By: Beth Blevins
The goal of Accountable Care Organizations (ACOs) is to reduce costs while improving patient care. The Michigan Center for Rural Health (MCRH) is helping two ACOs in their state do just that. “This is all about changing from volume to value in primary care outpatient settings for Medicare fee-for-service beneficiaries,” said John Barnas, executive director of MCRH. “It’s a care coordination primary care model where primary care providers work together to reduce costs and improve the health outcome.” Read More
By: Beth Blevins
Like many other states, Connecticut is facing a drug crisis. The number of drug overdoses in the state nearly doubled between 2014 and 2015. More people die there from drug overdoses than from car accidents or firearms. To combat this, the CT SBIRT (Screening, Brief Intervention and Referral to Treatment) program is training students who are enrolled in health profession programs to screen for substance misuse and to refer patients for treatment. Read More
By: Beth Blevins
The Oregon Office of Rural Health (OORH) has learned that the simple act of listening can be a powerful tool for change. With Listening Tours conducted in 2014 and again this year, OORH has met with Oregon rural facilities to see what their most pressing challenges are, and has brought together stakeholders who can help them. Read More
By: Beth Blevins
For the last 12 years, Jim Harvey has been “poking along the back roads” of Pennsylvania, visiting agricultural producers across the state. The visits are both friendly and educational. Harvey, the state’s Rural Health Farm Worker Protection Safety Specialist, is there to teach farmers about the safe storage and use of agricultural pesticides, and to help them comply with the Environmental Protection Agency’s (EPA) Worker Protection Standard (WPS), which aims to reduce the risk of pesticide poisoning and injury. Read more
What started with a simple conversation between two programs within the same bureau, has turned into an annual rural health clinic statewide survey with an incredible response rate. Since 2013, the Kansas State Office of Primary Care and Rural Health has partnered with the Kansas Health Facilities Program to survey the more than 160 rural health clinics across the state. These two programs are co-located within the state health agency and were moved together into the Bureau of Community Health Systems in 2012, resulting in a great partnership. Read More
In July 2015, the Wyoming Department of Health’s Office of Rural Health (ORH), through the Wyoming Telehealth Network (WyTN), began offering telehealth technical assistance grants with the goal of connecting rural Wyoming facilities to telehealth services. Grantees represent public health nursing, physical rehabilitation, behavioral health centers, private practice physicians, community health centers, prevention programs, rural health clinics, and hospitals. ORH currently contracts with Ptolemy Data Systems to work directly with sites to assure connectivity. Read More
The Rural Collaborative Opportunities for Occupational Learning in Health Scrubs Program, supported by the Center for Rural Health (CRH) and the North Dakota Area Health Education Centers, provides unique, interactive opportunities for rural North Dakota students to learn about health care careers from professionals in the field. Based on programs offered by the South Dakota Healthcare Workforce Center, the goal of the program is to increase students’ knowledge and interest in health careers available in rural North Dakota. Read More
The work of the Arizona SORH was recently highlighted by 3RNet for their exceptional collaboration with other state partners using the state 3RNet membership to work on improving access to health care in rural and underserved areas across the state. The Arizona 3RNet membership is divided among the following organizations:
These organizations started what they call their “enhanced collaboration” with 3RNet in 2012. Joyce Hospodar with the Center for Rural Health said, “We each were focused on meeting the needs of recruiting and retaining health professionals in the rural and underserved areas of our state. We shared a common understanding of those needs in our state, and we believe that working together and sharing the national 3RNet resource works best for all.” Read more.
On National Rural Health Day 2015, the Kentucky Office of Rural Health (KORH) hosted The Rural Collaborative: Kentucky’s First Rural Health Network Showcase, Funding Workshop, and Idea Exchange. The one-day event highlighted the work that has been accomplished across the state as it relates to the HRSA Federal Office of Rural Health Policy (FORHP) Community Based Division grants. Attendees also received assistance in preparing to submit competitive applications for upcoming opportunities.
“It is encouraging to witness the impact these investments have made across our rural communities”, said Ernie Scott, KORH Director. Read more.
Rescue Divas is a camp for middle-school girls that aims to attract new recruits to the field of emergency medical services. The Ashland Bayfield county areas, like many rural areas, has a difficult time recruiting volunteers for EMS services. They decided to change their focus to recruiting women, who are underserved in EMS, and to develop a pipeline system, getting girls interested in becoming EMTs or working in emergency medicine. Two years ago, Carrie Okey approached Kevin Jacobson of the WI Office of Rural Health with an idea: a summer camp to inspire more young women from the Ashland area to become EMTs. “We would not have been able to do this without ORH,” she says. Read more.
ICD-10 became a reality for all providers on October 1, 2015. It is too early to fully assess the impact from the transition. Over the next 6 months, the needs of rural providers will be better understood. If providers in your state still require assistance, look to the North Carolina Office of Rural Health (NCORH) for resources.
NCORH partnered with the NC Community Health Center Association (PCA), the NC Division of Public Health, the NC Association of Local Health Directors and the NC Public Health Association to offer four two-day Regional ICD-10 Education Sessions. These trainings were conducted in rural regions of the state over a five-month period for over 300 participants. Additional one-on-one trainings were conducted for individual clinics. In total, approximately 700 participants were educated on ICD-10. Read more.
Frustrated with the lack of media coverage on public health issues, John Packham of the Nevada SORH approached the local Nevada Gazette to establish a bi-monthly column devoted to public health issues. The newspaper was very interested in this idea since they had recently reduced staff and were eager for anyone to provide local content. Since 2008, John has written over 100 articles with topics ranging from health reform to tobacco tax. All the articles can be found here.
John was given wide latitude to write about various topics from local issues to those topics focused more on a statewide level. The only restriction is to keep the article to under 500 words. “This has been a very rewarding process,” John explains. “I am used to writing long reports, so it was tough to distill the information down into 3 to 5 major bullet points. People don’t want to read dissertations, instead I had to focus on writing something relevant, succinct, timely and of interest to rural.” Read more.
Arizona is already seeing the benefits of SB 1353 that went into effect this past January. SB 1353 requires health care insurers to cover services provided through telemedicine, if those services would be covered if provided in-person. The AZ SORH helped make this bill a reality by providing information and data to underscore the need especially in rural areas. Dr. Dan Derksen, director of the AZ Center for Rural Health, explained that, “We helped inform the legislative process with workforce studies and identified areas of need. Several of these studies indicated that reimbursement for telemedicine services was the main obstacle to implementation.” The AZ SORH worked closely with the Arizona Telemedicine Program with Ronald S. Weinstein, MD at the helm to ensure that Arizona’s small, rural communities would be able to provide more services locally by using telemedicine. Read more.
The Louisiana Office of Rural Health gets together with rural health partners every quarter for an informal luncheon to discuss the latest issues and to identify areas of collaboration. Tracie Ingram, SORH Director, says, “We communicate so often anyway that we decided we needed a day set on the calendar to all get together.” Invited are those with a statewide rural interest. The key attendees are the SORH, the Primary Care Association, Hospital Association, Rural Health Association and QIO. They discuss policy implications, grant opportunities, and hot topics to see how they can partner with each other or help one another. Read more.
The South Carolina Office of Rural Health is partnering with Dr. Amy Martin of the Medical University of South Carolina and SC Rural Health Research Center at the University of South Carolina to identify best practices to incorporate oral health interprofessionalism into rural health clinics. SCORH wants to develop a national model for SORHs interested in providing technical assistance for oral health integration to meet the objectives of the Triple Aim. Read more.
Safety advances have been broadly implemented in many healthcare settings, similar to aviation and other high-consequence fields. Aviation, with its long history of reporting systems, has shown that event reporting systems can yield previously unknown, but safety-critical information for developing a proactive approach to managing human error. Despite many similarities between health care and aviation, event-reporting systems have not been well received in health care. Read more.
Americans are watching increasing numbers of videos online. According to comScore, this number has jumped over 43% to 100 million daily views (that’s roughly one-third of the U.S. population watching a video online each day). Many companies are using videos in a variety of ways to reach broader audiences in more impactful ways.
The CO SORH has embraced this technology and uses video and digital media in a number of ways to reach constituents. The CO SORH website hosts a number of examples of digital media including infographics, legislator packets, and videos. Videos range from National Rural Health Day promotion to their Annual Report. This was the first year the CO SORH decided to transform the paper annual report into a video report, and it has reinvigorated it in the process. Read more.
Community Paramedicine (CP) is an evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations. Several countries and states around the U.S., including North Carolina, Colorado, Minnesota, Maine, and Texas, have implemented variations of Community Paramedicine. Every state has implemented a CP model that works best for them. Taking a closer look at how Maine implemented their CP program across the state provides examples of best practices and the role of the State Office of Rural Health (SORH). Read more.
The Oklahoma State Office of Rural Health (SORH) has recognized the importance of evaluating the success of grant initiatives, so much so, that they decided to hire an internal evaluator to analyze grant program outcomes. Oklahoma’s SORH Program Evaluator, Pete Walton, plays an important role in the SORH’s efforts toward accountability. Being on staff allows Walton to have better access to those working on program activities as well as records, history, and important information that may not be available to an external consultant.
According to Walton, it is important to set up effective program measures while writing the grant. He believes it is critical to sit down with all staff and discuss not only the goals of the grant guidance, but also the goals of the office. Taking both priorities into consideration, he then helps staff develop goals and objectives that are meaningful. His next priority is to establish an effective mechanism to capture data to show the impact of activities. Read more.
The West Virginia Flex Program partners closely with the West Virginia Hospital Association Critical Access Hospital Network (WVHA CAH Network) to help improve quality and financial performance for all 20 CAHs throughout West Virginia. The Network developed ten years ago through a HRSA Network Development Grant and has continued to thrive ever since. According to Shawn Balleydier, Assistant Director of the West Virginia Office of Rural Health, “this is the best thing that has happened to the Flex Program in
West Virginia.” Balleydier works closely with Network Director Dianna Iobst to ensure that the quality and financial improvement needs of CAHs are met.
Communication is key to ensure the continued success of the Network. Balleydier and Iobst meet regularly to discuss progress and next steps. They also meet monthly with CAHs by phone and make sure they conduct at least one on-site visit each year to provide technical assistance for any of the program areas. CAHs are truly engaged with the direction of the Network.
In an effort to provide consistent medical care to thousands of underserved residents, South Carolina’s “Medicaid System” has implemented a statewide program designed to coordinate care and provide a medical home for some of its most at-risk residents.
Now in its second year, the Healthy Outcomes Plan (HOP) asked every hospital in the state to identify a predetermined number of low-income, uninsured residents who visited the emergency department at least five times in the last year, and who suffered from a chronic condition such as diabetes, cardiovascular disease, hypertension, sickle cell or HIV/AIDS. The size of the hospital determined the number of residents they were required to identify, with 50 being the minimum for the state’s smallest hospitals. Read more.
With its leaking roof, numerous building code violations and lack of modern technology, everyone agreed that Madison County Florida’s 60 year old hospital desperately needed to be replaced. Thanks to a sales tax referendum passed by Madison County residents, and financial assistance from Florida’s State Office of Rural Health, the brand new, state-of-the-art Madison County Memorial Hospital is proof of what can be achieved when residents and local and state officials work together.
“Florida only has 13 Critical Access Hospitals, so we can give them more personal attention and provide funds to entice them to modernize their facility and adopt new technology,” said Florida SORH Director Bob Pannell. When the new hospital was still in the development stage, the Florida State Office provided a $24,000 grant to educate the community on the need for and benefits of building a new hospital. Read more.
The future just got healthier for millions of Minnesotans, thanks to being one of seven states to receive a $45 million State Innovation Model (SIM) testing grant through the Center for Medicare and Medicaid Innovation (CMMI). “We are very excited to receive this grant,” said Mark Schoenbaum, Director of the Minnesota Office of Rural Health and Primary Care. “It’s a great opportunity for rural communities to get new support and build on the kinds of innovations that already take place in rural areas.”
The grant was awarded to Minnesota in February 2013 and will be used over a three year period ending in October 2016. The grant will be used to test new ways of delivering and paying for health care using the Minnesota Accountable Health Model framework. The goal of this model is to improve health in both rural and urban communities, provide better care, and lower health care costs. Up to three million Minnesota residents are expected to receive care through this model over the three year period. Read more.
It was a big loss to the state of Georgia when four rural hospitals closed over the course of two years. The closures gained state and national attention, and started a much needed conversation among rural health care leaders: How to help a rural community after a hospital closure. “Four hospitals is a lot to lose in our rural communities,” said Charles Owens, Executive Director of the Georgia State Office of Rural Health.
In May 2014 Georgia enacted regulations that would allow a closed rural hospital to be reopened as a freestanding ER department within 12 months of the initial closure. The facility would need to be located in a rural county within 35 miles of a licensed general hospital, be open 24 hours/365 days a year and provide non-elective surgery and emergency treatments. Freestanding ERs must also maintain a license through the Healthcare Facility Regulation (HFR), and cannot house a patient for more than 24 hours. To date, no closed hospitals have reopened as freestanding ERs. Read more.
With funding from a Centers for Disease Control and Prevention (CDC) Oral Health Infrastructure Grant, the Hawaii SORH has partnered with the Hawaii State Department of Health (DOH), Family Health Services Division to assist in rebuilding its oral public health program. Other partners include staff from the Primary Care Office and Title V Maternal and Child Health Services Block Grant.
“Hawaii’s oral public health program was shut down in 2009 due to lack of funding,” said Gregg Kishaba, Hawaii SORH Rural Health Coordinator. “The need for the program to be restarted was clear when we received two consecutive “F” grades on our PEW Foundation report card for achieving only one of eight key benchmarks.” Some of the indicators used to measure success included fluoridated water systems, school-based dental sealants programs, expanding dental hygienists scope of work, and Medicaid reimbursement. Read more.
The New York Office of Rural Health (NY SORH) is playing an essential role in a new commission that is looking at how to develop an effective, integrated health care delivery system that will serve all communities in New York’s North Country. (The North Country is composed of nine counties in the northern part of the state, encompassing 13,100 square miles.)
The North Country Health System Redesign Commission (NCHSRC) was created by Governor Andrew Cuomo in December 2013 to examine preventative, medical, behavioral and long-term care services in the region. “When my boss (the Deputy Commissioner for the Office of Primary Care and Health Systems Management) informed me that the Governor created the Commission, we put together a team of folks from various Centers and Divisions in the Department and we were off and running,” said Karen Madden, director of the NY SORH.
In a state known for technical innovation, the California State Office of Rural Health (CalSORH) uses technology to keep rural providers in the state abreast of current issues. The SORH frequently hosts webinars on topics of current interest, in addition to in-person training workshops.
“We offer training on the topic of the day,” said Corinne Chavez, CalSORH Program Coordinator. “We definitely try to have a pulse on the emerging issues – so we see if we need to contract out to make sure that health care providers are getting the information they need.”
Topics covered in the recent past include Bringing the Community Apgar Program to California, Affordable Care Act implementation, Medi-Cal Billing and Reconciliation, and ICD-10. Last year, CalSORH hosted a multi-part webinar over three months on LEAN quality improvement training for rural clinics. LEAN is a methodology used by businesses to identify and eliminate waste and improve flow and efficiency; in hospitals, Chavez explained, it can be used to help streamline wasteful patient flow, or to look at how to treat patients in the ER. Read more.
A project sponsored by the Massachusetts State Office of Rural Health (MA SORH) is helping rural hospitals in the state learn how to reduce the possibility of medication-related patient harm. With the Medication Safety Performance Improvement Project, the MA SORH has contracted with the Institute for Safe Medication Practices (ISMP) to perform one-day targeted medication safety risk assessments at the hospitals.
ISMP recently started offering these one-day medication safety assessments with small and rural hospitals in mind. Each hospital assessment visit focuses on one or two predetermined, mutually agreed upon topic areas in medication safety such as sterile compounding, oncology, medication use in the perioperative areas, or medication administration practices. The ISMP team meets with and interviews key hospital administrators, medical and clinical staff, and other hospital managers to gain an understanding of current medication use practices in the areas of focus. Although the hospital pharmacist takes the lead, it’s important that other hospital staff is included since they all have a role in medication safety, said Cathleen McElligott, director of the Massachusetts State Office of Rural Health. Read more.
As part of an ongoing effort to promote and support telehealth projects in the state, the Alabama Office of Rural Health (AL SORH) has helped a Critical Access Hospital (CAH) attain funding for equipment that can facilitate telewound care locally for its patients.
“Right now, money is tight in Alabama,“ said Debra Robbins, SORH Program Manager. “There are very limited state funds. But we still can help facilitate telehealth.” For example, the AL SORH had some SHIP money leftover last year, Robbins said, which they are using to reimburse Washington County Hospital (WCH), a CAH in a very rural part of the state. The SHIP grant paid for half of the cost of telemedicine equipment and the hospital paid the balance. Read more.
The Colorado Rural Health Center (CRHC) is helping rural health clinics (RHCs) in the state improve business operations and move into quality improvement activities with their Healthy Clinic Assessment (HCA) program.”
With HCA, we go in and do a basic assessment of operations of the clinic,” said Michelle Mills, CRHC CEO. “Then we put together an action plan on where they need to make improvements, and what they are doing well. This strengthens the foundation of the clinic and allows them to focus on bigger, greater things like quality improvement, collecting data in disease registries, or focus on gaining patient-centered medical home (PCMH) status and other care transitions. We’re trying to create synergy for all the things we do for folks. It’s exciting.” Read more.
The Kentucky Office of Rural Health (KORH) is helping get the word out about the Kentucky Health Benefit Exchange (KHBE), the state-run health insurance program, by helping facilitate information sessions in different regions of the state.
The sessions are geared toward health care providers, administrators, boards of directors, community agencies, coalitions, navigators, mid-level managers, front-line staff and other health care workers. “Our partners wanted more community-type events, so we thought, if they’re willing to put forth the effort, we’re going to give it a shot,” said Kayla Combs, KORH rural project manager. “The people working within the exchange have been wonderful to work with. Since they have been so willing to help we
decided to do a roadshow of sorts.” Read more.
The Georgia and Alabama State Offices of Rural Health (SORHs) have been working together to help provide training and technical assistance to the 165 Rural Health Clinics (RHCs) in their states, which lack RHC associations. The SORHs are also engaging with their state rural health associations (RHAs) in the effort.
Over the last three years, RHCs in Georgia identified three issues they were struggling with: HIT implementation, technical assistance and ICD-10 conversion, according to Charles Owens, director of the GA SORH. There is no RHC association (RHCA) in the state, and Owens describes the RHCs there as “low-hanging fruit—under-represented, and begging for resources and technical assistance. Read more.
Through a federal grant program, the Alaska State Office of Rural Health (AK SORH) is expanding telehealth technology and mental health services for veterans in the state. Alaska is one of three states (including Montana and Maine) awarded $300,000 for the second three-year cycle of the Flex Rural Veterans Health Access Program; (it was awarded funds in the first program cycle as well). The program is part of an ongoing collaboration between HHS and the Department of Veterans Affairs (VA) towards implementing an information infrastructure for rural health. “The federal mandate is to provide access of care closer to home and develop increased collaboration between the VA and local providers,” according to Tracy Speier, Health and Social Service Planner and RVHAP Director at the AK SORH. Read more.
Given its emphasis on access to care and workforce development, it was a natural fit for the New Hampshire State Office of Rural Health (NH SORH) to be a part of the NH Legislative Commission on Primary Care Workforce Issues. The five-year commission is working to coordinate workforce as a part of Affordable Care Act (ACA) activities in the state.
“What we’re finding is that because of the ACA, people are very interested in talking about workforce development, when maybe in the past they didn’t have an understanding of these issues,” said Alisa Druzba, director of the NH SORH. “We’re focusing on using the resources we have in the most efficient manner.” Druzba is the NH Department of Health and Human Services appointee. The Commission also includes individuals who represent medical, oral health, and mental health associations and providers in the state. Additional members have been requested to bring in more diversity and non-rural representation, Druzba said. Commission members meet together on a monthly basis. Read more.
Peer-to-peer sharing is one of the benefits of the Michigan Rural Health Clinic Quality Network (MI RHC QN), sponsored by the Michigan Center for Rural Health (MCRH). What started as a small, informal quality network with only 15 active members in June 2011 has continued to grow and gain enthusiastic members. Today, representatives from over 50 of Michigan’s 170 clinics participate in the network and attend its quarterly meetings held in Mt. Pleasant, Mich.
“When members want to talk about quality improvement initiatives in their clinics, we make sure they’re on the agenda,” said Crystal Barter, MCRH Health Systems Development Coordinator, who coordinates the network. “It doesn’t matter what initiative they choose, as long as it has made an impact in their clinic and they feel their peers would benefit from listening to it.” Read more.
If rural veterans are going to get more access to good care, there must be more collaboration between the Veterans Administration and non-VA providers, according to Gloria Vermie, Director of the Iowa State Office of Rural Health (IA SORH). To aid in that effort, Vermie has worked to develop a collaborative relationship between her Office and the Veterans Rural Health Resource Center-Central Region, (VRHRC-CR) located in Iowa City.
“Maybe because my dad was a veteran, it has kept it upfront for me,” Vermie said. When the Iowa City VA got a grant from the Veterans Health Administration’s (VHA) Office of Rural Health to be a resource center for the central region of the United States, Vermie contacted them. “I spent some time talking with them about rural health care in Iowa and about Critical Access Hospitals. I put them on my distribution list, and they invited me to meetings.” Since then, Vermie has been to meetings where she was one of the few non-VA people in attendance, and where she has served as a guest panelist speaking about rural Iowa. Read more.
An ongoing partnership between the Delaware State Office of Rural Health (DE SORH) and the Delaware Rural Health Initiative (DRHI), which serves as the state rural health association, has helped forge new ways of helping the mentally ill and those experiencing psychiatric crises in rural areas of the state.
The partnership has evolved over time with the support of DE SORH funding, according to Kathy Collison, director of the DE SORH. The DE SORH and DRHI collaborate on an annual rural health conference that focuses on issues that affect access to health care for rural Delawareans. For the last several years, the conferences have focused on mental health. “As a result of networking and bridge building at the rural health conferences, a mental health leadership team was established to look at the rural mental health system,” Collison said. “That team has identified and addressed problems with infrastructure in rural Delaware.” Read more.
Lynda Bergsma, SORH Program Director at the Arizona State Office of Rural Health (SORH), believes that rural programs must learn to prove their worth, especially in today’s funding climate. “Many people in health and public health are starting to understand that they will no longer get money to fund programs for which they cannot show specific impacts and outcomes,” Bergsma explained. “There’s no way of knowing if a program is effective without evaluating it.”
Yet, Bergsma said, “when people like me from academic institutions try to help these wonderful, well-meaning rural health folks understand how to do program evaluation, we often make it so complex and overwhelming that we just confuse them, and they give up before they start.” She gave an example of a university researcher, who visited a county cooperative extension office to explain program evaluation, but many staffers said afterwards that they were more confused than when they started; one staffer was so overwhelmed she was in tears. Read more.
A Health Professional Workforce Summit, held on April 12 in Albuquerque, NM, gave participants an opportunity to meet in person and develop strategies for retention of clinicians in the state. The one-day event sparked discussions based upon real data, as opposed to supposition and/or anecdote, according to Britt Catron, Director of the New Mexico Office of Primary Care and Rural Health (NM SORH). Summit participants included non-profit employers, health care providers, members of the NM legislature, Residency Program Directors, and representatives from institutions of higher education and other state government agencies. Read more.
Two Recruitment and Retention (R&R) programs sponsored by the South Dakota State Office of Rural Health (SD SORH) have been so successful that they were recently revised and expanded. The programs are designed to help rural facilities— including hospitals and long-term care facilities—recruit physicians and other health professionals.
“We have great support from the executive and legislative branches in the state—both programs are funded by the state government,” said Sandra Durick, Administrator of the SD SORH. “Our governor has been supportive of rural health care including R&R programs.” Read more.
An online brochure, created by the Southwest Rural Policy Network (SWRPN) and distributed by the Arizona State Office of Rural Health, aims to provide quick and easy information on the Affordable Care Act (ACA) for a rural audience there.
The brochure was a response to a W.K. Kellogg Foundation initiative called Rural People, Rural Policy and was developed by the SWRPN’s Health Action Team, according to Joyce Hospodar, AZ SORH Health Systems Development Manager and SWRPN Action Team Chair. Using money from that initiative, the AZ SORH was able to make printed copies to distribute in the state, which so far it has distributed to many organizations including AHECs, FQHCs and hospitals. “All the other material we are seeing on the ACA is so complicated,” Hospodar said. “We’re trying to get the information more understandable to people living in rural communities. As people become more aware of the ACA, we’ll be able to increase their participation in what they’re eligible for, so more people will be getting insurance and be involved with the benefits of the ACA.” Read more.