The House Passes a Shameful ACA Replacement Plan

Susan Todd, Executive Director, 504HealthNet                                                   5/4/17

The American Health Care Act (AHCA), the GOP-sponsored ACA replacement plan, passed through the House of Representatives today. This bill cuts $800 billion to the Medicaid program, eliminating benefits for people on Medicaid; decrease subsidies that help people pay for their health insurance; and effectively eliminates Medicaid expansion. In March, the CBO estimated that 24 million Americans would lose health insurance under this bill. Recent amendments to the AHCA made it even worse by allowing states to waive protections for people with pre-existing conditions, meaning that they could be charged much more for health insurance. The high-risk pools that will be implemented to cover people with pre-existing conditions are drastically underfunded, and are subsequently unable to fill the gap. As such, we believe that 24 million is a conservative estimate, as health insurance will certainly be unaffordable for many Americans with pre-existing conditions under this bill.

The AHCA shifts $10 billion in Medicaid costs to Louisiana. With a radical decrease in Federal support, our resource constrained state will be forced to end Medicaid expansion. Over 420,000 low-income Louisianans who recently gained coverage under Medicaid expansion will lose it. Huge cuts to Federal Medicaid funding plus per-capita caps will also lead to reduced coverage and services for 1.28 million Louisiana residents, many elderly or disabled, who rely on Medicaid for health care

Source: The Center on Budget Policies and Priorities

Furthermore, decreased subsidies for insurance will raise costs for Louisianans with Marketplace coverage, on average, by $4,823 annually. Finally, the AHCA will deepen Louisiana’s budget crisis. In the midst of this mess, the wealthiest Louisianans will get a big tax break.

This bill now moves to the Senate, and we ask Senators Kennedy and Cassidy to vote against it. We commend Senator Cassidy for his public opposition to the AHCA over the past few weeks, and urge him to stand by his commitment to prevent anyone from losing coverage, protect those with pre-existing conditions, and to design a system that puts patients first. As Senator Cassidy says, “it is better to give patients adequate coverage.” The alternative is costly, episodic, emergency care for the uninsured.


504HealthNet is a non-profit coalition of 23 independent community health service providers who represent the primary care and behavioral health safety net for Southeastern Louisiana. Together, this network of community health centers is working collaboratively to improved access to services and better meet the primary care and behavioral health needs of low-income, uninsured, and underinsured residents in the Greater New Orleans area.


Health Insurance Marketplace Open for All



Contact: Ariel White, 504.206.6275

Health Insurance Marketplace Open for All

NEW ORLEANS, LA — This week marks the beginning of open enrollment for the Health Insurance Marketplace. Starting on November 1, local organizations are mobilizing to help Greater New Orleans area residents sign up for health insurance coverage through the Health Insurance Marketplace—a tool to help individuals find health insurance that is right for them at affordable prices.

504HealthNet partners will host a number of Marketplace enrollment events which will take place from November to January to provide information and one-on-one assistance to residents seeking to apply for insurance coverage. The events are organized by members of 504HealthNet, a non-profit organization comprised of 22 community health care providers representing the primary care and behavioral health safety net for Jefferson, Orleans, St. Bernard and Plaquemines parishes.

“Most people need medical care at some point, but will not know in advance when that is. Having health insurance helps you cover these costs, protects you from very high expenses, and can make it easier to see a doctor,” said Susan Todd, executive director of 504HealthNet. “Through the Marketplace, financial assistance is available to help lower the cost of health insurance. Nearly 6 in 10 uninsured Americans could get insurance for $100 month or less. Depending on your income, you could pay as low as $20 a month for coverage.”

All plans offered through the Marketplace cover a comprehensive set of benefits, including physician visits, preventive care, hospital stays, and prescriptions. Discrimination based on gender or pre¬existing conditions is no longer allowed, making it easier to get covered. Also, many individuals, families and small businesses will qualify for a discount on their monthly premiums.

Those seeking Marketplace enrollment help can attend an upcoming Marketplace enrollment event or visit or call a Greater New Orleans community health center offering assistance. Upcoming Marketplace enrollment events offer an opportunity to receive in-person enrollment assistance at a convenient location. Visit or call (504) 658-2053 for more information.

It is important to note those without any health insurance coverage may have to pay a fee of $695 per person ($347.50 per child under 18) or 2.5% of your income, whichever is higher. Avoid the penalty and enroll in coverage by January 31!

For more information on the Marketplace, visit

About the 504HealthNet & Tulane Internal Medicine Residency Program Clinical Update

Dear Friends and Colleagues,

504HealthNet and the Tulane Internal Medicine Residency Program are pleased to present you with the first quarterly Clinical Care Newsletter. 504HealthNet is a non-profit organization that represents the outpatient safety net providers for the Greater New Orleans area. Through work with member organizations like the Tulane Drop-in Center, Tulane/Ruth Fertel Clinic, and the UMC primary care clinics, 504HealthNet strives to ensure that everyone in the community has access to high quality primary care and behavioral health services.

In primary care settings it is often difficult to keep up on the most current guidelines. This newsletter seeks to distill some of the most useful articles that internal medicine/primary care track residents at the Tulane Internal Medicine Residency Program have found to improve their practice and the practice of their peers and mentors. Keeping providers at all levels informed about the latest advancements and updates in health care best practices is important to both Tulane and 504HealthNet, which is why we are creating this quarterly publication.

Topics for this issue focus on guidelines for daily aspirin use, screenings for diabetic neuropathy and Hepatitis C, and updates on recommendations for the different pneumonia vaccines.

It is our hope that this newsletter will be helpful for providers’ continued practice, and that you are able to go forward and care for those who need it most. To sign up for the electronic version please visit


Susan Todd, MPAff
Executive Director

Anjali Niyogi, MD, MPH
Assistant Professor, Department of Internal Medicine and Pediatrics
Tulane University School of Medicine

504HealthNet Marks the 10-year Anniversary of Hurricane Katrina

NEW ORLEANS—504HealthNet executive director Susan Todd released the following statement on the anniversary of Hurricane Katrina.

“It has been ten years since our city was changed momentously by Hurricane Katrina. In the past decade we have grown in ways we could not have imagined. Through the rebuilding process the city has increased the number of locations that people can receive primary care and behavioral health services in their neighborhood.

Having community-based providers located in all neighborhoods through out the city—and throughout the region—means that access to affordable, high quality care is more available than ever before. Across the 504HealthNet member clinics providers see more than 140,000 patients. These community based health clinics have become centers of care for anyone who needs it—from working parents with a cold, to the waiter with a burn, to the student with a migraine. These health centers are working tirelessly to build a healthier New Orleans and to continue to serve the people who need it most.”


504HealthNet is a non-profit organization comprised of 22 community health service providers representing the primary care and behavioral health safety net for Orleans, Jefferson, St. Bernard, and Plaquemines Parishes. Together, 504HealthNet is working collaboratively to better meet the primary care and behavioral health needs of low-income, uninsured, and underinsured residents in the Greater New Orleans area.

504HealthNet in the News

By the time patients arrive at Dr. Monir Shalaby’s office at the EXCELth clinic in New Orleans, they have run out of options: Most have little or no income, no health insurance and, usually, a heap of health issues.

Ten years ago, their options shrunk to nothing when Hurricane Katrina’s storm surge breached the levees, swamping homes and businesses. With many of the city’s charitable hospitals closed due to storm damage and two of EXCELth’s clinics flooded, patients came to the third from all over the city, standing in blocks-long lines to replace lost prescriptions and seek health care.

Read the full story here.

504HealthNet in the News

Access Health Louisiana (AHL) is marking National Health Center Week 2015 (NHCW) with a special Voter Registration Drive as well as a Coloring Contest for Children in all its Community Health Centers in seven parishes in south Louisiana.

This is part of a weeklong campaign (Aug. 9-15) to raise awareness about the mission and accomplishments of America’s Health Centers – the largest and most successful system of primary healthcare.One of the bright spots in America’s health care system, health centers started 50 years ago as a pilot project during President Lyndon Johnson’s War on Poverty.

Read the full story here.

504HealthNet in the News

Some had no place to go or no wheels to take them. The sick and the elderly waited helplessly. Thousands stayed for their pets or figured they’d just ride it out as they had before. In a pinch, there was always the Superdome.

Roxy Wright was too connected to get stuck like that.

Wright counts prominent musicians, judges and politicians in her orbit of family and friends, and for a time she attended Mass with former Gov. Kathleen Blanco. She was Blanco’s New Orleans office director when she tuned in to watch her boss stand before the TV cameras on Aug. 28, 2005, ghostly white, and plead for rapid flight.

Read the full story here.

Guide to Community Health Care in Grater New Orleans

Guide to Community Health Care in Grater New Orleans

Download our PDF guide: 504 Health Net Guide to Community Health Care in Grater New Orleans. Includes Primary Care, Counseling, Dental Caere, Obstetrics and Gynecology, Pharmacy, Podiatry, Psychiatry, Testing and Labs, and Vision.

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504HealthNet, New Orleans

by Vic Hinterlang – PhotojournalistIf it’s true that every cloud has a silver lining, then one thread of that surrounding Hurricane Katrina is the opportunity the disaster gave New Orleans to reinvent its health care system. Prior to the storm, the system revolved around Charity Hospital and its 70 downtown clinics. This centralized structure imposed serious limitations particularly on the ability of low income, uninsured individuals to receive primary care, both due to the limited number of clinics providing such care and their locations far from where many such individuals live. Probably not coincidentally, a large percentage of this demographic suffers from diabetes, high blood pressure and asthma, chronic conditions which can largely be avoided through regular access to primary care.

In the immediate aftermath of Hurricane Katrina, clinics sprang up organically across New Orleans, often in tents and largely run by volunteers. Eventually, a number of these locations, including ones operated by universities such as Tulane and LSU, faith based organizations and government, transitioned into more permanent structures. By October, 2005, barely a month after Hurricane Katrina struck the city, planning for a redesigned health care system had begun under the auspices of the U.S. Public Health Service. Through the winter of 2006, the Bring New Orleans Back Commission, the Louisiana Recovery Authority and its Public Healthcare Sub-Committee worked to devise a patient centered, prevention oriented, community based system supported by cutting edge health information technology that would offer access to patients regardless of their ability to pay.

During the past five years, the health providers that constitute this new system have increasingly integrated their efforts. 504HealthNet is a result of this process. Seventeen of the new community based health providers belong to the network, whose goal is to coordinate their efforts among themselves, as well as with the larger health system, to optimize results. My guide to this new model was Karen DeSalvo, M.D., the Vice Dean of Community Affairs and Health Policy at Tulane University School of Medicine, who generously took time from her busy schedule to arrange visits by me over several days to a number of participating community health centers.

My first stop was the Tulane Community Health Center at Covenant House (TUCHC), across Rampart Street from the French Quarter. TUCHC began as a first aid station in Katrina’s aftermath and now provides comprehensive primary and mental health care to 10,000 downtown New Orleans neighborhood residents. The majority of the patients are middle-aged, working poor individuals, approximately 60% African-American and 12% Latino, whose preferred first language is Spanish. Slightly more than half of patients are women. During my visit, I followed Adrian Calvin through his appointment.

Dr. Eboni Price talks with
Adrian Calvin about his diabetes.

Mr. Calvin, 43, suffers from diabetes. He began his visit by having his blood sugar level checked by Nurse Lakeesha Allen. From there he proceeded to Dr. Eboni Price’s office for a consultation and examination.

Mr. Calvin’s diabetes is relatively severe, affecting his ability to work. He told Dr. Price that he had been having problems with his vision and that his feet were often numb. Although he said he was trying to follow his diet and medication regime, he was having a difficult time, partly due to his inability to afford all the medications he needs. “Sometimes I just feel like giving up,” he said at one point.

Dr. Eboni Price checks the
condition of Adrian Calvin’s feet.

Dr. Price encouraged Mr. Calvin to maintain his course of treatment and suggested that he apply for Medicaid, which, with the help of Case Manager Tawana Ewing, he did. However, for an adult in Louisiana to qualify for Medicaid, they must be a parent or disabled, having an income of less than 12% of the federal poverty level if not working, and 23% if a working parent. Mr. Calvin is not a parent, so he would only qualify if he were determined to be disabled and not working with an income less than 12% of the federal poverty level.

“I’m too young for all this,” he told me, shortly before I left for my next appointment.

Case Manager Tawana Ewing helps
Adrian Calvin apply for Medicaid.

From Covenant House, I headed out I-10 East and the Chef Menteur highway to the Tulane Community Health Center in New Orleans East. This center, in an almost exclusively Vietnamese language shopping center storefront, opened in August, 2008 with Tulane partnering with the local community and the Mary Queen of Vietnam Community Development Corporation. The center provides adult primary care, preventive care, including vaccinations, obstetrics and gynecology services and mental health services. It serves a population that is 65% Vietnamese and 15% Latino, with the remaining 20% consisting of predominantly African-Americans. English, Vietnamese and Spanish are spoken and the center serves all clients regardless of insurance status or ability to pay. While there, I sat in on a visit by Trung Cong Huynh.

Dr. Tuan Nguyen listens to Trung Cong Huynh’s lungs.

Mr. Huynh, a construction worker, had come in because he was having some breathing difficulties, primarily due to congestion. Dr. Tuan Nguyen knows Mr. Huynh well, characterizing him as a generally healthy and robust middle-aged man. After discussing his symptoms with him, in Vietnamese, and performing a basic physical examination, Dr. Nguyen concluded that Mr. Huynh was likely suffering from allergies. He recommended an over-the-counter decongestant and sent him on his way.

Next morning I rendezvoused with a Tulane Community Health Center Mobile Clinic in the parking lot of the Winn-Dixie in Gentilly. Part of the “On the Road” program, this custom built bus, with a team including a doctor, nurse, social worker and driver/data entry technician, provides a mobile medical home for adults and children in neighborhoods still lacking permanent health care facilities. On board, I observed Patrice Brown’s appointment.

Tulane Community Health Clinic bus in Gentilly.

Ms. Brown, like Mr. Calvin at the Covenant House clinic, had come in for a check-up primarily related to her diabetes. In the small examining room, Dr. Chukwunomnso Dennar began by asking Ms. Brown if she was following her diet and medication regime. She replied, in a lighthearted tone, that she was trying, but that she often slipped up, adding that she felt good nonetheless. Dr. Dennar took this in, then without criticizing Ms. Brown, explained the nature of diabetes.

The disease, he told her while diagramming its course on the examining table, is chronic and progressive. Without effective treatment, it will eventually cause blindness, loss of limbs, heart attacks and strokes, among other unpleasant developments. He emphasized that the goal of maintaining her diet and medication regime is to reach the end of her life, hopefully at a ripe old age, without suffering any of these afflictions. It was hard for me to tell how convincing he had been, but Ms. Brown did appear to be paying attention.

Dr. Chukwunomnso Dennar explains
diabetes to Patrice Brown.

After the tutorial, Dr. Dennar performed a physical examination of Ms. Brown, apparently finding nothing unexpected. Her appointment ended with her, still in a jocular mood, discussing her life in general while Dr. Dennar entered information about her condition on his laptop.

My penultimate working morning in New Orleans, I went to the St. Thomas Community Health Center, just off Magazine Street a couple of miles south of the Quarter. After a short wait, I was surprised to find myself ushered into the office of Dr. Don Erwin, the President and CEO of the Center. Dr. Erwin is a tall, distinguished gentleman, old enough, I believe, to be considered a doctor of the old school. He was obviously intent on conveying to me the nature and history of St. Thomas, and its relationship with 504HealthNet.

St. Thomas
Community Health Center

St. Thomas Community Health Center is the successor to the St. Thomas Health Services Clinic, which was started by Sister Marion Puerzer and Sister Jane Meurschel of the Sisters of Charity along with resident leaders of the St. Thomas Housing Development, then the largest public housing complex in the United States. The St. Thomas Housing Development Resident Council and the St. Thomas Irish Channel Consortium worked together to develop a community driven, accountable, anti-racist healthcare model, including requiring health care providers at the clinic to receive special training in addressing racism and poverty. Unfortunately, Hurricane Katrina wiped out the St. Thomas Health Services Clinic, forcing it to close. With the help of a long and impressive list of benefactors, the St. Thomas Community Health Center replaced it, beginning while the destruction Katrina caused was still wet.

Dr. Erwin made it clear that although the public housing complex is now closed, the relationship between the St. Thomas neighborhood and the Health Center remains at the heart of the Health Center’s mission and purpose. He spoke protectively and with obvious affection of the people the Health Center serves. And it is the potential effect that 504HealthNet might have on this unique relationship that gives him pause.

Essentially, Dr. Erwin is concerned that the St. Thomas Health Center might lose control of its own destiny and identity by becoming part of a larger entity with its own agenda. He said that he had seen this happen too often when powerful interests had put their own priorities over those of the people they were supposedly organized to serve.

“You know, a lot of these experts think people are stupid because they’re poor. But they’re not. They’ll tell you exactly what they need if you’ll just listen to them.”

So Dr. Erwin’s priorities are clear. He will support 504HealthNet only to the extent that it supports St. Thomas and its mission. While he believes that 504HealthNet has great potential, he’s keeping his powder dry until he sees how things develop.

“It’s too early to know if it will be a success or not. Maybe in a year we’ll know.”

My last stop was the Daughters of Charity Health Center, a new facility on South Carrollton Avenue not far from Xavier University. The Daughters of Charity have been providing healthcare to New Orleanians since the early 1800’s and the Health Center, which is part of Daughters of Charity Services of New Orleans, offers primary and preventive care for infants, children, adults and seniors. During my visit, I attended a routine examination of a two month old infant, Deianka McGuffey.

Deianka McGuffey attracts attention
as Maria Cuellar takes her to be weighed.

Deianka was brought in by her mother, Bianca Walker, and her big sister Dernee. The first order of business was a weigh-in. Medical Assistant Maria Cuellar carried Deianka from the examining room to the scale located in the hall near the station desk, causing quite a stir as Sister Mary John Code and Medical Assistant Carman Izaguirre momentarily abandoned their posts to have a look at the infant. Gently placed on the scale by Ms. Cuellar, Deianka weighed in at seven pounds, nine ounces. Returning to the examining room, Ms. Cuellar arranged Deianka on the examining table, putting her yellow booties and knit cap on her to keep her warm until Dr. Denise Woodall-Ruff, her pediatrician, arrived.

Dr. Denise Woodall-Ruff listens
to Deianka McGuffey’s abdomen.

Dr. Woodall-Ruff began by asking Ms. Walker questions about the general state of Deianka’s health, which appeared to be good. She noted that she had gained weight at a normal rate since her last visit. Dr. Woodall-Ruff then began her examination by listening to Deianka’s heart, lungs and abdomen before examining her navel to be sure that the stump of the umbilical cord was healing properly. She then turned her attention to Deianka’s head, examining her eyes, mouth, throat, and ears. Lastly, Dr. Woodall-Ruff checked the development and flexibility of Deianka’s legs, ankles and feet. On all counts, everything appeared to be in order. Deianka’s visit ended with her mother playing with her as Dr. Woodall-Ruff entered the results of her examination on her computer.

Dr. Denise Woodall-Ruff enters the results of her
examination of Deianka McGuffey on her computer.

My visits to the 504HealthNet affiliated health centers convinced me that the system is, in fact, a patient centered, prevention oriented, community based system supported by cutting edge health information technology that offers access to patients regardless of their ability to pay. However, patients’ ability to pay, or lack thereof, is perhaps the fly in the unguent. Currently, the system is supported by a variety of methods, including sliding scale fees, but primarily by time limited federal grants and philanthropy. Policy reforms to realign state-based health care financing are needed to establish a solid, reliable financial basis for the system. Should these reforms be accomplished, 504HealthNet could well become the national model its organizers aspire for it to be as the Health Care Reform Bill is implemented.