EXECUTIVE SUMMARIES

Advocacy, Prophecy and the Common Good Page 6

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

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.

Can Public Policy Save Rural Health Care? Page 13

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

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 Page 20

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

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.

Economic Inequality and the 2020 Campaign Page 27

DAVID SHEETS — With the 2020 presidential campaign well underway, economic inequality continues to gain strength as one of the top issues in the election. Six in 10 U.S. adults believe the level of inequality is too high, according to the Pew Research Center. Of those, most say the solution requires a wholesale change to the economic system.

Today, America has two sides to its economy. One outwardly appears to indicate we are on an unrelenting trajectory upward. Job creation entered its 110th month in January 2020 and unemployment hovers around 3.7%, a level unmatched in 50 years. Gains in employment raised median household income to a level 49% higher than in 1970.

The numbers are starker on the other side. Fewer people constitute the workforce since the Great Recession of 2007- 2009. Part-time job growth outpaces full-time job growth. Household incomes on average grew at an annual average rate of only 1.2% in 2000-2018 against an inflation rate that lurched between 3.4% and 2.5% during the same period. Each of the frontrunning 2020 presidential candidates at press time had promised to pursue a different course if elected. The article summarizes their approaches.

Fighting Fragmentation — Mental Health Benefits from Integrated Care Page 31

BENJAMIN F. MILLER — It’s 2020, and we are losing more lives to preventable causes than ever before. Deaths due to drugs, alcohol and suicide are at an all-time high, and our citizens are hurting in ways that are multifaceted. For some, it may be access to affordable health care. For others, it may have more to do with social and economic factors. Loneliness, worry, isolation and issues of belonging are key drivers of despair, and we must be bold in our vision and courageous in our decision making if we are serious about making a difference in our country’s health.

Integrating mental health and primary care provides one of

the best-use cases for successfully integrating mental health into a medical team approach.

Recently, Well Being Trust, a national foundation committed to advancing the mental, social and spiritual health of the nation, in partnership with several key collaborators, launched a federal policy guide. It is “Healing the Nation: Advancing Mental Health and Addiction Policy.” The goal is to provide members of Congress a comprehensive guide on ways to impact mental health through policy. Leveraging a framework for action, “Healing the Nation” offers a plan that will start with the federal government and extend into our states and communities.

Medicaid Expansion in Michigan Reflects Catholic Social Principles Page 37

ALISHA COTTRELL, SEAN D. GEHLE and LINDA ROOT — Michigan responded to those most in need by creating the Healthy Michigan Plan, the state’s unique response to Medicaid expansion.

Healthy Michigan aims to ensure that every low-income Michigan resident who was uninsured or underinsured has access to medical care and services. The plan primarily focuses on prevention and primary care access through a number of key elements including: an increase in healthy behaviors that would manifest

as healthy behavior change; management of chronic conditions; provision of preventive care; and a reduction in emergency room utilization and inpatient hospitalization. Though this plan has its limitations, it is an example of how we can influence and support our vocational call to provide health care for those most in need.

The Healthy Michigan Plan was launched in the spring of 2014. The program opened enrollment for beneficiaries up to 133% of the federal poverty level. Early enrollment projections of 300,000-400,000 were quickly exceeded, and enrollment over the last several years has averaged more than 600,000.

A Reflection — Moving from Desire to Action Page 42 SR. DORIS GOTTEMOELLER, RSM — Nothing is as intuitively simple to grasp and as complex to implement as the concept of the common good. According to the U.S. Catholic bishops, the common good comprises “the social conditions that allow people as individuals and groups to reach their full human potential and to realize their human dignity.”

What makes it so hard to craft laws and public policies that promote the common good, especially good health care? The size and diversity of the population make generalizations about needs and preferences difficult. The influence of the social determinants of good health are beyond the control of health care providers. The sheer number of differing health care stakeholders is daunting. And loyalty to one’s political party sometimes overrides the common good.

Efforts to transform a desire for the common good from a feeling into a way of life can be both individual and institutional. In an increasingly integrated world with porous boundaries, we are called to a love for all of God’s people. Let us join hearts and hands in that common effort.