As a candidate, President Trump promised that not only would Obamacare be repealed, but more Americans would have access to healthcare. We now know that "access to healthcare" means "ability to pay for insurance." Any American can have healthcare access, if they can afford it.

Thanks to Americans who care enough about real access to healthcare to show up for town hall meetings and contact their representatives, many Republican politicians have realized they do not have the political support to repeal the Affordable Care Act. In our congressional district, we are fortunate to have representatives on a state and federal level who support actual, rather than potential, healthcare for all Americans, but what about local politicians? What about our hospital commissioners? I'd like to make a case that concerned citizens are needed to effect change in healthcare policy locally, too, and that we have upcoming opportunities to shape the healthcare debate in Jefferson county.

You may have already heard, for example, that Jefferson Healthcare has changed the way it performs anticoagulation testing. Maybe you or someone you know depends upon this kind of testing to manage a heart condition or medication like warfarin. This test used to be done simply with a drop of blood, pricked from a finger, at the anticoagulation clinic. Now, the test requires a blood draw at the lab. What's the difference? Cost and access. If you don't have insurance or your insurance has a high deductible, the blood draw is more expensive. Patients who live in far away from the hospital--in Quilcene, for instance--have complained they now have to drive to the lab at the hospital rather than having anticoagulation testing at their local clinic. Anticoagulation testing is often part of the treatment for chronic conditions, so these trips and charges can mount up to a significant cost for patients. And the chronic conditions that require anticoagulation testing aren't so easy to manage. Patients used to have a face-to-face conversation with a nurse, who could help assess and educate patients in person. Now, patients are more likely to speak with anticoagulation nurses by phone, instead of in person.

It may be that this change in Jefferson Healthcare's policy is driven by the desire to provide more accurate testing. It is true that the lab test is more accurate than the fingerstick test. But Dr. Richard Lynn, a beloved local primary care doctor (now retired, to the regret of many of his former patients) has researched this issue and has found that many other hospitals, including Swedish, Virginia Mason, Harrison, Evergreen, and Olympic Medical Center in Port Angeles all continue to use fingerstick anticoagulation testing. Lab tests with a blood draw are also sometimes used to confirm significant abnormalities discovered by fingerstick tests. He is a doctor making a good case for the continued use of fingerstick testing.

Dr. Lynn reported his research to a local organization called Citizens for Healthcare Access. The group sent a letter to Mike Glenn, CEO of Jefferson Healthcare, and to the commissioners of our public hospital district, asking for the policy to be reexamined. After all, even a perfectly accurate test isn't going to improve health outcomes if it is so expensive or inconvenient that some patients don't get the test as often as they should because they can't afford it. As of the last meeting of Citizens for Healthcare access, no response from Jefferson Healthcare or the commissioners as a body had yet been received.

If you are also concerned about this issue, you have some upcoming opportunities to share your views with Jefferson Healthcare and the hospital commissioners. On Thursday, April 13th, the commissioners are holding a community forum at Quilcene Community Center from 6-7:30pm. Their next regular commissioners meeting, with a period for public comment on the agenda, will be on Wednesday, April 19th at 3:30pm in the Vic Dirksen conference room near the main entrance of the new hospital building on 834 Sheridan Street in Port Townsend. Can't make either meeting? You can share your concerns with the commissioners by e-mailing commissioners@jgh.org.

If you are interested in the work of Citizens for Healthcare Access, their next meeting will be on Tuesday, May 9th, from 8-9:30am in the conference room of the Jefferson County Public Health Department (near QFC) at 615 Sheridan Street in Port Townsend.

It will interesting to see how the commissioners respond to the letter from Citizens for Healthcare Access. We will next have an opportunity to vote for a commissioner in 2018, when Tony DeLeo's term of office will be completed.