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The uninsured rate among veterans less than age 65 declined by nearly 40 percent during the first two years of the Affordable Care Act (ACA), according to a new study by the Urban Institute with funding from the Robert Wood Johnson Foundation.

The uninsured rate fell from 9.6 percent in 2013 prior to ACA, to 5.9 percent in 2015, according to the report. Approximately 429,000 veterans gained coverage, and the gains were broad-based across demographic groups.

Among veterans ages 45 to 54 and those who served in the era between the Vietnam and Persian Gulf wars, the uninsured rate dropped by almost 50 percent.

Before the ACA’s implementation, nearly one million veterans — almost one in 10– were uninsured, the study said. By 2015, the number of uninsured veterans fell to 552,000.

While many veterans have access to healthcare through the Department of Veterans Affairs, not all use or qualify for these services, the report said.

The study found that Medicaid expansion also helped to lower the uninsured rate for veterans. The uninsured rates in 2015 averaged 4.8 percent in expansion states, compared to 7.1 percent in states that didn’t expand the program. Iowa is one of 31 states that have expanded Medicaid.

For veterans with incomes up to 138 percent of the federal poverty level and eligible for Medicaid in expansion states, the uninsured rate dropped by 43 percent.

Veterans’ families also benefited from ACA, the study said. Using data from the 2013–2015 American Community Survey, researchers found uninsured rates for veterans’ spouses dropped from 9.2 percent in 2013 to 5.5 percent in 2015 and from 4.5 to 2.9 percent for their children.

Among black and Hispanic veterans, uninsured rates fell from 10.6 to 6.5 percent and from 11.0 to 7.1 percent, respectively, by 2015.

“The coverage provisions of the ACA have led to a 40 percent decline in uninsurance for non-elderly veterans,” said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation. “Expansion of Medicaid in remaining states would increase those gains.”

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Craig Morgan (center left) with some members of his care team: (left to right) Chelsea Apland, a Friendship Ark Homes coordinator; Gina Smith, RN; Carrie Adams, BSN, RN, clinical supervisor for cardiac rehab, and Andy Nichols, a Friendship Ark Homes supervisor.

Something was clearly wrong with Craig Morgan. Those closest to him could sense it. He wasn’t himself. He seemed tired and confused.

Craig, unfortunately, couldn’t really explain what he was going through. A resident of Friendship Ark Homes (FAH) in Ames, Craig is an adult with intellectual disabilities. While his communication skills are limited, he’s an endearing guy, agreeable almost to a fault. His response to any question is often, “Yeah,” accompanied by a big smile.

His well-being depends on those who know him best being able to read his moods and actions, and, by doing so, help others provide Craig what he needs.

“Craig is eager to please. He’ll always say ‘yes’ and can feign understanding whether he has it or not,” says Andy Nichols, a supervisor at FAH who has known Craig for years. “That’s a big part of working with Craig in the community – helping him understand and helping others understand him.” This was vitally important when Craig was brought to McFarland Clinic and then to Mary Greeley in early August.

“His spirits were fine,” says Nichols. “He was a little more confused than normal and over the weekend had become very weak and tired. We thought he might have pneumonia.”

From McFarland, Craig was sent to Mary Greeley’s emergency department for immediate tests. It wasn’t pneumonia. Craig had experienced a heart attack.

Diagnosis and Big Decisions

Craig was admitted to Mary Greeley’s intensive cardiac care unit (ICCU). The next day, he underwent an angiogram performed at Mary Greeley’s cardiac catheterization lab by Iowa Heart
cardiologist Dr. Ravinder Kumar.

Kumar discovered that all three of Craig’s major heart vessels were seriously blocked. He had suffered what’s called a NSTEMI (Non-ST elevation myocardial infarction). It is sometimes called a silent heart attack. Conversely, a STEMI (ST-elevation myocardial infarction) is an immediate emergency type of heart attack.

Heart bypass surgery was considered the best option, but Craig’s family and FAH caregivers felt that he wouldn’t be able to understand the recovery and rehabilitation requirements of such invasive surgery. Doing the surgery was as potentially dangerous for Craig as putting him through it.

A decision was made to monitor Craig’s condition, to treat it medically and not surgically. That decision was promptly reconsidered after Kumar visited Craig the next day in the ICCU.

“He was miserable,” says Kumar. “Just sitting up on the side of the bed would make him exhausted. There’s no way we wanted him going home feeling like this.”

Kumar spoke to a colleague, and Craig was transferred to Des Moines for a high-risk stenting procedure to open his blocked arteries, with the help of an Impella heart pump during the procedure. (Mary Greeley’s cardiac cath lab can perform stent procedures but does not have the Impella device.)

Rehab Challenge

Carrie Adams, BSN, RN, clinical supervisor of Mary Greeley’s cardiac rehabilitation center, was surprised when she ran into her old high school friend Andy Nichols in the halls of the hospital that day in August.

“One of my guys had a heart attack,” Nichols told Adams.

A few weeks later, Adams met that guy. It was Craig, who had been referred to Cardiac Rehab after his surgery. In these cases, a patient is generally referred to the rehab service closest to their home.

When Adams received the referral details and realized who the patient was, she knew to call Andy. That local connection was important because Adams and Nichols had an instant trust. Their conversation was the beginning of a coordinated effort to help Craig.

It is not unusual for the cardiac rehab staff to make accommodations for patients, but because of his cognitive abilities, Craig posed a new kind of challenge.

“It’s pretty individual for everyone,” says Adams of the Cardiac Rehab program. “We’ve had competitive athletes and people who have never stepped on exercise equipment in their lives. You’ve got to make it work for all of them.”

Making it work for Craig was personally important to Adams, who has a close relationship with a nephew who has special needs.

Cardiac Rehab at Mary Greeley usually involves small classes of people going through a prescribed set of exercises while wearing heart monitors. Rehab can last several weeks. Could Craig handle this? Should he receive treatment on a one-on-one basis, or be part of a regular group? Would being in a group be too busy for him, too much stimulation?
Nichols assured Adams that Craig could handle it all.

“The goal is to progress the exercise without making it too difficult,” says Adams. “Craig does a lot of active outings and we wanted to make sure he could get back to doing those things without Friendship Ark staff having to constantly worry that they were pushing him too hard.”

Recovery Plan

It was decided that Craig would benefit from being part of a regular rehab class. A slightly shortened 12-session course of treatment was planned. Because he had had falls at home, it was also decided to limit Craig to seated equipment. FAH coordinators Cassie Shivers and Chelsea Apland attended classes with Craig. They provided encouragement and helped cardiac rehab staff work with Craig.

“We would ask him ‘Are you OK?’ ‘Is this too hard?’ ‘Is this really easy?’ ‘Does your chest hurt?’ ‘Is it hard to breathe?’ Yes or no questions for the most part,” Adams says. “We couldn’t have done it without his helpers.This really was a team effort, with our staff working closely with staff from Friendship Ark to make sure Craig got what he needed.”

Friendship Ark staff echoed those sentiments.

“In the 10 years I’ve been with Friendship Ark and working with Craig, this was the most exemplary health care experience he’s had,” says Nichols. “The cardiac rehab staff
paid very close attention to him and got more out of him than any medical professional ever has since I’ve known him.”

In October, Craig finished his therapy. “We wanted him to feel like part of the group, and he did,” says Adams. “Other patients would ask him how he was doing and they cheered when he graduated. I loved seeing that. It was really sweet.”

Craig is back home at Friendship Ark, keeping busy with regular outings, or crocheting and jigsaw puzzles. Did he enjoy his cardiac rehab experience? You already know that answer. It’s a big smile and, “Yeah.”

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Fifty-five percent of Americans now support the Affordable Care Act (ACA), a major turnaround from five months ago when 42 percent approved and 53 percent disapproved, according to a new Gallup poll. This is the first time a majority of Americans have approved of the health care law, also known as Obamacare, since Gallup first asked about it in this format in November 2012.

Since the ACA’s passage, the law has been a significant political issue in each of the past four national elections. Republicans’ opposition to the ACA helped them win control of the House in 2010, control of the Senate in 2014 and the presidency last year.

However, Republicans’ plan to repeal and replace the health care law foundered last month, as House leaders’ replacement bill ran into stiff opposition within the party.

Republicans, Democrats and independents are all more likely to approve of the ACA now than in November, a few days after Donald Trump’s victory in the presidential election left Republicans in control of the legislative and executive branches. Independents have led the way in this shift toward approval, increasing by 17 percentage points compared with 10-point changes for both Republicans and Democrats.

Although the ACA never garnered majority support in Gallup polling before this month, nearly half of Americans (48 percent) approved of it the first time the current version of the question was asked in November 2012. In response to a previous version of the question that asked whether Americans thought passing the health care law was a good thing or a bad thing, 49 percent said it was a good thing when the question was first asked in early 2010. However, support was a few percentage points lower each of the next two times it was asked.

Though a majority of Americans now approve of the ACA, only about one in four (26 percent) want to keep it largely as it is. Forty percent want to keep the law in place but make significant changes, while 30 percent want to repeal and replace it.

What Americans want Congress to do next regarding health care hinges on their views of the ACA:

  • Twenty-six percent want to keep the law in place largely as it is.
  • The 40 percent who want to keep the law but make significant changes are evenly split: 49 percent want Congress to continue to work on healthcare in the next few months, while 49 percent would like to see Congress turn its attention to other issues for the time being.
  • Among the 30 percent who want the ACA repealed and replaced, most (64 percent) say Congress should continue to work on health care. Another 32 percent say Congress should turn to other issues.

The Gallup poll was based on phone interviews with 1,023 US adults in all 50 states and was conducted April 1-2. Its margin of error is plus or minus 4 points.

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Helping others has always been a passion for Carroll native Jamie Waller. It’s why she pursued a career in nursing at Iowa Central Community College in Fort Dodge and it’s why she participated in a three-week mission trip to Tanzania in Africa following her freshman year of nursing school.

“After going to Africa, I discovered that nursing was my true passion in life,” Waller said. “It confirmed my interest in serving others and solidified my decision to become a nurse.”

Today, Waller is a registered nurse and six-year veteran of St. Anthony Regional Hospital in Carroll. She works on the medical, surgical and pediatric floor and often serves the role as charge nurse. But her commitment to serving others extends beyond her daily shifts.

In November 2016, newlyweds Jamie and her husband, Cory, ventured to Haiti with Grace4Haiti, a medical mission group based in Omaha. The couple joined the team’s 15th trip with the purpose to work in a hospital setting, perform medical services, prepare patients for surgery, assist surgeons, and care for patients in a hospital.

Jamie shares that she grew both personally and professionally from the experience.

“We saw many, many patients in the clinic every day and performed small procedures in the clinics if able,” Waller said. “I realized on this trip that we have many luxuries we take for granted here in the in U.S. – things as simple as running water and electricity in every health care facility, and features as complex as all of the technology and supplies we have available. It was an eye-opening experience.”

Yet, most memorable of all, Jamie recalls two premature infants the medical mission workers saved during their stay.

One afternoon several of the mission team members walked to the beach during a short break from the hospital. As they were walking back, additional group members met them with the urgent message that an abandoned, premature baby had just been dropped off at the hospital.

“Luckily, we had the biggest group at the hospital that week, because at the same time this baby was struggling to breathe, another mother was having a scheduled C-section,” Waller said. “Once we delivered the baby via C-section, we knew right away the baby was not 40 weeks along. We had to cardiopulmonary resuscitate the baby for a short while and perform other medical techniques for this child to survive.”

At St. Anthony Regional Hospital, Jamie Waller (left) is a preceptor for nursing student Morgan Neary.

Within hours, the medical team had both babies stabilized and transferred them to a nearby hospital, a couple hours away. The infants were transported in the missionaries’ vans, because there is no organized ambulance service in Haiti.

“I truly felt the difference our team was making in that moment to help those babies,” Waller said. “We used the resources and skillsets we had available to provide great care. Had our team not been there, I don’t believe they would have lived.”

Waller is grateful for the support of St. Anthony, which provided supplies and a mission trip support fund to match her employee vacation hours.

“St. Anthony’s generous donations were an invaluable asset for our trip,” Waller said. “We used many supplies while there. Every little bit counts and each donation helps to lessen the burden of providing health care in Haiti. The vacation match program also helped my husband and me financially with the trip. It meant the world to us.”

Jamie encourages others to partake in the same types of endeavors. She and Cory are leading by example, returning to Haiti in April with the hopes of spending more time in orphanages to show their support of Haitian children and continuing the relationships they built in November.

“I felt God’s presence many times while there – whether it was getting to know the people around me or guiding my hands while working with patients,” Waller said. “I truly believe that everything happens for a reason. My husband and I went on this trip to serve God and show love to other parts of the world by hugging someone that needs a hug or providing life or death care to a newborn baby. I am incredibly blessed and grateful for the opportunity to help others.”

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The Iowa Hospital Association is pleased that the American Health Care Act was not pushed through the House on a wave of political pressure. There is far too much at stake – and too many unanswered questions – to force through a bill that would jeopardize health insurance coverage for more than 20 million Americans, including 200,000 Iowans.

The Affordable Care Act is not perfect, but Iowa’s hospitals are committed to working with elected officials and agency administrators on addressing those problems and making it better, just as we have been for the last seven years.

However, the AHCA was not the answer. It endangered the health of thousands of Iowans – senior citizens, children and families, the disabled, veterans and others – who have received health coverage under the Affordable Care Act. It threatened the Medicaid program that serves 630,000 Iowa residents. And it would have been an economic disaster for our state budget as well as hospitals and other health care providers that all Iowans depend on.

Iowa’s hospitals will continue to work with our congressional delegation as advocates dedicated to improving the health and lives of Iowans.

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