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Health cuts: Will Washington end up a lot like Arizona on transplants?

Cutting the state's Basic Health Plan, as Gov. Gregoire suggests, might leave some potential transplant recipients in a position that wouldn't be all that different from Arizona's.

Cuts to state funding could make health care harder to access for many people.

Cuts to state funding could make health care harder to access for many people. Sen. Bernie Sanders

It's hard to think of any political similarities between Washington’s Democratic Gov. Chris Gregoire and Arizona's Republican Gov. Jan Brewer. But there is one. Both governors want to cut off funding that affects people needing transplant operations.

Brewer caused a national furor last month when she defended her state's budget-saving termination of Medicaid coverage for certain types of transplant operations, which has placed about 100 patients on transplant waiting lists at risk of imminent death. Critics have called it Brewercare, the real-life version of the bogus death panels dreamed up by foes of President Obama's health reform legislation. Even some Arizona Republicans — though not Brewer — have begun backing away from the transplant cuts.

Now, Gregoire, an advocate of universal health coverage, has proposed eliminating the state’s 17-year-old Basic Health Plan, an affordable health insurance program for working-poor families with incomes at 133-200 percent of the federal poverty level. Zeroing out the program as of March 1 would save $219 million over the next two years, as part of her proposal last week to slash nearly $4 billion in spending and close the state’s huge budget deficit.

The proposed termination of the Basic Health Plan (BHP) came as a shock to a man I’ll call Jim, a 34-year-old Spokane electrician and father of seven whose kidneys are failing. I’m not using his real name because his unemployment benefits could be jeopardized if the state learns he can't work due to poor health. Jim’s BHP coverage will end if the Legislature approves the governor’s plan, which appears likely. As a result, he may not receive the kidney transplant he’s waiting for at Providence Sacred Heart Medical Center. And his wife, who’s also on BHP, wouldn’t be able to afford the care involved in donating a kidney to him.

"Gregoire proposed that?” Jim said when I talked with him last month. "I don't even know why they would try to do something like that. It would leave a lot of people in a lot of hurt. I’m a union worker. I voted for her."

A kidney transplant costs tens of thousands of dollars for the operation and the anti-rejection drugs, which must be taken for years after the surgery. Like other transplant centers, Sacred Heart won’t perform transplant operations on patients who don’t have the means to pay for the operation and the drugs, because kidneys and other organs for transplant are scarce resources.

“Our purpose is providing patients access to life-saving transplants,” says Dr. Okechukwu Ojojho, the surgical and program director at Sacred Heart’s kidney transplant program. “But they have to be able to afford the medications which help keep the body from rejecting the new transplant. So financial issues will have to be a consideration in deciding whether to transplant (Jim).”

Jim is not the only Washington resident who may lose access to a transplant if Gregoire’s budget passes. BHP paid for eight transplant operations in 2009 — a kidney, a liver, two lungs, two bone marrow grafts, one heart, and a liver/intestinal transplant. While state officials couldn’t say how many BHP patients currently are waiting for transplants, Dr. Ojojho says Sacred Heart has at least a couple of other BHP patients waiting for kidneys. Another hospital official said Sacred Heart does four to five heart and kidney transplants each year on BHP patients.

State officials are well aware of the harsh impact that terminating the program would have on patients in need of transplants. And, of course, it also would have major consequences for the rest of the 66,000 BHP enrollees who may have serious if less critical health care needs —not to mention the 138,000 people on the program’s waiting list. “We understand and shared those impacts with the executive and the Legislature,” said Preston Cody, BHP’s director. “If the program is eliminated, we’ll make every effort to communicate with the entire population and send them information on other resources to see what their other options are.”


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Comments:

Posted Tue, Jan 4, 8:20 a.m. Inappropriate

Several years ago Oregon adopted for their state-funded medical aid, a system of priorities. Child health was near the top; organ transplants were near the bottom. What has been the outcome in Oregon?
Michael Cain

Posted Tue, Jan 4, 8:36 a.m. Inappropriate

Michael, this article by a respected health policy scholar says transplant coverage under the Oregon Health Plan actually became more generous.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC81116/

Posted Tue, Jan 4, 11:22 a.m. Inappropriate

Well, for people that want to get the government out of their health care, and everyone else's for that matter, here we go. I guess it's better for tax payers to save a few bucks than to help our neighbors in need. Is this the best that Washington can do? God help us.

jsperry

Posted Tue, Jan 4, 11:29 a.m. Inappropriate

And here's a good new piece from the Spokesman-Review on how the Washington Medicaid cuts will impact dental care:
http://www.spokesman.com/stories/2011/jan/04/dental-dilemma/

Posted Tue, Jan 4, 12:07 p.m. Inappropriate

Jim should contact Tim Eyman. I know Tim cares deeply for us all, that's why he does what he does. I bet with all the money he has saved with his tax cuts, paying for Jim's transplant should not be a problem at all.

Bob_Katz

Posted Tue, Jan 4, 3:44 p.m. Inappropriate

Tim hasn't done anything without the support of a majority of Washington's voters, Bob. If you wish to help with Jim's transplant, I'm sure the author can provide an address for you to send a donation.

BlueLight

Posted Tue, Jan 4, 10:43 p.m. Inappropriate

Recipients need to re-qualify for this program annually yet haven't, and eligibility needs to be tightened. For instance, where folks have decided not to get married so as to qualify for BHP, with one with employment that has health benefits, why should state taxpayers be picking up the tab instead? Under today's BHP, this is happening. It's too bad that things like this couldn't have been tight to begin with instead of everybody losing with perhaps the entire program being gutted. This seems to be typical for government, however.

bricsa

Posted Tue, Jan 4, 11:30 p.m. Inappropriate

Loss of the Basic Health Plan isn't at all desirable, and I hope it doesn't happen.

As for Jim and his situation, please get it right.

Medicare WILL pay for both preliminary dialysis AND a transplant, not "probably"--and his doctor is either being dishonest (not outside the bounds of possibility, since there are differences in financial return to providers of care, depending on the source of payment) or simply ignorant of the facts. In the latter case, the good doctor should consult with his back-office staff, who I'm sure are VERY WELL INFORMED of the facts.

Health care benefits come from many sources, and it takes careful digging to uncover all of the facts in this complex industry.

For more on this issue, consult:

http://www.cms.gov/manuals/downloads/clm104c08.pdf

Seneca

Posted Wed, Jan 5, 11:12 a.m. Inappropriate

Actually, Seneca, my article was correct that Medicare “probably” would pay for Jim’s dialysis. Medicare eligibility for an under-65 dialysis patient like Jim is not automatic. It depends on whether he has enough work credits or hours. Most patients do but some don’t, according to Todd Seiger, business manager for Sacred Heart’s transplant program.

If Jim qualifies for Medicare, Seneca is correct that the program would pay for his kidney transplant as well as dialysis. But here’s the kicker. Jim would need supplemental health insurance or other financing to cover the large out-of-pocket costs for the anti-rejection drugs and other care that Medicare doesn’t pay for. Sacred Heart, like other transplant centers, would put Jim on hold for a transplant until he was able to obtain the financing for those out-of-pocket costs, Seiger says. Perhaps Jim would qualify for Medicaid to fill in those Medicare coverage gaps. But at this point the financing is not certain. If the Basic Health Plan is terminated, there is no certainty about if and when Jim would be able to get his needed kidney transplant.

Beyond that, Seneca, the termination of BHP would clearly leave other types of transplant patients – heart, liver, bone marrow, etc. – out in the cold, because those patients would definitely not have the Medicare option that’s available only to kidney patients.

Bottom line, my article did get it right. Termination of BHP would leave Washington transplant patients and many other BHP members in severe straits.

BTW, my apologies, I misspelled the Sacred Heart transplant surgeon’s last name. It’s actually Dr. Okechukwu Ojogho.

Posted Wed, Jan 5, 6:14 p.m. Inappropriate

Based on your description of Jim (electrician, age 34), I made the assumption that he would easily have satisfied the minimal criteria for Medicare eligibility under the ESRD (end-stage renal disease) program, which does not limit eligibility by age. Given that assumption, my statement was correct (as is yours, given a different assumption).

As I said at the start of my comment, loss of the Basic Health Plan would be unfortunate, and I hope it doesn't happen; setting aside Jim's situation, there are indeed many other kinds of conditions for which BHP provides the only insurance coverage. A 'ray of hope' for salvaging at least part of the program is the quite recent federal approval of a Medicaid waiver submitted by the state of Washington. The feds are agreeing under that waiver to provide partial federal funding (known as the 'federal match') for the Basic Health Plan and the newly-named Disability Lifeline program. Both the BHP and DL have heretofore been totally state-funded, so the approval by Health and Human Services may influence the legislature to find a way (even in this gruesome budget environment) to come up with the state share of funding.

Seneca

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