From Families USA

TWAS THE NIGHT BEFORE CHRISTMAS

By Ron Pollack
Executive Director, Families USA

Twas the night before Christmas and all through the Senate
The Democrats were working for a fundamental tenet:
All Americans should have health care at a reasonable price
By forcing insurance companies to finally play nice.

The reform bill they pushed took some very strong positions,
Like no one denied coverage due to pre-existing conditions.
Premiums, in the future, would need to be fair
With no differences for women and people needing care.

The Democrats made sure that the bill they designed
Would give folks 'cross the nation some real peace of mind.
Health care would not end if jobs changed or were lost
As all could choose health plans at an affordable cost.

For seniors needing medicines, the bill had much to extol:
It plugged gaps in their coverage, like the bad "doughnut hole."
And for empty-nesting parents, there was reason to rejoice
Kids could keep family coverage, this was now a parent's choice.

But all Republicans scoffed and persistently said "no"
With the sometimes exception of their colleague, Ms. Snowe.
With obstructions and filibusters, they tried every delay
To stop the bill and kill reform, before Christmas day.

So Leader Reid called his colleagues from left and from right,
For all 60 to join him, lest they lose this big fight.
Now Nelson, now Lincoln, now Franken and Wyden,
On Lieberman, on Bingaman, on Harkin and Cardin.

Christmas eve turned to night, and when the votes were all counted,
The filibusters and obstructions were completely surmounted.
The vote was inspired by the memory of Ted
Who'd applaud the victory for the cause he had led.

The work isn't over, there's much yet to be done
The Senate and the House bills must be merged into one.
But the vote on Christmas eve offers reason to cheer
'Cause health care reform will pass in the new year.

So call your fine leaders, and let your voice be heard,
With letters and emails, we must spread the word.
Our message is clear, and it shines a bright light.
"Health care coverage for all, and for all it's our right."

Thanks to your tireless dedication and hard work, the health care justice movement continues to advance. May your holidays be filled with much health and happiness.

Best wishes,

Ron Pollack
Executive Director
Families USA

Breaking News - Senate Bill Passes

POLITICO Breaking News:
-----------------------------------------------------

After months of blown deadlines and political near-death experiences, a sweeping health care reform bill that would expand coverage to 31 million currently uninsured Americans cleared the Senate early Thursday morning on a 60-39 party-line vote, putting President Barack Obama within reach of a domestic policy achievement that has eluded Democrats for decades.

Happy Holidays

If you're at all like me, you are looking forward to the holidays as much because it means a chance to get some rest as because it means some gifts and nice social events. I can feel it -- it's almost here -- I can almost sleep as long as I feel like!

But this time of year also heightens my emotions. Maybe it's because I'm exhausted beyond comprehension, but I'm the kind of teary that makes you cry at Hallmark card commercials. I listen to Christmas music (I'm Jewish, but I love the music of the holidays) and it reminds me of my mom and I cry. I listen to my favorite Peter, Paul and Mary and it reminds me of Mary Travers, whom we lost this year, and I cry. I hear that a friend's child with awful cancer has clear scans and I cry. Good tears, tears that mean I'm alive.

This has been quite a year. We lost not only Mary, but Ted Kennedy -- I so wish he was here to vote yes tomorrow morning when the Senate passes its reform bill. It touches me so that his widow will be in the gallery.

And we lost the public option. But in 2010, we will have health insurance reform, and everybody in America with a pre-existing condition will be able to sign up for a high risk pool in a matter of weeks or months, with more changes taking effect over the next few years. 30 million people will get insurance. We just have to make it through conference and it will be done.

Here's what the LA Times said today:

These "insurance reforms ... will open a new chapter in the lives of sick people ... those with mental illness, heart disease, cancer, diabetes -- chronic ailments that touch almost every family in America. Those patients are the ones most likely to lose coverage because their policies impose lifetime limits, or because they have, in industry parlance, a 'preexisting condition.' ... (L)egislation President Obama is expected to sign into law next year will almost certainly ensure they have access to health insurance."

And it's been a busy year in other ways, as well. In October, I was quoted in AARP Magazine and our call volume exploded by 50%. I had two trips in October, one in November, and surgery in November, so the past few months have been absolutely insane. I'm due for a break and I will get one -- Advocacy for Patients will be closed for the holidays so I can recharge my batteries.

It's been a good year, in all. We were overjoyed by the addition of little Amieta to the Advocacy for Patients family. Between Amieta and Emily (the cat), Celeste and I have two good helpers!

Anyway, I'm too tired to do any serious writing, but I wanted to wish you all very happy and HEALTHY holidays, and a wonderful 2010. Maybe next year will be the year when we raise the money to hire a second lawyer! Regardless, though, we'll do our best to be here for you if you need us.

After the holidays!

Wishing you and yours the very best, Jennifer

Charter for Compassion

Please check this out. It's pretty much my answer to everything.

May 2010 bring us health and love and peace. Jennifer

Victoria Reggie Kennedy on Health Reform

On Sunday December 20, 2009, Victoria Reggie Kennedy -- the widow of Senator Edward M. Kennedy, published a moving essay urging Americans -- including but not limited to members of Congress -- to get behind the health reform bill. Here is an excerpt:

The moment Ted Kennedy would not want to lose

By Victoria Reggie Kennedy

My late husband, Ted Kennedy, was passionate about health-care reform. It was the cause of his life. He believed that health care for all our citizens was a fundamental right, not a privilege, and that this year the stars -- and competing interests -- were finally aligned to allow our nation to move forward with fundamental reform. He believed that health-care reform was essential to the financial stability of our nation's working families and of our economy as a whole.

Still, Ted knew that accomplishing reform would be difficult. If it were easy, he told me, it would have been done a long time ago. He predicted that as the Senate got closer to a vote, compromises would be necessary, coalitions would falter and many ardent supporters of reform would want to walk away. He hoped that they wouldn't do so. He knew from experience, he told me, that this kind of opportunity to enact health-care reform wouldn't arise again for a generation.

***

The bill before Congress will finally deliver on the urgent needs of all Americans. It would make their lives better and do so much good for this country. That, in the end, must be the test of reform. That was always the test for Ted Kennedy. He's not here to urge us not to let this chance slip through our fingers. So I humbly ask his colleagues to finish the work of his life, the work of generations, to allow the vote to go forward and to pass health-care reform now. As Ted always said, when it's finally done, the people will wonder what took so long.

The full text of the essay is in the Washington Post, here. Jennifer

But if we don't do this now ....

The last time health reform was taken up with any seriousness was 1993. That means we may wait another 15 years to get ANYTHING if we don't take as much as we can get NOW.

Senator Reid is not at 60 votes yet. Ben Nelson is still stuck on the abortion issue. Although anti-abortion Senator Casey from Pennsylvania has drafted compromise language, Senator Nelson is not yet on board. As I've already explained below, the issue is the use of federal funds -- subsidies, basically -- to pay for insurance policies that cover abortion. Senator Nelson wants to prohibit any policy covering anybody who receives a subsidy from covering abortion. A majority of the Senate has rejected this because it would essentially eliminate insurance coverage of abortion, even if paid for by a woman's own money. Senator Nelson appears to be the lone Democrat hold-out.

Why should we support a bill even though it won't have a public option?

• The Senate compromise will result in coverage for more than 30 million people who don't have insurance and cannot afford insurance today.
• The Senate compromise will allow people to buy insurance through an Exchange so people can see all of their options and make informed choices.
• The Senate compromise contains subsidies making health insurance affordable for people who otherwise could not afford insurance. This includes people who are unemployed and cannot afford COBRA premiums.
• Insurers no longer could charge women more than men for the same coverage.
• The Senate compromise will eliminate lifetime caps on benefits.
• Children will be covered to age 26.
• The Senate compromise provides subsidies for small businesses who provide insurance for their employees.
• The Medicare coverage gap or doughnut hole will be plugged, so people who have high prescription drug costs will not have thousands of dollars of out-of-pocket expenses.

I'm deeply saddened that, due to Senator Lieberman and others, we will not be able to control premium prices by creating a public option that would cost less and, thus, create real competition in the insurance industry. But if the Senate fails to garner 60 votes to end debate and bring the bill to a vote, we will get none of that, and it's likely that we won't have another shot at reform for many years. And cost may be controlled to some extent; there is a push on to require that insurers spend 80 or 85 percent of premium dollars on medical benefits rather than administrative costs and profits. So there's still hope.

So please, please, please CALL YOUR SENATOR TODAY. The first "cloture" vote to end debate and bring the bill to a vote is expected to occur on Monday. You can find your Senator's contact information here. Alternatively, call 1-800-828-0448 and ask to be connected to your Senator's office. Thank you. Jennifer

I stand by my opinion, but here's another point of view

Visit msnbc.com for breaking news, world news, and news about the economy

Jennifer

Reform is dead. Long live refrom

They're whipping out one of Ted Kennedy's favorite sayings a lot lately: Don't let the perfect become the enemy of the good. And so it was that we have danced this dance with a pretty good idea of how it was going to turn out.

There will be no public option. There will be no Medicare expansion. We await Congressional Budget Office figures on the creation of a national, nonprofit plan administered by the Office of Personnel Management, to approximate the state employee plan. We also wait numbers to see if Medicaid will be expanded beyond 133 percent of the federal poverty level, to 150 percent.

We can look at this as a loss. It is a lost opportunity, for sure, that won't come again for a long time. Those of us who are intimately acquainted with health insurance know that we have lost the opportunity to control cost, and that's a big problem. There will be subsidies for people up to 400 percent of the federal poverty level (almost $40,000 for an individual and $80,000 for a family of four), so for them, the cost will be more bearable. But for those of us who earn more than that, we can still expect to pay in the neighborhood of $600-1000 per month. Without a public option, there's nothing to change that.

However, people with pre-existing conditions will have more choices because all insurers will have to cover them. And we will be able to research our choices on the Exchange. There will be no lifetime caps, and although there is an obnoxious loophole in the Senate bill that would allow "reasonable" annual caps, I am hopeful that those kinds of small tweaks will be taken care of in the Conference Committee. There will be out-of-pocket caps at about $5000 for individuals and $10,000 for families, virtually eliminating medical bankruptcies -- EXCEPT that no reform proposal has even tried to address denials of coverage, which will continue unabated. Indeed, I suspect, as insurers try to find new ways to profit, that we will see MORE coverage denials under a reformed system.

Is there anything to be happy about here? Yes. Millions of people who don't have insurance now will get it. People with pre-existing conditions will be able to chose their insurance. Do we accomplish all that we set out to do? In particular, did we curb insurance company abuse? No -- the insurance companies will have gotten exactly what they wanted -- pretty close to the status quo. They knew they had to give on pre-existing conditions and so they did. In exchange, they get an individual mandate requiring young, healthy people to buy insurance; they get a whole lot of new enrollees with no controls on premium prices -- they're even walking away with their antitrust exemption in place (although I'm really hoping this will go in Conference).

Still, our primary goal was universal coverage. We will get something close to that. It's not perfect, but it's too much to walk away from.

If Ted Kennedy were here, I suspect Joe Lieberman might not have gotten away with what he did, killing the public option and then Medicare expansion. But right now, he would be telling us not to let the perfect be the enemy of the good. What we're getting is far from perfect. But it's still good. Jennifer

Senator Flip-Flop

And here's the illustrious Senator Lieberman speaking IN FAVOR OF EXPANDING MEDICARE in an interview with the Connecticut Post only three months ago:


Thanks to Huffington Post for digging up the video.

Thanks to Senator Lieberman for making himself such an easy target. Jennifer

Say It Ain's So Joe . . . er. . . Mr. President

Yesterday, Connecticut's embarrassment -- Joe Lieberman -- made it clear that he's still not happy with health care reform. He killed the public option, but that's not good enough. Now, he needs to kill Medicare expansion, as well. He seems to be determined to protect the insurance companies no matter what the cost.

I'm mad, but I've come to expect nothing more from our Joe.

And then comes the following into my Inbox:

POLITICO Breaking News:
-----------------------------------------------------

The White House is encouraging Senate Majority Leader Harry Reid (D-Nev.) to cut a deal with Sen. Joe Lieberman (I-Conn.), which would mean eliminating the proposed Medicare expansion in the health reform bill, according to an official close to the negotiations. Lieberman threw health care reform into doubt Sunday when he told Reid that he would filibuster the bill if it allowed Americans ages 55 to 64 to purchase coverage in Medicare.

For more information...http://www.politico.com
-----------------------------------------------------

For the full story, go here.

I try hard not to be overly political here, but I have to say: Is this the change we voted for? Really? Jennifer

Completely Crazy

I can't believe today's wrinkle. Well, okay, yes I can. After all, it's the Congress of the United States. They do things like this.

A Democrat, Senator Dorgan, proposed an amendment permitting drug reimportation from Canada as part of the health care reform package. Reformers love this idea because it will greatly reduce the cost of prescription drugs in the United States.

But Pharma, the lobbying arm of the drug industry (and why do they get to operate as a single entity, in violation of antitrust laws, from which they have no exemption? A story for another day), has a war chest full of money that they've pledged to run ads favorable to health care reform in exchange for their deal with the White House -- they will cut the cost of drugs in the US by $80 billion, but not one penny more. Now, they are making it clear that they will use their war chest to run ads AGAINST reform if reimportation is permitted.

And so the Republicans have jumped on the reimportation bandwagon. After all, if they can kill health care reform by pretending to care about prescription drug costs, that's fine with them.

So now the White House and Senators committed to passing reform are BEGGING Democrats to vote AGAINST reimportation. Indeed, there is now a hold on Senator Dorgan's amendment, so all progress has ground to a complete hault.

And so the Republicans checkmate the Democrats on health reform by being stronger reformers than the Democrats, at least some of whom find themselves having to defend Pharma because doing so is the only hope of getting us to something -- anything. And, of course, we don't even know what that something is any more because the Congressional Budget Office hasn't yet scored (figured out the costs of) the latest compromise, which eliminates the public option in exchange for a nationwide nonprofit plan and Medicare expansion.

And oh -- by the way -- Medicare expansion? Lieberman, Snowe, and others think they might have a problem with that.

No public option. No Medicare expansion. No drug reimportation. I guess it will be good to eliminate pre-existing condition exclusions, but I think Congress probably had the votes for that a long time ago.

Only in Congress. Only in America. Jennifer

The Death of the Public Option

The Huffington Post reports that the public option died a quiet death on Thursday December 10, 2009 at 11:12 a.m. After the Senate Democrats appeared to reach a compromise that does not involve a public option, but that does include (tentatively, at least) a private nonprofit option and expansion of Medicare, and President Obama stated that he approves of this compromise, the public option died, finally, when Nancy Pelosi -- who previously said that the House could not pass a version of reform that did not include the public option -- said that, in fact, the House will support an option that ensures affordability for the middle class, security for seniors, and responsibility to our children, without adding to the deficit. The public option is now effectively dead.

Thanks so much to Joe Lieberman for killing it. Jennifer

Do we have a deal?

The Senate defeated the abortion amendment. Senator Reid says they have reached "broad agreement" on a plan to abandon the public option, though. Instead, there will be a national plan that will be made up of private insurers who negotiate rates with the federal Office of Personnel Management, which would oversee the plan. A government run option would be triggered if this national plan was not cost-effective. And they're still talking about allowing people age 55 and over to buy into Medicare.

People are going to be upset with me, but I don't think this is the worst thing that could happen. There was never any way the Senate could pass a public option once Joe Lieberman said he would vote to filibuster with the Republicans. I don't know that I've ever been angrier at another human being than I am at him. But we've known this for weeks. I've never seen a way around it. I'm not happy; but I think I'm being realistic. Make no mistake -- I (and thousands of others) will never forget that this is Joe Lieberman's fault. But he doesn't seem to care. And of the non-public options that have been discussed, this seems relatively inoffensive.

However, I don't know if the Democrats have the votes to end a filibuster (vote for cloture) without the abortion amendment. Senator Nelson has said he'll vote against it without the strict abortion ban. Unless Senator Reid picked up a couple of Republicans to vote for cloture -- perhaps Senator Snowe, who likes the public option with a trigger, perhaps Senator Voinovich who is retiring and so he won't be pressured to stick with the party line like some of the others -- I don't know if there are 60 votes to close debate even on this watered down bill.

We'll keep an eye on things over the coming days. Once Senator Reid has the votes to cut off debate, they will do so. They want to go home for Christmas, and Senator Reid is not taking a break until this is done.

Check back for updates. Jennifer

Quick Update

Things are pretty hectic here on the ground, where real people who can't afford their health care or have some other health-related problem are calling us for help at an unprecedented rate, so I only have time for a quick update.

As you know, the Senate is considering the health reform proposal put forth by Senator Harry Reid, summarized in detail below. The two most difficult obstacles are (1) the public option; and (2) abortion.

An amendment that would preclude any woman receiving subsidies to use her own money to buy a plan that covers abortion services has been introduced. It's identical to the House version that was passed. However, the votes aren't there to pass it in the Senate. So there are a handful of Senators striving for a compromise. Democrat Sen. Nelson of Nebraska is needed to cut off debate and bring the bill to a vote and he says he won't vote to allow the bill to go forward unless it has something pretty close to this language included. That means Senator Reid needs at least one Republican to cut off debate and bring the bill to a vote (called cloture).

As for the public option, it seems to be all but dead in the Senate. Right now, a group of 10 Democrat Senators -- 5 moderate, 5 liberal -- are working on a compromise. The latest word I've heard is that they are talking about creating a national insurance plan to be offered by several health insurers at non-profit rates, administered by the Office of Personnel Management, EXACTLY the same as the federal employee plan. This is not considered a public option because the insurance would be offered by private health insurance companies, even though it would be overseen by a federal government agency. Works for me -- I've never lost a health insurance appeal to OPM, so if they're in charge, I'm comfortable with that. But this is not yet a done deal.

Liberals are pushing for more. Earlier today, there was talk of expanding BOTH Medicare and Medicaid -- people age 55 and over would be allowed to buy into Medicare, and Medicaid would be available to individuals up to 150 percent of the federal poverty level (as opposed to 133 percent in the Senate bill). The Medicaid piece of that took less than a day to die because Medicaid is partly funded by the states, and most states are cash strapped already. The Medicare expansion is opposed by the hospitals and other health care providers because Medicare reimbursement rates are lower than insurance reimbursement rates, so providers don't want to have to accept lower reimbursement rates for a whole lot more people.

As best I can tell, there are several variations on these themes being bandied about. My own (yuk) Senator Lieberman has said he's open to the look-alike federal employee plan, but Republican Olympia Snowe is saying no deal, according to Politico. That takes us back to Senator Nelson and abortion.

And the beat goes on. Updates to follow. Jennifer

I just can't resist!!!

Are you as outraged by this as I am?

gregg -

Grab a box of tissues

Thanks to Sari-sis for the link. Jennifer

Insurance Insanity: Batteries Not Included

Read Forbes Magazine article about a case filed on behalf of one of our patients who has an electrical device to aid in her digestion, but her insurer won't pay to replace the battery -- here.
Jennifer

Senator Reid Releases Bill

At over 2000 pages, Senator Reid gets the prize for volume. He may also get the prize for quality.

I've read all of the portions of the Bill that directly affect patients (skimming sections on things like data collection and health care workforce development), and I'm impressed by how good a job Senator Reid seems to have done at synthesizing the Senate HELP Committee and Senate Finance Committee Bills, while also anticipating some of the differences between the Senate and the House versions.

As is true of all the plans, Senator Reid's would eliminate pre-existing condition exclusions, cancellations of policies based on health status, lifetime maximums, or premium rating based on health history or gender. Also as in all of the other plans, an insurance "exchange" will be established where you can shop for insurance, see the available alternatives, and weigh your options. Among the options is a public option -- a plan run by the government that will be available as an alternative to private insurance if the patient chooses -- that will allow states to opt-out if they wish. In addition, the Bill would allow the creation of nonprofit co-ops. Further, states can create a program for low income individuals not eligible for Medicaid, and Medicaid is expanded to include anybody with income up to 133% of the federal poverty level. Multi-state compacts are permitted, along with nationwide plans with state opt-outs.

While most of the changes will be effective in 2014 (one year later than the House plan), immediately, there will be a national high risk pool for people with pre-existing conditions who have gone without insurance for at least 6 months.

There are limits on out-of-pocket costs -- deductibles are limited to $2000 for an individual and $4000 for families. Other cost sharing -- copays and coinsurance -- are limited to the same limits as apply to health savings accounts -- right now, according to the IRS website, $5600 for an individual and $11,2000 for a family. These out of pocket limits are decreased on a sliding scale for people with incomes below 400% of the federal poverty level. There are tax credits that are calculated based on a formula that, frankly, is so complicated that I can't tell you what it means, but it is tied to (1) the cost of plans in the Exchange; and (2) household income. People with incomes up to 400 percent of federal poverty level would be eligible for a tax credit. Premiums are capped at 9.8 percent of income.

Individuals would be required to have insurance, but the penalty for not doing so is very small, starting at $95 per year, and increasing over time to $750. There is no requirement that employers provide insurance, but employers with 50 or more employees will have to pay a fee of $750 for each employee who is not covered who receives a tax credit. There also is a small employer tax credit for employers with 25 or fewer employees.

Medicare improvements include a reduction of the "doughnut hole" by $500 and 50% discounts on name brand drugs for low and middle-income consumers. Rates paid to Medicare Advantage Plans are decreased to match what the government pays for the same coverage.

In addition, there is a mandatory appeal process, including both internal and external appeals, applicable to all plans included in the Exchange, and there will be a uniform appeals process for Medicare Part D plans.

To pay for the plan, there will be a series of taxes. First, so-called Cadillac plans -- plans that cost more than $8500 for an individual and $23,000 for a family -- are taxed at 40%. Further, the Medicare tax will increase from 1.45% to 1.94% for people with income over $250,000. In addition, there are the penalties mentioned above for failing to obtain insurance, and for employers who don't cover employees who get tax credits. In addition, there is a 5% tax on elective cosmetic procedures -- procedures necessary to correct congenital deformities and so on are not subject to tax. in addition, every health insurance policy and every health insurance plan, including self-funded plans, will pay $2 per covered person.

Those are the highlights. It's very similar to the House bill in many respects, although the House has a so-called millionaires tax, larger penalties for individuals who don't buy insurance, and larger penalties on businesses who don't provide insurance.

There are, of course, some sticky issues remaining. Rather than prohibiting all plans in the exchange from covering abortions, even with the woman's own money, the Senate version segregates the federal money from private money and allows insurers to cover abortions as long as the woman's own money is used. Illegal immigrants are not covered at all.

That's the summary. Of course, you are welcome to read the whole thing here. There's also an excellent comparison of the House and Senate versions by the NY Times here.

Please note that I will be taking a short break from blogging. I'm having a small hernia repair tomorrow. It's not a big deal, but I'll be out of commission for as long as I'm on pain meds and could say something stupid!!! Take care of yourselves in the meantime. Jennifer

New Lies

With what appears to be an unbridled willingness to invent doomsday scenarios about health insurance reform, some conservatives have sunk to a new low, arguing that people can be sent to jail for up to five years if they don't buy insurance. True, there's a penalty if an individual doesn't buy insurance. True, the penalty MIGHT be treated as a tax. True, failure to pay taxes can be treated as a criminal violation. True, that violation could hold up to a five year jail sentence. But come on, people -- when was the last time anybody was prosecuted for failing to pay $750 in taxes? How about never?

Just more scare tactics from those who want to stop health insurance reform. Jennifer

Vote for Advocacy for Patients

If we win this, we can hire a second lawyer and help twice as many people. PLEASE vote today! Thanks. Jennifer

My Friend Jesse's New Film

Famed director Jesse Dylan does it again in a video about a quality improvement project that is changing the face of treatment of pediatric inflammatory bowel disease. Watch. Jennifer

Nobody is Immune

I spend much of my time fighting with insurance companies on behalf of other people. I'm pretty good at it. But nothing I know about fighting with insurance companies makes it any easier for me to fight the fight myself.

I have gastroparesis. My gastric emptying test shows 0% emptying after 90 minutes. What goes in just sits in my stomach for hours and hours. Without two medications -- Reglan and Protonix -- I either don't eat at all, or I vomit. A lot.

My insurance company, Anthem Blue Cross Blue Shield of Connecticut, doesn't want to pay for Protonix. For my $1000 per month premium, they want me to take Prilosec, Prevacid or Nexium instead. Anthem gets a better price on those meds. So once a year, they require that my doctor prove to them that I really, really need Protonix.

Last month, I filled my prescription. The label on the bottle said I had 2 refills left, so I didn't give it another thought. This week, I went to refill my prescription and it was denied. I need prior authorization for Protonix.

It's not like we didn't go through this a year ago. And it's not like anything has changed since then. But they make me jump through these hoops anyway.

I've tried all of the other meds. In fact, if Anthem would check its own records, it would see that it paid for them!!! If I proved to them a year ago that I've already tried those meds, then I've still already tried those meds this year. History doesn't change.

Next, Anthem wants to know why I need two Protonix a day rather than the usual one. A year ago or so, we tried to decrease the Protonix because it might also cause diarrhea, which is a problem due to my Crohn's disease. I immediately started vomiting. We told Anthem that a year ago. They want to hear it again.

Insurance companies won't let you have more than a 30 day supply of meds, so when it's time for a refill, it means I've just about run out of my meds. And I'm traveling this week-end, so not only am I going to run out, but I am going to run out far from home. Apparently, Anthem would rather that I end up in an emergency room hundreds of miles from home than give me enough medication to get me through the week-end, while they take their time processing a request for prior authorization that says NOTHING different than the one they approved a year ago.

Patients come to me expecting me to be able to fix this insanity. After all, I read all the time that one of the biggest problems with controlling the cost of chronic illness is that patients are non-compliant with medication regimens. I'm not non-compliant. I'm trying to take my meds; my insurance company apparently WANTS me to miss my meds for several days between the time I run out and they time they get around to reviewing my request for prior authorization. By then, I will be vomiting. By then, my illness will be out of control. I'm not non-compliant; my insurance company is.

And the worst of it is that I have absolutely no power here. None. I have good contacts at Anthem -- their lawyer, the head of their appeals unit. I have a friend at the Attorney General's Office who does health insurance work for consumers. I have all of the medical information and completely, totally understand what's going on here. And none of that does me a bit of good. Because I still don't have my medicine. I'm still going to get sick.

I know the rules, so I play by them. But why didn't Anthem tell me last month that I would need prior authorization this month so it could have been done in time? Why won't Anthem give me enough medication to get through the week-end when they know full well that I'm going to run out of meds and get sick? There is NOTHING I could have done differently, NOTHING my doctor could have done differently, that would have avoided this.

And nothing in health insurance reform is going to fix this sort of thing. Congress isn't even trying to address issues like this one. Indeed, our NIH study is showing that these sorts of coverage issues are the biggest problems people are having with insurance. Even when you have insurance, you pay your premiums, you do everything right, insurers can pull the rug out from under you whenever they like. And it's legal.

In the end, if I land in an emergency room because I'm vomiting a lot and can't keep anything in me, it costs Anthem more money than it would have cost them for my medicine. But saying that assumes the system is rational. And it's absolutely not. Jennifer

P.S. -- I GOT IT. It took relentless badgering of the insurance company, but they finally agreed to expedite the review and then they granted the authorization. It took about 2 hours yesterday and 2 hours today on the phone to make it happen. Had I not been going out of town, this definitely would have carried over to next week. Lesson: don't ever take no for an answer! J

How Can This Not Move YOU?

Representative Debbie Halvorson of Illinois explains her vote in favor of health reform.

Robert Reich on the Public Option

A simple, straightforward explanation of how the public option would work:

A Nice Interlude

Just Breathe.

http://bit.ly/3wuKap

Jennifer

Miles To Go

It was hard not to feel some satisfaction in the House passage of health insurance reform on Saturday night. But the satisfaction was tempered with deep concerns.

First, in order to get the win, Speaker Nancy Pelosi had to allow an amendment that will prevent any woman receiving a federal subsidy to have an abortion covered by her health insurance policy. The effectively means that the plans offered in the exchange -- essentially all plans for individual and small to mid-sized employers -- will not cover abortions. Only about 13% of abortions are funded by private insurance, so this was more of a symbolic vote than one that will make abortion unaffordable and, thus, even more rare. But what bothers me most is that it makes abortion even more of a class-based issue. If you had enough money to afford a privately-funded abortion, you probably won't qualify for a premium subsidy for your health insurance. In other words, the people who will receive subsidies are the people least able to pay for abortions, and those are the ones whose insurance will not be allowed to pay.

And if you watched any of the coverage over the week-end, you also know that male Republicans shouted down every woman in the House who tried to make comments about the impact health reform will have on women. No woman could get past a sentence. If I can find it again, I'll post it here. It was quite upsetting. It's bad enough that there are only 17 women in the House today. Those who are there were censored, and that was wrong.

Even more wrong is the fact that the Senate still doesn't have a bill or Congressional Budget Office estimates. Joe Lieberman and some of his misguided cronies have said that they will not allow a bill with a public option to even come to a vote. It's one thing to oppose; it's another thing to refuse to let something come to a vote. The way I count it, that's two acts of censorship.

I watched the HBO movie about Obama's campaign over the week-end. It made me recall the optimism I felt when he was elected, the tears of joy that flowed while I watched his inauguration. It's been 9 months, and now we have posters comparing health reform to the Holocaust, Obama in white-face, with a Hitler mustache -- where is this mean-spirited, small-minded, right-wing insanity coming from? And how is it that this fringe -- this small group of ultra-conservatives -- have taken over the Republican party and been given a voice that they now are using to censor dissenting opinions?

Health reform passed a major hurdle on Saturday night, but it is nothing like the hurdles that remain. I will be very surprised if we get any public option out of the Senate, and if Senator Reid doesn't hurry, we may get nothing at all, at least until the 1st of the year, which will give the Tea Baggers another shot at members when they are home for the holidays -- more scare tactics that seem to have worked against conservative Democrats in the House, and will be even more effective in the Senate.

And I am literally sick over the fact that a Senator from my state -- a state that has gay marriage, that is generally among the most liberal -- has pledged to shut down health reform in the Senate if it contains any form of public option -- even one with a trigger or an opt-out or an opt-in. Joe Lieberman will never be elected dog catcher again in Connecticut after this. But that doesn't change the fact that he -- that any one of 60 Democrats (and 2 Independents who vote with the Democrats) -- has veto power over the future of health care in America.

Where did the optimism go? Where are all the young kids who supported Obama? Why do the Tea Baggers go unresponded to? Why are the liberal Democrats sitting on their hands? Why are ANY Democrats hedging over the need to provide life-and-death health care to all? Indeed, why are any Americans against it?

I understand the fear of big government. But it's, frankly, a stupid argument in the health care context. We already have the federal employee plan, the VA, Medicare, Medicaid, coverage of all prisoners (state and federal) -- plus state employee plans, county plans -- and regulations that exist in EVERY state regulating health insurance. This is not about a government take-over; it's about a change in the substance of the government position. Why isn't that totally obvious to everyone?

I watch and listen in amazement. Are people really so poorly informed that they don't know that insurance already is regulated? Do they really believe that health care is not already rationed by health insurance companies (not to mention the government plans listed above)?

If you believe these things, then you need education. Now. I beg you -- urgently -- to read, listen. Talk to someone you know with a chronic illness and ask them if health care isn't already rationed by insurance companies. Email me and I'll send you a link to your state's insurance regulations.

This is too important an issue to shoot from the hip. If you are buying the Tea Baggers, it's because you are lacking information. If you want to be informed, there are thousands of us out here trying to get you that information. All you have to do is take the time. This isn't about politics. It's not about abortion. It's about life and death. Of our citizens. Of our Nation. Jennifer

WE DID IT!!!!!!!!!!!!!!!!!!!

The House passed its bill late last night.

Now, on to the Senate!

It ain't over 'till it's over, but this sure was an historic, thrilling step. Jennifer

The Big To Do About Abortion

I've stayed away from this controversy for a long time, but since it now seems as though a major hang-up in the health insurance reform battle relates to whether federal funding will be used to pay for abortions, I feel that I should address the issue head on.

Why have I avoided the issue? I have tried to keep my former life as a pro-choice advocate separate from the work I do with Advocacy for Patients just because the abortion issue is so highly charged with politics and rancor. Although I have participated in the Connecticut Women's Health Campaign and supported efforts to protect women's reproductive health, the truth is that reproductive rights simply have not come up in the work I do on behalf of the chronically ill.

Until now.

I've seen so much misinterpretation and misrepresentation around health insurance reform that I feel I have to at least make sure that you know what the issue is and what proposals are on the table to address it.

Under current law made by the Supreme Court many years ago, the federal government is allowed to prohibit the use of federal funds for abortion. Nobody -- NOBODY -- is trying to change that in the course of health insurance reform.

The issue, though, is how to ensure that federal insurance premium subsidies, and any public option, are not used to fund abortions.

The Catholic church would like to prohibit any insurance plan sold through an insurance exchange (the marketplace that will be created where you can shop for insurance) -- including private plans, including for people who do not receive any federal subsidy -- from covering abortion. This clearly is broader than just prohibiting the use of federal funding to pay for abortions. So both the Senate and House bills try to create a way to segregate federal subsidy money from the private portion of insurance premiums and ensure that only private money is used to fund abortions.

Abortion opponents say any compromise will not guarantee that no federal funds are used to pay for abortions. Abortion rights advocates say there has to be a middle ground because a woman has a right to pay for insurance that will cover abortions with her own money.

The compromise that has been offered by Rep. Ellsworth would require that the exchange hire private contractors to administer all payments for abortion under any plan sold through the exchange to make sure that only private money is used for this purpose. As of this morning, the Catholic Bishops have said that this still isn't good enough. It's not clear what, if anything, will be.

And this is the hang-up. It is NOT the case that ANYBODY -- even Planned Parenthood, et al. -- are trying to get abortions paid for by federal money. Everybody, including Nancy Pelosi, agrees that we're not going to try to change the law on abortion funding through health insurance reform. That's a fight for another day. But pro-choice members of Congress do not want to use health insurance reform as a way to ban all abortions, either.

The issue is whether they can find middle ground. I surely would hate for this to be a major hang-up when so very much is at stake. Jennifer

From the NY Times -- Pain Management (or NOT)

An interesting piece on how to treat pain here. Jennifer

Stand Up!

The House is just days away from voting on comprehensive health reform. With special interests stopping at nothing to block reform, your personal stories send a powerful message to Congress.

Watch the video we put together with your voices and photographs – and then tell your Representative to support the Affordable Health Care for America Act (H.R. 3962). Call 1-800-828-0498

Is Imperfect Better than Nothing?

There are flaws in the House health care bill, and I'm likely to think the Senate version is even more flawed once it's released. But do I agree with the liberals in Congress who think they should vote NO if there's no strong public option? Or with the conservative Democrats who think they should vote NO because there's imperfect language relating to the use of federal funding for abortion (more on this another day -- but for now, suffice it to say I think the language is sufficiently clear that no federal funds will be used to pay for abortions)? Or with Joe "the Plumber" Lieberman, who thinks nothing would be better than a bill with a public option?

No, I don't. And here's why, from this morning's Politico:

“The civil rights community, Whitney Young, Roy Wilkins, Martin Luther King Jr. — all these people were for a big, comprehensive Civil Rights Act,” Clyburn told the caucus. “Johnson realized he couldn’t get in one fell swoop all that they were asking for and made it very clear to them in the negotiations: ‘If you want me to put this bill on the floor, I’ll put the bill on the floor, but it’s not going to pass. If you want to pass something, then we have to go into this bill to see what will pass.’”

The voting rights provisions came out and didn’t pass until 1965, after the presidential election. And while the 1964 law outlawed discrimination in the private sector, it wasn’t until 1972 — when Clyburn was on the staff of a South Carolina governor — that the same requirement was imposed on state and local governments, which had resisted the federal mandates.

“I didn’t want anyone to think that if you don’t get everything you want in this health care bill right now, that’s the end of the game,” Clyburn said. “What we need to do is lay a foundation. Get passed what we can pass that will have a meaningful impact on people’s lives — not put too many of our people in jeopardy — and then build upon it later. It’s a long road."

Yes, it is a long road. It's been a long road. Martin Luther King railed against injustice in health care in the 1960's. Lefties have been talking about universal healthcare as long as I can remember. The Clintons did their best in the 1990's and we lost -- perhaps in part because we strove for perfection, for the total fix.

I am in favor of single payer universal healthcare -- period. No exchange. No public option. No premiums. No subsidies. No managed care. None of it.

But I will support -- indeed, cheer -- whatever we get this time around. If we just get rid of pre-existing condition exclusions and lifetime caps, things will be better. If there are caps on out of pocket expenses, that would be very good. Subsidies for the middle class and expanded Medicaid will go a long way towards covering the uninsured.

Will insurance still be too expensive? Yes, it will because Congress is not prepared to go toe to toe with the insurance lobby or the pharmaceutical lobby or the health care provider lobby. We are not going to get it all done this time.

But what we do get done will be a step in the right direction -- a big step, a first step that makes next steps pretty inevitable.

I don't need perfect. I just need progress. Jennifer

Whew!

I finally made it through all 1990 pages. I could live with this bill, although it won't be the final result after conference with the Senate. And there are flaws.

According to today's NY Times:

Under the House bill, the budget office said, a family of four with income of $78,000 in 2016 would pay, on average, an annual premium of $8,800 and co-payments of $5,000, for a total of $13,800, equivalent to 18 percent of the family’s income.

A family of four with income of $90,100 could also receive subsidies. It would pay $11,100 in premiums and $5,500 in cost-sharing, for a total of $16,600, or 18 percent of family income, the budget office said.

For lower-income people, the subsidies would be more generous. A family of four with income of $66,000 would pay premiums of $6,300 and cost-sharing of $3,700, for a total of $10,000, or 15 percent of its income in 2016, the budget office said.

That worries me a lot. Don't forget that I think that's gross income compared to actual costs, so actually the families would pay a much higher percentage of take-home pay. It's better than it is today -- a $5000 cap on out-of-pocket costs is better than catastrophic losses people suffer today with hundreds of thousands of dollars out of pocket for long hospitalizations, stays in intensive care, and expensive infusion drugs. But still -- this is a huge amount of money to expect people to pay every year, year after year.

And this is why we need a less expensive public option. Because with prices like these, we are not making insurance affordable enough. People will still have to go without insurance.

Now, to answer Rabbit's questions from yesterday's post -- I'm answering them here rather than in a comment because they're particularly good questions that others probably have, too:

There's no info about whether the House's high risk pool would be priced like state high risk pools, which tend to be very expensive. The national high risk pool would be temporary, just to find a way to cover people with pre-existing conditions until the exchange gets up and running. There's very little detail about the plan, though.

The rules about pre-existing conditions will be the same no matter how many pre-existing conditions you have. Between 2010 and 2013, the existing rules, which require states to offer a guaranteed issue option if you've had insurance and you don't have more than a 63 day break in coverage, you'll be able to get insurance. And there will be the national high risk pool, as well. After 2013, when the exchanges go up, there will be no more pre-existing condition exclusions -- period. One condition or many, the rules will be the same.

I'm worried about letting states opt-out of the public option, too. We have to hope that political pressure and federal funding stop that from happening. And the new Medicaid rules, which will cover single adults with no children up to 133 or 150% of the federal poverty level (depending on whether we get the House or the Senate version), will apply in every state -- no opt-out allowed. So that's going to be a very big and welcome change.

And what's a medical home? It's a proposal for chronic care management which has a primary care doctor or physician's assistant as the person who coordinates care and is the point of contact for the patient. In the House version, it can be a specialist, too. That person coordinates care among all the specialists and makes sure that all of the patient's needs are met. The idea is that the patient will have one-stop-doctoring at the medical home, which will also hold all of the patient's medical records, make sure there are no medication interactions, etc., etc. For those of us with chronic illnesses, the medical home should simplify our lives. My problem with most medical home models is that they focus on doctors and coordinating care, all revolving around a single doctor when they should revolve around the patient. But that may come as more of this pilot projects get under way.

And finally Rabbit wants to know how I'm doing. I've been talking about myself less lately, mostly because it's so important to get accurate info about health care reform out there. But I've lost 12 pounds. I have one more trip -- DC next week -- and then hernia surgery on November 20. It's pathetic, but I'm looking forward to it because it will give me an excuse to take some time off, and the week of Thanksgiving should be slow anyway.

And that's the scoop. If anybody has more questions, let me know and I'll try my best to answer them. Jennifer

The First 870 Pages & the Ad War

That's how far I've gotten in the House bill -- 870 pages. So far, I'm pretty pleased with what I've read. Although the insurance exchange -- the marketplace where you could shop for insurance -- won't be up until 2013, and, thus, some of the important insurance reforms, like the elimination of pre-existing condition exclusions, won't take full effect until then, there are some provisions that would help in the meantime.

For example, there would be a national high risk pool for people who can't get insurance due to pre-existing conditions. The catch, though, is that you have to go without insurance for 6 months before you qualify.

And the current rules about pre-existing condition coverage -- if you have 18 month of continuous coverage and no break in coverage of 63 days or more, and they look back 12 months to see if you had a pre-existing condition -- would be relaxed. You'd only have to have 9 months of continuous coverage and they'd only look back 3 months.

Although the public option is in the plan, it is not the "robust" public option that the liberal Dems wanted -- reimbursement rates are not tied to Medicare, but instead, they would be negotiated, so providers will do better under this version. And states could have their own plans. Even co-ops would be an option.

There's a strong pilot plan for "medical homes" that should help coordinate care of people with chronic illnesses.

There's a lot more in this 1990 page draft. I'll report back when I know more.

But another thing struck me this week-end. I was watching the Sunday talk shows and there were so many commercials opposing health care reform. I hope you're looking at who's paying for the ads. The Chamber of Commerce hates the House plan because it includes an employer mandate -- employers whose annual payroll is over $500,000 will have to provide insurance for their employees or pay a fine.

But the one that gets me is this ad that tells Seniors that Medicare's going to be cut to pay for reform. I couldn't catch the name in tiny print at the bottom of the screen, but you can bet it's related to someone who doesn't really represent Seniors. I can tell you it was a group I've never heard of before.

The truth is that the House bill helps Seniors. The House bill begins to close the doughnut hole, making prescription drugs more affordable from Seniors starting on day one. The coverage gap -- currently, drug coverage stops at about $2800 and starts again at about $4500, so that leaves about $1700 out-of-pocket -- would be reduced by $500 immediately. And the drug companies would offer discounts on drugs during the doughnut hole. This has been one of the biggest obstacles for Seniors, and the House bill starts to eliminate it right away.

And yes, Medicare Advantage plans -- plans that already deny coverage more than traditional Medicare, but which are paid more than traditional Medicare costs -- would have their costs cut. Not services; costs. Medicare Advantage plans cost the government more than traditional Medicare because they are private insurance companies and they charge higher administrative fees than traditional Medicare. So those administrative fees are being slashed. Not services; just costs. Why should private insurers get more to run Medicare plan than it costs the federal government?

The House bill is by no means final. The House will debate the bill on the floor and there will be lots of Amendments. And then the Senate will pass something and the House and Senate bills will have to be combined in conference committee. But slowly but surely, we are making progress.

If only people don't buy into those commercials. In 1993-1994, health reform failed because of the famous "Harry and Louise" commercials that were paid for by the insurance companies. Let's not be so gullible this time. Jennifer

Apology to America

I apologize, America. My Senator -- much as I hate to admit it -- has said that he would stand with the Republicans to block health reform with a public option. Yup, Joe Lieberman. The guy whom we elected despite the fact that he was trounced in a Democratic primary. The guy who was allowed to keep his committee chairmanships because he promised to vote with the Democrats on procedural motions -- and last time I looked, cloture was procedural. The guy who used to be a Democrat. The guy who supported John McCain for President and still believes we belong in Iraq, and said so in a speech to the RNC.

How the heck did liberal, justice-loving, rights-loving, humanity-loving Connecticut end up with this !@#@!$% as our Senator?

Connecticut is resoundingly in favor of universal healthcare. Indeed, we passed the Sustinet plan which, when implemented in two years, will provide health care for everyone in Connecticut. It passed the General Assembly. The Governor vetoed it. And then the General Assembly overrode her veto. The citizens of Connecticut have spoken.

Joe Lieberman has been around Connecticut politics for a long time. When he beat Ned Lamont, it seems to have emboldened him. So he endorsed John McCain despite the fact that Connecticut voters were strong supporters of Barack Obama. He has maintained his hawkish positions despite the fact that the Democrats voted him out of the party for it. Joe Lieberman seems to think he's invincible.

Let me say this loud and clear. If Joe Lieberman stands in the way of health reform with a public option, as he seems determined to do, I will make it my life's mission to ensure that he cannot be elected to any office ever again in the State of Connecticut. After all, if our Senator really betrays us with such colossal disregard for the views of his constituents, we here in Connecticut will owe all of America a big apology for re-electing him despite knowing that he didn't care about our views on Iraq.

Indeed, maybe we need a constitutional amendment that allows us to recall a Senator who cares so little for what his constituents believe. Jennifer

Total Calls -- AMAZING!!!

315,023.

That's the total number of pro-reform calls made to Congress yesterday (or those are the ones that were reported -- there probably are more).

To all of you who thought you couldn't make a difference, I think you did. That's a huge number at a time when Senator Reid and Speaker Pelosi are in the final stages of drafting the bills that will be brought to the floor of both chambers.

Great job! Jennifer

WE DID IT (and are still doing it)!!!!!!!!!!!!!!!!

From Huffington Post:

It's not even noon on the West Coast and already Capitol Hill staffers say they're getting nonstop calls from constituents in support of President Barack Obama's health insurance reform. At about 2:15 EST, Organizing for America (OFA) surpassed it's goal of 100,000 phone calls to Congress, each one imploring representatives to vote for reform.

The nationwide "Time to Deliver on Health Reform" event is the most massive outpouring of support from Obama supporters since Election Day 2008.

Senate Democratic aides told HuffPost that their phones have been ringing off the hook. "We're getting completely crushed with calls, jamming our phone lines from the moment we opened," said one aide.

Another said they'd gotten "pretty much non-stop health care calls from OFA." A third also said their office was getting bombed and that four out of every five calls specifically mentioned the public option.

Only one aide contacted said that the calls had not been heavy. "We've had about 130 [health care] calls to the DC office today," said a staffer, explaining that on busy advocacy days the number can climb much higher.

Several aides said the callers seemed less informed about the issue than typical advocates, indicating that Obama is reaching a wide variety of voters who do not typically engage in the political process. Almost all of them called on the senators to support the President's health care plan. Several aides noted with irony that the president doesn't have a specific plan that he has endorsed - to the great frustration, in fact, of many Democrats.

After the election, Obama for America (OFA) became Organizing for America (OFA), an issue-oriented advocacy arm of the DNC whose primary purpose is to help make campaign promises a reality by cultivating public support for Obama's agenda.

Calls officially started at 9:00 AM Eastern, and supporters reached 40,000 calls about noon. From there, the numbers climbed quickly, hitting 85,000 around 1:30 PM and 95,000 around 2:00 PM -- fifteen minutes after that, 100,000.

To generate these numbers, OFA organized over 1,000 phonebank events across all 50 states. Yesterday, OFA said its phonebanks would make hundreds of thousands of calls to voters in order to generate 100,000 calls from constituents to Congress.

This morning's email to OFA members said, "If we hit 100,000 calls made or committed to, we'll send an unmistakable signal that this time, families must come before insurance companies. We'll be tracking progress toward our goal publicly -- make sure to report your call back to us so we can count it." (See the current count.)

President Obama will speak to OFAers across the country today at 8:00 PM Eastern to kickoff the evening phone banks. Sources within OFA say they are going to raise their goal to 150,000 calls to Congress but no official word yet.

Read more at: http://www.huffingtonpost.com/dawn-teo/ofa-healthcare-phonebank_b_327418.html

Pick Up the Phone NOW!

Today is a national call-in day for health reform. Call the Capitol switchboard and ask to speak to your members of Congress. The number is 1-866-210-3678.

Pick up the phone. Now. Jennifer

Don't Rely on What You Hear/Read

We sent out an email blast today encouraging people to call their members of Congress tomorrow, the national call-in day for health care reform. I got the following response:

I am both suprised [sic] and shocked that someone with such a serious illness and a person running a non for profit would use public funding to promote your own political agenda. I am really dissapointed [sic] and wonder if those who give you funding would approve of what you are doing....personally if I was forced into what you are promoting, my son who has crohns disease may not be alive today as no hospitals "on my plan" in this area would give him the treatment he needed because of insurance. Because I pay for a plan that allow, I am able to go "out of network" to get the best possible care. If you read ANYTHING about health care reform, it is those with cronic [sic] illness that will be the most effected. Did u not hear congressman ERIC Cantors [sic] speech?

First, we don't receive one dime of public funding to fund our day-to-day work. In 2009 and 2010, we will have received a small grant to fund the chronic illness survey we are working on with the University of Michigan Center for Managing Chronic Disease. That's all the public funding we receive.

Second, supporting health care reform isn't about politics in the sense of Democrat or Republican. Indeed, Bill Frist, Mike Bloomberg, Bob Dole and Arnold Schwarzenegger all are prominent Republicans who are publicly in favor of health reform (although they have not endorsed any particular plan). However, Eric Cantor -- the person this emailer wants me to listen to -- is the House Minority Whip, the second-in-command Republican in the House of Representatives. Any question that he's a politician with an agenda? I don't think so.

Third, I have read the health care reform proposals, and this writer clearly has not. Let me say it again -- nobody is being "forced into" a public option. An option is just that, an option, a choice. People would be allowed to choose between a publicly run plan and a private plan. There would be several private plans from which to choose, some of which no doubt will cover out-of-network benefits. There is NOT ONE WORD in the health reform bills I've read that would eliminate out-of-network coverage, as my correspondent suggests.

I emailed her back. I sent links to factcheck.org; the Kaiser Family Foundation's health reform page; the Robert Wood Johnson Foundation health reform page; the White House health reform page.

Do you think she'll read anything I sent her?

It scares me when I see people -- people who've called here for help, so they know something about chronic illness -- opposing health reform because they don't understand it (not to mention assuming that I, who do this for a living, would not have read up on it myself).

So really, my message to you here is just this: Don't believe me OR Eric Cantor. Read, listen, judge for yourself. Read not only the New York Times (i.e., liberal): also read the Wall St. Journal (i.e., conservative).

This may be the most important public policy debate of our generation. Don't have a knee-jerk reaction. Don't label the "fors" Democrats and "againsts" Republicans. Don't assume Eric Cantor is right any more than you assume Nancy Pelosi is right. Don't assume anything. Educate yourself enough that you can make an informed choice.

I'm confident that I've studied this well enough so you can count on what I've told you the various drafts say, but don't assume I'm truthful or accurate. Read. Listen. Hear diverging views. When Betsy McCaughey or Sarah Palin talks about "death panels," check it out. After all, Ms. McCaughey said it appeared on page 425 of the House Bill, so it was easy enough to prove that no such thing appeared on page 425, section 1233 (they posted it without page numbers so you have to scroll down to section 1233, end of life consultations -- which, as you can see, would have reimbursed Medicare providers for talking to patients about things like living wills, but which would NOT have created panels to decide when to "pull the plug"). If you don't have time to read for yourself, then go to the non-partisan cites linked above, and the always-reliable independent factcheck.org.

I'm not telling you to just take my word for it. I'm so sure that I've been accurate in my statements in this blog that I welcome your researching and reading. I've told you when I've been unhappy with Senator Baucus's bill. I've told you that I favor a public option and why. But please, don't take my word for it.

This legislation will affect every single person in the United States. If ever you were going to get informed and involved, now's the time. I trust you to make the right decisions once you know the facts. So go get 'em. Jennifer

National health reform call-in day

Tuesday October 20 will be a national health reform call-in day. Please mark your calendars. You can find contact info for your member of the House here, and your members of the Senate here. Or you can use the toll-free number to the Capitol switchboard, 1-866-210-3678.

What should you say? Well, as you know I'm strongly in favor of a public option. This is not a government take-over of health care. What would happen is that all the private plans would be offered through the exchange, a marketplace where you could view and compare available plans. In addition to the private plans, a public plan would be offered. If you wanted to choose the public plan, you could. If you're happier sticking with Blue Cross or United Healthcare or Aetna or CIGNA -- if you're one of the lucky ones who doesn't see coverage denials on a regular basis -- you can stay with them. But the public option would cost less because no executives would be paid $1.5 billion bonuses for denying coverage. Administrative costs of a public option would, therefore, be less and so premiums would be lower. In order to compete, the private plans would then have to lower premiums.

There are other ways to force private plans to lower premiums, but they're not even on the table. You could limit executive pay, for example. You could cap premium rate increases at the same rate at which incomes grow each year. But a public option that would compete with private options is more in synch with free market ideals. And a public option would save over $25 billion over 10 years, or even more if reimbursement rates -- the rates paid to doctors, hospitals, labs, etc. -- were tied to Medicare rates.

So if you agree that it's important to have robust competition, you might tell your members of Congress that you support a public option.

If you have a story -- if you've suffered at the hands of health insurers -- tell your story.

If you feel strongly about elimination of pre-existing condition exclusions and eliminations of lifetime caps, say so. If you want these sorts of insurance market reforms to take effect immediately, that's a really important point because otherwise, they won't take effect until 2013.

If you agree that private plans that administer Medicare shouldn't be paid any more than it costs for the government to administer Medicare (a savings of about $220 billion), chime in.

And if you just want to say we need change now, that would be great.

What you should NOT do is nothing. If everybody who reads this makes a call to his or her two Senators and one member of the House of Representatives, we may actually make a difference. Three phone calls. They'll be short -- the staff on the Hill doesn't want to have long conversations. It won't take you long. Indeed, if you'd rather email than call, go for it. But please do something.

If you care about chronic illness, you have to be for reform. It's as simple as that. Jennifer

Breaking News: Finance Committee Passes Reform Bill

The Senate Finance Committee passed its health reform bill on a vote of 14-9. Senator Snowe was the only Republican voting for the measure.

For the first time in the history of the United States, all five committees with jurisdiction have passed health reform, paving the way for consideration by the full House and Senate.

We are making progress. Jennifer

Breaking News: Senator Snowe will Vote YES!

The Republican Senator from Maine, Olympia Snowe, has said that she will vote in favor of the Senate Finance Committee bill when they vote later today. She will be the first and only Republican to vote in favor of any health insurance reform proposal.

Call or email her to thank her, even if you aren't from Maine. Her phone number is (202) 224-5344. Jennifer

Finance Committee -- Call your member

Today, the Senate Finance Committee will vote on its not-so-great plan for health insurance reform. It's not great for a lot of reasons -- it doesn't take effect until 2013, there will be a tax on so-called "Cadillac" plans even when the reason the plans are expensive is insurance company excess, the subsidies don't cover enough people, and most of all, there's no public option. But it's better than the status quo. And it's not the final bill -- it's only the product of one of five committees with jurisdiction. But before anything else can happen, the Finance Committee has to vote out a bill. So moving forward today is crucial.

If your Senator is on the Committee, now's the time to pick up the phone. Here is a list of the Finance Committee members:

Democrats:

Max Baucus (MT)
Jay Rockefeller (WV)
Kent Conrad (ND)
Jeff Bingaman (NM)
John Kerry (MA)
Blanche Lincoln (AR)
Ron Wyden (OR)
Charles Schumer (NY)
Debbie Stabenow (MI)
Maria Cantwell (WA)
Bill Nelson (FL)
Robert Menendez (NJ)
Thomas Carper (DE)

Republicans:

Chuck Grassley (IA)
Orrin Hatch (UT)
Olympia Snowe (ME)
Jon Kyl (AZ)
Jim Bunning (KY)
Mike Crapo (ID)
Pat Roberts (KS)
John Ensign (NV)
Mike Enzi (WY)
John Cornyn (TX)

You can find their phone numbers here.

The bill has been debated and amended, and the non-partisan Congressional Budget Office says it will save $81 billion dollars over 10 years.

The insurance industry has released a totally biased report saying that premiums will increase with this bill because the fines on individuals who choose not to purchase insurance are not large enough and they're acting like a bunch of children who didn't to sit with the popular kids at lunch. As long as reform is an economic boon for the insurance industry, they're happy to watch it happen and not try to block it. The minute it looks like they aren't getting everything they want, they change their tune. The report is a farce. Footnote 2 says they are not considering the effects of subsidies and taxes and other revenue-enhancing features of the Finance Committee bill. Well, sure. If all you look at are the parts that cost money, and you ignore all the parts of it that save money, the result looks lop-sided. DUH!

I can only hope that there are enough people like me reading and writing and doing their best to get the truth out to counteract this biased negativity.

The truth is, folks, that no matter what Congress passes, it's likely to need tweaks down the road. Medicare is constantly being tweaked. That's of necessity. This is something of an experiment. Parts of it will work and parts of it won't. I'm nervous, and you have a right to be as well.

But what's absolutely clear is that we cannot maintain the status quo. We can't have a health care system the costs of which grow faster than the rate at which our income grows. We can't afford premium increases of over 20% every year forever. We can't have sick people -- people with pre-existing conditions -- unable to get insurance.

We need change. If we can get a public option out of Washington, premiums will decrease. Indeed, a public option is a complete response to the insurance industry's so-called report because it would be a lower-cost alternative that people could choose, so for insurers to compete, they would have to lower prices.

But even if we can't get that this time around, just the elimination of pre-existing condition exclusions and lifetime caps on benefits would be a huge step forward.

So do your civic duty. Call your Senator today and let them know how you feel. If enough people call, we can make a difference. So just do it. Jennifer

Insurers Fight Reform -- The Inevitable

It was only a matter of time.

As long as they thought that the costs of health care reform would all fall on the government, the taxpayers, individuals, drug companies, and hospitals, the insurance industry was silent, even mildly supportive.

No longer.

When the Senate Finance Committee cut the penalties people would have to pay if they don't buy insurance, the rumblings started. The penalties went from $950 for an individual and $3800 for a family down to nothing for the first year, and then $200 for an individual and $1900 for a family eventually, on an increasing basis over time.

And the insurance companies started to yelp. If they have to accept people with pre-existing conditions, they need, they say, the young healthy people, too -- the people least likely to buy insurance even if there's a mandate. They'd rather pay the $200 fine than spend $300-$400 per month on a premium. They're young. They're short-sighted. They don't hear the calls I get from young people who found out they had a chronic illness after having foregone health insurance, and now they can't find anything to cover their pre-existing conditions.

The insurance companies were willing to take us sickos as long as they got these healthy kids. But with penalties this low, they aren't assured they'll get the healthy. So now, they don't want to have to take people with pre-existing conditions.

And they hate the tax on so-called Cadillac plans -- plans that cost $8000 per year for an individual and $21,000 for a family. I'm no fan of this tax, either, but that's because I understand that many plans are this expensive because insurers charge groups with sick enrollees more, even if they aren't supposed to. The insurers hate it because the tax is on them, not on the insureds.

And finally, the insurers don't like the cuts to Medicare Advantage plans. That's because private insurers run Medicare Advantage plans. They've been making out like bandits on these plans, getting paid more by the federal government than it costs the government to provide the same services under traditional Medicare. We advocates knew the Medicare Advantage plans were rip-offs because we are the ones who heard from the patients who faced denials of coverage of things that would have been covered by traditional Medicare. Medicare Advantage plans were rip-offs all along. The government finally figured that out and decided to take away their profits. Boo hoo.

Here's what I think. What's bad for insurers is probably good for the rest of us. I'm not overjoyed by the Senate Finance Committee bill, but I'm surely not going to mind at all if the insurers have to feel some of the pain. After all, if they hadn't put profit motive over health all along -- if they hadn't denied coverage to people with pre-existing conditions, if they hadn't denied coverage of things that were life and death necessities -- we might not have needed health insurance reform at all.

Most of us have to live with the consequences of our actions. Sorry, UnitedHealthcare. Sorry, Aetna and CIGNA. So so sorry, Blue Crosses who like to pretend that they're better than the rest but most definitely are not. Sorry you'll have to pay part of the price for the damage you've done.

It was inevitable that the insurers would oppose reform efforts. It only took this long because they really thought they would walk away from this unscathed until the Senate Finance Committee bill was written and then amended. Now that they see the writing on the wall, the inevitable screaming has begun.

Let's see if our elected officials are ready to stand up to them. Jennifer

Deep Throat . . . er . . . Pocket?

When my phone rings at 7 am, it usually means something's wrong. Today, it meant something very different.

A gentleman who would not give his name said he works for Care Corps International, a third-party payer that also does medical necessity reviews for insurance companies. In other words, he is the first-line reviewer deciding whether a request for prior authorization for anything from a drug to a test to a procedure will be approved. He saw my name and phone number in AARP Magazine in an article about health insurance denials of coverage and he wanted to tell me the "other side of the story."

He called to complain about doctor's offices. He said offices with "employees with foreign-sounding names" provide less good care. He said he often calls a doctor's office for more information and, instead of getting a medical professional on the phone, he gets "someone without a high school education." He remembers one call that will "stay with [him] always," in which he asked a doctor's office about the patient's symptoms and the person on the other end of the line said "huh," apparently not understanding the question.

He complained that his company often faxes a request for additional information to a doctor's office, and all they get back is the same information they were given in the first place. He was very annoyed that doctors won't take the time to call them back and explain their treatment plan. When he has questions he can't get answered, he explained, the claim gets denied unnecessarily. And it's the doctor's fault, not his or the insurance company's.

Oh -- and by the way -- especially when someone's on Medicaid, he said he believes "we" should have a say in the medical care they get.

When I suggested that these reviewers are a big part of the problem, leading to unnecessary denials because their requests for additional information are so burdensome, he blurted out the following. He is audited monthly. He has to dispose of a certain number of cases per hour. Each health plan has different criteria for medical necessity, so he has to keep track of all of them. If his "certification rate" -- the rate at which claims are approved or denied -- is too low, he can lose his job.

I don't know about you, but I'm not thrilled with the thought that medical necessity decisions are being made (1) by someone with a bias against foreign-sounding names; (2) by someone with a bias against people on public programs like Medicaid; (3) by someone who denies medical necessity because the person at the other end of the line doesn't understand his questions; (4) by someone whose job performance is measured by the number of claims he processes per hour; and (5) by someone who has to "certify" (or not) a certain number of claims per hour. Nor am I thrilled to be reminded that, a good part of the time, our doctors' offices don't provide reviewers with the information they need to approve the claims (which is why I ALWAYS tell patients they have to gather and submit their medical records with their appeal).

My anonymous caller -- who said he didn't expect anybody to answer the phone at 7 am, and had planned only to leave a message -- thought he was giving me information that should make me blame medical offices, when all he did was further confirm that patients are getting screwed from all sides.

And think about it. Why are the criteria for medical necessity different for each insurance company? If we're talking medicine -- science -- shouldn't the criteria be the same?

But of course, we're not talking medicine. We're talking money. Jennifer

Breaking News - Congressional Budget Office Scores Finance Committee Bill as REDUCING the Deficit

By DAVID ESPO, AP Special Correspondent David Espo, Ap Special Correspondent –

Health care legislation drafted by a key Senate committee would expand coverage to 94 percent of all eligible Americans at a 10-year cost of $829 billion, congressional budget experts said Wednesday, a preliminary estimate likely to power the measure past a major hurdle within days.

The Congressional Budget Office added that the measure would reduce federal deficits by $81 billion over a decade and probably lead to "continued reductions in federal budget deficits" in the years beyond.

The report paves the way for the Senate Finance Committee to vote as early as Friday on the legislation, which is largely in line with President Barack Obama's call for the most sweeping overhaul of the nation's health care system in a half-century.

Fatigue & Chronic Illness

We're starting to get some of the preliminary data from our chronic illness survey (and if you haven't taken it, PLEASE do -- there's a version for patients and a version for caregivers). It's no surprise to me that people are saying that their major obstacle is fatigue.

I know my most major obstacle is fatigue. I traveled to Atlanta this week-end and spoke to a wonderful group of families who have a child with inflammatory bowel disease. I talked about school law, family and medical leave, and health insurance. For the first time in my life, I got wheel-chaired around the airport (I have Crohn's-related arthritis in my knees, a problem with my lower back that's made my right leg both numb and painful at the same time, like pins and needles). The Atlanta airport is huge, so although I don't like to admit that I need help, I did this time.

Due to my gastroparesis, I pretty much don't eat when I'm going to be traveling. This time, I ate my usual breakfast on Friday morning at home at about 7 am, and then I ate breakfast on Saturday morning at my hotel at about 6 am, and that's what I ate for the two days (good for my diet!). So that contributes to my fatigue.

And I gave 2 talks, 40 minutes each. And then took questions, and hung around to talk to parents who wanted to talk about their individual circumstances. By the time I was finished, my knees, ankles and feet were throbbing, and I was really fried.

I got home at about 10 pm on Saturday night. By the time I unpacked and got organized, it was about midnight when I went to bed. I stayed in bed until Monday morning. That should have been a good rest, eh?

I'm so tired I could cry. My Crohn's is acting up a bit, but not terribly. I am disadvantaged this week because I have a wound on my hip (not sure how I got it), so the doctor said I can't swim because I can't take a chance of it getting infected. I know swimming helps my energy level. But no matter what, when I have a week-end like that when I have an extra long day on Friday (I didn't get to my hotel until 10 pm) and Saturday (6 am to 10 pm), I don't bounce back so easily.

Basically, I can work because I do absolutely nothing else. I go to bed early and I spend my week-ends in bed. Even though I don't sleep a lot of hours, I do rest. And when I don't, I pay. So today, I've already gone to the bathroom too many times. My knees are killing me. My leg is numb. And I have a migraine "aura" (like you're seeing through a pool of water). I'm trying to work, but I really feel like I belong in bed. And it's only Wednesday.

People don't get how exhausting chronic illness is. You can't really see fatigue (unless you count the rings under my eyes). It doesn't show up on blood tests or anything. I can't prove it. But I know that, when I talk to patients, they always stress how tired they are. It's not sleepy tired -- it's bone tired. I wrote a book called Friday Tired -- so tired that every day feels like Friday. And I sure do wish Friday would come.

On days like today, I don't know how to be the person upon whom everybody else relies. Somehow, I manage to get through the day, but the effort is tremendous. By Friday night, I'll be a basket case. And while other people are out all week-end looking at Fall foliage, shopping, seeing friends, Emily (the cat) and I will lie in bed watching crappy TV or crappy movies, sleeping as much as possible, and trying to figure out how to avoid Monday.

I don't know anybody with a chronic illness who doesn't get this. And I don't know too many people who don't have chronic illnesses who do. Jennifer