LWVPT Health Care Roundtable Goals

Program Goals for 2023-2024

Related to LWVUS positions on Health Care as listed in the 2023-2024 Voter Impact

“….quality health care at an affordable costs should be available to all U.S. residents”. “The League supports the single-payer concept as a viable and desirable approach to implementing League positions on equitable access, affordability, and financial feasibility.” 

We resolve to study:

1. The statistics for the counties of the Piedmont Triad relating to the expansion of Medicaid coverage and the number of uninsured who remain. We will educate the public regarding these statistics beginning with expected implementation in January of 2024
2. The financial effects of hospital systems’ expansions and acquisitions in the Piedmont Triad. We will educate the public regarding expected financial and health care access effects. 
3. The threats to Medicare solvency and report on these to the membership and the public.

Policy Statement

The 2016 - 17 public policy statement of the League of Women Voters of the Triad under social policy, health care was, "Promote a healthy community that recognizes the importance of social, geographic, political influences. Promote a health care system for the Piedmont Triad that provides access to affordable, quality care for all residents, including prevention of disease, primary care (including prenatal and reproductive health), acute care, long-term care, and mental health care (including substance abuse treatment). Promote control of health care costs, equitable distribution of services, efficient and economical delivery of care, advancement of medical research and technology, and a reasonable total expenditure level for health."

Two minute video about your vote

This short video explains all the ways you can use your vote to affect health care policies, many of which are not obvious. They are nonetheless extremely important.

NC Medicare for All Coalition

NC Medicare for All is a statewide coalition promoting  a single payer health care system in the US that covers everyone. Please spend some time on their website. 

What About My Pre-existing Condition?

Rob Luisana's Op-Ed in Nov. 1, 2020 News and Record

In the News: Links to Relevent News Articles

Cone Hospital System Appeals Decision to Permit Atrium Satellite Hospital Beds in Greensboro

Blue Premier Healthcare Initiative Savings

Health Disparities in Greensboro

COVID Update Sept. 8, 2023 & Blue Cross Lowering ACA Premium

A Conversation About Health Care 

Rob Luisana's Powerpoint presentation promoting universal health care

Resolution to Present to Guilford County Commissioners

Working document on health care FAQs. 

 Responses to frequently asked questions about changing to a national health plan. 

Lunch with the League Presentation

The Overturn of Roe vs Wade: It's implications for Women's Healthcare, Sept. 20, 2022

Equal Access to Care in Our Communities, Olu Jegede, MD Cone Health Nov. 4, 2023

Minutes from recent meetings 

Minutes for Health Round Table Meeting

Health Roundtable Minutes 12/04/23 

• Attending: Theresa Bratton, Laurey Solomon, Barbara Carter, and Wayne Hale
• Review of Dr. Jegede’s Lunch with the League presentation
  • Wayne shared the difficulties with the Mullin Center set-up with the LWVPT Executive Council. 
  • Problems: Lectern between audience & screen, speaker couldn’t advance slides, second mike not available, screen not on lectern, limited parking, only USB access to projector. 
  • Dr. Jegede’s main message was what Cone Health is doing to reverse the disparities in health outcomes in Greensboro and surrounding areas. 
  • Anticipated benefits to local hospitals from Medicaid expansion
    • https://greensboro.com/eedition/page-a1/page_0a6c2512-7cfb-5da0-a3e4-22ed16d76fb6.html
    • Health care to >600K North Carolinians.
    • Link to local statistics, see “Health & Equity” under Guilford County
      • https://datausa.io/profile/geo/guilford-county-nc/?lengthOfLife=indicator_3
      • Reports from Medicare 4 All NC Coalition and Health Care Justice NC (Charlotte chapter of PNHP) Rebecca Cerese was at both. She stated that 200K new Medicaid recipients were enrolled on day one. She also attended the PNHP annual meeting in Atlanta and with others said the workshops were excellent. Communication: Use active voice, name the villain (Corporations care about profits not people), Avoid Medicare Disadvantage (Not really Medicare), seek small wins. 
      • “Moral injury” to health care providers is increasingly resonating with them. 
      • Better Medicare Alliance (pro Medicare Advantage annual letter for congress to sign) No sponsor in the house this year, but still being circulated in the Senate. Contact Senators. 
      • HCR4US (national LWV committee) website https://lwvhealthcarereform.org See their newsletter at the bottom of the page. 
      • NC4ANC will host Alex Lawson of Social Security Works to the Core meeting Weds. 6th at & PM. Email me for Zoom link. He pursues Truth in Advertising and small wins. 
      • PNHP will have session on Power Mapping your legislator Dec. 13 at 9 AM. 
      • Reminder of Margaret Villani’s Medicare for All Advocate gathering, Weds. Dec 13 at 2:30 PM at Katherine Clay Edwards Family Branch Library. The Medicare for All proposal that she is presenting to the Guilford County Board of Commissioners is on our HRT forum page. 
      • FYI: CVS owns Oak St. Health, Amazon bought One Medical which owned Iora which is now called One Medical Seniors. 
      • Suggestions for local organizations with whom to collaborate with in promoting single payer included Red, Wine &Blue, Common Cause, AARP, and NAACP.  
      • See these Minutes on our Forum web page for links to pages and meetings mentioned today. Barbara will send me pdfs of the News & Record articles so non-subscribers can read them. 

Noon, November 6, 2023

Attending: Rob Luisana, Wayne Hale, Laurey Solomon, Barbara Carter, Theresa Bratton, Tim Lane, Margaret Villani, Phillip Villani

 We unfortunately had no new members to introduce but had a solid turn-out of our most dedicated attendees, excepting the Stollers who are on vacation. 

Since we are the sponsors of the November 21 Lunch with the League we went through the agenda for the meeting. Wayne will introduce the speaker, Dr. Olu Jegede, VP of Clinical Care & Health Equity for Cone Health System who will speak on “Equal Access to Care in our Communities”. Theresa Bratton will supervise collection of questions from the audience and will collate them for Wayne to ask the most popular questions. We then had a discussion of topics we would like to ask about if he has not included them in the presentation. Among those brought up were the status of the mobile health units funded by the Cone Health Foundation, replacement of the closed Evans-Blount Clinic in S.E. Greensboro, effects of the primary care provider shortage, the RN shortage, fragmentation as the enemy of continuity of care, Cone Health’s satellite health care units, Cone Outpatient Pharmacies as sources of less expensive medications, effective responses to deficits in patients’ social determinants of health, and his opinion of a single-payer reorganization of health care funding in the U.S.

We had a brief discussion of how to improve attendance at Lunch with the League and at roundtable meetings open to League members and the public. Rob and Wayne attended an ad hoc meeting on communications led by Mary Coyne out of which several suggestions emerged. Jane Harris was on vacation, so final recommendations will await her return. We did ask our HRT members to ask others with interest in this area to attend the November Lunch with the League. 

 We took a break to go outside and take a photo of our current group to replace the old one on our LWVPT HRT web page. 

 Margaret Villani then gave us an update on the Medicare for All resolution that she attempted to have presented to Guilford County last spring. Despite having had a similar one passed by the Greensboro City Council last year, and initially getting indications of support, progress has been delayed. The county commissioner, Mary Beth Murphy that Margaret and I met with in the spring recommended presenting it later in the year. So far, she hasn’t responded to Margaret’s recent attempts to contact her. We also discussed our prior attempts to get Kathy Manning to sign on to the Jayapal Medicare for All bill. Tim reported that his wife, Robin, has continued to be active with the LWV group working with national League leadership to promote the single-payer approach endorsed in the 2023-2024 Impact on Issues and has also been in contact with Rep. Manning’s staff on the issue. 

We then had a spirited discussion about the arguments presented by Rep. Manning and others reluctant to endorse a single-payer approach. One example being, the loss of jobs by those employed by insurers, pharmacy benefit managers, and other middlemen managing our failing health care system. 

Our December meeting will be via Zoom at noon on the 4th.  We’ll continue our discussion of the “cons” of implementing a single payer system so that we may anticipate arguments we may face from politicians and the public.

Submitted by Wayne Hale. 

Noon, October 3, 2023

• Attending: Rob Luisana, Wayne Hale, Barbara Carter, Theresa Bratton, Mary Ellen Shifflet, Andrew Stern
• This meeting was a Zoom presentation entitled: Medicare Choices 2023 with subtitles:

What is the future of Medicare? Which is the best plan for you? 

Wayne presented for 15 minutes on challenges faced by the Medicare system, then Rob presented for 15 minutes, and the remainder of the hours was open to questions and comments. The Zoom meeting was not recorded due to technical problems. 

Wayne’s main points were:

1. Medicare is health insurance coverage that we rely on for our retirement years. 
2. The U.S. League of Women Voters last year endorsed a single-payer system as the best means to meet its goal of universal health care for the U.S. 
3. The Center for Medicare and Medicaid Services (CMS) is trying to reduce costs.
4. CMS is depending on replacing fee-for-service with value-based care to do this. 
5. The Piedmont Triad population is aging as rapidly as the entire U.S. 15% over 65. 
6. The over 65 population will be more than 20% by 2030. 
7. There is a worsening shortage of primary care physicians. Nurse practitioners are growing much more rapidly.
8. New technologies and medications may prolong life but are very expensive. 
9. The COVID epidemic temporarily slowed cost increases. 
10. Fee-for-service has been rightfully criticized for incentivizing rescue care over preventive care and increasing costs. 
11. CMS used Accountable Care Organizations (ACOs) and direct contracting entities to promote value-based care. 
12. This year the first two were renamed ACO-REACH (Realizing Equity Access and Community Health). 
13. Medicare Advantage Plans now cover more people than does Traditional Medicare.
14. Advantage plans have the disadvantage of limited provider networks.
15. Traditional Medicare Plans permit seeing any of the 95% of providers who participate with Medicare. 
16. Usually, Traditional signees add supplemental insurance to cover what Medicare doesn’t. 
17. Failing to buy a supplemental plan in the first 6 months of becoming eligible may prevent you from buying one later. 
18. Locally, Atrium has combined with Wake Forest Baptist and is opening a medical school in Charlotte. 
19. Atrium is moving 25 beds from High Point to a new hospital they are building in west Greensboro. Cone Health is contesting this.
20. The ACO affiliated with Cone Health and Eagle is Triad Healthcare Network which has been successful at improving value and saving Medicare money. 
21. Upstream is a new ACO being formed in Greensboro.
22. Medicare Advantage plans are funded by the same revenues as Traditional Medicare.
23. Part A Medicare (hospitalization) depends mainly on the Medicare Hospital Insurance Trust Fund which is funded by payroll taxes. 
24. The Medicare Trustees project that expenditures will exceed income into that fund in 2028.
25. Congress has always rescued the fund in the past, but 2028 is an election year. 

Rob’s Main Points were:

Don’t take life too seriously, you’ll never get out of it alive!

1. Medicare coverage is incredibly complicated.
2. Advertising and solicitation add to the confusion.
3. Most people don’t realize the differences between Traditional Medicare Plans (Administered by the Government, through the Center for Medicare Services) and Advantage Plans (Administered by Private For-profit Insurance Companies).
4. Both sets of Plans offer government mandated benefits but reimburse hospitals and providers under different payment systems.
5. In general Advantage Plans offer $0 monthly premium plans with a limited doctor & hospital network, versus a nationwide doctor and hospital network (95% of US physicians) under Traditional Medicare but with an additional cost for a supplemental or gap plan.
6. Comparing the efficacy of Traditional Medicare versus Advantage Plans is next to impossible, because of the different reimbursement systems. Traditional Medicare pays providers under “Fee for Services,” while Advantage Plans reimburse providers per covered individual, leveraging that fee by additional payments for chronic conditions.
7. Complicating comparison is an insurance term called “Adverse Selection,” meaning that individuals with complicated issues and illnesses will sign up for Traditional Medicare, which has a wider provider network. 
8. Just to make comparison even more difficult, Advantage Plans frequently offer additional benefits like dental, vision, and hearing aids.  Individuals should be aware that these benefits are usually very restrictive in terms of providers and benefits and should not be the basis for choosing a medical plan under Medicare.
9. There is an ongoing controversy about whether Healthcare and Corporate Profits are compatible.

In the Q&A discussion we further defined ACOs and REACH plans. In addition to Triad Healthcare Network, Novant and Atrium (Chess Genesis) both have their own ACOs active in the Triad. Other ACO-REACH plans in the Triad are One Medical (was Iora) and Oak Street Health. These are primary care offices for Medicare Patients, although One Medical takes all ages. After the Biden administration received much input against the further expansion of ACO-REACH it was greatly slowed down for the coming year. We discussed whether State Health Plan beneficiaries could see out-of-network medical providers without greater costs and Rob clarified. 

Our November meeting will be live at the Deep Roots conference room at noon on November 6th. We’ll take a new group photo for our web page and prepare for the presentation by Olu Jegede, MD entitled “Equal Access for Care in Our Communities” at the November 21 Lunch with the League.

Minutes for Health Round Table Meeting

Noon, September 11, 2023 

• Attending: Merle Green, Carol , Rob Luisana, Barbara Carter, Eleanor Stoller, Michael Stoller, Laurey Solomon , Tim Lane
• Review minutes of last meeting which are on our RT web page. The links listed in the agenda for this meeting will also be put on our RT page. 
• Update of N.C. Medicaid expansion status: Wayne reviewed and shared links to the recent Greensboro N&R articles indicating that passage of the state budget is being held up by Phil Berger’s efforts to get more legislators to support approving a casino in Rockingham and 2 other counties. Kody Kinsley, the state’s health secretary said that Medicaid expansion will have to be delayed until December 1, 2023 or later. HB 76, the bill permitting expansion will expire July 1, 2024. 
• Update of health system changes affecting the Piedmont Triad. Wayne referred to the N&R articles describing Cone Health System’s contention that Atrium Health should not be allowed to move hospital beds from High Point Hospital to western Greensboro, 2 miles from Cone’s new Drawbridge facility. Merle commented that providers will back whatever maintains their current income level. 
• Wayne confirmed Olu Jegede, MD as speaker at the Nov. 21 Lunch with the League.  He is Area Medical Director for Cone Health Medical Group. In that role he has shown improved medical care outcomes among lower income patients served by those clinics. 
• Wayne is updating our HRT page on the LWVPT website and asks round table members to visit it and suggest improvements. 
• Report on N.C. Medicare for All Coalition Zoom meeting which Wayne attended last week. Rebecca Cerese of the NC Justice Center described a protest they are supporting where a patient suffering illness due to lack of Medicaid expansion will confront legislators in Raleigh. Also, the movie “Healing US”, available on Amazon Prime, was recommended by an attendee from Asheville.
• Rob Luisana reports three recent speaking engagements in NC were well received and he perceives more acceptance of the need for universal health care coverage in the U.S. The fairness of covering everyone seems to resonate with audiences. 
• Rob feels it is important for us to educate local League members about the pitfalls of signing up for Medicare for the first time and about confusing aspects of Medicare Advantage plans. Wayne noted that some are calling them Medicare DisAdvantage plans partially due to their potential for bankrupting the system. Tim sent a link to an article on a surprising recent plateau in Medicare expenditures. Rob and Wayne plan to discuss exploring these issues in more depth at our October HRT meeting and to invite local league members to listen in via Zoom. We will begin with a disclaimer that we won’t be able to discuss individual Medicare decisions in detail. 
• COVID update – Cases rising locally, but no significant rise in hospitalizations yet. Immunocompromised people should consider wearing a mask in crowded situations. 
• The next HRT meeting will be October 2 at noon via Zoom. Wayne will send the agenda and Zoom link.