LWVPT Health Care Roundtable Goals

Program Goals for 2024-2025

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. 1. Threats to patient/care provider relationships related to governmental and corporate intrusions with a focus on reproductive rights.
   2. The effects of managed care on Medicaid and Medicare benefits including the threat to Medicare solvency related to increased management costs. 
   3. Hospital systems and private equity expansions and acquisitions in the Piedmont Triad area considering effects on the public’s finances and health care access. 

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 

Health Roundtable Minutes 6/3/24 

Attending: Barbara Carter, Rob Luisana, Wayne Hale, and Laurie Solomon

This meeting took place via Zoom hosted by Barbara Carter

 Wayne reminded the attendees that the Co-presidents of the LWVPT had asked HRT to consider doing the October Lunch with the League (LwL) on a topic related to reproductive rights. Barbara repeated her opinion expressed at our last HRT meeting that this topic would be repetitive of our 2022 Lunch with the League on the repeal of Rowe vs Wade. Wayne stated that we could focus on the interim ill effects on the patient/physician relationship and the moral injury that physicians suffer due to being prevented from providing their ideal treatment to maternity patients. Rob had called me earlier; unsure he would be able to connect from his care. He is driving back from Connecticut after having visited his sister shortly before she died in the hospital. 

He had suggested that for LwL we could do a panel discussion about the advantages of a single payer system with someone like a representative of the John Locke Society to represent an opposing position. During the meeting he was able to connect from his car and added that our HRT should be able to choose the topic that we wish. Laurey concurred with this. Barbara pointed out that the October LwL will occur after early voting begins and may not have much effect on voter’s opinions. Wayne shared that he had a week ago emailed Kelly Leggett, MD who is the obstetrician who had presented at our LwL in October of 2022 asking if she would be interested in presenting again. She has not responded. Wayne will bring it HRT’s ideas at the LWVPT executive committee meeting July 6th.  He’ll also report on the Vermont chapter’s result from seeking a concurrence at the LWVUS national meeting with their position that investor-owned entities are harmful to Medicare. We agreed to discuss this further at an HRT meeting August 5th.  

Health Roundtable Minutes 4/1/24 

Attending: Barbara Carter, Wayne Hale, Tim Lane, Laurey Solomon, William Hensel

 We met in the conference room of the Deep Roots Market with our guest, William Hensel, MD. Bill worked until his recent retirement at the Cone Health Family Medicine Residency program where Wayne had worked. Bill held many leadership roles including Residency Director, Chair of the Ethics Committee, Medical Staff President and was one of the founders of the Triad Healthcare Network. The latter is the ACO of which Cone Health was a part. That accountable care organization was organized as one of the higher risk types and was successful in achieving improved health results and cost savings. Cone Health initially invested $20 million which was repaid in the first year. Quality measures improved and THN surpassed the threshold goal in the first year. Bill couldn’t comment on changes that occurred with the transition to ACO-REACH. Cone Health also started the successful Health Team Advantage Medicare Advantage plan which it subsequently shared with Novant.

Bill’s knowledge of the failed merger between Cone Health and Sentara was limited to the reported last-minute realizations that the organizational cultures clashed. Sentara was significantly larger and may have not guaranteed the retention of the Cone executives, but that is supposition. For perspective, Tim noted that Cone is a $3 billion enterprise whereas the recent Aurora-Atrium merger created a $40 billion corporation. Wayne interjected that a Yale study showed several years ago that beyond a certain size these mergers increase healthcare costs for the population served. 

While discussing challenges to the future health care system, Bill listed cost control as the greatest failure. Cone has had some success in improving access locally, which is now being further improved by Medicaid expansion. Fee for service earnings were down during the pandemic due to patients avoidance of the healthcare system, but capitated plans such as Medicare Advantage did well financially due to decreased utilization.  Currently costs are skyrocketing due to pent up demand, and increasing medical care related deficits are predicted. These are threatening Medicare Advantage and similar entities’ ability to reward their investors. 

 Improving access to primary care might help, but Tim reminded us that the average medical graduate has $200,000 in debt which disinclines them from going into primary care. Wayne noted that medical schools are only producing about 5000 primary care physicians annually and that attempts to replace them with Advanced Practice Providers has had limited success. They earn lower salaries but tend to order more tests and make more referrals to physician specialists. He suggested that single payer is the only way to control costs, but Bill was dubious that there would be the political will to support such a drastic change in the system. 

 We thanked Dr. Hensel for sharing his insights about the local healthcare system. 

Health Roundtable Minutes 3/4/24 

 Attending: Theresa Bratton, Barbara Carter, Rob Luisana, Lynn & Wayne Hale, Tim Lane, Eleanor Stoller, and Margaret Villani 

 Wayne welcomed attendees and thanked Barbara for providing the Zoom link and hosting this session. He plans to ask the LWVPT board for permission to write a letter of support for the Vermont LWV to hold a concordance discussion at the LWVUS national meeting seeking approval of their position on universal health care coverage. The HCR4US toolbox pages giving the details of their proposals was viewed via the link https://lwvhealthcarereform.org/vermont-concur-steps/ 

Rob reported on his presentation to a Charleston, SC Rotary group which went well. In the discussion afterward it was pointed out that for many in S.C. Medicare Advantage plans are all that many folks can afford since they are zero premium and traditional Medicare with supplemental insurance is not. Margie Villani then expanded upon information she has learned from MedPAC, the advisory group that makes recommendations to CMS on Medicare administration. She recommended that our group read the Medicare Advantage plan (Chapter 11) of their 2023 Annual Report which can be downloaded at https://www.medpac.gov/document/march-2023-report-to-the-congress-medicare-payment-policy/

 Teresa Bratton commented on the current experience of practicing in a clinic with a high managed Medicaid pediatric patient population. Clinician time is increasingly taken up with doing prior authorizations and dealing with the limitations of the Medicaid medication formulary. She believes that Medicaid expansion will have a much greater effect on clinics with a large adult Medicaid population. 

 Wayne brought up for discussion that we should determine our roundtable’s study issues for the 2023-24 year.  Our current issues are listed as: 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

  Wayne suggested we should we add “reproductive choices” since these were listed as important by several of the responders to the 2024 Issues survey.  He referred to the League’s “Public Policy on Reproductive Rights” as detailed on pp 57-61 of the 2022-24 LWV Impact on Issues. The group discussion settled on a more general issue of government intrusion into the physician-patient relationship. An initial statement of the issue was to study: The reaffirmation of the privacy of patient-physician relationships as necessary for quality healthcare. Wayne will send this out to the group with a restatement of issues #1 and 3 for their input.  

Our next meeting will be April 1 when William Hensel, MD will discuss recent changes in Greensboro’s medical care environment. Bill is recently retired from the Family Medicine faculty as professor at the University of North Carolina School of Medicine and past director of the Cone Health Family Medicine Residency program. He also served as the president of the Cone Health medical staff and was one of the founders of Triad HealthCare Network, the largest Accountable Care Organization in North Carolina.

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.