BELLINGHAM, Wash.1 – Revocar la Ley de Cuidado Asequible (Affordable Care Act, ACA) significaría dejar de fondear la expansión de Medicaid en los estados, y eso afectaría desproporcionadamente a las comunidades rurales, de acuerdo a un reporte del Centro sobre Presupuesto y Prioridades de Políticas (Center on Budget and Policy Priorities).

Mientras sigue el debate en Washington DC sobre la revocación de la expansión de la Ley de Cuidado Asequible (ACA), la parte rural de Washington toma fuerzas para enfrentar los efectos del rechazo.

Los condados rurales encaran un conjunto de retos en cuidados de la salud diferente a los de las áreas urbanas, y podrían ser afectados desproporcionadamente por la revocación. Hay pocas instalaciones para los habitantes rurales que precisan de atención, y los presupuestos para operar los hospitales son frecuentemente más bajos.

Sherilyn Hughes, quien trabaja en un asilo en Bellingham, dice que si la Ley de Cuidado Asequible es revocada, los pacientes resentirán el recorte.

“Yo definitivamente me preocupo por nuestros residentes. Si pierden su seguro o tienen menos acceso a los cuidados, qué les pasaría? Si estuvieran en instalaciones con menos personal, con menos gente entrenada. Si terminaran en instalaciones de supervivencia asistida, o en lugares donde estén solos.”

Un reporte del Centro sobre Presupuesto y Prioridades de Políticas (CBPP) muestra que si la A-C-A es revocada, 775 mil personas menos del estado de Washington tendrían seguro de salud en 2019. El Presidente electo Trump ha dicho que llegaría una revocación con un plan de “reemplazo simultáneo”, pero no se han dado más detalles.

La revocación también afectaría los presupuestos de los estados.

El mismo reporte estima que el estado de Washington perdería algo más de tres billones de dólares en 2019, lo que muy posiblemente sea un golpe duro para los hospitales rurales. Otro estudio, publicado en Asuntos de Salud (Heath Affairs), dice que los hospitales rurales han pasado por mayores aumentos en ingresos por Medicaid que los hospitales urbanos que operan bajo la “ACA”.

A Belinda Hewett, asistente de enfermería en los hogares de Richland, le preocupa que, si menos pacientes pueden pagar los cuidados, eso significa también un recorte de empleos para las enfermeras.

“Nos recortaría nuestras horas a mí y a mis colegas, y luego tendríamos que salir a buscar un segundo empleo para tener ingreso y apenas pagar nuestra renta y cuentas, y las cosas que tenemos.”

El rechazo podría afectar a Hughes de otra manera. Ella tiene asma y usa un inhalador de esteroides dos veces al día. Hughes dice que el medicamento es caro y piensa cómo lo pagaría si fuera sacada de su seguro.

“A través de la expansión de Medicaid se me pagó eso, así que puedo seguir yendo a trabajar. Puedo pagar para ir al “College”. No sabría qué hacer si perdiera mi seguro. No hay manera de que pudiera pagar el plan de seguro que me ofrece mi patrón.”

El reporte del “CBPP” está disponible (en inglés) en cbpp.org; y el estudio sobre “Health Affairs”, en content.healthaffairs.org.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.