One way the Republican health plan will impact my rural county

Last night I used this nifty tool released by the Kaiser Family Foundation to calculate how the proposed health care bill released by the Republicans Tuesday night will impact Washington County.

In Washington County, if you are 60 years old and making $40,000 a year (per capita income is under $38,000 in my county), the Affordable Care Act (Obamacare) health insurance tax credit in 2020 will be $7,800. The House plan would provide a credit of just $4,000 in 2020. That means the cost of buying health insurance for a 60-year-old making $40,000 per year will GO UP by $3,800 if the Republican plan is adopted.

Washington County health data comparing ACA and proposed plan from Republicans

Under the current plan, insurance companies are capped at charging three times the amount charged for coverage for younger people. Under the Republican plan the cap increases to five times the cost of rates charged to younger people.

There are also considerable cuts to Medicaid and Medicare.

All of these proposed changes will impose serious financial and health threats to people in my county who may not be able to afford insurance any longer, and these expenses will be added to the other cuts to funding in the proposed legislation. These factors, plus others in the proposed plan, do not bode well for our hospital or facilities in other rural communities.

Last May Washington County voters took on a bond to support our hospital, knowing that the bond could not solve all of the financial problems for our struggling facility. We still have work to do if we want to keep our hospital open.

“The little voice in your heart must guide you”- my daughter’s letter to her children

The Friday Photo
January 20, 2017
reposted with permission from my daughter McKinsey Cummings

photo credit McKinsey Cummings, Macon, GA, Martin Luther King Jr, Day, January 16, 2017 Chase, 8.5 years old, Ella, 10 years old

An Open Letter  to My Children on MLK Day

4 days prior to the inauguration of He Who Must Not Be Named: I’m sorry. Sorry that the world you were born into is about to change. Sorry that the value I raise you with: honesty, kindness, and fairness to all will not be the values reflected by the head of government in this country. When all this is over you will be teenagers and trying to find your place in the world. You will have heard and witnessed things I would have never thought possible for your generation. I promise I will show you the path of generosity of spirit and deed. And that the little voice in your heart must guide you in the face of overwhelming animosity that is sure to come. #notmypresident #bluedot #notthis

Git yur guns, boys!

What started after the 2008 election with the election of a black man to the White House, threatens to come full circle to a full-on “take back the government” uprising if Hillary Clinton is elected. Jimmy Arno of Georgia is just one of many who say they will be, I don’t know, marching to Washington, D.C., to lead some type of revolution if the election doesn’t go their way. Militia member Charles Keith Cobble claims they screen their fanatic members to make sure they aren’t KKK folks, but really, this type of “background check,” as Cobble calls it, is a farce.

In his conversation with Ryan Lentz of the Southern Poverty Law Center’s Intelligence Project, Adam Ragusea of GPB rightly makes note that white people carrying guns are usually called militia members, and brown people are called terrorists.

The fear gripping white people, primarily poorly educated, lower-income men (I am making a broad statement and I am not going to go down a rabbit hole with anyone on it), started with racism, and now it has expanded to include women. Donald Trump fed this type of mindset. He started with birtherism, and has woven in a complete and utter disrespect for women into his mixture of hatred and fear.

It bears repeating: we withstood the resignation of one President, and a 5-4 Supreme Court vote for another one. Electing Hillary Clinton will not be the worst thing to happen to this country. And it certainly won’t be worth starting a civil war over.

 

 

You never know where you’ll meet a member of your tribe

The Friday Photo
July 29, 2016
IMG_1173

Wednesday afternoon I stopped to get gas after picking up some groceries in Milledgeville, the “big” city to the west of my home town of Sandersville. A small SUV pulled up at a pump diagonally to mine. The driver, a woman maybe in her mid 60s, jumped out of her car and started walking toward me, smiling as she approached me standing at the rear corner of my car.

With great enthusiasm in her voice she asked me where I got my bumper sticker. She looked so happy, like she had finally come across another kindred soul, that she gave me a high five and immediately started telling me how worried she is about Donald Trump becoming President.

I replied that the racism and hate people feel comfortable sharing is horrifying, adding that the judgmental attitudes about people who don’t look or behave like them is stunning.

She said she’s taken issue with people she knows who judge gay people as sinners, saying that her response has been, “Do you believe God made everyone, and does God make mistakes?”

From there she said friends and family had turned away from her after she came out as gay, and that others in her family have been treated similarly.

Think about that- a family shunned one of their own, not because she was a murderer or thief, but because she wanted to date women instead of men.

This woman then looked at my car tag and realized I live in a neighboring county, and she said, “You live in Washington County and you have this one your car? You are a brave woman.”

It’s not so hard to be a privileged, white, straight woman driving around rural Georgia with a Democratic pride sticker on your car. When it helps you find members of your tribe while doing the ordinary things in life, it is even easier.

Thank you Bonnie, for extending your hand, telling me your name and story, and saying We Are Stronger Together.

And the winners are…..

Current leadership in the Georgia General Assembly never fails to disappoint. This year’s session has been a catalog of hate-baiting legislation against LGBTQ citizens and people of faith (and no faith). Rape victims have been dismissed, and Georgia’s Guns Everywhere mentality threatens campuses across our state.

Creative Loafing Atlanta didn’t wait until the end of the session to announce this year’s Golden Sleaze Awards. If you want to hear keen political analysis of this year’s General Assembly session in Georgia, tune in to GPB’s Political Rewind at 3:00 this afternoon.

 

Contracts, consultants, and hotel bills

Note concerning documents: some of the documents I am posting pertaining to Washington County Regional Medical Center and the Washington County Board of Commissioners have notes and underlined portions. I have not marked up any of the documents, they are uploaded exactly as I received them. All documents here and in a February 15, 2015 post on Rural and Progressive were obtained through Georgia Open Records Act requests.

Sometimes the best way to solve a problem is to have a fresh pair of eyes look things over. In September 2014 the Washington County Board of Commissioners (WCBOC)  received a contract from consultant Alan Richman, the President and CEO  at InnoVative Capital(IC).  Richman offered to assess and advise on several areas of hospital operations.

On October 9, 2014, Board of Commissioner Chair Horace Daniel signed the contract (InnoVative_Capital_contract_Sept_2014) . The contract detailed seven tasks for Richman to complete:

  • Hospital Financial and Operational Review
  • Staffing Study Review
  • Review of Outstanding WCRMC Funding Requests of Washington County
  • Review and Critique Management and Consulting Proposals Received by WCRMC
  • Identification of Issues Statement
  • Produce a Strategic Roadmap of Next Steps
  • Present Finding to Washington County

The contract included the possibility of an extension through December 2015. Washington County agreed to pay a “hospital consulting fee” totaling $40,000. A non-refundable payment of $20,000 was due when the contract was signed, and the remaining $20,000 would be paid when Richman presented his findings to the county.

My Open Records Act document search included an email to former County Manager Chris Hutchings in late March 2015 from Richman detailing his suggestion that additional consultants may be required for his project here. These consultants would be “retained” by Washington County. Richman credited the county’s earlier $20,000 payment to his new contract proposal and requested an additional $10,000. On April 13, 2015 Horace Daniel signed a new agreement on the county’s behalf that included a monthly payment to IC for $7,000 plus expenses. (InnoVative_Capital_contract_April_2015)

What is especially interesting about the April 2015 contract is item 14 on page 2: “If the Transaction involves the WCRMC’s Partner’s commitment to a replacement hospital or major renovation/project (“Hospital Modernization Project”), InnoVative Capital may provide mortgage banking services for this purpose under a separate contract with the WCRMC Partner, if asked to do so by the WCRMC Partner, the Hospital Authority, or the County.”

The county’s hospital consult also does mortgage banking services.

And bonds.

Think about that for a minute.

If the county’s consultant recommends a new hospital building or major improvements, he can then step up and offer financing services. If bonds are needed, Richman’s consulting company does those too.

And there’s more.

On pages 3-4, (InnoVative_Capital_contract_April_2015) the contract spells out what Richman’s company receives in different scenarios. for example:

  • The county requires debt funding of $7-10Million, signs an “External Management Contract” or extends the Management Agreement with University, or “retention of Replacement Internal Management”

If University Hospital is the signing partner InnoVative Capital would be paid a $40,000 transaction fee.

If a partner other than University was the Partner for an External Management Contract, Richman’s company would receive an  $80,000 fee.

  • WCRMC enters into a Lease or Change of Ownership  and the county has a net debt funding requirement of less than $5Million:

If University is the Partner, InnoVative Capital receives $100,00 plus 5% times the final Net Debt Funding required < than $5M

If a Partner other than University is engaged, IC makes more money. Richman’s company would be paid $140,000 plus 5% times the final Net Debt Funding required < than $5M

Any agreement or modernization project that didn’t include University Hospital meant a bigger check from Washington County for Richman’s work.

Richman made seven trips to Washington County that cost taxpayers $14,483.45. Some of Richman’s expense reimbursements are a simple word document with no receipts attached. However, the request submitted on  June 29, 2015 reveals that Richman’s hotel of choice isn’t anywhere near Sandersville. The county’s consultant stays at the Ritz Carlton in Atlanta’s toney Buckhead district near the Governor’s Mansion, and commutes to Sandersville in a rental car. (see page 10 InnoVative_Captial_invoices)

Richman submitted another contract for his services in November of last year, one that would run from November through July 2016. Richman’s monthly consulting fee jumped from $7,000 per month to $10,000 per month, an increase of almost 43 percent. Horace Daniel committed the county to the higher monthly consulting fee when  he signed the contract on November 13, 2015. (InnoVative_Capital_contract_November_2015)

The November 2015 contract includes a list of 12 items for Richman to work through. Item 8 reads, “Identify potential partners for the County and Authority and work to make the process competitive, if possible.”

If possible.

Hospital leaders here did a call for proposals for management/lease options in the fall of 2014 from nine companies/organizations. University, Navicent Health, and Augusta University were among the nine asked to submit proposals. The resulting document includes a response from University but nothing from Navicent. Augusta University (Georgia Regents Health system at the time, still often called the Medical College of Georgia) was interested in a partnership but “without any change in management,” i.e. they didn’t want to run our hospital.
( see the last page in WCRMC_requests_for_proposals_fall_2014)

We had a plum lease agreement from University Hospital last spring that was left on the table by county leaders (University_proposal_to_WCRMC_April_29_2015). Navicent Health never made an offer last summer, which prompted local officials to pursue a partnership with Augusta University Hospital (which had already said it didn’t want to manage WCRMC).

The contract Horace Daniel signed in November includes a scope of services for Richman to complete. The resulting recommendations for the county to consider are contained in no more than two pages in a January 21, 2016 document, titled Washington County Regional Medical Center-Plan B:Repurposing WCRMC-Business Plan Development is “for discussion purposes only.”

The proposed plan development team includes two consulting firms in addition to InnoVative Capital. Richman allows for eight weeks of work. Depending on the amount of work required, the fees for the market and financial feasibility consulting firm DHG Healthcare could range from $35,000-$45,000. Adams Management Services, a capital consulting company, would ring in at $12,500. Both companies would also bill for expenses in addition to their fees.

Who would manage this project?

If you guessed Richman proposed that his company should serve as the Project Manager you would be right.

Through January 2016 Washington County taxpayers have spent $102,000 on consulting FullSizeRenderfees to InnoVative Capital. Combine those fees with $14,483.45 in travel expenses, and we’ve spent $116,483.45.

The more time I spend reading these documents, the more I scratch my head.

Of course we need a hospital here, and it should be a good one. We are fortunate to have good doctors and hospital staff who want their friends and family to receive the best care possible, at home, when they need it.

I don’t expect the bond to fail in May, and I am not suggesting that people consider voting against it.

What we need to understand as voters and property owners, is that we didn’t get to this question overnight. We are more likely to hold our local leaders accountable for our hospital’s sustainability if we know the full story.

The documents behind a $15.4M question

Washington County Regional Medical Center (WCRMC) has steep financial challenges. That doesn’t make the rural hospital in Middle Georgia unique.

The solution proposed by recently appointed Hospital Authority members led by Chair Jim Croome, and, the Washington County Board of Commissioners (WCBOC), is to ask the county to approve a $ 15.4Million dollar bond.

The debt that citizens can choose to take on in a May referendum will fund $9M for infrastructure, IT, and computers at WCRMC. Property owners will have to decide if their personal budgets can stretch to take on more in property taxes to also give the hospital $6.4M to pay down debt, address pension plans, and general operations.

Last year the Washington County Tax Commissioner included a neon green insert with 2015 property tax bills stating that one mil of their taxes was being used for the hospital.

Last year county leaders could have chosen a course of action that might have made last week’s 2.5+ hours county commission meeting a lot shorter.

In late April 2015, county and hospital leaders had an option to improve operations and secure $5Million in capital improvements through an offer from University Hospital in Augusta. A management agreement already in effect between the two hospitals had already secured a $1Million line of credit for WCRMC.

University’s offer included a 20 year lease with an option for Washington County to sell the hospital if it decided that was the best course of action (University held first right of refusal. After that Washington County could pursue another buyer: page 3, University_proposal_to_WCRMC_April_29_2015). University guaranteed 24/7 Emergency Department operations, surgical and inpatient nursing services, and diagnostic and imaging services.

The lease proposal also stated that University, “will not seek any support from Washington County for the operation of WCRMC” during the first five years of the lease agreement (page 3, University Hospital offer to WCRMC April 2015).

University has already proven it can right-size a small hospital; just ask McDuffie County residents and patients at University McDuffie County Hospital.

Instead of saying “No thanks” to the offer, the Washington County Commissioners took a different tack, one that broke the management agreement with University and a retraction of their April offer.

County Attorney Tom_Rawlings hand-delivered letters on June 8th to local doctors inviting them to a private meeting with Navicent Health representatives from Macon to “structure a partnership with a larger hospital system.’ The meeting wasn’t planned for county offices or Rawlings’ office , both located on the high visibility Courthouse Square.

Instead, the June 8th meeting to discuss a possible relationship with Navicent was planned at Daniels Heating, Air, and Electrical just north of Sandersville, where cars travel pass at 55 MPH. The Chair of the Washington County Board of Commissioners is Horace Daniels.

While Navicent Health was planning a meeting with Washington County leaders and physicians, their 11 month old management arrangement with neighboring Oconee Regional Medical Center was spiraling towards a fatal crash.

The meeting Rawlings convened where the WCBOC Chair works violated the Management Agreement between University and WCRMC according to a letter dated June 12 from University’s CEO Jim Davis.

Davis closed his letter with, “We wish you and the Commissioners the best of luck in preserving a hospital in Washington County.”

Washington County leaders signed an agreement with University that secured a $1Million line of credit for our hospital. The organization that right-sized McDuffie County’s hospital proposed a 20 year lease agreement with $5Million of improvements to our struggling hospital. It did not include a request for $15.4Million in bond debt funded by Washington County property owners. It did include a restriction on future requests for taxpayer dollars.

Washington County needs a good hospital. Voters should have an opportunity to read the documents that brought us to a $15.4Million bond referendum in May. As I work through more documents I’ll post them here.

Photo unavailable

The Friday Photo
December 11, 2015

I couldn’t manage a photo of what I saw this week, but it bears describing.

At an office supply store I watched an elderly man getting information for some type of technology problem he couldn’t solve. The young man at the service counter very patiently repeated what needed to be done, and assured the customer that if he brought the item in, the problem could be solved. The customer left to go get the item out of of his car.

The elderly man was wearing Confederate flag suspenders and a replica Confederate battle cap. The polite young man at the counter was black.

The irony was almost more than I could stand.

 

 

 

What’s happening to teachers’ health insurance is just TRAGIC

TRAGIC

This was posted on the Teachers Rallying Against Insurance Change (T.R.A.G.I.C.) group page. It is an open group, so if you want to stay current on what the state and Governor Deal are doing to teacher’s health coverage join the group and do your part to protect one of Georgia’s most valuable resources, our public school teachers!
https://www.facebook.com/groups/TRAGIC4GEORGIA/

***ACTION ALERT***
By now, you should have seen the 2015 Rate Comparisons for both the Active and Medicare Advantage plans. While we are pleased the Department of Community Health has offered choices for 2015, these choices are just as unaffordable as last year! The premiums and deductibles are way out of line with state employee and teacher salaries, and mean financial ruin for school support personnel and other state employees.

The newspaper headlines have been mainly positive, telling a very different story than the unaffordable reality that we will be dealing with next year. There are numerous lobbyists and pubic relations people working for the other side, spinning the story and getting their side out. We have only our voice (and our vote!).
We are strong when we speak as one, and it is time to speak up!

Call the Governor’s Office tomorrow and the DCH. Send emails. Contact your Legislators.

Here are some sample questions, but feel free to ask your own!“ Can you explain how I am supposed to afford this insurance and pay up to $28,000 on my salary of $___________?”

“Can you explain why the BCBS Medicare Advantage plan costs 300 – 700% more than it does this year? Why is it so much higher than United Health Care?”

“Why is the United Health Care HMO 25% more than the Blue Cross HMO?

What are members getting for that additional money?”

“Why are the Board of Regents, with fewer employees and a smaller risk pool, able to offer so much better insurance than the State Heath Benefit Plan?”

Office of the Governor: (404) 656-1776
Email the Governor: http://gov.georgia.gov/webform/contact-governor-domestic-form

Call the DCH: (404) 656-4507.
Email the DCH (use both addresses): DCHBoard@dch.ga.gov, creese@dch.ga.gov

Find your Legislators: 
Georgia House of Representatives: http://openstates.org/ga/ 
Georgia Senate: http://www.senate.ga.gov/senators/en-US/FindyourLegislator.aspx

Contact the Governor electronically here.

A win for Georgia

20131107-115102.jpgGuest Post by Rob Teilhet,  former state legislator
and Executive Director of Georgia Conservation Voters.
He works as a private practice attorney at The Teilhet Firm.

 

Any community is made better when it is served by quality public officials. And in order to have quality public officials, we need quality political candidates.

Whether Senator Jason Carter wins next year or not, the State of Georgia isalready better because he is a candidate. Governor Deal will be a better candidate for having to face him. And we as Georgians will be well-served by an election that is competitive, as opposed to a foregone conclusion.

When the outcome of a political campaign is known before it even takes place, the quality of public service plummets. If you doubt that, look at the Unites States Congress. With few exceptions, incumbents in Congress easily dispatch only token opposition, and return to Washington with their minds not on their constituents or their districts or the impact of public policy, but rather on the nonsense that passes for debate in DC these days. If they had to compete for our support, and were held accountable for their results, we would be better served.

I couldn’t care less who his grandfather is. What matters to me is that in the decade I spent in Georgia politics, Jason Carter proved to be one of the smartest and most genuine people I came to know, with real concern for how decisions made in Atlanta impact people and their families. As they get to know him, the people of Georgia are going to like him. And they will listen to him. And the quality of the campaign and its impact on all of us will be better as a result.

Proverbs 27:17 says that as iron sharpens iron, so one person sharpens another. No matter the outcome, Georgia’s political iron will be a lot sharper next year as a result of today’s announcement.

For that, we will all be better off. And for that, I am thankful.

I have to give Rep Mack Jackson credit for follow through

Last week when I was doing back flips over HB 475, which gives Industrial Development Authority boards far too much power over and control of taxpayer dollars. I called my rep in the Georgia General Assembly, Mack Jackson, to “share” my concerns (he might say I vented).

If you follow the Georgia General Assembly during the session, it is a chase. The schedule is crazy, committee meetings are cancelled after rooms are packed, there is the race to Cross Over Day, and a helmet is suggested for the last day of the session. Lobbyists have money and staff support to sway legislators but the average citizen like me doesn’t.

Mack offered to send me a link to the House Daily Report each day. With everything he has   to do, plus keeping up with a church and congregation in Tennille, he has gotten the link to me since he made his offer to do that. He encouraged me to stay in touch and he asked me specifically about the charter school bill HR 1162 last week. The Democrats have now countered with HR 1335.

This isn’t just a bill though, it is a resolution which would go to voters to amend the state’s constitution. The vote could happen today and the hallways under the gold dome are filled with lobbyists and children (Should parents and administrators use students in the front line of political warfare? That’s fodder for another post).

My phone rang a few minutes ago with Mack calling back about a question I had raised about the Democrats counter-proposal. We had a good discussion about the impact charter schools could have on rural districts with the resolutions on the floor (I found Maureen Dowd’s column on the rural impacts since Mack and I hung up the phone). Part of our discussion also included the use of constitutional amendments for policy and program change.

Mack added, and this is sad folks, I am the only person contacting him about legislation. We commiserated about the lack of online news access for people in his district which might facilitate keeping folks current. I offered to think of some ways to get information out that would be readily accessible to his constituents (the constituent has an obligation to show up at places besides the voting booth). In the mean time I offered to forward the link to my friends who follow the session. Better yet, I am adding it as a link on my blogroll to the right.

I haven’t agreed with all the votes and bills Mack has sponsored since he was elected. That is already the case with this session too. He deserves credit for following up with someone who has been his critic. Today I want to applaud him for his efforts. Let’s step up in Georgia House District  142. Mack’s contact info is here.