January 14, 2017

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What An Obamacare Repeal Would Mean For Rural Hospitals

Scott Simon speaks with Maggie Elehwany of the National Rural Health Association about a possible Obamacare repeal. She supports the law, but says the way it was implemented has hurt rural hospitals.

SCOTT SIMON, HOST:

The House and Senate have taken the first steps to dismantle the Affordable Care Act. It’s not clear whether lawmakers will have a replacement for the law before it’s repealed. The Affordable Care Act has allowed millions of Americans to buy health insurance for the first time. But it has been controversial. We don’t know the impact on hospitals. We’re joined now by Maggie Elehwany. She’s a lobbyist with the National Rural Health Association. They represent nearly 2,000 hospitals in rural America. Thanks for joining us.

MAGGIE ELEHWANY: Thank you.

SIMON: Recognizing that there’s no one answer, how has the Affordable Care Act affected rural hospitals?

ELEHWANY: Well, let’s talk about kind of the overview. So the goal of the ACA was to help the 37 million uninsured out there. And, yes, uninsurance rates have gone down dramatically or at historic lows. But I think a lot of things were unforeseen.

And the way some of the regulations were implemented are actually harming rural America and not fulfilling the ultimate goals of the ACA. And what I mean by that is half of those 37 million – the goal was to expand Medicaid and get those folks into a Medicaid program. We know that a lot of states have taken the Supreme Court up on its option of opting out of Medicaid. That has predominantly hurt rural America.

In fact, if you’re a rural state, if you’re a poor state, more likely than not, you have not expanded Medicaid. So we’re seeing millions of folks left behind at that. Our concern is that since the ACA was passed, we’ve had an escalation of rural hospitals close. We’ve had 80 rural hospitals close since 2010. If this rate continues, in less than 10 years’ time, we’re going to have 25 percent of rural hospitals close within less than a decade.

SIMON: Do you have any concern about the Congress repealing the Affordable Care Act – what’s called Obamacare – without a replacement?

ELEHWANY: We certainly do. I do not want to take away, by any means, the good that it has done in rural America. I said it’s brought uninsured rates down by 8 percent. It’s allowed families to keep their children on their plan until they’re age 26. It’s helped people buy insurance if they’ve had preexisting conditions.

We do not want to see rural Americans lose one lapse in the benefits that they have. We are not mad at Republicans or Democrats. We’re mad at Republicans and Democrats. We want to make sure that they understand that the well intentions of the ACA have really fallen short and may actually be exacerbating the hospital-closure crisis.

SIMON: We’ve done a little reporting. I’ve done some stories in rural hospitals and health care over the years. It can be hard to get doctors to some locations, can’t it?

ELEHWANY: Yes, absolutely.

SIMON: Because they spend a long time in medical school. And there just aren’t necessarily the opportunities for economic success in a rural environment that they would have in a big city.

ELEHWANY: That’s absolutely true. Recruitment and retention of physicians remains one of the top problems in rural-health-care delivery. And I talked about – to bring it back to the Affordable Care Act, there was some other positive provisions in the Affordable Care Act that, sadly, were never funded by Congress through the appropriations process that we think really could’ve helped recruitment and retention of physicians. There were some specific programs targeted to help workforce issues in rural America. We would love to see, when we address building upon the ACA, reforming it, those programs.

SIMON: What do you hope Congress does?

ELEHWANY: I’m not speaking in one political aisle or the other.

SIMON: Yeah.

ELEHWANY: But rural America spoke very loudly. On a 3-to-1 basis, they voted for Donald Trump. They were voting for a concept. I believe that they feel that they have been left behind. And if you think about it, it’s not just health care, where they see their hospitals closing. And one hospital CEO described it as a three-pronged stool. It’s the churches, the hospitals and the schools. If you lose one of those legs of that stool, the whole community collapses.

So these towns with their hospital closing are seeing elements of their community go away. Their physicians may leave ’cause they’re hospital-based. The nurses leave. The pharmacists leave. These medical deserts are forming. You know, there’s studies that show even housing values drop after a hospital closes. So what business wants to relocate to these communities?

There’s just not the vitality, the job growth in rural communities. And I think there’s a lot of frustration out there that these are hardworking folks who sometimes feel that, inside the beltway, the people in Washington D.C. have forgotten about them.

SIMON: Maggie Elehwany is vice president of government affairs and policy and chief lobbyist for the National Rural Health Association. You represent rural hospitals. Thanks very much for being with us.

ELEHWANY: Thank you so much.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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A Snowstorm Didn't Stop This LeBron James Fan From Catching The Game

NPR sports correspondent Tom Goldman’s son Max really likes LeBron James, so Goldman got the two of them tickets to see the Cleveland Caveliers play. Then a snowstorm hit.

SCOTT SIMON, HOST:

And one more sports story left. The NBA champion Cleveland Cavaliers and the Portland Trail Blazers played a midseason game this week. January games are not usually considered momentous. But for our friend and Portland-based NPR’s sports correspondent, Tom Goldman, and his son, this game was.

TOM GOLDMAN, BYLINE: Like zillions of kids who play basketball, my son Max loves LeBron James – always has. Even when Steph Curry became the NBA’s it guy, Max stayed true to LeBron. But he never saw him play in person. So for Max’s recent 18th birthday, I bought two tickets to see LeBron and the Cavaliers this week.

As the day approached, his excitement was mixed with apprehension. Fans in Memphis recently were furious when James didn’t play in a game there. Resting your superstars has become more common and a point of contention in the NBA. But Max and I decided to stay positive, believing LeBron would play. The big day finally came. And so did the snow.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED NEWS ANCHOR #1: And there’s the cars just littering the roadway that were left last night.

UNIDENTIFIED NEWS ANCHOR #2: And those abandoned cars still – yes. Just by the dozens…

GOLDMAN: News stations heralded Portland’s biggest snowstorm in 20 years. It brought the city to a screeching halt. But the game was on. And the latest word was everyone would play, including you know who. One problem – our 20 to 30-minute car trip to the arena now was impossible. The light-rail train was an option. But the nearest station was a two to three-hour hike. Who would be crazy enough to do that in the freezing cold and snow?

Boots?

MAX: Check.

GOLDMAN: Warm socks?

MAX: Two pairs of socks – check.

GOLDMAN: Gloves?

MAX: Check.

GOLDMAN: Tickets?

MAX: Check.

GOLDMAN: Tickets right there. It’s 2:30. Game’s at 7:30.

MAX: 7:30?

GOLDMAN: We’ll try to make it.

We set out. And, soon, it started snowing again. But with visions of LeBron pulling him forward, Max set a ferocious pace.

Max, hold on up there. He’s a full hundred yards ahead of me. He’s actually been jogging a few times uphill.

The whole first part of the trip had been uphill. We got to the top after an hour and 40 minutes.

How you feel?

MAX: Better than ever.

GOLDMAN: Better than ever? How are your feet? How are your feet?

MAX: My feet are fine. My legs are kind of sore.

GOLDMAN: Right. Yeah, but you were running a little bit up there.

MAX: Yeah. Well, I wanted to get to the top.

GOLDMAN: Well, hold on. Wait. Wait. Wait. Wait. Wait. One more thing – we can still go back.

MAX: Never.

GOLDMAN: We pressed on and got to the train stop at 4:30, two hours after we set out. The train traveled exactly one block and stopped. A tree had fallen on the tracks. So we got out, walked another 10 city blocks, got on another train. And sooner than you can say frostbite, we were in.

(CHEERING)

GOLDMAN: About 40 minutes before gametime, fans cheered as LeBron James stepped onto the court to warm up. Max opened his mouth but could only muster sounds.

MAX: Uh, uh, hey.

GOLDMAN: After 10 minutes of gawking and Instagramming from courtside, we headed up to our seats and watched the hometown Blazers pound the Cavaliers, 102-86. Normally, Max would be ecstatic. But on this night, anything Portland did was secondary. LeBron was good, not great – twenty points, 11 rebounds. But he also had five turnovers. No matter – he was there. So was Max. Mission finally accomplished. Tom Goldman, NPR News, Portland.

(SOUNDBITE OF LALO SCHIFRIN COMPOSITION, “MISSION: IMPOSSIBLE”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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For People With Developmental Disabilities, Food Work Means More Self Reliance

Customers at Puzzles Bakery & Café in Schenectady, N.Y. More than half the staff at the café has a developmental disability. Rhitu Chatterjee/NPR hide caption

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Rhitu Chatterjee/NPR

Every child wants to grow up to be independent — to leave their parents’ home, find work, build a life of their own.

But that seemingly simple step into adulthood can be a monumental challenge for children with developmental disabilities like autism spectrum disorder, cerebral palsy, or any of a range of other such disabilities that affect about one in six American children, according to the U.S. Center for Disease Control and Prevention.

Most of them remain dependent on their parents and families for support well into adulthood, or they end up living in a home under the care of professional caregivers. Only a fraction of adults with developmental disabilities end up finding steady employment.

But some people are finding work and a path to self-reliance by working in the food industry. Parts of this industry are particularly well-suited to many people with developmental disabilities, like Victoria Reedy of Schenectady, N.Y.

Reedy is 23 years old and lives with her parents and two sisters. When I met her in her parents’ home, she was dressed casually in a sweatshirt and wore sparkly nail polish. She’s of average height now – about five feet five inches – but growing up, she says, she was a very small child.

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“I was 6 years old, and the same size as my little sister who’s four years younger than me,” says Vicky.

She has a condition called panhypopituitarism, which is a problem in her pituitary gland that causes it to not produce enough hormones, including growth hormone.

Vicky’s condition affected the development of her brain as well. She struggled with a range of learning problems while growing up, and school felt extremely hard. “I struggled at just about everything but art,” she says. “I had a really hard time reading, [a] hard time writing, and learning things in general.”

Her speech was affected, too. And she shied away from social interactions. As she grew up, she depended on her parents and a close friend for everything outside her home, from getting around to handling money.

Victoria Reedy, 23, has worked at Puzzles Bakery since the day it opened in 2015. It’s her first job as an adult and she says it has helped her grow and become more independent. Rhitu Chatterjee/NPR hide caption

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Rhitu Chatterjee/NPR

But today, Vicky is a very different person. She’s more confident and independent. She even takes the bus everywhere, all by herself. “I take the bus just about everywhere I have to go, unless I’m traveling with Mom or Dad or any of my friends,” she says.

That’s because a year and a half ago, Vicky got a job at a bakery in downtown Schenectady.

Puzzles Bakery & Cafe in downtown Schenectady is bright and spacious. The winter sun filters through the glass door and windows and fills the front of the café. On the day I visit, it’s packed with customers sitting down for lunch at the small white tables lined on either side.

Vicky is a senior café attendant here. She stands behind the counter, matching orders coming out of the kitchen, making sure the right order goes to the right tables.

Vicky also handles customers herself sometimes. She trains interns, organizes food and clean tables when necessary. Some of her favorite tasks, though, involve working behind the scenes, in the kitchen. She loves doing dishes, slicing meat and cheese on an electric food slicer. It’s mechanical, somewhat repetitive work that takes time, but Vicky says she finds it satisfying.

In the time that she has worked here, Vicky has even made new friends among her colleagues. Her colleagues say she has grown tremendously at the job. She’s now one of the few employees who have a key to the store, so she can open and close the café when necessary.

Sara Mae Pratt, 26, is Vicky’s boss and the owner of the cafe. She says she’s very proud of Vicky. “She’s come such a long way.”

As have many of her other employees, who have some sort of a developmental disability. Pratt opened Puzzles Bakery & Cafe in April 2015 with the goal to employ people with special needs, who otherwise struggle to find jobs. “There [are] not a lot of opportunities, certainly not in the way of employment,” Pratt says. Once they graduate from the school system, they often “kind of fall off a cliff,” she says.

And statistics back up her point. According to the U.S. Bureau of Labor Statistics, the percentage of working-age people with disabilities who are employed is about one-third of the percentage of people without any disability. And some 50 percent of people who are employed struggle to complete their tasks due to their disabilities, according to the BLS. Many face compensation gaps and discrimination at their workplace, according to the Arc of the U.S.A, an advocacy group for the developmentally disabled.

The BLS also finds that those who are unemployed report many obstacles to finding employment, including the absence of sufficient and appropriate training.

Pratt knew a lot of this from her personal experience. Her 23-year-old sister, Emily, has autism. As her sister approached adulthood, she says, she and her parents worried what her sister would do once she graduated high school and no longer had any support from the state education system. “I certainly struggled with what my sister will be doing for the rest of her life. She has a very long life ahead of her.”

Her sister is too disabled to work – she recently moved out of their parents’ home and into a group home, where she could have round-the-clock help. But Pratt wanted to help those who could work, to find a sense of self-reliance and purpose in their lives.

Before deciding to open a café, she did a lot of research and found that working with food is a particularly good fit for many people with developmental disabilities. For one, “food is very forgiving,” she says. “If you mess up, [it’s] not a big deal. You can throw it away, try it again.”

And it’s no surprise that Vicky enjoys simple, repetitive tasks like doing dishes and slicing and arranging food, she says. “It can be quite therapeutic to kind of do the same thing day in and day out, and it’s something many people with developmental disabilities can actually excel at.”

There is another factor about this work that helps people like Vicky overcome their struggles with social interactions. “They actually get to take part in the creation of this food and bring it to the customer and see that smile on their face,” says Pratt. “They’re seeing this day in and day out. That’s the really wonderful thing about food, it really connects people.”

Madaline Hannon, 23, a café attendant at Puzzles takes a sandwich to a customer. Hannon has autism. Her parents say the job has helped her become more social and independent. Rhitu Chatterjee/NPR hide caption

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Rhitu Chatterjee/NPR

Similar bakeries and restaurants exist elsewhere in the country. Some, like Jack’s Bar & Grill in Arvada, Colo., employ people with special needs. Others, like Sunflower Bakery in Gaithersburg, Maryland, also train and then place such individuals at other businesses in the food service industry.

Today, more than 50 percent of Pratt’s employees have a developmental disability, she says. That includes 23-year-old Madaline Hannon, who has autism. She has limited vocabulary and according to her parents, she has always been painfully shy.

Now, though, Hannon works four days a week at Puzzles. She only works three hours a day and spends a lot of it serving customers, mostly during the lunch rush.

Dressed in a loose T-shirt, jeans and a baseball hat, Maddy stands behind the counter, keeping an eye on every plate of food that comes out of the kitchen through a little window on the wall behind the café’s counter. She matches the food on the plate with the orders flashing on a little screen above the window, then she calls out the order loudly to find the right customer. “Order for Mary Ann!” she says, holding a plate with a sandwich in her hands. When the customer raises her hand, Maddy walks over the plate of food to her, then wishes her a good day. She rarely makes eye contact, but she interacts with every customer as she serves them their plate of food.

And she tells me she enjoys the work. She’s been working here for about a year and a half, and she says she now has big dreams for her future.

“I wanna work at Disney World, in a bakery,” she says. “They have more gourmet stuff.”

Maddy still lives with her parents and unlike Vicky, she still depends on them to bring her to work and take her home at the end of her shift. So, I ask her if she’d be willing to leave her parents’ home and move out of Schenectady to pursue her dream. “Definitely, yes,” she says with a smile.

Her mother, Kathleen Hannon says, this job has transformed her daughter.

“[The] Maddy that walked in here the first day probably didn’t say hello to people who’d come in,” she says. “Today, she’s out there. I know she will talk to the customers. And we’ve seen a big difference at home. She’s happy!”

The job has given Maddy a sense of belonging, she says. “It’s her job. It’s her friends. It’s her responsibilities. And that’s important. We all want that. We all want to fit in. We all want to belong. We all want friends. And I think that’s helped a lot.”

She says her daughter recognizes that she’ll always need extra support, but the job has made her realize how much she can do on her own.

“She’s wandering further and further away from us,” says Kathy Hannon. “She’s looking for more independence.”

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