A time of changing priorities in America.

How federal cutbacks are impacting health care services.

For many people who may need it the most.

And a very complicated family Christmas from back in the 12th century.

It's now hitting the stage in the cities.

From a federal government shutdown to cutbacks in Medicare.

To the ongoing threats to the Affordable Care Act.

Each of these developments is leaving health care professionals in a state of uncertainty, and the clients that they serve are definitely caught in the middle of it all.

That includes the 38,000 people in the cities who rely on the medical, dental and behavioral health care provided by community health care.

We're joined by the executive director of CHC, Tom Bowman.

But first of all, thanks for joining us.

We are, of course, in that period of time where flu shots are so important.

Covid shots are, all of the viruses that are occurring.

What are your doctors telling your patients who are a little confused about who gets what shot?

And do I really need one?

Yeah.

I think, you know, from the flu shot specifically, that's been incredibly consistent and successful, as we've seen in other years.

Our our patients are still seeking out flu shots.

And so we're, we're seeing about a similar demand, for the flu.

So that's good.

People recognize that, you know, they want to prevent getting the flu, or at least lessening the symptoms if they were to get the flu.

And so we've been happy to see that we haven't had much pushback on on that side.

On the Covid front, I think we've seen that really, since the pandemic started to fade, of people just not prioritizing the Covid shot.

Our, our docs definitely.

When they talk to a patient, they're going to look at their full medical history and really counsel them if they have underlying conditions that would make them more susceptible, to respiratory illness like Covid.

They're still recommending that they get that.

And we have a lot of patients that are requesting to get the Covid shot.

So, it's still it's still important from a treatment perspective.

And, and our docs are doing a great job of having that conversation, a lot of patient by patient basis.

Because one of the things the changing, rules and regulations from the CDC have been upsetting to certain people has been confusing to a lot of people.

And when it comes to the Covid shot, it really does impact, infants as six months, to 17 year old children, that it's, once again, the recommendation has changed.

And the key is to talk to your physician.

And I would assume the physicians at CHC and elsewhere really welcome that discussion, because they can clarify so much miscommunication.

Yeah, I think that's true.

Our docs, you know, vaccine hesitancy and what we've seen, from patients really over, you know, the last many years, there has been hesitancy on vaccines.

There's a lot in the news about effects of vaccines and what it could cause and what it could.

And so, you know, we've had to put in place conversations with our patients.

Maybe we talked to them about being on alternative schedules, because they don't want to get 4 or 5 vaccines on the same visit.

Maybe we do some vaccines and not others.

And so our docs have become really adept at really, working with the patient to meet their needs and what they want.

Because you're dealing, especially in those younger ages you know, patients and parents that just they want to protect their child and they want to make sure that they're they're being very careful.

And so our docs do a great job of of that with the Covid shot specifically, just because they've changed the recommendations, whether or not it's recommended as like an automatic part of the vaccine schedule is different than whether or not that patient should be getting the shot.

And so our docs will have that conversation similar with adults, like if there's an underlying condition or that that child, you know, has something that they would benefit from having the Covid shot.

We we certainly would, would work with the parent to get that done.

I think people may not quite understand the total impact that community health has.

In the Quad Cities, more than 38,000 patients.

Actually, I think we're going to cross 50,000 this year.

Okay.

Yeah.

Got to update your website.

Yeah, I do, I do.

Yeah.

So I mean, we're talkin about a large number of people that are served by this safety net of health and tell me the struggles that are going on right now because so much of what you do is dependent on, government, financing.

So, so when we're seeing, the shutdowns of the government or changes in priorities when it comes to health funding, how does that impact CAC?

Yeah.

Any time, you know, lawmakers or policymakers, when, when they are making changes to the Medicaid program predominantly, that has a, outsized impact on CHC, almost 65% of our patients are covered under the Medicaid program.

And so when we talk about the implementation of, let's say, work requirements, which has now passed as part of the one big, beautiful bill, we anticipate that will have a pretty significant impact on our patients.

And so correct me if I'm wrong, though, the work when does that go into effect?

Is it December of 2026 or sooner?

Yeah.

So December of 2026.

That's what I thought.

All right.

It was going to be sooner.

Yeah.

But we've, I think the state of Iowa is going to move to align with the federal guidelines on that.

So at the federal level, it was, December.

Of thank you for clarifying it, because it is down the road.

It's, you know, it's more than a year away, but it is coming.

Yeah, it is coming.

And we've got to prepare for that.

And so you're talking about a, you know, the Affordable Care Act expanded coverage in the Medicaid program.

You know, in 2010, when that was passed, it allowed states, to expand their program to cover people up to 138% of the federal poverty guidelines.

And so.

That's.

Somebody making about 1040 an hour.

So it's not, you know, high levels of income that are covered, but there, you know, what the one big beautiful Bill act does through work requirements is they want to make sure if you're receiving Medicaid benefits, or your your care is covered under the Medicaid benefit, they want to make sure that, you know, if you could be covered through your employer plan because you're working or you're maybe you the Affordable Care Act, the health care exchanges for your coverage, they would rather that than continue to have you in the Medicaid program.

And so, you know, from our perspective, what we're doing, to prepare for that is one, we want to make sure that we fully understand what the requirements are.

So we know that patients are going to have to submit work requirement information at least twice per year.

And so if we understand that, then we can educate our patients on exactly what they have to do.

We're workin with the managed care company.

So both states, Iowa and Illinois, outsource their Medicaid program, to managed care company.

So we're working with them as well to understand which patients that they cover would, you know, fall under the work requirements.

We've had conversations at the state level in both Iowa and Illinois to understan how they plan to implement it, because they don't have the infrastructure right now to even collect this information and analyze it.

And so we need to understand exactly what they're going to do so we can educate patients about that, and then making sure that if they are, if they meet any of the exemption categories.

And so people that are medically frail, disabled, children, that kind of thing, we want to make sure they're classified correctly within the Medicaid system so that they remain covered.

Even after work requirements and maybe are exempt from having to do the work requirements.

So it's really just advocating for our patients understanding changes happen in health care all the time.

You know, CHC has been here, long before the Affordable Care Act was passed and lon before, Medicaid was expanded.

And, and we, you know, continued to thrive at that time and will continue to thrive into the future.

But, we'll have to adjust how we offer those services.

You, of course, offer services on both sides of the river.

We do.

But Iowa and Illinois have very different legislatures.

So tell me, is there a major difference between the two states moving forward when it comes to, Medicare?

Well, with Medicaid, I'm sorry.

Thank you.

Yeah.

They're there.

So, for instance, in Illinois, they had covered more things in their Medicaid program.

They covered more individuals.

It was a little more, just less barrier to entry into the Medicaid program.

Iowa's done a really good job.

They do have a good Medicaid program, and that covers people.

They were one of the first Republican states, honestly, to expand, and take the Medicare Medicaid expansion, through the Affordable Care Act.

And so they're both they're they both operate the way they do.

I would say, it's just it's a different, maybe different goals.

I think, you know, when you're when you're working in Illinois, they want as broad of coverage as possible in Iowa.

They want broad coverage, but they want to make sure anybody in that program is, you know, needs to be there, 100%.

And in that they are not taking advantage of the system.

And so we just work within the confines of those two states.

When it comes to, divulging your, your work requirements, your work history, or when it comes because you serve a large minority population as well.

And, and we've heard about these Ice raids and we've heard of crackdowns on on immigration.

Are you worried that has a chilling effect when it comes to, some of your clients, even seeking medical care, on a regular basis?

So, you know, the number of patients that we're seeing continues to rise.

We haven't really seen, people leave the practice.

And so I don't we don't collect immigration status as part of our, our documentation because we're here to serve everybody, regardless of ability to pay, regardless of anything else.

That's our mandate from person of the Health Research Service Administration, is that we're in the community to serve anybody that needs it.

So we we don't really take, immigration into or immigration status into account.

And so it's hard for me to put a number on how many patients that we're serving that might fall into some of the concerning areas that, that, policy makers may have.

But anecdotally, we've heard from our teams that, yes, patients do have concerns, with utilizing benefits and, and so forth.

And so we want to make sure that, if they come to CHC, they know that they can come in and we're going to continue to see them.

And I think that's been pretty successful.

We have done programs time and time again in regards to the community health needs assessment.

And you've you've, of course, read it from cover to cover.

It is such a comprehensive look at, at the health of, quad citizens on both sides of the river.

The 2024, Community Health Needs Assessment found that a 15% of residents sai their health was fair to poor, that was, I should say, let me get this right.

It's it's increased from 15% to 30% in 2024.

We have seen more people that believe that their health care is not improving.

And you've seen these statistics.

What's going wrong here?

Yeah.

The service are there in some, many cases.

In many cases the services are there.

And so I think we got to remember that it's, you know, it's the patient's perception of their care.

Also, in those statistics that you cite, Jim, it's, you know, across the board probably the biggest predictor of somebody feelin like their health is, is poor, income level has a, has a huge.

It's a matter of fact, 44% said their, health was poor.

Among low income people 50% of the very low income are saying the exact same thing.

Yeah.

And so I don't think we've seen, the expansion of services necessarily in that lower income area.

Certainly CHC and other safety net providers of hospitals do great work here locally as well.

In trying to, to bring access into those communities.

But I work in the Or, CHC works in the primary care space.

And so, you know, sometimes patients d have access to basic services.

You can go in and see your doctor, you can come and see CHC, and we'll help with chronic disease management and annual screenings and, and, you know, acute care, if you're, if you're sick, but it's a lot of those other services that go beyond what, what primary care is able to offer.

So if you need to see a specialist, you're going to, especially if you're low income or you're in the Medicaid programs for many of those specialties, you're going to travel to Iowa City, or you're going to travel to Chicago or Peoria, where they have large tertiary centers.

And so the access locally becomes harder.

And so it makes it more difficult for patients to manage their health.

I think also that perception on, mental health, certainly rise to the top.

I think we are seeing more people that are, you know, identifying that they have anxiety, they have depression, they have those types of mental health challenges.

And, you know, access for that continues to grow.

But it's certainly not meeting the needs yet.

And so I think all of that weighs into overall health, but also beyond the medical component, health is also driven by, you know, do I have access to parks and do I have access to a good education.

And and that can drive overall health.

So the quality of living and quality of life.

Right.

And so in some of those cases, especially in very low income, communities in the Quad Cities, some of those, those factors have not necessarily changed for the.

Better over time.

And community health doe offer behavioral health, help.

Which is such a as you pointed out.

I mean, mental health is one of the biggest health concerns, according to these surveys.

Time and time again in the Quad Cities, it is.

And that's why we have really, tried to grow that, that part of our, our offerings.

We've always had some basic level of behavioral health services, but it is now over 10% of the the services that we offer and total visits, are directly behavioral health, whether that's medication management or therapy.

And so it's it's one of those areas.

It's, patients need it.

If you want to manage your physical health, you need to have good mental health at the same time.

And and vice versa.

It's it's the two are codependent.

And so that's, that's our model of care is how do we wrap those together and have them integrated.

So, if you're dealing with chronic disease or you're managing chronic disease, that can lead to anxiety and depression, because your health isn't good.

And so we want to make sure that we're addressing both at the same time.

One last area.

And I want to get into it real quickly because dental health is sometimes forgotten.

But that also has domino effect for your health.

And CHC has got a dental program that's thriving.

We do.

We have a very large dental program, actually, locations in Davenport, Rock Island, Muscatine and Clinton.

And so, quite a number of, professionals that are working there.

I had a dental director when I first started at CHC, and she she made the comment to me one time.

Just think of your mouth, how close that is to all your other vital organs.

And the health of your mouth will directly affect the rest of your health as well.

And I've always kept that in mind when we talk about dental.

But, that dental is is an area we've grown.

We've been very happy.

We brought, pediatric dental services, to the Quad Cities or to CHC, in, in the fxxk that we operate.

And so that has been a huge growth for us.

We were referring, when we were just doing general dentistry.

We were referring so many kids to Iowa City or to areas in Illinois and transportation issues and other things.

They can now get that care, here locally, through our board fellowship trained, pediatric dentist.

And so that's just been just another benefit.

And then adding hygiene, and adding additional, dentist to our, to our team has just allowed us to, to meet an ever growing need.

Well, you really did point out that CHC existed before the ACA, the Obamacare, before, changes in, the Medicare program.

I did it again.

The Medicaid programs.

Okay.

So tell me about 2026 and whether you have concerns in particular for the coming year.

I think any health care provider and we've we've had a lot of conversations locally with our, our partners that that deliver care.

Yeah.

2026 and beyond, with some of the changes specific to the Medicaid program are going to be challenging.

We've got to think about how we deliver that care differently.

You know, what we are trying to do is look at, are we operationally sound within our clinics?

Are we are we making sure that we're making good decisions on on costs, but also on the things that, produce, revenue, that we can remain sustainable.

And so we're making those, evaluations also looking at other ways that we can, expand services that would diversify the, the revenue streams that we offer.

And so I think any healthcare organization right now knows that it's going to be a more challenging environment if you serve a significant portion of Medicaid.

But as I tell my team all the time, you know, we're going to control what we can control, can can control, we will we've faced, challenges before.

We'll we'll continue to face those.

And we need to advocate for ourselves, at the federal and state levels to make sure that our lawmakers and policymakers know that they still need a good safety net.

Regardless of who's paying for the care, the patient is still there.

The patient is going to require care.

Where do you want them to get that care?

I would say most of our policymakers don't want everybody to go to the emergency departmen for their ongoing care.

Right.

And so we're going to have to find other ways as a community to work together to make sure that we can, provide for our friends and neighbors who maybe don't have the income to, to pay for, their coverage or their ongoing care.

Our thanks to the executive director of the Community Health Center, Tom Bowman.

Just ahead.

One theater is taking us back in time to the Middle Ages for Christmas.

But before we get there, here's some of the other great events being staged close to home, thanks to visit Quad Cities.

Check out the things to do this week in the Quad Cities.

The classic holiday movie White Christmas will be brought to life on stage a the circa 21 Dinner Playhouse.

Then join us for Destination Kick.

This is a time to connect, network with fellow community members, exchange ideas and be inspired.

Then Donelle Rollins will make a comedy tour, stop at the Atlas Theater stage.

Next, enjoy holiday themed events, activities and Santa Claus in downtown Moline for holiday hop.

Finally, continue to enjoy the great House Farmers Market indoors at the fruit House.

For more events like these, check out our events calendar app.

Visit Quad cities.com.

The Black Box Theater in downtown Moline stages some great holiday performances each year, and this year it's featuring a story from the Middle Ages of England that has been a successful production on both stage and screen.

Black Box Theater's Laura Adams joined us to talk about The Lion in Winter.

What made you pick this?

Well, because the writing is so fantastic.

I think that's one of the things that, most people don't know what goes into making a season.

And, you know, so I read a lot of plays and I think there comes a time when, you know, the words literally leap off the page and you go, that is that smart writing?

That's brilliant writing.

And so this just happens to be the case.

It's I had seen the movie many, many, many years ago and really was amazed at the movie itself, but then realized that the scripts are very similar.

There's very little difference, in terms of writing, between the movie and the play.

And you've had some interesting holiday productions.

I mean, you've had you've had some lighter fare and some more serious fare.

So does that play a role in what you decide, what you want to do during the holiday season?

Well, I think finding any play that has that is not your typical Christmas carol.

Yeah, It's a Wonderful Life or whatever sort of regurgitating that, is a trick for me, but I really thought that this one, and like we did when we did All Is Calm, and that's the only play.

That's what I was thinking.

I have ever done twice.

And part of that is because the number of people who said, I really didn't get a chance to see it, and I only heard great things about it.

And, you know, and the funny thing is, these are all true stories.

They're traumatized.

They're traumatized, of course, but they are.

They're true stories.

They're things that happened at the holiday season.

And I think that's one o the things that appeals to me.

The line in the winter is set like i the 1100s in the 12th century.

1183.

And is I mean, you read the plot and the fact that you said it's got a historical basis, it's so complicated, it's so crazy.

It's got to be tough to put on the stage.

I think, because the writing is so well in it and the flow of it, you know, there is a that it has a beginning, middle and end.

Even though of course, their lives go on, past the end of it.

But people will remembe not characters, but the people like Richard the Lionheart and, Prince John.

Everyone remembers Prince John and Robin Hood, you know, because he's the nasty prince and frankly, he is a whining 16 yea old with pimples in this play.

Don't like, yeah, he's not.

Going to like.

Him.

But I think the thing about it is that these folks, existed.

Obviously there's no record in terms of this particular Christmas, but these things happened.

You know, Henry was married to Eleanor of Aquitaine.

He put her in jail because she tried to overthrow him in order to put her son on the throne.

Her favorite song, her favorite son.

Their first son, Henry, died.

So Richard was next in line.

But I think because she wanted Richard on the throne, he went for John.

John was the least likely to be a good king.

And, And they ignored Geoffrey.

Their their middle son.

So they were not the greatest parents.

But then in all of that, you then have the king of France show up, who's only 17 years old.

His sister, who was brought to the English court when she was just eight, was there to to grow up and marry Richard.

But now Henry wants her to marry John.

Meanwhile, she is his mistress.

It's a it's a very, dysfunctional family.

And days of our lives doesn't even equal.

No no no no no no no.

And I think Geoffrey has a line in the play, which I absolutely love, because he says, I know, you know, I know Henry knows that we know it.

We're a very knowledgeable family.

And I think that's one of the great things about it.

It's a very much a play about they know each one of the is trying to one up the other, and and, and the, the, the arc of what's going on in each of their lives is really very interesting.

Once again, it, it three weekends.

Yes.

And you're starting November 21st through Thanksgiving and the weekend after that as well.

So you got chances to watch it.

Yes, absolutely.

And it's great fun in so many ways.

It is great fun and I am, you know, I'm a bit of a history buff.

Yes.

A lot of the people in my, in my season have been real people.

We did a play about Marie Curie.

We did a play about the parents of Ken Ludwig and their romance through letters, during World War two, all of those.

I love the reality of those real things that happened.

It's one of my favorite things about doing theater.

And then in the month of December, you also have wives and homers and guys and ties that that will have performances that they show up o your stage every now and then.

Yeah, that is all.

I mean, I'm talking about great fun.

I mean.

Just they are they are wonderful, improvisers, you know, it's very family friendly, wise.

And Hammer's definitely not for kids.

And they're long form, so whatever the idea that they get from the audience, that is what they do for the entire time they're on the stage.

Whereas guitar is more, episodic.

Yeah.

And tell me a little bit about that.

This is your going to be your 10th year and.

I know how can how did that.

Happen?

It's fantastic.

You're located downtown, Moline, across from the, access hotel.

Yes.

You were there before access was there?

Yes, we were.

And they had just opened when Covid hit.

So really crazy.

But you're part of that vibrancy that Moline is trying to create.

Tell me a little bit about the scene downtown Moline right now.

Well, you.

Know, there's there are, there's barely Quad Cities is going to be down the block from us.

Sound Conservatory unfortunately, is closing.

And that would have been brilliant.

And then a couple blocks over, you have Spotlight Theater.

So there is sort of an arts, Mecca happening right there.

And I think that's one of the things that that makes downtown Moline so much fun right now, because there are restaurants there.

There ar there are things for you to do park and go, have a good time is basically it.

And you and you hit it upon is that next year is the 10th year that, black box theater has been open.

Without giving a great amount of details, you must have plans.

I do have plans.

A couple of plays, that I know for sure we are doing is the shark is broken, which is actually about the filming of jaws.

And all of the actors play the three actors that were on the boat.

So Dreyfus and Shaw and, Scheider.

So they play those actors talking about what's going on because the, you know, because, you know, the shark never worked very well.

And so they it the movie became actually scarier because they couldn't show the shark as much as they wanted to.

So yeah.

So that's one of them.

That's one.

And the other one is called Murder Girl.

And it takes place at Christmas and we will be the thir theater, in the United States.

That's producing it.

So that's one of, that's another one that's happening.

Takes place in a Wisconsin supper club.

Oh, my.

I know since you are a Wisconsin right, that you will love the whole supper club.

Oh, yeah.

Five of it.

Yeah.

So there are those are two of them that I know that are on the, the schedule and, but there are a few others.

There's one that I'm just lobbying for, but it's in London and, you know, I did that once before where I just annoyed people for five years and they finally let me produce this play.

I saw it in London, so I'm hoping it's not five years, but it's a really funny script and it's written by, one of the guys who wrote Sherlock with Benedict Cumberbatch.

So it just is.

And it's very now it's a play that is has to do with how we are now in the world.

And I think that's, that makes it more fun.

Well, happy 10th anniversary.

Well, thank you very much.

And the lion, I want to say the winter lion in winter, of course, is coming up.

See it.

See it.

I'm actually in it.

Our thanks to Laura Adams of the Black Box Theater a great friend of this program and of Wqpt Public television.

The lion in Winter opens November 21st.

It closes December 6th.

Check out what the theater has to offer at the Black Box theater.com.

And as we mentioned earlier, this program marks our 15th year of broadcasting the cities on Wqpt, your local public television station.

And we thank you for watching on Wqpt and its many platforms and for listening to this program on VK radio as well.

It's been an honor to be in your home for the last decade and a half on the air, on the radio, on the web, on your mobile device, and streaming on your computer.

Thanks for taking some time to join us.

As we talk about the issues on The cities.