EXECUTIVE SUMMARIES Advocacy, Prophecy and the Common Good FR. CHARLES BOUCHARD, OP — All of us would like to see the ministry of Catholic health care as prophetic and oriented to the common good. That should be easy, except for two things. First, the common good is widely misunderstood, and second, prophets have an image problem. The popular image of a prophet is a wild-eyed, marginal character who promotes extreme and anti-social ways of life. It is not surprising that we view prophets with skepticism and that “prophetic” has come to be associated with a kind of political extremism that involves demonstrations, confrontation and generally bad news. Biblical scholar Walter Brueggemann has made it part of his vocation to rescue prophecy from such misperceptions. The
Can Public Policy Save Rural Health Care? RACHEL C. TANNER — Across the United States, rural communities are facing enormous pressure to survive. Employers are shutting down. Younger generations are leaving to find economic opportunity elsewhere. The remaining population is aging, and health care providers and facilities are stretched nearly to the breaking point. In fact, more than 160 rural hospitals have closed since 2005, and 21% of all rural hospitals are at high risk of closure due to financial instability. How can Catholic health care help? The answer may lie in public policy. While rural communities face serious policy hurdles, such as workforce sustainability, a challenging payer mix or overly burdensome regulations, we may be able to im-
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prophet’s job is to reveal God’s plan and call us to participate in it, whatever the cost. We may not have a monarchy in the U.S., but something like “royal consciousness” is alive and well in our society. It is marked by collusion among the privileged to secure their own interests, often at the expense of the poor. The common good is an antidote to royal consciousness. It focuses on equity rather than personal gain, participation rather than disenfranchisement, and the many rather than the few. The Catechism of the Catholic Church defines the common good as the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily. The common good concerns the life of all.
Page 13 pact change through advocacy. Under-reimbursement by Medicare is only part of the problem. Rural communities face higher rates of unemployment, and thus lower access to employer-based insurance, than their urban counterparts. In these areas, expanded access to government insurance is key. Rural medical practices and hospitals need generalists in an era of medical specialty. They need greater leeway to use advanced practice providers for general medical services. The federal government could utilize greater student loan paybacks to entice clinicians to rural areas. Loosening some of the regulatory burden around workforce would help reverse the trend of physicians opting for urban over rural practices.
Moving the Needle — How Hospital-Based Research Expanded Medicaid Coverage for Undocumented Immigrants in Colorado LILIA CERVANTES and NANCY BERLINGER — Hospital-based research moved the needle at one health system, resulting in policy change to Colorado’s Medicaid program. Following research at Denver Health and nearly two years of dialogue between the research team and the Colorado Department of Health Care Policy and Financing, Colorado in 2019 became the 12th state to allow Emergency Medicaid funds to be used for standard treatment of end-stage kidney disease by including the diagnosis of end-stage kidney disease as an “emergency medical condition.” Previously, undocumented
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immigrants with this diagnosis could access dialysis only after meeting clinical criteria for diagnosis of critical illness, pushing patients to the brink of death each week. By including the diagnosis of end-stage kidney disease itself in the Emergency Medicaid scope of services, Colorado Medicaid created a policy pathway that allowed clinicians to practice to standard of care, prevented suffering and lowered costs. This language change made scheduled dialysis accessible to 137 undocumented immigrants with end-stage kidney disease residing in the state. Colorado Medicaid expects a cost savings of $17 million per year, reflecting the significantly lower cost of outpatient versus emergency treatment.
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