Espanola Farmers’ Market has partnered with the El Centro clinics for a very effective fruit and vegetables prescription program (FVRx) funded by Wholesome Wave, a foundation based in Connecticut.This grant enables the entire family of children diagnosed with diabetes or obesity to recieve a dollar per day per family member to purchase fresh fruits and vegetables at the participating farmers’ market. For example, a family of seven was issued a weekly prescription for $49 (7 people x 7 days) which they presented to the Market staff for wooden tokens, then used those tokens to buy fruits and vegetables from many farmer/vendors.

Last season, about 20 families participated fully in this program. The Market redeemed $9,330 in purchases, over 90% redemption rate. We had to report the prescriptions weekly, listing the number of wooden tokens issued, the number redeemed and the code number of the prescription. The clinic was also reporting weekly, with coded data related to measurable heath monitoring to evaluate any improvement resulting from four months of eating more freshly grown food. This accumulation of statistics is what makes the Wholesome Wave FVRx program unique and effective. They are accumulating health data to be able to prove what we know intuitively, that eating healty food improves health.

This could potentially result in more funding throughout the country for preventative care under Obama’s health plans. Espanola Farmers’ Market & El Centro were the only market/clinic partnership to recieve this grant in New Mexico and only one of two rural markets in the country for this program. Most partners were in northeastern low income urban areas.

We have been invited to apply again for this season and have already been collaborating on building a more effective program, including printing bilingual recipe cards for farmers to distribute at their tables and having El Centro health workers at the Monday Market to guide the patients in their vegetable purchases and to provide other health information to our customers.

Sabra Moore, Market Manager
(505)685-4842

Check out this interactive site at the Washington Post to see how sequestration will impact New Mexico. You can look up public health, education and other topic to find out what the latest Washington pie fight means to our community.

Recently, after months of silence, New Mexico Governor Susana Martinez became one of several Republicans to blur the Right’s anti-socialist line in the sand by adopting Medicaid expansion. As New Mexico is surpassed only by Texas in its ranks of uninsured, and leads almost every list of scary medical conditions known to humanity, adding 170,000 insured out of a population of 2,000,000 is obviously good for our statewide health.

But health wasn’t the primary reason Martinez bucked her party. Her decision is rooted in New Mexico’s economy.

I live and work in Rio Arriba County. Like most of New Mexico, it is rural. Forty-one thousand people inhabit a County that is larger than Connecticut and Rhode Island combined, often in remote mountain villages.

New Mexico leads the US in drug overdose deaths, while Rio Arriba’s death rate surpasses New Mexico by 2.5 to 1.

Several years ago, in an attempt to understand the causes of the epidemic, I compared demographically similar northern New Mexico villages.

Contrary to popular belief, overdose deaths in these communities did not correlate with poverty: Taos and Tierra Amarilla experience lower death rates than nearby Chimayo and Española despite lower median incomes.

The communities with higher overdose death rates shared two important  but unexpected distinctions. These towns bordered New Mexico’s wealthiest counties; a large percentage of adults thus commuted more than 30 minutes to work in Los Alamos or Santa Fe (or even Albuquerque),  often as much as 60 to 90 minutes one way.

If an adult commutes more than 30 minutes one way, the commute exceeds the lunch hour making him or her unavailable to social networks during working hours. If a high enough percentage of adults are traveling more than 30 minutes one way to a job in a given community, then there is nobody left behind to care for children, bring soup to a sick neighbor, or retrieve forgotten homework assignments.

We are emptying southern Rio Arriba County of healthy adults during daytime hours for relatively low-paying jobs. Because we lack monetary resources, we have very little public or private afterschool programming. Gangs are targeting middle school age children, offering them drugs and alcohol to act as mules.

It appears that the best community-wide resolution to the drug epidemic in Rio Arriba may be the the return of good jobs to the County.

Health Care is the fastest growing sector of New Mexico’s economy, and its largest source of local wages. Twenty-five percent of all Rio Arriba wages can be attributed to healthcare-related jobs. These are also the best-paying jobs, and tend to include benefit packages. In our most remote villages, often, the local clinic is the largest, or even the only employer. Northern New Mexico College, located in Española, offers several health care degrees and certificates. The local hospital and clinics are among the best in the state. Rio Arriba is perfectly situated to expand employment through health care.

Medicaid expansion is one several important ways the Affordable Care Act (ACA) makes it possible to bring health care jobs home. Another has to do with the state-based Medicaid Reform prompted by the ACA.

In New Mexico, the health care delivery system is fragmented. In fact, use of the word ‘system’ in the same sentence as ‘healthcare’ is an oxymoron. Trying to make sense of the cacophony is like trying to put together a thousand piece jigsaw puzzle in which few of the pieces fit.

In 2008, the Rio Arriba Community Health Council produced a report demonstrating that, while the State of New Mexico spent $6.6 million providing behavioral health services to residents of Rio Arriba over 18 months, 75% was spent out-of-county, much of it on youth residential services in Texas or southern New Mexico without family involvement or aftercare based in our own community.

Basic services remained unavailable in-county because this huge expenditure was draining the budget. Local government has been forced through mandatory sentencing and other laws, to spend extraordinary amounts of money on law enforcement and preventable emergency room costs. Medicaid reform offers us the opportunity to build a health care system that focuses on producing health over profit, and enables us to provide basic preventive care close to home. Working with state government to return $3.3 million per year to our county for badly needed preventive care could result in 60-70 jobs. We will keep people healthy while enabling an additional 70 adults to remain close to families and neighbors during daytime hours.

There are numerous provisions in the ACA that encourage hospitals to reduce readmission rates for preventable conditions. The ACA provides incentives to  hospitals to keep people healthy, and penalizes them for failing to connect discharged patients to follow-up care. The Center for Medicaid and Medicare Services (CMS) tracks hospital quality, and assists the public to compare hospitals online at Hospital Compare. Rural hospitals that capture 75% of the Medicare market share qualify for substantial federal subsidies, adding a further incentive to improve care and build relationships in the community.

Instead of wasting money on billboards, Rio Arriba County is collaborating with Española Hospital to coordinate a series of immunization clinics designed to entice seniors with free preventive care including immunizations for pneumonia, influenza, tetanus, whooping cough and shingles; medication reconciliation clinics where a medical professional examines all of a patients’ medicines to insure they can be taken together; and enrollment fairs.

We hope the fairs will increase our share of the Medicare market, qualifying the hospital for a $1.8 million subsidy, decrease hospitalization rates through proper prevention, and increase payment sources through Medicare and Medicaid enrollment. It is much easier for me as a local government official to work with our hospital to improve care when the system incentivizes collaborative hospital behavior. Moreover, a further revenue capture of $2 million to our system could mean an additional 40 jobs.

Changing the shape of our healthcare system to one that produces healthy people strengthens communities by building community networks and community attachment.

It’s a win-win for everyone!

Last year, Rio Arriba County ranked last in the New Mexico for immunizations of Seniors. In one year, we went from last to second by bringing our immunization campaign directly to neighborhood senior centers. This year, we are expanding our push, bringing immunizations for influenza, pneumonia, tetanus and whooping cough to the senior centers once again, but als joint pain prevention, Medicare enrollment, heart and diabetes checks, and more. The site managers of each community we visit are organizing some of their own activities as well. As a result, the tone of each outreach mirrors the personality of that community.

Espanola Hospital, the NM DOH and El Centro Family Health have accompanied us to each site to provide medical staffing. We need to pass the Hospital Mil Levy, and to raise our Market Share among Medicare recipients from 45% to 75% in order to qualify for the $1.8 million federal subsidy for Sole Community Provider Medicare Hospitals. Rather than marketing through ads, Espanola Presbyterian Hospital is assisting us to bring preventive services directly to Rio Arriba Senior Citizens.

We’ve had other providers helping us as well: AmberCare, NM Disability Rights, and the Espanola Energy Employee’s Resource Center for folks who have been harmed by radiation.

In Dixon, they held an arts and crafts fair; we came up with a collaborative solution to a crisis; and we visited the home of a Centenarian. Each of these events has been so inspiring. I hope these videos help you to enjoy them, too!

After climbing a steep iMovie learning curve, I am finally able to post our video of the outreach in Chimayo! We administered 52 vaccines before running out! In addition, Site Manager Elias Fresquez hosted a car show (with awards), a farmers’ market, education for seniors by the Public Regulatory Commission, among other things. County Commissioners, the Mayor of Espanola, the Sheriff, school board members and other officials mingled with the public. A great time for everyone!

All this and more in our second minimentary of the series: Hospital in Chimayo!

On August 31, the Rio Arriba Community Health Council and its member agencies went to the Senior Center in the village of Truchas to conduct joint pain prevention classes, immunizations, diabetes screenings and other preventive services. We met a lot of folks and learned that co-pays, even small ones, are a huge barrier in our small farming towns. The RACHC will be working to find ways to eliminate or reduce co-pays for key services such as immunizations.

In the meantime, this is our story:

It’s not a coincidence that the Affordable Care Act has spawned a host of bills in states dominated by the religious right masquerading as anti-abortion legislation, but in fact punishing women for being able to bear children.

In the last year, attempts have been made in the US House of Representatives and the state of Arizona to defund Planned Parenthood. “Personhood bills” have been introduced in the same time frame in Virginia, Oklahoma, Mississippi and Colorado seeking to ban both birth control and abortion. Bills were also recently introduced in Georgia and Tennessee to criminalize miscarriage, potentially making it a capital offense. And who can forget Virginia’s effort to force medically unnecessary vaginal ultrasounds on females with the temerity to seek medical care?

The ACA may be the most important piece of civil rights legislation effecting women since we gained the right to vote in 1920.

Sadly, the value of the ACA to women remains America’s best kept secret.

The Commonwealth Fund has produced an interactive map and a study (aptly entitled “Oceans Apart”) that make the impact of the ACA on women visually apparent at a glance. Scroll the map to see for yourself! (Don’t forget to click the arrow that shows you the change in hue after the ACA is fully implemented.)

According to the Commonwealth Fund, 35.4 million American women between the ages of 19 and 64 were either uninsured or severely underinsured in 2010. Indeed, the number of uncovered women has increased by 6 million (17%) in the last decade, mostly due to lay-offs of teachers, nurses and other federally funded jobs that are both primarily occupied by women, and targets of right wing budget cuts. The five states with the highest rates of uninsured women were Texas (30.3%), Florida (26.2%), Arkansas (25.3%), New Mexico (25.3%), and Nevada (25.2%).

The study also found that America leads the world in numbers of women who forgo health care for lack of a payment source.

Forty-three percent of American women reported having skipped medical care due to cost, more than twice the number of most other industrialized nations. Germany and Australia reported 28% of women forgoing care due to cost, still far below American rates. Ironically, the only state to almost fully insure women prior to implementation of the ACA is Massachusetts.

Which begs the question: when it comes to women, is America a third world country?

Seventy-Seven percent of American women who opted to forgo care were uninsured. These are the very families that the proposed ACA Medicaid Expansion would benefit.

Is it merely coincidence that the (dark blue) Commonwealth Fund states in which women are most likely to forgo care appear to be an overlay of the Jim Crowe South with states that have large Hispanic populations? Or that they are agricultural states? Or that they are located in the Bible belt?

The interactive map raises more questions than it answers for me. But it makes one thing very clear. Implementing the ACA and its Medicaid expansion will help lift women out of poverty in New Mexico.

It’s the humane thing to do.

Yesterday, when we opened the box of mugs we ordered to promote our council and website, we were surprised to find lovely mugs commemorating Jessop’s 70th birthday. Today, I came to work expecting all of our hard work to bring us into compliance with the ACA to be thrown out the window. Instead, I got to celebrate Jessop’s 70th!

Apparently, CNN was taken by surprise too, as they posted a front page story for ten minutes proclaiming the law as having been struck down.

I wish I knew how to post the screen save. You’ll have to click the link to see the visual!

“When the people find that they can vote themselves money, that will herald the end of the republic.”-Ben Franklin

When asked by a woman what sort of government had just been created, Frankin famously replied: “It’s a Republic if you can keep it.”

Last week, I had the great good fortune to attend a number of panels on money in politics at Netroots Nation (NN12) including the panel composed of Senators Sheldon Whitehouse (D-RI), Jeff Merkley (D-OR) and Sherrod Brown (D-OH) along with Trevor Potter (former council to Presidents Reagan and Bush cum comedy sensation), and Becky Bond of CREDO. The panel was moderated by former Congressman Tom Periello (D-VA).

I have always believed that despite the goodness of individuals, there is an inner Nazi lurking within every nation, snarling for its late-night human snack. The Senators confirmed my worst fears.

In 2010, the Supreme Court reversed over one hundred years of precedent limiting private donations to political campaigns by ruling in favor of Citizen’s United, a non-profit attempting to televise a video “documentary” about Hillary Clinton in violation of the McCain-Feingold Act. The SCOTUS went far beyond a discussion of documentaries, and gutted McCain Feingold along with a number of state laws limiting political donations. They equated money with speech.

(Trivia note: Citizens’ United claims it is not related to Citizens United Not Timid, an organization similarly devoted to defamation of Senator Clinton which produced tasteful tee-shirts emblazoned with their C.U.N.T. acronym, depicting what text suggests is a nude outline of Clinton with a triangular flag covering her genital area. The press generated by the non-coordination of the two allegedly distinct non-profits bears a certain resemblance to the efforts of comedians Jon Stewart and Stephen Colbert, and their lawyer-turned-panelist, Trevor Potter, to completely legally not coordinate their own Superpac as seen in the video below:)

Senators Whitehouse and McCain (R-AZ) are fighting back (notwithstanding the polarized nature of Congress) by jointly filing an amicus brief supporting the State of Montana in a challenge to the decision which also torpedoed Montana’s anti-corruption laws. Whitehouse and McCain take particular exception to a finding of fact by the SCOTUS that no corruption or appearance of corruption will arise from unlimited donations since most donations will be adequately disclosed.

In fact, because of a loophole, political contributions are being made billionaires and corporations to 501-c-4 non-profits which do not have to disclose the sources of their funding (and hence, serve as a corporate drycleaning solution). We may know which phony non-profit has contributed to a campaign, but we can’t know who has donated to the dubious non-profit. According to Senators Merkley, Brown and Whitehouse, corporate CEOs are funneling large amounts of shareholders’ funds (but not their own personal wealth) into these non-profits without shareholders’ knowledge, thus divesting us of our right to limit contributions of collectively held funds.

And who are the shareholders? You and I. Our pensions are being diverted towards political contributions that limit our rights as workers, and even the transparency and solvency of our pension funds!

Moreover, as consumers we are buying products. Some of our purchases are helping to fund contributions to political candidates and causes we don’t support. Did you know that Brawny Paper Towels and Dixie Cups are manufactured by the Koch brothers, who appear poised to spend a billion dollars to influence candidates? Did you know that a dollar spent on Dixie cups could be a dollar spent intimidating politicians into opening up our watershed to fracking by Koch Industries? Would you buy a Dixie Cup if you knew that? Did you know that some of this corporate money is being poured into local races?

Senators Merkley, Brown and Whitehouse are betting that you wouldn’t want to buy that Dixie Cup if you knew it was going to be used to pour a sludgy oil-and-feces-infested concoction down your throat! This summer, they intend to introduce the Disclose Act repeatedly, forcing a series of all-night filibusters by Republicans. They’ve asked for bloggers to conduct all-night blogathons to draw attention to the need for disclosure.

I’m getting an early start!

But don’t get complaisant because there’s more to come about suppression of voter rights as “free speech” in future posts.

Senator Bingaman and Commissioner Montoya

I want to thank each and every member of the RACHC who came to the March meeting to get to know me. I enjoyed answering your many questions about health care.

It has taken me some time, but I’ve even learned to use your blog in order to continue our dialogue. See, you can teach an old perro new tricks!

I would like to be the one to announce, in response to your request, that the Rio Arriba Board of County Commissioners will be supporting the work of the health council with seed money in the upcoming fiscal year. It won’t replace the zeroing out of health council funding by the Department of Health, but it will enable you to continue the outstanding work you have been doing.

Several nights ago, I had the opportunity to speak to the League of Women Voters in Los Alamos. Many questions were asked about water and the environment. While I did not have the opportunity to speak with the RACHC about Rio Arriba’s water resources, I realize that the issue is important to your membership. I would like to share some of my thoughts with you now.