Stories for the week

1) http://www.nytimes.com/2011/11/24/health/policy/dr-donald-m-berwick-resigns-as-head-of-medicare-and-medicaid.html?_r=1&ref=health


2) http://www.thestatecolumn.com/health/according-cdc-four-drugs-er-visits/

Political Story

Gov. Christine Gregoire’s special 30-day legislative session slated for Nov. 28 aims to carve out $1.4 to 2 billion from next year’s budget, cutting up to $440 million from state health and housing programs for the elderly and disabled most in need of government aid.

But behind the nearly incomprehensible numbers, many disabled and elderly who were left reeling from this year’s cuts may face an even more dire reality if the newest round of proposed cuts are enacted: homelessness. 

“To look in somebody’s eyes (whose lack of state funding has led to homelessness), the fear that you see in their eyes when they come in here, they’re so scared it’s like they’re not even living, like they’re not even able to exist,” said Linda McClain, the executive director of Coalition of Responsible Disabled (CORD), an advocacy group based in Spokane, Wash., that provides living opportunities for persons with disabilities, and is the only center of its type in the region.

Because CORD is federally funded, its services will not be affected by state budget cuts. However, the cuts will affect Eastern Washington residents that CORD serves on a daily basis and who rely on state funding for housing, medical care or other services. 

“There’s 1800 people in Spokane County alone that have been eliminated off of the disability lifeline program (during the latest budget cuts),” McClain said. “What is happening is they are calling, our phone is ringing off the hook, people are coming into our building or living in our parking lot because they have no place to go.”

McClain fears the desperation could worsen if any more money from social services for the elderly and disabled is cut.

Which is exactly what may happen next year.

“When you don’t have money, you can’t pay rent,” McClain said. “And there’s some pretty notoriously cheap places with horrible living conditions here, and people can’t even go stay in those places because they’ve lost their funding.”

Current plan would cut health care

In addition to cuts in in-home care and housing, health benefits could be cut as well. One proposed plan would eliminate prescription drug coverage for thousands in need across the state.

“I think that would be catastrophically foolish,” said Jae Kennedy, an associate professor in the Health Policy & Administration program at WSU Spokane. “And some of the across the board cuts to essential services would be foolish.”  

McClain said even taxpaying citizens with disabilities may soon lose access to essential health care benefits like dental coverage that keep them independent.

“(Some of our clients) really need dental because maybe they are HIV positive or they have other disabling factors in their life,” she said. “If you can not get dental care it’s going to lead to other long-term health problems which in turn costs the taxpayers more money.”

In addition to cutting funding for state programs, the cuts could also decrease access to the programs themselves. 

“(The cuts may) raise eligibility requirements and eliminate services for 25,000 developmentally disabled and elderly clients who now receive services ranging from in-home assistance with eating, bathing, medication management and toileting, to extensive hands-on assistance in a nursing home,” a release from the governor’s office said.

The changes to eligibility requirements would save the state $204.3 million, and the alternative measure would save $35 million by reducing eligibility for Medicaid beneficiaries and cutting services for 5,000 elderly clients and 600 people with developmental disabilities. 

Cuts taken from developmental disabilities programs and long-term care would total $403.5 million according to the latest draft of proposals, and could rise to more than $440 million if alternative cuts are enacted as well. 

Cheryl Amann, the associate director of CORD, warned that this round of cuts could take even more away from programs that were already hit badly this year.

“Last year the legislature disbanded the disability lifeline program,” Amann said. “When they did that, they transferred funds into the Department of Commerce under the housing and essential needs grant.”

Within the governor’s current proposal, more money would be siphoned out of the Department of Commerce, likely cutting the disability lifeline program even further, she said. 

“We are talking probably less than $150 a month for individuals with disabilities who have absolutely nowhere else to go,” McClain said. “We’ve had a couple folks that because of the proposed budget cuts and from the loss of disability lifeline, they literally have been put in a psychiatric ward to be stabilized.” 

McClain fears that as the newest round of cuts are happening, more people are going to become part of this worst-case scenario. 

“I understand that we need to have a balanced budget, but (the legislators) are doing it at by sacrificing human value and human life,” McClain said. 

Jobs for the developmentally disabled could become harder to find. 

The cuts that will come out of this month’s special legislative session will take money away from programs that place people with disabilities into jobs, Executive Director of Palouse Industries Eric Hoyle said. 

Palouse Industries is a non-profit in Pullman, Wash., that aims to educate and train adults in vocationally-related programs, according to its website. 

As a result, Hoyle and Palouse Industries are able to see the effect of job cuts for persons with disabilities on the ground level. 

“On the employment day programs, we are most certain to have approximately 37 percent cuts,” he said. “So people (with disabilities) who are working out in the community will be experiencing the cutbacks.”

These employment day programs often provide job support services, where job coaches support workers with disabilities and help them gain the skills and independence needed to retain their jobs, Hoyle said. 

“If (the job support services) are cut back by a third, there could be growing issues in terms of job security for people with developmental disabilities,” Hoyle said.

Some people with developmental disabilities may even lose their jobs, he said, though the cuts will most likely result in fewer days of employment for Palouse Industries’ clients each week.

In spite of the likelihood of funding cuts, Hoyle remains optimistic that day programs can trim services to fit within the cuts that have been proposed.   

“Although its going to affect Palouse Industries as a non-profit agency and the services  we offer, we will just have to be very strategic and efficient with the services that remain in order to help people retain their jobs,” he said. 

Solutions and sacrifices

While solutions or alternatives to the budget cuts may be rare, Kennedy said smarter moves in health care for the needy could be made.

One example would be a reorganization of Medicaid, Medicare and President Obama’s Medicare Part D program, a federal program that aimed to help states pay for medication for those eligible for state Medicaid and Medicare (dual eligibles). 

After the Part D program was implemented in 2006, dual eligibles were taken out of their Medicaid programs and enrolled solely in Part D programs, Kennedy said. The program ended up being more expensive for the patients, and more expensive for the federal and state governments combined. 

“There’s been some talk about folding dual eligibles back into the state drug benefits and then paying a federal premium to the state Medicaid programs, which would increase revenues for the states,” Kennedy said.

The states would then be able to negotiate lower costs for drugs and not have the type of administrative overhead and profit that Part D plans have, he said.  

With so many cuts to services for the elderly and disabled, it is not clear whether the proposed cuts will work in the long run.

“Some people will end up going to the nursing home earlier and some people will end up going to the hospital earlier,” Kennedy said. “Whether that’s going to partially or totally offset the savings from reducing program enrollments is not clear.”

Many elderly will end up relying on the care and budgets of families and friends, Kennedy said. And many will go without. 

Though Kennedy believes the cuts are necessary, it does not mean they are moral.

“I think that as a society we should ensure ourselves and our community against impoverishment and involuntary institutionalization and foregoing essential health services just because we’re not willing to pay for it,” he said.

Kennedy was quick to note that the legislature and governor are not immoral for proposing or enacting cuts, but simply dealing with the economy they have been dealt. 

The blame may lay at a much broader level.  

“The fact that the US is one of the few developed countries on the planet that doesn’t have an adequate and rational system for providing healthcare and long-term care benefits for the poor and disabled is immoral,” he said.  

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Eric Hoyle - Executive Director of Palouse Industries - 509.332.6561

Linda McClain - Executive Director of CORD - 509.326.6355

Cheryl Amann - Associate Director of CORD - 509.326.6355

Jae Kennedy - Associate Professor at WSU Spokane - 509.368.6971

...

http://www.kplu.org/post/gregoires-budget-cuts-46-billion-ends-funding-state-parks-and-basic-health

http://www.kplu.org/post/gregoire-eliminate-states-basic-health-program-poor

Weekly articles

1) http://www.nytimes.com/2011/11/12/us/soy-diet-is-cruel-and-unusual-florida-inmate-claims.html?_r=1&ref=health

2) http://www.nytimes.com/2011/11/08/health/research/freshman-15-weight-gain-freshman-3-may-be-more-realistic.html

NYtimes story

* Is the coverage sensational? Why or why not?
I don't think the coverage is sensational, although I do think it focuses on a fringe element while neglecting the treatment of the majority. If there were 700 deaths accounted for in 2009, how many were accounted for? The article provides number that give great detail, but don't add any context. If there were 1,000,000 deaths overall, 700 might not be so bad. Whereas 1000 total deaths may cause more worry. In my opinion, the story is not necessarily sensational, but it definitely focuses on the most 'newsworthy' cases. 



* What is the most compelling paragraph in this story? Why?
I liked this one toward the end:

On a recent day, as Mrs. Taylor sat on the back porch of her apartment at a retirement home in Saratoga Springs, wearing tennis shoes and shorts, she leafed through the guestbook from her son’s funeral, filled with 300 signatures, including those of local elected officials.

“I don’t know if my kid died with dignity or not,” she said.

I think this quote perfectly captures the complex pain the mother is feeling. It really brings the government/policy/bureaucracy thing full-circle as well with the "elected officials" part as well. 



* How do the writers provide context and understanding for this story?


As I mentioned before, this is the thing I think the article lacks the most. I think the numerical values in the article need to be cast in a more fair light, rather than thrown in to startle the reader.


The reporter uses lots of personal anecdote and some dialogue to flesh out the plight and personality of some of the victims and their families. The story depends almost entirely on the readers' compassion for context in the story. 

Social Issues Seattle Times Response

The first thing I thought was in reaction to the title. Who are the homeless that you do see?

The piece was very well shot. I liked the cinematographic quality of the first 30 seconds. Those first shots built a lot of tension for the rest of the segment.

I think the story is very compelling. When you think of homeless people, you conjure up images of a different nature. This challenges the "homeless" stereotype we all share. The journalist and photog seem like they spent enough time with the duo as well, and really got to know the duo and gain their trust.

Journalists shouldn't take a position in their piece, although it is inevitable. It's their job to present an objective piece for the public to judge. Neutrality should be their goal.

Stories for the week.

http://www.nytimes.com/2011/11/05/us/politics/mitt-romney-proposes-medicare-and-social-security-changes.html?_r=1&ref=health