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Shaheen listens to health care worries in Salem

SALEM, N.H. - Getting a wheelchair for Seth Peake, a 14-year-old from Northfield, is a six to eight month process every time he needs a new one through his medical insurance. Peake has been in a wheelchair since he was about 2 or 3 because of his hemophilia.

To live with his genetic disease Seth needs about $250,000 in medication a month. He and his mother Cristelee were in Salem visiting with U.S. Sen. Jeanne Shaheen and medical professionals at Northeast Rehab to discuss the impact of the Affordable Care Act (ACA), and the how President Donald Trump's proposed budget affects Medicare and Medicaid patients through requiring prior approval.

The medical professionals were excited to see more patients covered by health insurance under the ACA, and Cristelee was grateful for the healthcare legislation staying intact. Prior to the ACA, often called Obamacare, her husband had to apply and take jobs based on the healthcare provided, and he had to switch jobs when Seth met his lifetime limit for insurance, she said.

"Seth is a trooper," she said. "And if it wasn't for the ACA it could be a lot worse."

She explained that the cost for Seth's treatment is dependent on his health. Medical bills could reach far beyond the typical $250,000 a month if he were to have a bleed, she said.

"Anyone who has any kind of expensive chronic illness has to balance these decisions," she said. "I’m thankful we have a senator who is supportive of the ACA. It can’t go away, it just can’t."

And it could be life-threatening to Seth, and others who have to weigh the cost of care with seeking it, she said.

Shaheen is familiar with Seth’s story, she had previously told it on the floor of the Senate Chamber.

"It continues in the case for why we need the ACA," Shaheen said.

She noted while there is not a consensus on the ACA as a whole, there are certain aspects that members of Congress from across the aisle can agree on - combating the opioid epidemic and prescription drug costs. Shaheen highlighted how switching federal opioid treatment funds from block grants to a need-based grant increased New Hampshire’s access to federal funds, which will be over $30 million this year, she said.

Currently Salem Fire is being considered for a grant for some of those funds that have yet to be distributed by the state.

Access to Care Issues

"Unfortunately it’s a negotiation with the health insurance" for every claim, said John Prochilo, CEO of Northeast Rehab Hospital Network. He added before the ACA it was even more so, he said.

Prochilo and other medical professionals shared their worries that getting patients the care they need, particularly getting into rehabilitation treatment centers, could potentially get harder.

"The biggest issue is putting barriers to care that are not provider to provider (decisions), instead opting for an algorithm to make that decision which might not be what a patient really needs," explained Lester Schindel, Northeast Rehabilitation Hospital Network’s vice president of Strategy and business development.

Schindel explained that under current Medicare and Medicaid guidelines patients with those forms of health insurance have their doctors collaborate on a rehabilitation plan. Patients can get varying degrees of rehabilitation depending on their health.

At the Salem center there is an inpatient program — which is the highest level of rehabilitation care — that allows physicians round-the-clock care and more than 15 hours of physical, occupational or speech therapy. Typically patients are in that program for 12 to 14 days, Schindel said.

Patients typically referred to that level of program need it and have good reactions to it, Schindel explained. And there are instances with Medicare advantage programs where healthcare providers see prior authorization as a roadblock to quality care because instead of doctors making those decisions it’s algorithms, he said.

"One third of patients (with Medicare Advantage who are recommended for inpatient care) don’t qualify for this level of care, so they aren’t provided access to care that would benefit them," Schindel said.

Listening to the specific struggles of medical professionals and patients, Shaheen said it helps her with making policy decisions.

"How expensive healthcare is relates to how people feel secure and can work," Shaheen said, adding that it is an important policy decision.