When my son was young, I used to read him a Dr Seuss Book entitled Oh, the Places You’ll Go! In this book, the protagonist, who is clearly going places except when he is not, is warned about the trap of waiting:
You can get so confused that you'll start in to race down long wiggled roads at a break-necking pace and grind on for miles across weirdish wild space, headed, I fear, toward a most useless place. The Waiting Place... ...for people just waiting. Waiting for a train to go or a bus to come, or a plane to go or the mail to come, or the rain to go or the phone to ring, or the snow to snow or waiting around for a Yes or a No or waiting for their hair to grow. Everyone is just waiting. Waiting for the fish to bite or waiting for wind to fly a kite or waiting around for Friday night or waiting, perhaps, for their Uncle Jake or a pot to boil, or a Better Break or a string of pearls, or a pair of pants or a wig with curls, or Another Chance. Everyone is just waiting.
We in Alabama now sit and wait and see whether or not our Governor will choose to provide health care coverage for our poorest citizens at little to no cost to the state for the next 5 years through the expansion of Medicaid (thanks to the Obama-supported PPACA). I have some questions for those of us in Alabama stuck in the Waiting Game:
1)We have an opportunity as a consequence of the expansion of Medicaid as provided by the ACA to provide coverage to 60% of our current uninsured and coverage for preventive services and chronic disease care to a large number of underinsured. Shouldn’t every organization interested in the health of Alabamians support this? For those of us who feel a sense of responsibility to our fellow Alabamians, whose job is it to go to the Governor and the key legislators? For those who can’t support it, how do we as a state provide the care to these poor folks when the DSH money goes away and hospitals are no longer given federal money “just for being open to poor people.”
2) Opportunities (i.e., grant $$) to improve community health markers are found throughout the ACA. Shouldn’t every agency interested in the health of Alabama be applying for these grants? That part of the law is not in question and is THE LAW.
3) The movement towards Patient Centered Medical Homes and ACOs has likely reached a tipping point. States like Alabama are very dependent on the legacy of Hill Burton hospitals in rural communities that are likely not going to survive the transition. How do communities plan for this and who helps them to do this if the state chooses to ignore the existence of the new law?