Thinking Scared...

I suppose I should preface these thoughts with a few disclaimers.  I work in health care, which means a great deal of the personal information that passes in front of my face is subject to this thing called HIPAA - which is, for the lucky folks who don't deal with it (see below) is a prohibition that makes sure I don't run up and down the street screaming out your address, your policy, your diagnosis, your copay, your medical condition, your social security number, your doctor's name, what ever it is that you're taking to keep you healthy, and etc., etc., etc.  Or in other words, pretty much the opposite of the little announcement I used to provide to folks whom I was about to start training on some computer system by simply noting that "hey, look, when you're using your work computer, it is important for you to remember that your employer paid for that computer, and they therefore have the right to see the data you have stored on it, the stuff you send out via email or however you use our company resources, and whatever responses you receive back.  So to put it in a nutshell, you have absolutely no expectation of privacy, anything you say or do with our technology may be reviewed and can potentially lead to discipline from warnings up to criminal charges and termination."  

(That see below note: If you are capable of moving through a doorway, whether it's under your own power, or via assistance of some sort, then you will be concerned about HIPAA, and if you are, let's just say, unlikely to draw another breath, assisted or otherwise, any time in the next 30 minutes, then you don't need to worry about it.  Or to put it another way, if you're alive, it's your data, your concern.  And that's why I don't violate that).  

So anyway, the other day it occurred to me, and this morning, I went back and confirmed it.

And because I don't want to be accused of even skirting HIPAA, I'm going to flat out rely on my experience gained in working to help a fairly large number of people in Texas.

Why Texas?  Because Texas appears to be a leader in the current rush to remove rights from people simply because they object.  And by that specifically I'm talking about their recent attempts to restrict access to abortion.

And to set up a few other points, I should note that after sixteen years of Roman Catholic Education, I came deeply and profoundly aware that the "Right To Life" movement was undoubtedly one of the most hypocritical groups of people that ever existed.  That is, I say, because of the overwhelming insistence that abortion be outlawed, and yet where any logical human being would seek to find ways to prevent an event from occurring by reducing the likelihood it would be needed, the "Right To Life" movement does not want any sort of birth control to be used, and does not want to have people educated in such a way that might reduce the chance that certain groups might find themselves needing this medical procedure.  And lastly, you would think that people who are absolutely insistent that pregnant women must give birth would be concerned about what would happen to that woman, and that former fetus now baby, after birth.  But nope.

So what started me thinking about all of this was the realization the other day about how Medicaid works in Texas.  And I do understand that a large number of you won't have my level of exposure.  I've been responsible for the last couple of years of looking to insure my employer gets paid for providing services to medical patients.  And a lot of those folks are in Texas, because that's one of the areas I've been assigned to work.  

And that's how I got my experience.  And I will grant that it is possible that some of this information may change, I doubt it will any time soon,  I deal with Texas Medicaid on a daily basis.  And that's where things get ... well, there's the saying "Experience is what you get when you wanted something else."  I'm lucky.  I get experience even from when things work out right.  It's all knowledge.

And one of the things I have learned over the years is that there are often system rules that some folks will follow, while other folks might work to find ways around them.  And so one big thing that stands out to me is from my own experience.

Mind you, it's not a HIPAA violation if I tell you about me.  And that's where we'll start.  Last fall, I was stupid.  I had this thing on my foot.  It started as an itchy spot.  I treated it with a number of over-the-counter athlete's foot treatments, because, well, according to Dr. Google, that's what it may have been.  Now, I will tell you that while Dr. Google has a hell of a lot of information, his diagnostic skills are right up there next to his bedside manner - which is to say my dogs are better doctors.  And to be fair, Dr. Google is only as good as the garbage that goes in.  So I do suppose that Dr. Google's key flaw is his primary assistant in this case, which would be me.  I would guess that while there's the old adage that an attorney who represents himself in court has a fool for a client is probably also replicated in the medical field, where I'm sure the fellow who diagnoses himself is probably equivalent to brains from a bedpan.  

So when I came out of the hospital with a hole in the top of my foot which was big enough for me to drop an old shooter marble into the thing, I was fortunate in that the insurance coverage we have is nowhere near the same sort of coverage that Texas Medicaid would provide.  And that meant that I could have nurses come to my home in a pandemic to make sure I was healing, slowly, but certainly making progress.  

And that's where, last week, when we got a bill for those visits, that I said "oh, now that sucks."  Because while I might have found a potential legal challenge to the Texas Law preventing abortions, I doubt it would work.  Because if you are a patient in Texas who has medicaid coverage, you don't have home nursing visits guaranteed.  

Now back up.  I need to explain a few things here.  And none of this is based on any individual patient I've seen.  It's more of an aggregate thing.  Like elsewhere, Texas has a multi-tiered system for patients who are on Medicaid.  There is the state, as a provider.  That means that if you have what we call "straight Texas Medicaid" the state pays your bills.  Directly.  But they're not the only one.  Throughout the state of Texas, there are a large number of other providers and programs who are contracted with the state to insure patients receive care. 

Here's where I get to reiterate a few things.  None of this is about a single patient.  I've seen this happen with multiple patients.  So it's not one individual I'm telling you about.  It's about the state of Texas.  What Texas does is they have patients who are medicaid patients who might be approved for Medicaid, and then assigned to an insurance program, provided by an insurance company.  This is fairly common.

And here's where we get to the point.  In my experience, the state of Texas when paying for medical services will never pay for a nurse to come visit you.  I did not pay 100% for my nursing visits.  They were partially covered by my insurance.  Most people with private insurance like that may have the same situation.  It could be if you're stuck at home and bedridden, you can't get out to the doctor's office without an ambulance to hall you downtown.  Or it could be you can use a cane, get out the front door, slide into the passenger seat of the car, and off you go.  

But if you can't move yourself around and you're in Texas and need a nurse to visit you, then you had better pray you don't have Texas Medicaid.  Because they won't - but some of the private insurers who are also providing sub-contracted coverage, well, there's the problem.  Some of those payers will, in my experience, pick up at least part of the tab for the nursing.  Some won't.  

So here's the thinking I have.  And again, none of this came out because of my experience with a single patient - it's just more of a "Well, that's not right."  

If a Texas Medicaid patient is homebound in terms of medical care, AND needs nurses to visit, AND will not be able to afford that nursing, well, here's where Texas may be on the hook.

I've never taken a medical oath.  But I do know a few doctors, and I know what kind of people they are.  And I also know that they're usually pretty intelligent and often caught in the middle of some ugly situations.  Such as what if you have a patient who might be able to go home out of the hospital, leaving that very expensive hospital bed for someone else, but because they don't have coverage for a nurse to come visit, do they keep the patient in the hospital?  Or send them to a nursing home, also for the state to pay?  

And there's the other uglier side.  This Texas Law now permits your average citizen to sue a woman who may have had an abortion.  Does that mean that doctors who provide care for pregnant women might be charged as accessories to crimes if these women have accidental, unintended, horrible miscarriages?  What can a doctor do to insure they aren't also held responsible for assisting in a patient's illegal abortion because they didn't guarantee their pregnant patient wasn't monitored 24 hours a day, 7 days a week?

In other words - could a pregnant patient forced to submit to frequent home invasions from nurses who are ostensibly to monitor their health, but who are also there to guarantee that fetus makes it out OK?  If that pregnant woman has to endure the nurse invasions, does that pregnant woman also then have to pay for those visits?  Could an unscrupulous doctor force women into the poorhouse by requiring additional monitoring?  

There are an awful lot of unintended consequences I can see from under or inside this law.  And a lot of terrible things that might happen to families who are already struggling.  I think back on when my wife was pregnant with Jack, we had one baby in the house already, could a doctor require nurses to come out and make sure my wife remained pregnant?  Our budgets back then were beyond tight.  Sure, we thought we'd be OK, but the line between "OK" and "we'll be fine, able to handle it all" is usually obliterated by the "oh, hey, the employer is relocating" and the "industry downturn" and the "reduction in force" actions that no one ever sees until the tire tracks are right up their back.  

I don't see the way out of this.  The only thing I do see, terribly, is the inevitable Pregnancy Cops who will need to be trained like doctors to determine if a woman's miscarriage was due to a medical issue which was not anticipated, or if there were deliberate actions taken to terminate a pregnancy?  I've known more than a few women who have had miscarriages.  And I cannot imagine, for a moment, that they would welcome such an intrusion at such a devastating time.  I know that more than a few of them would want to know what they might have been able to do to avoid the outcome they experienced.  I can't help but think that, if abortion is made illegal, there will be more than a few women who will, in the end, resort to methods that are far, far more terrible and dangerous to end a pregnancy they don't want.

Look, I know that some people will look on that as murder.  I also know that there are more than a few people who have been raped and gotten pregnant.  While it's not the baby's fault, there's a life sentence served by at least two people in any crime like that.  The first is the mother, who has had to endure the violation and brutality, and there's the child, born of rape, who may end up being the reminder of their mother's worst moment ever.  And then there's the family of the victim, who ends up having to support the victim going through something they may never have wanted.

And there's the other inevitable parts, too.  Take a woman who is already struggling economically, force her to carry the product of this rape to term, paying for the doctor visits, the equipment a baby needs, and all the rest.  Sure, that baby could be put up for adoption.  But what if the future mother isn't ready, or able, to give birth?  Dunno about you, but I have eyeballs and brains and I do know, not from personal experience or work experience, but I do know from my friends and others that childbirth is not a guaranteed thing.  Babies die all the time.  So do mothers.  If a sharp-eyed doctor hadn't been in the nursery when my own son came into the room, he might not have made it.  Again, thanks to good health care, good insurance policies, thanks to where my wife found work, and just damned good luck, my son was diagnosed, sent to a special hospital, and he was kept alive.  

So there it is.  This new Texas Law could be used to bankrupt entire families, and more.  It's not just a brutal, horrible tool, it's a deadly, terrible sword that could be used to destroy lives.  And that makes me want to vomit.