Measles Outbreak-What It Means When Your Neighbors Don't Vaccinate

Outbreak in Preventable Childhood Diseases On the Rise in the United States
The measles outbreak in the nation has been on the rise for the past two years, but is nearly at epidemic proportions now. http://www.cdc.gov/measles/cases-outbreaks.html  There are 141 cases of measles in 17 states so far in 2015. This chart from the CDC shows the states which have the most outbreaks of measles.

 Measles, is a preventable childhood disease for which an immunization (a shot) is usually given to a child when the child reaches nineteen to thirty-five months of age. Measles causes red spots, fever, and in some cases can result in death. This article reviews changes in childhood immunization patterns, which were reported for all fifty states in Unraveling U.S. Healthcare-A Personal Guide, published in 2013.  Information is drawn from the U.S. Centers for Disease Control and Prevention and is inclusive of 2013 calendar year data. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6334a1.htm?s_cid=mm6334a1_e#Tab1

In 2011, the national immunization rate for children between the ages of nineteen and thirty-five months was 83.34% for all recommended childhood vaccinations. In 2013, the immunization rates for the same age-group of children and the same vaccines had dropped to 83.07%.
 Here are the states with the lowest rate of immunization for these diseases as of  the end of the reporting year for 2013, as compared to the national average. As you can see, the western states do poorly for immunization compliance, as reported in my 2013 health scorecards. The one bright spot is Utah, which matches the national average for the top three vaccines. The outlier in the group is Vermont, which has achieved the dubious designation as the state with the lowest rate of childhood immunizations. And though much of the country seems to ignore the District of Columbia, seat of our nation's capitol, it has a better vaccination rate than the national average, at 86.7% penetration versus 83.07%. Here is information from the table, showing the worst states for immunizing their children:

Children's Health Scorecard-2013	National Average		Oregon	Montana	Wyoming	New Mexico	California	Colorado	Alaska	Vermont
Ranking			44	45	46	47	48	49	50	51
DTaP	83.10		83.80	79.00	80.90	79.80	83.10	81.20	75.50	85.80
Hep B	74.20		66.80	73.90	67.00	67.50	70.30	60.20	59.40	44.80
MMR	91.90		89.40	87.30	89.00	89.10	80.70	86.00	90.50	91.20
Average Rate	83.07		80.00	80.07	78.97	78.80	78.03	75.80	75.13	73.93
Variance			-3.07	-3.00	-4.10	-4.27	-5.03	-7.27	-7.93	-9.13
Notes: Negative number means performance is worse than the national average.
Immunization rate is for Heb B only.
Immunization rates are from the Centers for Disease Control for 2013 year In short, this is the reason there are large outbreaks of childhood diseases now. An immunization is a preventive dose to activate the body's immune system to the disease vector. In order to have adequate protection for a population, which means a community, a school, a state, the majority of the population has to become immunized. In the United States, especially on the west coast, we are in danger of losing our herd immunity, which is a scientific term that means the actions of a significant minority can imperil the entire population. The standards for public health in the United States and all developed nations are based on scientific data, using gold-standard studies and analysis, not spurious opinions of the uniformed in social media. The recommended immunizations for children in the above age-group are as follows: Diptheria, Pertussis, and Polio- Pertussis is known as whooping cough and there has been an increase in preventable childhood deaths from this recently as well. Polio of course, causes paralysis and shortened life expectancy and was thought to have been eradicated in the U.S., but thanks to the actions of a minority, this may no longer be the case. Diptheria is a respiratory disease. Measles, Mumps, & Rubella-Measles is an infectious disease causing fever and rash. Mumps is a disease of the salivary glands, causing swelling, fever, and muscle aches. Rubella, also known as German Measles can cause incurable illness for pregnant women, and significantly increases the chance of miscarriage. Influenza-This is a respiratory disease which can and does cause deaths in infants and others whom have immune deficiencies. Hepatitis B-This is a  blood disease which can damage the liver; is transmitted through bodily fluids, and can  be passed from mother to child. Varicella or chicken pox-This is a blister-like rash, fever, and can result in death for those with compromised immune systems. In The Russell Guide for Diabetics, I share information about the science and the reality of childhood diseases. A 2003 Italian study,  found that early childhood exposure to two diseases damaged the immune system and was significantly linked to causation of Type 1 or juvenile diabetes. Here is an excerpt from my book explaining the findings: In 2003, a population-based case-control study in Italy, published results which found that childhood exposure to two infections significantly increased the likelihood of a child contracting Type I Diabetes. Infections which were reviewed in the study included; pertussis (whooping cough), varicella (chicken pox), rubella, parotitis, and morbilli.[1] Here are the findings of the study: 1.      The statistically significant finding with no confounding variables,  showed that children in the Abruzzo region of Italy who were exposed to two of the childhood viruses listed, had a higher incidence of Type I Diabetes compared to the population who had been exposed to a single childhood infection. 2.      Children who had been exposed to only one of the listed childhood infections did not show an increased incidence of contracting Type I Diabetes. 3.      Childhood immunizations were also analyzed as risk factors for contracting Type I Diabetes and there was no statistical increase shown in the incidence of juvenile diabetes for the immunized children. 4.      However, for children who had received the pertussis (whooping cough) and MMR (measles, mumps, and rubella) vaccinations, a significant decrease was found in the contraction of childhood Diabetes.  My brother, Russell was diagnosed with Type 1  Diabetes when he was three years old, three months after his exposure to chicken pox. He had also been exposed to mumps within the year, by his school-age siblings (including moi). Unfortunately, this event was due to the fact immunizations were typically provided through the school at the time of enrollment, so children younger than school age were at risk. Russell died at 42 years of age, following multiple organ transplants, and amputations all related to Type 1 Diabetes. To all parents who think they are "boosting their child's immune system" by avoiding immunizations, do take the long term view and consider all adverse consequences. This article of course, is written for those whom do base their decisions on scientific evidence. Considering the low-level of science readiness in our national population, as compared to other countries, perhaps this issue will ultimately be decided through tort action in the courts. The CDC clearly states these immunizations prevent 722,000 deaths over a lifetime, so the parents whom are abdicating these preventive measures must be assuming some other child or relative will be in that statistic and not their own. Truly it is just a question of time before the actions of one parent bring irreparable illness to the lives of others, which is similar to driving a vehicle without auto insurance. Considering that many of those eschewing immunizations are patrons of  the well heeled in private schools, this population is an easy target for social responsibility through the courts. And this is the healthpolicymaven signing off, encouraging all to share this article virally, just as childhood diseases are spreading through our population. Roberta Winter is the author of http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972# Roberta E. Winter is a graduate of the University of Washington School of Public Health and Community Medicine and the Evans School of Public Affairs. She has spent the past 12 years advocating for consumer issues in health care.

  

Insurance Mandate Tax Tips and Report Card on Performance

One Year Out From the Inaugural Insurance Exchange Launch
Now that the nation has passed its second enrollment in the Affordable Care Act (ACA) Insurance Exchanges, it is time to do a bit of a scorecard and though the second enrollment went well, let's look as the predictions versus the actual participation.
Original Whitehouse Projections Versus Actual Enrollment

Number expected to gain insurance coverage because of either the employer or individual insurance mandates under the ACA-32,000,000
Since the employer mandate is just starting this year and the phase-in penalty for firms without compliant medical plans only applies to firms with 100 or more eligible employees, it is not possible to discern the total reduction in the uninsured yet. But here is the rate of the uninsured as a proportion of the national population.
Uninsured rate prior to ACA- 18% After ACA-12.9%
Number Health & Human Services projected for the 2015 Insurance Exchange Enrollment-9,100,000


Number of the uninsured who obtained coverage through Medicaid or an Exchange product-9,500,000, which exceeded their projection by 4%. This information  may be found at: http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/

Number enrolled in the federal insurance exchange-7,100,000
Number enrolled in private insurance exchanges-2,400,000

Percentage of  Actual Enrollment compared to the Eligible Enrollees
I reviewed the Kaiser Family Foundation's report on the insurance exchange enrollment by state and it was no surprise there was a lot of variation, with a low enrollment in the states with robust economies, such as North Dakota (13%) and Massachusetts (8%). Whereas, 87% of the population deemed eligible to enroll in the insurance exchange in Vermont actually did. For more information go to the Kaiser Foundation web site at: http://kff.org/interactive/mapping-marketplace-enrollment/

Income Tax Tips for Insurance Exchange Participants
For my followers, I have been tweeting tax tips regarding the reconciliation of the government tax credits for those who purchased insurance through the exchanges. To assist those who are filing income taxes, here is a step-by-step guide to the insurance mandate and tax credit posting:

1. If you purchased medical insurance through an insurance exchange, either federal or state, you may have received an advance from the federal government, to pay for part of your insurance premiums. If you enrolled in Medicaid through an exchange you did not have to pay any premiums and this does not apply to you..
2. The government advance, which went directly to the insurance company, was an estimate of your tax credit eligibility based on the income and family information you provided at enrollment in the previous year. If your status changed, there may be a difference in the amount the government advanced and what you should have received. 
3. Your insurance exchange should have distributed form 1095-A by January 31st, assuming they have your current contact information. You will need this form to complete your income tax.
4. Form 1095-A has a monthly break-down of your insurance premiums for the 2014 year, both the amount you paid, the amount of the tax credits, which is what the government contributed to the cost of the insurance (thank you Uncle Sam), and the total premium.
5. If you are using an electronic tax preparation tool, which I highly recommend, it will have an insurance page or folder, which will walk you through the form. But just in case you are still old school and use paper returns, the federal tax credits which were used to pay for your insurance will be entered into the Premium Tax Credit form 8962 of your 1040 Personal Income Tax Return. 
6. Enter your total premiums paid, total premiums credited from the government and wait until you complete your return. After you have entered all of the other information to complete your income tax return you will you have a final result in terms of what your tax credits should have been and what they actually were. If the government estimated too high, then you might owe some money. If the government estimated too low, then you will have a refund coming.
7. For example-Total insurance premiums were $7,032 for a single individual (yikes) and you paid $348, with the government contributing the rest. The government paid $4,716, but it turns out you were only eligible for $4,368 in credits. This means you owe the difference between the two or roughly $348. This government advance will be deducted from your tax refund or theoretically, you will get a statement saying you owe income taxes.
8. Bottom line, the federal tax credits were an estimate of what you were eligible for, based on information you provided, and not a guarantee, so expect some variation in the actual result. If the government gave you $4,716 and you only had to give back $600, that is still awesome.

Hopefully this helps some of you with your income tax filing for the 2014 year. This information is not meant to give tax or legal advice (CYA-disclaimer) but is a journalist's view on publicly available information. Feel free to share this with everyone, with appropriate attribution of course.
And this is the healthpolicymaven signing off. Viva Le France!

healthpolicymaven is a trademark which has been in continuous use sine 2007 and is the property of Roberta E. Winter, MHA, MPA, President of Praevalere Inc.

 

Liberty, Equality, and Fraternity As Demonstrated by the French This Week

Since the second largest demographic for healthpolicymaven readers hail from the beautiful country of France, this column acknowledges their January 8th loss, due to the terrorist acts of a few deranged Muslims. Radical Muslims persist in trying unsuccessfully to unravel democratic nations. United States citizens have marveled at the French demonstrations drawing 10,000 people against this senseless violence. The fact so many French people were willing to risk their lives for the sake of a free press underscores one of the fundamental principles of liberty, which is our right to gather and demonstrate, and the right to a free press. It is the latter of these principles which our forefathers held so dear which seems so fragile in these turbulent times. Though in the United States the loss of freedom in our press is due to corporate tyranny and public apathy as opposed to violence. Please understand the United States was appalled at the terrorism in Paris, but we are a country numbed by school shootings every year. The U.S. Justice Department indicates there are 45 violent deaths at schools in the United States each year. http://nces.ed.gov/pubs2014/2014042.pdf  Though a vigorous American population is trying to change this metric, we are making pithy progress. 

For the Americans reading this column, here is some information about our French countrymen, one of our strongest allies,  and their direct impact on the United States:

1. According to the U.S. Census Bureau's 2013 Population Survey the third most common language in the United States is French, after English and Spanish, with 1,755,433 using French as their predominant language. http://www.census.gov/prod/2013pubs/acs-22.pdf
2. Washington State alone has 7,000 French households
3. France is one of the largest investors in U.S. businesses and has been since the 1980's. http://www.econlib.org/library/Enc1/ForeignInvestmentintheUnitedStates.html
4. There are nearly 5,000 French-owned companies doing business in the United States and they employ over 650,000 people.http://www.ambafrance-us.org/spip.php?article2538
5. France is the world's 5th largest economy with a gross national product of 2.8 trillion. http://www.export.gov/france/doingbusinessinfrance/index.asp
6. According to the U.S. State Department there were 1.5 million French visitors in 2013. http://travel.trade.gov/view/f-2000-99-001/forecast/Forecast-COUNTRIES.pdf
7. France is one of the oldest democracies in the world, overthrowing the king in 1789 and Bastille Day is celebrated on July 14th each year.
8. The colors of the French flag are the same as ours and the Statue of Liberty was a gift from France.
9. The French health system is widely considered to be one of the best health care systems in the world, providing care for all, and with electronic medical smart cards for residents since 1997 (something the U.S. still hasn't mastered).
10. The United States spent $8,508 per capita on health care in 2011, while France spent $4,118, and they generated better health results. http://nces.ed.gov/pubs2014/2014042.pdf 

 To all French residents, visitors, and citizens I say "Vive la France! Where would we be without French influence in the troix F's; Food, Fashion, and Film. Merci Beaucoup.

If you are interested in learning more about French culture, here are some organizations in the United States which may be of interest:

Federation of Alliances Francaise U.S.A.
http://www.afusa.org/

French Embassy in the United States
http://www.ambafrance-us.org/

 French Culture.org
http://frenchculture.org/about/cooperation-with-civil-society-organizations

French American Foundation of the United States
http://www.frenchamerican.org/

Feel free to share this liberally throughout the globe. And this is the healthpolicymaven signing off  "au revoir."

Reviewing Centers for Medicare and Medicaid Incentive Programs

As 2014 fades from view, I am barely making my monthly deadline for the Straight Talk column. but I would like to leave you with a couple of thoughts for the new year. There have been more than a few articles detailing the Centers for Medicare and Medicaid (CMS)grant awards as well as enforcement efforts impacting your health care. First, let's start with the positive, CMS provides grant awards for government agencies as well as multi-agency initiatives to study ideas for improvement of health care. In 2014, these states received grant awards for initiatives to better resource care for Medicare, Medicaid, and the Children's Health program: Arizona, California, Colorado, Connecticut, Georgia, Florida, Illinois, Iowa, Kansas, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, Mexico, Ohio, Pennsylvania , South Dakota, Texas, Virginia, Washington, and Wisconsin. Washington State has received a 65 million dollar grant, starting February 2015, to work with government and private sector health care providers across the state to look at methods to reduce administrative redundancies, eliminate unnecessary costs, and strive to improve health care. So, congratulations to Washington for going after the grant, which is a multi-year laborious effort, and for winning it! The venerable Washington Health Care Authority will be in charge of the project, which is the same agency which has run the State Employees Health Plan for decades and also implemented the Health Insurance Exchange. For more information on the type and amount of the award follow this link to the CMS site: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Round-2.html

Scale of these Government Funded Health Care Programs
To give you an idea of the scale of Medicare, it represents 12% of the entire federal budget. Medicaid and the Children's Health Program represent 8% of the nation's budget, but remember these programs are also funded by the states. According to the Center on Policy and Budget Priorities, the 2013 budget allocated 22% for these three programs, which is a significant increase over 2010, when the total was 20% for these three programs. For more information on this you can follow this link:
http://www.cbpp.org/cms/?fa=view&id=1258  Just to keep this in perspective, defense spending was 19% during the same time frame. CMS is the primary government authority charged with administering these programs, as well as performing investigations into health care innovations. And finally, a huge aspect of CMS's role is to police the payment system and stop abusive practices.

Accountable Care Organizations
Under the Affordable Care Act, the Centers for Medicare and Medicaid are charged with implementing the Accountable Care Act, which specifies performance indicators linked to government payments for health services. In a recent report, 2, 225 hospitals, which represent about one fourth of the nation's hospitals, are going to experience reductions in CMS payments because they didn't meet the standards. Now, in the private sector, this is referred to as a performance agreement and if a contractor doesn't hit his target, he gets dinged with a penalty. However, this is a new aspect of publicly funded health care. A 2% penalty is also huge, because as you have already observed, CMS provides anywhere from 20% to half of some of these hospital budgets. For example, trauma center and public hospitals, like Harborview Medical Center, in Seattle or Bellevue Hospital, in New York, serve a much greater population of low-income patients, so government funding provides most of their budgets. Though hospitals are concerned about the penalty assessments, the program appears to be working, because penalties are down nationally by 4% overall for 2013, compared to the previous year. And let's give credit where it is due because 1,154 hospitals, which represent about 10% of the nation's facilities, did not get fined. This means they met all of the Accountable Care Organization targets, including reducing re-admission rates. For more information on this program go to Kaiser Health News.org at: http://kaiserhealthnews.org/news/readmission-penalties-medicare-hospitals-year-two/

Concerns About Cost Punish Clinicians
One of the consequences of the cost reduction efforts, which are certainly needed, is that clinicians who treat these patients are not getting paid enough, especially for Medicaid. This worrisome trend has continued in a downward trajectory for years. Presently, only 46% of doctors will accept Medicaid patients nationwide.http://www.businessweek.com/articles/2014-04-10/doctors-shun-patients-who-pay-with-medicaid Further, by punishing safety-net hospitals, like Harborview, we are making it even harder for low-income folks to access health care. It seems to me if CMS decided to pay even a modest $10 more per patient visit for Medicaid, this would help offset the dearth of providers for Medicaid patients. At the end of the day, it doesn't matter how fantastic your grant program is if the people who are supposed to benefit are unable to see a doctor. Access to health care is really the issue. Meanwhile, the medical device companies are lobbying their way through Congress trying to get out of their lousy 3% assessment to fund their part of the Affordable Care Act, while they charge Americans 40% more for their equipment than they do other nations. Here's a thought, let's use all of that 3% to provide money for primary care clinicians to serve Medicaid patients. In fact, I suggest you contact your Congressman or Congresswoman and lobby for this provision.

This is the healthpolicymaven signing off, wishing you a healthy new year. For more information on my work, you can also follow me on TUMBLR or Twitter. In 2015, I will be offering some new services as well.

Non-profit is Not Synonymous With Good Health Care-Anti-Consumer Practices at a Federally Subsidized Clinic

Non-profit is Not Synonymous with Good Health Care-Anti-Consumer Practices at a Federally Subsidized Community Health Clinic

On October 31^st, I took my teenage son to Peninsula Health Clinic in Bremerton, for evaluation of a clinical intervention for depression. My regular readers will recall the trauma center blog I posted in October 2012, when my son was hit by a pickup truck and sustained a traumatic brain injury. Head injuries can take a long time to heal and depression often follows. As a healthcare advocate I am compelled to share my experience to illustrate the complexity and failings in primary care in the U.S.A.

Teen Denied Care at State and Federally Financed Community Health Clinic

Arriving at the health clinic after a 2 hour commute walking and via public bus in a driving rain storm, I went to the counter to get my son checked-in for his appointment. There was no queue of patients standing in line, and I was informed we were 6 minutes late for our appointment. I explained that we had traveled by bus and we got to the clinic as soon as possible, and we were still within 10 minutes of the scheduled time. After several minutes, the administrative staff informed me that the doctor was unwilling to see my son, even though he was not a new patient and this had been his primary health care location for over 5 years. At this point, I was incredulous that we were being urged to leave and stated my son was there for evaluation for depression, which had been discussed with the school nurse. What happened next will floor you.

Clinic Staffer Encourages Dumping Practice of Referring Patients to the Local Hospital for Non-Emergency Treatment

Peninsula Health Clinic which actually denied care for my son, which was not of an unusual nature, encouraged us to use the emergency room of the local hospital. My son’s health did not merit an emergency intervention, which is why we were at a primary health care clinic or in layman’s parlance, the doctor’s office. This behavior is referred to as “dumping” when patients are unable to get care at appropriate primary care facilities and sent to the ER of hospitals. In Chapter 9, of Unraveling U.S. Healthcare-A Personal Guide, I explain how people in the United States should access health care wisely from an economic and health outcome basis. The emergency department of hospitals is the most expensive place to obtain primary health care and is thus to be avoided. Patients are often derided for over utilization of the “ER”, but there is more to this picture than meets the eye, as the options for obtaining health care are limited in many areas of the country. If the clinics which receive government funding to provide primary health care are insolent and unwilling to serve their community members, what choice do these folks have but to go to the hospital? In my son’s case we elected to defer treatment because he had to get back to school. As a parent I am concerned about his health and we do have a follow-up appointment scheduled at Seattle Children’s Hospital In December.

How Money Impacts Treatment

Peninsula Health is a designated federally qualified health center located in Bremerton and other sites in the county.[1]  In 2014, Peninsula Health received $1,572,083 from our federal government to provide primary health care.[2] This means that the clinic is charged with serving patients who may not have access to other health care options or for which there are obstacles, such as lack of transportation, or clinicians who refuse to treat them.  The community of Bremerton has a disproportionate share of low income residents, in large part due to zoning laws which allowed less restrictive housing per parcel from World War II. Harrison Medical Center is the hospital for nonmilitary personnel in Bremerton and the Franciscan Order, which acquired the publicly financed facility wants to close the hospital. The reimbursement mix just doesn’t work for their bottom line, religion or not.  Consequently, the ability to obtain health care for those who are most in need is becoming more tenuous in this community. As a federally funded facility the clinic must adhere to certain practice standards, which in theory, should provide basic or primary health care more effectively than other options.

As a healthcare insider some of you may wonder why I choose Community Health Plan’s Peninsula Health Clinic and the answer is, we ended up there as a last resort. Briefly, over the course of the past eight years the following circumstances gave us no choice but to use the Sixth Avenue Clinic or take the longer commute into Seattle for health care: 

1.   In 2006, when my son and I relocated to Bremerton, largely due to the walk-on ferry access to Seattle, we initially sought care with a private practice physician. With each appointment the doctor complained about his reimbursement, the staff wasn’t very nice, and getting there required a 10 mile round trip bike ride and a ferry trip to Port Orchard. Still, we persisted until the clinic was closed, meaning the doctor moved his clinic to a more lucrative location. 
2. When my son was in middle school we sought family health care in a neighboring community, but found the transportation options unworkable. 
3. Services to deal with pediatric or youth depression are extremely limited in Kitsap County, yet the State of Washington under Senate Bill 6312, has just approved a new plan to make the entire Olympic Peninsula and Kitsap County one service area.[3] The few services available for mental health are for adults and drug offenders in the area. My son and I have found it more efficacious to spend 2 hours on the ferry and 1 ½ hours busing to appropriate services in Seattle, for which I have paid 100% of the cost out of my pocket, as it is deemed out of our service area. 
4. Given that my son was in grade-school when we moved here, I felt it was prudent to seek health care that was local, hence the Sixth Avenue Clinic, located less than two miles from our house.

Increasingly Those Providing Primary Health Care Are Getting Squeezed

Firstly, we don’t have enough primary clinicians in the United States, so this creates a problem with patient access. Secondly, there is high employee turnover in health care, which exacerbates the problem. Thirdly, clinics serving a higher proportion of low-income patients are dealing with grittier issues than in more affluent areas. It all comes down to the money, Medicaid doesn’t pay enough for 46% of the doctors to accept Medicaid patients.[4] This means federally qualified clinics, public health departments, and the public emergency room are where patients seek care.  But the fiscal situation of the clinic is not the fault of the patient, nor should patients be refused treatment.

What You Should Do To Advocate for Your Child to Get the Health Care They Deserve

Fast forward, Peninsula Health sent a letter to our house indicating my son was a no-show for his appointment, which of course was not true. As your advocate for patient rights, here is what I did; composed a single page letter with our grievance on patient care, sent it to the local clinic-Peninsula Health, to Community Health Plan of Washington the affiliated insurance provider, and to the State Medicaid office which provides funding for the clinic. Next steps- to date there has been no written response from any of the clinic representatives, because they are demanding a HIPAA form be completed first. If getting refused for health care doesn’t kill you, the paperwork will.

A Little Respect

Having commuted by bicycle and public transportation in multiple locations since 2003, my son and I have learned to be resourceful, which is not always met with appreciation by health care providers. In an era when a third of the nation’s children are overweight, getting regular exercise is the surest way to maintain a healthy weight. And I am happy to say, I do not take any medication, because of my diet and exercise regime. We are doing our part not to add to the burden of the U.S. health care system, so rather than being treated with derision, how about encouragement. Though I am loathe to share personal information, this situation really shows how people are dumped in the health care system and it is even worse for those patients who lack my education and tenacity. As for the clinic admissions representative who refers to me as “the mother,” even Safeway personnel manage to get my name right and add a salutation. Yes, I am “the mother” who will stop at nothing to assure my son and others like him get decent health care because that is the right thing to do. 

This is the healthpolicymaven signing off, encouraging all of you to resource your health care wisely and stick up for yourselves. Don’t think that everyone behind a desk has your best interests at heart. Feel free to share this article virally but please provide appropriate attribution to the author and Praevalere!

For more information on federally qualified health centers and other resources read my book which is found in public libraries throughout the land and of course, on Amazon, ranked #35 for health and medicine books.

http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972/ref=sr_1_1?s=books&ie=UTF8&qid=1415590699&sr=1-1&keywords=unraveling+u.s.+healthcare-a+personal+guide

---

[1] *Peninsula Community Health Services is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

[2] http://datawarehouse.hrsa.gov/Tools/FindGrants.aspx

[3] http://apps.leg.wa.gov/billinfo/summary.aspx?bill=6505

[4] http://dailysignal.com/2014/05/08/medicaid-half-doctors-wont-accept-new-patients/