SUPPORT MISSOURI MEDICAID EXPANSION

Register by July 8 to Cast Your Vote on August 4 Ballot

On Tuesday, August 4th, voters in Missouri will have the opportunity to vote on a ballot measure called Amendment 2, which amends the Missouri Constitution to “adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133% of the federal poverty level.” Your vote is critical.

The referendum prohibits making eligibility requirements more strict for the expanded group than what the more limited group faces. It requires state agencies to maximize funding received from the federal government for expanding Medicaid in Missouri, making millions of dollars available for health coverage to Missouri’s poor.

Medicaid is a critical part of our healthcare system, providing coverage for people with limited incomes. But in states like Missouri that have not yet expanded Medicaid, many people fall into what is called the “coverage gap” - a no-pay zone where poor and mostly working Missourians live without the benefit of health insurance and cannot receive subsidy or help with their premiums as their peers in 36 states across the nation do.

Medicaid expansion would allow those poor Missourians to get basic coverage they need to take care of themselves and face health crises of any kind head on –  even things like COVID-19!  Employer-based health coverage is being cut drastically due to COVID and people need help, NOW!  Nearly one-quarter million Missourians would receive help through expansion - and that’s a figure before COVID-19 happened resulting in thousands more laid off workers who now have no income for health coverage.

The expansion of Medicaid in Missouri is funded by tax dollars that Missourians pay and receive no benefit. In effect, the expansion “brings our tax dollars home,” putting that money back into local communities, creating jobs and supporting hospitals from inner city urban areas to small rural communities  - the very settings that are struggling to keep their doors open.

We need every voter in Missouri to register to vote by July 8 in order to cast a ballot on August 4 for Medicaid expansion in Missouri. Do you part and take action, spread the word.

For more information about keeping our communities healthy through the Missouri Medicaid expansion and how you can support this initiative, go to yeson2.org 

National Healthcare Decisions Day 2.0

In the future, those of us who survive 2020 will use words like “scary,” and “uncontrollable” in describing this pandemic year. But right now, you can control one very important aspect of your life – the end of your life. I’m not being flippant. It’s true.

Due to the pandemic, National Healthcare Decisions Day (NHDD), which is always the day after Tax Day, is doing a reboot or a second round – a 2.0. Since Tax Day was moved to July 15, NHDD is moving to July 16. NHDD has always used the “death and taxes” slogan to remind people to complete or review their advance care directive.

On the Center for Practical Bioethics website, we’ve made it easy to host an NHDD health fair-type event at your hospital or organization with your choice of two marketing kits.

If you’re an individual who hasn’t completed your advance care directive, we offer a free download from our website of our workbook in English or Spanish. 

Whether you are an organization or an individual, you can call us anytime if you have questions or need guidance on advance care directives.

So 2020 is scary and much of what’s happening may be uncontrollable, but hosting an NHDD event or filling out your directive can be an easier accomplishment in 2020 with the Center’s resources.

Written by Monica Delles

Ethics Consultation in COVID Times

Q:  What happens to clinical ethics consultation in a pandemic?

A:  Ethics consultation continues, only more so.

During the first few months of the coronavirus pandemic, with a significantly lower overall inpatient census and fewer providers seeing outpatients, ethics consultation at the University of Kansas Health System (UKHS) increased rather than decreased. Not all of the increase is COVID related. Most consultations reflect issues that arise during normal times as well.

Typical Issues, New Perspectives

Some consultation has been COVID specific, including participation on the UKHS Pandemic Triage Team assisting in preparation of guidelines for allocation of scarce resources under crisis standards of care. If hospital admissions exceed our critical care capacity, who gets an ICU bed? If there is just one ventilator available and two patients need ventilation support, who gets it and who is allowed to die? Or the shortage may be of personnel, or dialysis, or medications. Who decides and how? These are matters of ethics.

Ethics consultation services, both at UKHS and the Center for Practical Bioethics, are always available. Always.

Early in this pandemic situation, we responded to queries about a provider’s duty to care and ethically appropriate exceptions to the rule. Other consultation addressed the need to encourage advance care planning further upstream of arrival at the Emergency Department by patients in COVID-19 crisis. Decisions then may need to be made emergently about resuscitation attempts on a patient who may not have wanted it, or for whom CPR will almost certainly be futile—and riskier also for those who provide it. Heightened risk to providers sometimes spawns awareness of ethics issues. This was discussed at great length most everywhere relative to shortages and conservation of personal protective equipment (PPE).

The UKHS Ethics Consult Service responded recently to several situations of ethics dilemma regarding decisions for patients who also are prisoners. Who decides for a ward of the state? Can the patient’s mother be contacted directly, or only by permission of the warden? Ought we allow prison guards in the COVID “hot zone”? Not all such cases arise as a direct result of a pandemic, but there seemed more of them recently, perhaps with correlation to the inordinately high incidence of coronavirus transmission within incarcerated populations.

Same Process, New Technology

Consult requests can come at all times, pandemic or not, and at all hours of the day and night. Health system ethics consultants typically are happy to respond with ethics assistance at 3 or 4 A.M. even on a holiday weekend, as happens occasionally for this consultant. I might heat up a cup of coffee before picking up the phone to return a call after the Ethics pager has gone off in the wee hours, but it is a privilege to collaborate with resident physicians and night shift nurses on ethical care to patients—whenever need arises.

The UKHS ethics consult service has been carried out during COVID times both virtually and with physical presence in clinical settings. For the most part, we are doing “tele-ethics.” Like tele-health generally, we too make optimal use of confidential email, phone calls, Zoom meetings, and ethics notes posted to the electronic medical record. Some of our consultation team members are considered “essential” healthcare workers in their primary roles of physician, nurse, social worker, or administrator. That has enabled us to offer physical presence at the bedside or on the unit when face-to-face communications are necessary or at least better than virtual only.

Ethics consultation continues during COVID times as it did before this global strangeness began. Pandemic conditions may have put the pause on elective services for a time, but Ethics is never elective. Ethics consultation services, both at UKHS and the Center for Practical Bioethics, are always available. Always.

By Tarris Rosell, PhD, DMin

Dr. Rosell is the Rosemary Flanigan Chair at the Center for Practical Bioethics and  Director of the University of Kansas Health System Ethics Consultation Service and Co-Chair of its Hospital Ethics Committee. He is also the Center for Practical Bioethics’ 2020 Vision to Action Award honoree.