providing the level of care to each resident that they want because of chronic under staffing problems. While this is not acceptable, it is unfair to always pin the problem on direct line care workers. More often than not, the misconduct can be traced to those making profits at the facilities deciding to keep their profit levels high in exchange for decreased quality of life for residents.

If you know of any residents in the Chicago-area or other parts of Illinois who might be affected by this sort of dynamic, please get in touch with the attorneys at our firm to see who we can help.

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New Medical Study on Long-Term Consequences of Pressure Sores

Perhaps no single medical problem is more closely tied to neglect or abuse in nursing homes than pressure sores. As those familiar with elder care treatment and long-term care quality understand, pressure sores are serious skin breakdowns that occur when residents are not properly cared for in various settings: including nursing homes and hospitals. The lawyers at our firm have worked with countless residents in Chicago and Illinois whose loved ones developed bed sores while under the care of others. Inadequate care which leads to these injuries is never acceptable. Fortunately, the civil law provides an avenue to hold those negligent caregivers and facilities accountable. That accountability is one of the best ways to fight the problem in the future, and prevent more residents from having to face the consequences.

A new study points out just how serious the consequences might be for those who do not receive the care to which they are entitled and develop the sores.

Pressure Sore Research
The UCLA Newsroom shared information this week on new research which examined the possible connections between pressure sore development in hospitals and long-term harm. This study did not look specifically at nursing homes. However, the lessons about the harm caused by these preventable injuries is universally applicable, no matter where the neglect which leads to the damage actually occurs.

Researchers looked at the records of 51,000 Medicare patients who were hospitalized in 2006 and 2007. They used the data to determine who developed pressure sores while at the facility and compare that with the long-term outcomes for those patients. This represents a unique approach to investigating this issue. That is because, there is no single database from which to cull information about pressure sore development. In that way it is hard to find reliable information about the long-term consequences. Much of the damage is swept under the rug or ignored.

In this case researchers took a look at data involving “adverse events” or “unintended harm” within Medicare patients. This allowed them to better identify pressure sore development rates and patterns. It also allowed them to track the long-term consequences of those injuries.

What did they find? The data was clear in that those who developed pressure sores were more likely to stay in the hospital longer, be readmitted within 30 day, and they were even more likely to die at the facility. Specifically, the data reveal that about 4.5% of senior hospital patients developed a pressure sore while at the medical facility. The most common site of development for these sores was the tailbone. Other common areas where they arose were the hip, heels, and buttocks.

All of his has led the researchers to reinforce the need for clear-sighted prevention efforts. One noted, “This is a serious issue, and we now have data that can help the health care system address this ongoing problem.”

The lesson for all senior caregivers–whether in a hospital, nursing home, or other settings–is clear: Pressure sores have serious, life-threatening consequences. Reasonable care demands that steps be taken to lower those risks and keep seniors safe.

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CMS Program to Lower Hospital Readmission Rates

As discussed earlier this week, the federal Centers for Medicare and Medicaid Services (CMS) is in a position to exert significant influence over quality of care at nursing homes. That is because most facilities depend on receiving payment from the CMS programs covering seniors without the means to pay for nursing home care on their own. For this reason, CMS has requirements, incentives, and programs aimed and getting facilities to provide better care to both improve senior lives and lower overall long-term care costs.

Minimizing Nursing Home Neglect
For example, last week CMS officials announced the start of a new program aimed at lowering avoidable hospitalizations of nursing home residents. When senior residents are abused or neglected, they often require hospitalization to treat the consequences of the mistreatment. It is not uncommon for those hospitalizations to drag on, as senior bodies are often frail–complications are common. Those hospitalizations are quite expensive. Minimizing readmissions to hospitals is therefore a key cost-containment effort.

According to the press release announcing the new CMS program, the Center is starting a new initiative with 145 long-term care facilities. The program “will test models to improve the quality of care and help reduce avoidable hospitalizations among nursing facility residents by funding organizations that provide enhanced on-site services and support to nursing facility residents.”

As part of the initiative CMS will partner with seven separate organizations to implement various techniques. Each partner organization represents a group within a different state. Illinois is currently not participating in this effort. However, depending on the success of each effort, it is likely that certain aspects of the trials will be rolled out nationwide, affecting nursing homes in Chicago and throughout Illinois.

CMS officials explain that the seven organizations will have staff on-site at each of the 145 participating nursing facilities. They staff members will “provide preventatives services as well as improve assessments and management of medical conditions.”

A key component of the effort will involve better transitions of care. Many seniors experience significant problems when first moving from the hospital to the nursing home and vice versa. In addition, new technologies to monitor care and identify problems early-on will be leveraged. As with all medical treatment, preventative care for seniors is far cheaper than emergency services.

All of these efforts will be vigorously monitored using external evaluations. The idea, of course, is to determine conclusively which programs work and which ones don’t. The winners will be saved and likely applied in facilities across the country.

It is no wonder why CMS is taking this step. According to the release, nearly 45% of all hospitalizations among those who are dual Medicare-Medicaid enrollees (usually the most chronically ill seniors) is avoidable. This represents a huge unnecessary financial expenditure. According to CMS estimates, if those avoidable hospitalizations were eliminated last year alone, between $7 and $8 billion would be saved. Considering the tight financial picture for the state and the federal government, savings of that size must be pursued at all costs.

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“Senior Gateway” Aims to Educate Seniors and Their Families

The Sacramento Business Journal reported today on a new website that the California Department of Insurance launched in order to help educate California seniors. The article highlights a few aspects of the new site called “Senior Gateway”, but once you visit the site, you see that it has a lot to offer to not only seniors, but their families, caregivers and representatives as well.

Here are a few bullet points outlined by the Sacramento Business Journal for what “Senior Gateway” offers:

*Avoiding and reporting abuse and neglect by in-home caregivers or in facilities
*Preventing and reporting financial fraud, abuse and scams targeting seniors
*Understanding health and long-term insurance
*Locating services and programs available to assist older adults
*Knowing your rights before buying insurance
*Investing wisely and understanding the ins and outs of reverse mortgages

The site is hosted by the California Department of Insurance and sponsored by the Elder Financial Abuse Interagency Roundtable (E-FAIR). Many representatives from a variety of California agencies came together to develop this website. Insurance Commissioner, Dave Jones, stated that, “The goal of this collaborative effort is to assemble, in one convenient location, valuable information not only for seniors, but their families and caregivers.” Jones went on to describe how, “This site will help California seniors find resources and solve problems, and will enable participating agencies to better serve this important segment of our population.”seniors.jpeg

“Senior Gateway”: The Site
The site is exceptionally user friendly. The different pages provide a wide range of information. The Abuse & Neglect page provides contacts to call if you suspect elder abuse. It links to a guide the Department of Justice provides addressing prevention and the reporting of elder abuse. This page also provides links to sites that describe the various forms of abuse and the warning signs accompanying those. The Fraud & Scams page provides information on common scams to look out for, how to avoid scams and additional financial information on common financial scams. The Health Care page provides information on Health Care and Insurance, Medicare and Medi-Cal and Long Term Care. The site also has a page entitled Know Your Rights outlining the responsibilities of insurance companies, health care providers, care-givers, and seniors. The Resources page is an excellent source to access a long list of government agencies and private associations that are all concerned in one way or another with the welfare of seniors.

Our attorneys applaud this step and encourage seniors and their families to utilize this tool. Seniors and their families need to be aware of their rights when dealing with insurance companies, healthcare providers, in-home caregivers and nursing facilities. They need to know the signs of abuse. They need to be aware of the various forms of financial abuse that take place. Oftentimes the news focuses on the physical abuse that takes place and the tragic consequences of physical abuse, but does not emphasize the widespread instances of financial scams that defraud unsuspecting seniors out of valuable dollars. So we applaud this site for tackling all the issues related to the welfare of seniors. This site is brand new so we anticipate there will be additional posts regarding this website and how it is utilized.

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Nursing Home Care, Medicaid, & The Presidential Candidates

What is the biggest insurance program in the country? Medicaid. Nearly 1 in 5 Americans participate in Medicaid, and that total is rising. According to some recent estimates about 11 million more people will be added to the programs over the next decade.

Of course Medicaid is often associated with Medicare, but there is much confusion over the basic roles of these programs.

In theory, Medicaid is suppose to help lower income Americans of all ages while Medicare is healthcare for seniors. However, the reality is that a large portion of Medicaid costs are actually spent on senior care as well–most notably long-term stays in nursing homes. That is because Medicare usually only covers limited nursing home stays–often 90 days–and only those directly from the hospital. Long-term care for seniors that have significant disability is usually not covered. That means that a senior who needs that care is either required to pay for it out of pocket, use private long-term care insurance (if they have it), or try to qualify for Medicaid. Medicaid is based on the individual’s assets. That means that many seniors are forced to “spend down” their assets in order to qualify for the program.

It is for this reason that nursing home compliance with federal Medicare and Medicaid laws is so crucial. If facilities are not allowed to participate in the CMS program–and lose residents on Medicaid–then they often are unable to function.

Possible Medicaid Changes
The connection between Illinois nursing homes care and Medicaid also means that it is important for local residents to follow political developments with the program. Political candidates are often talking about different changes to the system–usually offered in order to save costs. That is obvious in the current Presidential campaign as both candidates often mention Medicaid in their long-term plans for the country.

In the midst of the campaigns spin and confusion, it is often difficult to get a clear idea of what each candidate is actually proposing for Medicaid. A recent NPR segment sought to clarify the issue, offering a straight-forward explanation for each candidate’s position.

The story notes that Governor Romney is proposing more far-reaching changes. Right now Medicaid is a joint state-federal program. Romney’s proposal would change that–giving individual states much more control. The federal government would simply give each state a block grant to use for the program as they wish. In addition, that grant would be capped year over year. Critics argue that the cap is lower than the annual inflation rates, meaning that this proposal would be nothing more than a pay cut for Medicaid providers (hospitals and doctors), which forcing states to do more with less.

Alternatively, President Obama’s Medicaid proposal was a part of the Affordable Care Act. Essentially it allows states to expand coverage to more low income families. The idea is that this growth in Medicaid participation will lower expensive emergency costs while improving the overall health of the community. Critics argue that this does nothing to curb the financial stresses of the program and that it is unsustainable in the long-term.

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