Some veterans of OFA 1.0 in my community started a local health care group in December, after OFA requested health care house parties. I went to one of their meetings recently. I was hugely surprised by what I discovered, so I wanted to shout this out:
Health care services are subject to enormous local control.
Fixing health care is going to require action at every level.
While the federal government provides funding for medicaid and other programs, the state chooses whether to provide matching funds (for medicaid, for example) and has the authority to set stricter limits on eligibility. Local governments then have the authority to set even stricter limits and to decide how funds will be disbursed.
My locality is just one example, but here are some things I discovered:
- My state refuses to provide enough matching funds to receive all the federal money it is eligible for.
- My local goverment has MUCH stricter rules limiting financial eligibility for assistance than a neighboring area, but more generous than other areas. The state's rules allow wide latitude.
- In addition to greater financial restrictions, my local government requires greater documentation and citizen ID than required by the state or federal government. Even for children.
- Even if eligible, patients in my area receive less funding than patients in that neighboring area.
- Health care delivery in my area is hurt by lack of a public hospital. There is strong opposition to allowing a nearby public hospital to open a branch in my area.
- One city in the state has a particularly efficient funding system that effectively combines federal, state and local funds for needy people. I don't live there.
- As a result of 1-6, the funding and care given to a needy, uninsured patient vary dramatically across the state, not to mention the country. Locally, we are neither the best nor (scary!) the worst.
The information involving local government and regulations was overwhelming, and we barely scratched the surface. I am new to this, so corrections and additions to my information are welcome!
Take-home message: Even if we get comprehensive national health reform, these local delivery systems are going to affect the health care that real people get in the real world. We need to be on top of this. If you do not know how the delivery system is governed in your area, you are missing a huge chunk of the puzzle - the chunk where you personally can be most effective. You are also missing the opportunity to be part of a group than can advocate effectively for your needs when the national campaign to pass comprehensive health care reform accelerates.
This is your chance to climb on the bus to effect real change.
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