Number of uninsureds Skyrockets.

Some of you may have wondered why Advocacy for Patients advocates for the unemployed as well as the uninsured and under-insured. Well here's why.

There are now 50 million uninsureds. We believe this number has skyrocketed due to unemployment. At least, that's what the people who call us say, and that's HuffPo's explanation, as well.

50 million people, many of them sick, unable to afford to go to the doctor or buy the medicine that keeps their chronic illness in check. 50 million people straining already over-crowded emergency rooms. 50 million people who need help.

Before you oppose health reform that, in 2014, will provide insurance to most of these, please think. It could just as easily have been you who lost your job, your insurance, your everything. Jennifer

Vacation

Yup, I'm really taking a vacation, until after New Year's. If anything really big happens, I'll post, but otherwise, this blog is on hiatus until January 3, 2011.

Have a happy and HEALTHY holiday season. Jennifer

Modern Day Health Care Hero, Moi?

So says Families USA in this really embarrassingly lovely blog. Jennifer

Thursday's Themes

Well, Congress finally passed the health care for 9/11 responders yesterday -- about time.

While Congress was busy wrapping up it's business for the 111th Congress -- ratifying the START treaty, getting the 9/11 health bill done, finishing up the food safety bill -- and while the President was signing the repeal of Don't Ask Don't Tell and childhood nutrition bill, the rest of us were getting ready for the holidays, so the other news is sparse.

Here's a surprising study -- placebos work even when the patient knows they're placebos!

In a happy reversal, health insurers in California are selling new child-only policies even though they now have to cover pre-existing conditions. Good news. Now, let's hope they do the same in other states.

Yet, other insurers are dropping mental health coverage entirely because they don't want to comply with new laws requiring that mental health benefits be as robust as medical/surgical benefits.

And that's all I've got for you this morning. I don't know about you, but I'm really excited that I only have one more day of work before VACATION! Jennifer

Tea Party Leader Slams Methodist Church for Supporting Health Reform

The Tea Party Nation's Judson Phillips slams the Methodist church for supporting health reform and for trying to "debunk the myths" of the reform law, among other things. Really? Because debunking the myths is somehow wrong? Oh, yeah - you don't believe they're myths, so the debunking really is myth-mongering to you, Mr. Phillips?

As my friend Susan Campbell would say, bless his heart. Jennifer

Wednesday's Health News

First and foremost, congratulations to the UConn women's basketball team -- the winningest team in history, men or women. I have to admit that I like seeing the UConn women on the front page of the LA Times. They deserve it.

Now, onto more serious fare.

Here's where you have to like health reform. Regulations issued yesterday would require health insurers to justify any premium rate increases of 10% or more. I haven't finished reading them, but I think we all welcome anything that tries to control premiums. Here's more about the new rules. The regulations doesn't allow the government to prevent all rate increases -- that's up to the states -- but it would make insurers whose rates are deemed to be unreasonable post their justifications on the federal health care website. In my opinion, that's not good enough. The government should have the ability to prevent excessive rate increases.

Stuart Taylor writes a really good piece explaining the litigation over health reform. If you're confused, this is a good place to start.

Medicare can do more to police its payments, says the Wall St. Journal. Medicare continues to pay even when doctors are under review or investigation. Part of the problem is that confidentiality prevents the government from releasing claims data to the public, letting them know that a doctor is under watch.

And here's a really interesting story -- do a physician's religious beliefs influence patient care? I never thought about this one.

Believe it or not, as we wind down to the holidays, that's all I have for this morning. It looks like there will be votes today on health care for 9/11 responders -- about time. Once that and the START treaty are passed, Congress will go on recess -- and so will I! In the meantime, have a great day. Jennifer

Tuesday News Bites

We start with a story of what happens when you don't have insurance and you, therefore, put off treatment. Something benign becomes life-threatening, and what might have been taken care of for a few hundred dollars ends up costing thousands. And you don't think we'll save money if everybody has insurance?

Here's the case for the individual mandate laid out simply, poignantly, truthfully. Before you oppose it, read this.

Health reform is phasing out annual dollar limits on benefits, but what about limits on the number of doctor visits, which have not been changed by reform? Here's a cautionary tale.

And still, the GOP plots repeal. One contender for the party chair says we should put it to a ballot measure.

And the newest draft of the temporary spending bill does not include funding for reform efforts. I don't know what this means for implementation; my guess is the White House will continue to press ahead.

Will the GOP continue to block health care for 9/11 first responders? They're taking some well-deserved heat for this one.

The House today should pass the food safety bill (again) and send it to the President for signing.

Palliative care -- good medicine or death panels? I don't know how you could read this story and think there's anything cruel about it.

Here's a new federal program aimed at keeping seniors in their homes, out of nursing homes and despair.

Do you get regular vision checks? Do it.

A personal case for mammography.

Learning more about the brain allows us to understand.

What makes you feel the warm afterglow after a serious workout? Not what you think.

A study finds a possible carcinogen in the water of 31 cities.

Overcoming stuttering -- easier said than done.

A large study says echinacea doesn't help cure the common cold after all. I'm telling you -- chicken soup is the way to go.

And that's it for this morning. Hope you have a healthy day! Jennifer

Monday Morning Smattering

The year's biggest lie: That health reform is a government take-over of health insurance.

Backers of the 9/11 health care bill are optimistic. Let's hope they're right. Here's why.

The need for mental health services is growing on college campuses.

There is a shortage of pediatricians in parts of the country, leaving almost 1 million kids without doctors.

The Senate passed the food safety bill again, after an error in procedure sent it back to the House after the first time.

It's okay. You can soak your feet in Vodka. I can't believe I just wrote that!

A brain anomaly leaves a woman without fear. Is this a good thing or a bad thing?

A majority of US adults had troubled childhoods, according to the CDC.

The FDA examines the health effects of mercury fillings. About time.

Top spine specialists reap royalties, Medicare payments.

Blue Cross of Michigan is fighting a lawsuit that says that they have anticompetitive prices with hospitals. It's called most favored nation status. Lots of insurers do it -- force providers to accept less from them than they do from any other payers. I'm watching this one carefully since it may be the first of many.

The health benefits of having a pet -- Emily and I already knew this!

As we run up to the holidays -- and vacation -- enjoy today's headlines. Jennifer

My Letter to the Editor in the NY Times

Rethinking Disability Insurance

To the Editor:

Re “Making Disability Work” (column, Dec. 10):

Peter Orszag rightly expresses concern about people on disability separating themselves from the workplace for longer than they might if they had other options. It is so difficult to get Social Security disability; the process of appeals and hearings often takes more than a year, during which applicants often have no income and no health care. The difficulty of this process provides a disincentive to give up disability benefits and try to resume work.

However, Mr. Orszag’s suggested solution — employer-sponsored disability insurance — is never going to happen. Many employers can’t afford to provide health insurance; it is unrealistic to think that they could be persuaded to assume additional burdens.

There are solutions, though. We should have short-term Social Security disability — a year or two during which a person could recover from surgery, stabilize a chronic condition or ride out an episodic flare. If accompanied by a streamlined application process, this would be favored by many applicants over permanent disability.

Not only would it provide an incentive to get back to work as soon as one is able, but it also would save money by shifting people from permanent benefits to temporary, short-term payouts. This type of system works well in New York and California, which have state-sponsored temporary disability. It should be tried on a national level.

Jennifer C. Jaff
Executive Director, Advocacy for
Patients With Chronic Illness
Farmington, Conn., Dec. 10, 2010

Legal Scholars on the Constitutionality of Reform

The NY Times ran an educational piece. Note the contributions of Mark Tushnet, my law school mentor and great friend -- and brilliant professor who clear is in the right. Jennifer

Don't Let Unpaid Medical Bills Ruin Your Credit Score

An important warning -- and good advice from our friend Walecia Konrad. Jennifer

Jonathan Cohn: Why Medicaid is Worth Saving

The ever-fabulous Jonathan Cohn argues that, while Medicaid is not perfect, it would be a mistake to unravel it. Yes, reimbursement rates are too low, so not enough providers participate, leaving enrollees with sub-par medical care in some cases.

But, Jonathan Cohn asks, what would you do instead? How would you provide care to the very poor, to pregnant women, to children?

Those who critique Medicaid don't have an alternative. That's why, when Gov. Perry of Texas threatened to pull Texas out of Medicaid, it was his health advisers who balked. How would the state pay for charity care at hospitals? Where would poor people go for non-hospital treatment? And, equally importantly, where would the state go to replace the MILLIONS in federal reimbursement it receives for providing Medicaid benefits to the poor?

It's easy to criticize, but not so easy to solve problems. As usual, I find Jonathan Cohn's reasoning to be unassailable. Jennifer

TGIF Edition

Yesterday was oral argument in the Florida case against health reform. As he has done in the past, the judge made several comments leading us to believe that he will rule against the individual mandate that people buy insurance. More here. And here. And here. And here. Here's why the individual mandate is so important. Still, experts continue to try to think of alternatives to the individual mandate in case they are needed.

You may have heard that the FDA has decided to ban Avastin for the treatment of breast cancer because they don't believe it's effective. Well, the Republicans say it's rationing and blame it on health reform. Huh? The FDA has been ruling on the effectiveness of drugs for a long time -- far longer than health reform has been around.

Community health centers will play an expanded role in health reform, as they apply for federal grants to expand services to those in need.

The wonderful Pauline Chen writes about the importance of the hospital room surroundings.

Seventy-five percent of doctors believe in miracles! I don't know if I think that's cool, or if it's scary that they think they NEED miracles!!!

States are cutting access to HIV drugs due to deficits. So when we need to cut a budget, we start with letting people die? Really? They couldn't find something else to cut, like all the government holiday parties maybe?

But hey -- it's Friday. That means we made it through another week, and it's almost time for our holiday break. So have a great day. Jennifer

Insurers to Be Required to Use Standard Terms to Describe Policies

No more jargon that none of us understands. Starting in March 2012, insurance companies have to describe their policies in clear, standard terminology, using a chart and definitions that are the same across the industry. This will make it easier for consumers to shop for insurance and know what they're getting.

The National Association of Insurance Commissioners is finishing up its work on draft rules for how insurers talk about their products. They will submit their recommendations to the federal government, which will issue regulations based on those recommendations.

Educated consumers will make better choices, and will know what they're buying. Power to the people, people! Jennifer

Thursday's First NEws

Oral arguments will be heard today in the Florida challenge to health reform. Meanwhile, the NY Times says the court cases about the new law highlight the partisanship among the courts. And pundits try to figure out what to do if the individual mandate falls. In many states, governors oppose reform but are still moving ahead with implementation -- what Politico calls a double-bind.

The White House is beginning a series of meetings between Don Berwick, head of Medicare, and stakeholders in the health debate -- primarily providers.

But here's how innovation will help us improve health care in America. Six large health systems -- Cleveland Clinic, Geisinger, Mayo Clinic and others -- are teaming up, pooling data on health care utilization to see what treatments are the most effective in terms of health outcomes and cost. This is really exciting. Here's more on this collaboration.

One bright spot in the fact that our health system keeps growing is that it's still creating employment opportunities.

And that's all the news for this morning. Have a great day! Jennifer

You've Got to Read This

HuffPo reports on the Republican strategy to de-fund health reform, which may include blocking the ENTIRE spending bill, effectively shutting down the federal government.

Really, is this what voters wanted when they voted Republican in November? A total standstill? Really? Personally, the threats and intimidation infuriate me. Jennifer

Hump Day Headlines

In what may be the most exciting news in our lifetime, HuffPo reports that a stem cell transplant cured HIV in one patient. If this turns out to be for real, we may see the end of this awful disease. Let's hope this is for real.

And in other news:

The Commonwealth of Virginia convened a panel to consider health reform. Although they are leading the charge against federal reform in the courts, their panel recommended implementing the health law and attempting to improve care.

The NY Times has a thoughtful piece on how opposition to the health law is steeped in tradition. Read the words that were said when Medicare was passed. Sounds very familiar.

Is the individual mandate necessary in order for health reform to work? I think so, but not everyone agrees. Here's WaPo's take.

A new study finds that the health reform law will help people close to retirement age.

Yesterday, HHS released a strategic plan for fighting multiple chronic conditions. We participated in a nationwide conference call yesterday afternoon about this initiative. To control health care costs, chronic illness must be dealt with, but how? It's great to see innovation happening in this area.

A special section on hepatitis from the patient's point of view.

A couple unites over cancer. Very moving.

Have you ever had c-difficile (c-diff)? I have. This new treatment seems sort of extreme, but c-diff can be so incapacitating that it's good to see new treatments coming to the fore.

The holiday season can be big on health issues. Here are tips from USA Today on how to avoid holiday heartburn. And here's a piece on seasonal affective disorder (SAD).

And that's it for this morning. Have a great one! Jennifer

Editorial: Health Law Will Survive

Attorney General Eric Holder and Secretary of the Department of Health and Human Services Kathleen Sebelius today published an editorial in which they argue that the health reform law will survive the legal challenges. They say:

The majority of Americans who have health insurance pay a higher price because of our broken system. Every insured family pays an average of $1,000 more a year in premiums to cover the care of those who have no insurance.

Everyone wants health care to be affordable and available when they need it. But we have to stop imposing extra costs on people who carry insurance, and that means everyone who can afford coverage needs to carry minimum health coverage starting in 2014.

If we want to prevent insurers from denying coverage to people with preexisting conditions, it's essential that everyone have coverage. Imagine what would happen if everyone waited to buy car insurance until after they got in an accident. Premiums would skyrocket, coverage would be unaffordable, and responsible drivers would be priced out of the market.

The same is true for health insurance. Without an individual responsibility provision, controlling costs and ending discrimination against people with preexisting conditions doesn't work.

Because this unfair cost-shifting of the expense of paying for the care of people who don't purchase insurance affects the marketplace, it is within Congress's power to regulate, say Holder and Sebelius. Read their whole editorial here. Jennifer

Tuesday Two to One Edition

That's two judges to one in favor of health reform's constitutionality.

As one would expect, the big news in health today is the judge's ruling saying the requirement that everybody buy insurance is unconstitutional. The NY Times says this is the beginning of years of wrangling among judges until we have a final ruling from the Supreme Court, and that's where the cases are headed, says WaPo. But however things turn out, there's no question that this ruling bolsters the GOP opposition to the law, so Republicans cheered the ruling, saying this is a great advance for liberty, some taking credit for forecasting the law's demise. Then again, the court didn't stop implementation of the law from going forward, which some see as a really positive step for health reform advocates. A good overview from the LA Times is here. USA Today thinks the law will be upheld in the long run, as do some bloggers. The Wall St. Journal explains how this ruling differs from the two upholding the law. And some criticized the judge, while the White House insisted that the law will be upheld.

Meanwhile, as Democrats try to tweak one part of the health law that everybody agrees should go -- the requirement that small businesses file 1099's for any vendor to whom they paid $600 or more -- Republicans stand in the way. Hate the law, but refuse to let it be fixed? They want to use this and other provisions for a piecemeal repeal of various parts of the law, so they don't want this fixed before they take power in the House, says Politico.

And there's more harm due to cuts in Medicaid due to state budgets.

In other news, we learned some more about Alzheimer's disease; and some more about ADHD. And why do we yawn? C'mon -- I know you always wanted to know the answer to that question! And did you know your senses of smell and taste would dull over time?

On a more serious note, have you thought about buying long-term care insurance? Are there better ways to plan ahead? WaPo discusses the options.

Doctors and nurses' weight biases harm overweight patients, says the LA Times. I could have told you that.

The President signed the child nutrition bill, expanding school lunches to more hungry kids, and making sure the menus are more nutritious.

Here are some exercises to help you maintain cognitive function as you creep into your 50s (ouch!).

Family in disagreement about how to handle aging parents? Try mediation.

And that's the way it is! Jennifer

White House Response to Health Law Court Ruling

Today’s narrow ruling in Virginia on the constitutionality of a provision of the Affordable Care Act is just one of many recent rulings on similar cases that have come down in recent months. Since the law passed, opponents of reform have filed more than 20 different legal challenges. Judges have already granted the Administration’s motion to dismiss 12 of these cases. And in two cases, federal judges looked at the merits of the opponents’ arguments, determined that the Affordable Care Act is constitutional and upheld the law.

We disagree with the ruling issued today in Virginia and the Department of Justice is considering its appeal options.

We are pleased that Judge Hudson agrees that implementation of the law will continue uninterrupted. In the nine months since the health reform law was passed, we’ve made tremendous progress to strengthen our health care system, including lowering costs and implementing a new patient’s bill of rights to end some of the worst insurance company abuses. That work continues. And we’re confident that when it’s all said and done, the courts will find the Affordable Care Act constitutional.

History and the facts are on our side. Similar legal challenges to major new laws -- including the Social Security Act, the Civil Rights Act, and the Voting Rights Act -- were all filed and all failed. Contrary to what opponents argue the new law falls well within Congress’s power to regulate economic activity under the Commerce Clause, the Necessary and Proper Clause, and the General Welfare Clause.

Opponents of reform claim that the individual responsibility requirement – the requirement that all Americans carry a minimum level insurance by 2014 –exceeds Congress’ power to regulate interstate commerce because it penalizes economic “inactivity.” Make no mistake -- individuals who choose to go without health insurance are actively engaged in economic decision making – the decision to pay for health care out-of-pocket or to seek uncompensated care. Every year millions of those who have chosen to go without health insurance actively seek medical care, which is evident in the billions of dollars spent on uncompensated care every year.

The Affordable Care Act came into being precisely because of the interconnectedness of our health care costs. People who make an economic decision to forego health insurance do not opt out of the health care market, but instead shift their costs to others when they become ill or are involved in an accident and cannot pay. Those costs – $43 billion in 2008 alone – are borne by doctors, hospitals, insured individuals, taxpayers and small businesses throughout the nation. This cost-shift added on average $1,000 to family premiums in 2009 and roughly $410 to an individual premium.

This concept is clearly seen in other areas of commerce. For example, in most states, drivers are required to carry a minimum level of auto insurance. Accidents happen and when they do, they need to be paid for quickly and responsibly. Requiring drivers to carry auto insurance accomplishes this goal. Similarly, the Affordable Care Act, through the individual responsibility requirement, will require everyone to carry some form of health insurance since everyone at some point in time participates in the health care system, and incur costs that must be paid for.

It’s no surprise then, that President Reagan’s Solicitor General Charles Fried recently wrote, “the health care law’s enemies have no ally in the Constitution.” Two federal judges that recently ruled on the challenge to the constitutionality of the reform law in Michigan and Virginia agreed. These lawsuits were dismissed, with the federal judge in Virginia concluding “how and when to pay for health care are activities…in the aggregate…substantially affect[s] the interstate health care market.”

Two federal judges have agreed with this argument. In an earlier ruling in the Western District of Virginia, a federal judge wrote:

“I hold that there is a rational basis for Congress to conclude that individuals’ decisions about how and when to pay for health care are activities that in the aggregate substantially affect the interstate health care market…Nearly everyone will require health care services at some point in their lifetimes, and it is not always possible to predict when one will be afflicted by illness or injury and require care…Far from ‘inactivity,’ by choosing to forgo insurance, Plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance. As Congress found, the total incidence of these economic decisions has a substantial impact on the national market for health care by collectively shifting billions of dollars on to other market participants and driving up the prices of insurance policies.”

The Affordable Care Act also bans insurance companies from discriminating against people with preexisting conditions. However, unless every American is required to have insurance, it would be cost prohibitive to cover people with preexisting conditions. Here’s why: If insurance companies can no longer deny coverage to anyone who applies for insurance – especially those who have health problems and are potentially more expensive to cover – then there is nothing stopping someone from waiting until they’re sick or injured to apply for coverage since insurance companies can’t say no. That would lead to double digit premiums increases – up to 20% – for everyone with insurance, and would significantly increase the cost health care spending nationwide. We don’t let people wait until after they’ve been in a car accident to apply for auto insurance and get reimbursed, and we don’t want to do that with healthcare. If we’re going to outlaw discrimination based on pre-existing conditions, the only way to keep people from gaming the system and raising costs on everyone else is to ensure that everyone takes responsibility for their own health insurance.

There have been many rulings on court cases regarding health reform and we know there will be many more. In the end, the Affordable Care Act will prevail and the American people will enjoy the benefits of reform.

Stephanie Cutter is Assistant to the President for Special Projects

Breaking News: Judge Finds Individual Mandate Unconstitutional

Politico is reporting that Virginia District Judge Henry E. Hudson has ruled that the portion of the health reform law that says people have to buy insurance is unconstitutional. This was expected. The government no doubt will appeal to the 4th Circuit, from where the case will go to the Supreme Court.

The judge did not stay implementation of the law, so the White House is continuing to move ahead while the case(s) progress. Jennifer

The I Hate Monday Edition

A judge in Virginia is expected to rule against the constitutionality of the health reform law TODAY. He signaled his negativity during oral argument, and the likelihood that the decision will come today has been floating since Friday. So check back here later today. His chambers says around noon.

The GOP blocks a bill to provide health care to 9/11 responders. Where's the morality in that?

Large employers -- what we call self-funded plans -- are getting ready for the health reform changes to kick in on January 1, when their new plan year begins. It seems they're focused on eliminating "Cadillac plans" although the tax on those plans doesn't kick in until 2018.

Should insurers that provide insurance through an Exchange starting in 2014 be allowed to cover abortion services when women pay for those services out of their own money? Expect the GOP to push for a "no" to this question. It's not about federal money going to pay for abortions -- that's already illegal. It's about insurers being able to cover abortion when paid for by private dollars.

Is there a way to facilitate organ donation? New York is going to try.

Do doctors already ration care? The NY Times says yes.

What to do about snoring.

Is mercury in fillings harmful? The FDA to look into it.

Half of doctors are using electronic records to some extent, says the CDC.

And that's the opening to the week. Have a good one. Jennifer

Why A Payroll Tax Cut is a TERRIBLE Idea

I'm not getting into the politics of tax cuts for the rich versus the middle-class, estate taxes, and all that other nasty stuff. But I have to make sure YOU understand why cutting the payroll tax 2 percent is a TERRIBLE idea.

Yes, it means more money in your pay check every week. But where is the money coming from? SOCIAL SECURITY!!! The payroll tax is the Social Security and Medicare tax. If we pay less into Social Security, it will just go broke that much sooner.

You want to give the middle-class a tax cut? Reduce the income tax 2 percent for a year. But do NOT cut payments into the Social Security system. Because it's the middle class who will suffer for that in the long run. Jennifer

Orszag on Disability

Former Obama budget director Peter Orszag argues that the disability system doesn't work. Once people go on disability, they become separated from the workforce and rarely re-enter the world of work. He suggests that employers be required to provide private disability insurance to workers -- something that has about as much chance of happening as, well, h*ll freezing over.

I've been arguing for years that there should be temporary, short-term (9 to 12 months) Social Security disability for people who need to recover from a surgery or get stabilized with treatment, accompanied by a streamlined application process for short-term disabilities. The five states that have disability benefits operate more like this. People can only stay on disability for that definite duration of time. After that, they have to apply for Social Security.

Orszag is right about one thing. People who are disabled but who would not otherwise be applying for disability are doing so because finding work is so hard. People with disabilities are more accepted in the workplace than they were before the Americans with Disabilities Act was passed. Until the recession hit, application rates were pretty steady. But now they've spiked. So a short-term benefit that would help people through a rough patch would hold the hope of employment in the future, whereas people who go on permanent Social Security disability are less likely to search for ways to re-enter the workplace.

Help those of us with temporary, duration-limited disabilities and you would reduce the cost of Social Security disability greatly. Jennifer

Finally Friday Edition

Here's a profile of the Department of Justice lawyer who's defending the health reform law. What a huge case to have on your shoulders. Very impressive.

The House has now joined the Senate in passing a delay in the Medicare rate cuts for doctors for a full year. The President is expected to sign it, so that puts this issue aside for a year.

Senate Republicans blocked a bill that provides health benefits to 9/11 workers. What are they thinking?

Although HHS is granting waivers to employers with limited benefit plans -- plans that cover as little as $2000 per year -- it is also making sure that employees enrolled in these plans are given notice so that they are not under the misimpression that they have more insurance than they do. New rules came out yesterday requiring employers to give their employees written notice about the limited nature of their plans. Although I don't like limited benefit plans, at least this way employees are not lulled into a false sense of security, thinking they have benefits until they get sick and find out that there's not much there.

Only half of women over 40 get mammograms. Really? If you haven't had a mammogram this year, call today to make an appointment.

And that's it -- a light morning today. Check back later to see if there's anything more, and have a good one. Jennifer

Thursday Morning Edition

A baby in Indiana needs surgery to save his life, but the State Medicaid program won't pay for it because it's experimental. Because it's a very rare condition, and you can't do placebo surgeries on babies, it will always involve small numbers of patients, and there will never be large, double-blinded studies. Like so many other treatments for rare conditions, this allows insurers and, in this case, state Medicaid, to deny coverage because it's experimental. But based on the standard of needing large, double-blinded studies, this and many other treatments will always be experimental. This is only one example of what Advocacy for Patients sees every day.

Women's health is declining, according to a new study by the National Women's Law Center. The number of women smokers has declined, but obesity is up, as is diabetes, high blood pressure, and STDs.

A new report from the Surgeon General stresses the harm from inhaling cigarette smoke.

Is there such a thing as chronic Lyme disease? The evidence is slimmer and slimmer, although there are still doctors who believe in it.

The National Institutes of Health has proposed adding a new center to accelerate the development of new drugs and treatments.

And here's a list of the top ten technology health threats.

The Senate passed the one-year delay on the Medicare rate decrease for doctors. The House still has to pass it. However, there are large cuts to home health agency reimbursement rates taking effect on January 1, and these may well hurt consumer access to these services.

Connecticut is the fourth healthiest state in the country, according to annual rankings. Where does your state fall?

That should start your day. Have a good one. Jennifer

Wednesday's News

Secretary Sebelius (HHS) says that health reform boosts quality of care, not just insurance coverage, through innovative approaches to health care delivery.

Health reform expanded drug discount programs, but somehow, that seems to have curtailed an important discount program for orphan drugs for children. If we had a Congress that could get things right, I would think this could be fixed easily. As it is, the children will suffer.

Health reform also is designed to encourage immunizations. Adults should have several vaccines. Do you have yours? It's about more than a flu shot.

The federal government continues to clamp down on health care fraud. Today, Abbott and two other firms settle a case for $421 million.

Some employers are offering wellness programs to cut down on health care costs.

Spotlight on caregivers, as AARP and Leeza Gibbons team up.

Doctors profit on prostate cancer treatments under Medicare. Through a process called self-referral, they refer patients to their own radiology practice for treatment, which pays lucrative benefits under Medicare. But does it work?

Meanwhile, the Senate appears to have reached a deal to delay implementation of a huge Medicare reimbursement rate decrease for doctors, for one year.

Have a healthy day! Jennifer

In Memorium

I can't start this day, or end it, without remembering two people who had a powerful effect on so many of us.

Elizabeth Edwards died yesterday. She was a tireless advocate not only for cancer-related causes, but for universal health care. She called it as she saw it -- and she saw the potential for goodness in America, the need for compassion for those less fortunate. She appealed to this greater good in us and made us better for it. This collection of tributes speaks to her impact.

John Lennon died 30 years ago. I was living on Long Island at the time, and going to Queens College. I remember crying and crying, and one of my professors saying he didn't understand what all the tears were for. After all, he was just a rock star. No. He was not "just" a rock star, although he certainly was one of the most important singer/songwriters of our generation. But more importantly, he had a clear-eyed vision of what it would take for this world to be a better place for all of us: Peace and Love. So simple. So impossible.

Imagine. A world in which people whose sole mission is to stop war and poverty and hunger and sickness are revered above all else. Both of these beloved souls showed us how. All we have to do is follow. Jennifer

Tuesday Teasers

Get your flu shot. Now. It may even be free under health reform.

Michael Kinsley ponders whether the GOP bid to kill health reform makes sense when considered in the context of their larger philosophy and, in particular, their opposition to judicial activism.

Meanwhile, Secretary Sebelius (HHS) promises new GOP governors the flexibility they need to implement reform in ways that make sense in their state.

And it appears that there may be a deal in place to fix the Medicare physician reimbursement rate decreases that were passed long ago, that have been delayed over and over again. The press account is vague, but it looks like the money is coming from subsidies to help people buy insurance through the Exchanges. I'd worry except for the fact that so much is going to happen between now and 2014 that I'm willing to take a "wait and see" approach.

UnitedHealthcare raises price of one brand of insulin, decreases price of another. What if the expensive one works for you and the cheap one doesn't? I'll never get used to this kind of gaming by insurers.

A survey finds that doctor-patient communication leaves much to be desired -- but when it works correctly, communication can lead to better health outcomes.

A fascinating article that begins to unlock the way the brain gets creative. I'm not sure I understand all of this, but it's really interesting. And here's a real world example.

Along similar lines, here's a medical mystery for you -- one that was found out and addressed in time to save a life. So interesting -- and scary.

A new study finds that aspirin helps reduce cancer deaths. But before you start taking aspirin, consult your doctor.

Guidelines for testing for food allergies in kids are revised. This looks like a step in the right direction.

And here's a tale of one hospital's efforts to cut hospital-acquired infections. We need to figure this out; we should be able to figure this out. Here's one strategy.

Primary care providers try to spot depression, other mental health issues, using screening tools.

Ever wonder how acupuncture works? Here you go.

And that, my friends, is an awful lot to swallow on a Tuesday morning. Take your time. Jennifer

P.S. - My thoughts and prayers are with Elizabeth Edwards and her family as she moves into the final stages of her illness. You done good, sistah Elizabeth. Now, you can let go.

What Will the Supreme Court Do with Health Reform?

Stuart Taylor predicts that the Court will base its decision on politics. Taylor -- contributing editor for Newsweek and the National Journal -- argues that, with no clear precedent, it's hard to predict. If it comes down to the question of whether Congress is doing the right thing, I believe that Justice Kennedy will side with the liberals and uphold the law. However, there's a judge in Florida and one in Virginia who seem to be leaning the other way -- and Supreme Court Justices Roberts, Thomas, Alito and Scalia will lean with them. So it's going to be a nail-biter.

And yes, you're right, politics isn't supposed to drive the Supreme Court. But it does, all too often. Jennifer

How to Save Medicaid

A special section in the NY Times -- how to save Medicaid. Different answers from different ends of the political spectrum.

One of the pieces is written by the sublime Judy Solomon, who saved Connecticut Medicaid for years and years until she moved to Washington. As always, she makes sense.

Jennifer

Monday Morning Round-Up

A smattering of news today.

The GOP unveils a devious strategy to unhinge reform. The Medicare cut in reimbursement rates for doctors that Congress keeps delaying a short bit at a time? Well, now the Republicans think they should use health reform dollars to pay for a permanent fix, which would totally undermine health reform. They'd cut the public health fund, which isn't at the core of reform, but this definitely would be a first step towards repeal. This seems particularly wrong since the Medicare cut was passed many moons before reform, so it's not like reform caused this problem. But rationality is not the goal, it seems.

Another GOP strategy -- let States decide on their participation in health reform.

A doctor in Baltimore facing suits over cardiac stenting that the government says may have been unnecessary. Apparently, Abbott Labs hired him even after he was barred from operating.

A new meningitis vaccine brings hope in Africa.

Do the Arizona Medicaid cuts -- eliminating some funding for transplants -- bode poorly for the nation?

Cuts in mental health services put law enforcement officers on the front line.

Eating disorders are hard to treat -- and expensive, since most insurance doesn't cover the treatment.

The federal government is putting up an internet database of federal workers' health claims. They say it will help to figure out what's working, what's necessary, what's wasteful, but others say it's a violation of privacy. No personal identifying information, but still -- do you trust this? It will expand to include high risk pools and publicly run multi-state plans starting in 2014.

A Connecticut study uses snakes to understand fear and how to rid people of it. YUK!

Happy Monday! Jennifer

Saturday News -- Chronic fatigue and other tidbits

The Red Cross bans people with chronic fatigue syndrome from donating blood. Chronic fatigue syndrome may be associated with a retro-virus that may be spread by blood transfusion. So the Red Cross decided not to wait for more conclusive evidence and exclude them from giving blood. So we can't prove they have a "real" disease, we have to fight like MAD to get disability benefits for them, but these patients' blood is not good enough for the general population? Talk about a raw deal. Either recognize chronic fatigues as a real, disabling illness or not -- but these half-measures are really hurting patients.

A Seattle doctor argues that patients must take more personal responsibility for their health. While I get his point and agree that patients have to participate in their own care and comply with doctors' orders, I don't much like his lawnmower analogy. I don't think people are quite the same as a lawnmower.

Doctors pledge to stop the overuse of radiation in a national program starting in Chicago.

That's it for today. Jennifer

WE WON!!!!!!!!!!!!!!!!!!!!

The Connecticut Insurance Department has denied Anthem Blue Cross's request for a rate increase! You can read about the decision here and here and here. The Department found the rate increase to be "excessive."

This is unprecedented in Connecticut, and shows what can be done to protect consumers when the State Insurance Department really does its job. Jennifer

Sound Off: Unemployment Benefits Foster Good Values

The now infamous Juan Williams, who recently was fired by National Public Radio for saying that seeing Muslim-looking people on airplanes makes him nervous, has something far more wrong and offensive to say. Appearing on his newly-embraced home, FOX News, Mr. Williams said that extended unemployment benefits foster the wrong values. He said that good values include showing up and dressing well. "You lose your work ethic" when you're out of work for an extended period of time, he said. Thus, he said, it's time to cut off unemployment benefits to give people the incentive they need to go back to work.

Setting aside how factually stupid these remarks are -- setting aside the fact that most people want to work, that there simply aren't jobs for everybody who's unemployed right now -- it seems to me that there is a competing set of values that we hold dear in America, and that's charity, compassion.

The unavailability of jobs is well documented. The unemployment rate actually rose in November. The fact that so many people are out of work is not the result of disincentives to work. While there may -- may -- be some people who, as the FOX News host speaking to Mr. Williams reported, are not looking for jobs because they get more money from unemployment than they could get from a job, this is not the majority. Of course, the way unemployment works, you cannot possibly be collecting more in unemployment than you were earning when you had a job. So the argument must be that you should give up unemployment benefits that are calculated based on what you were earning when you lost your job to take a job that pays far less money. But if you are faced with a mortgage to pay, a health insurance premium, and children to feed and clothe, should you be required to give up unemployment to take a minimum wage job -- assuming you can find one -- that would leave you and your family homeless and hungry? Is that what Mr. Williams is advocating?

The problem is not that people don't want to work; the problem is that there are not enough jobs. What are the GOP-ers planning to do about that other than give tax breaks to millionaires which they continue to claim -- despite forty years of evidence to the contrary -- will trickle down to create jobs for the middle class?

No, if I have to choose between the values of compassion and charity on the one hand and the values implicit in the work ethic -- showing up and dressing well, according to Mr. Williams -- I have no problem choosing. I'll take compassion and charity any day. We should be helping those who've lost their jobs. We should be ensuring that their families don't go cold and hungry and sick. We should give. Because everything you give comes back 100 fold. That is a core American value that I personally hold above most anything else.

So, Mr. Williams, I wish for you a lump of coal for Christmas. I wish that the gifts under your tree could be converted to jobs, homes, food, health care and given to those who need them. I wish that you could imagine what it's like not to have the option of taking a job, of showing up and dressing well.

It seems to me that the value you are lacking is a little bit of humility. Jennifer

TGI Friday Edition

I looked. I mean, I went through the NY Times, Washington Post, LA Times, USA Today, Wall St. Journal, Huffington Post, Politico, the Hill, the Hartford Courant, Connecticut Mirror and CT News Junkie, and there's just not a lot of health news this morning. Here are a few items:

Congress passed the child nutrition bill, expanding school lunches and setting nutritional standards for them. A rare show of bipartisanship, but a good one.

Meanwhile, Arizona has stopped paying for some transplant under its Medicaid program -- a certain death for some patients.

And here's some more on the report released yesterday about how states are handling requests for health insurance premium rate increases -- and the need for Connecticut and other states to beef up staffing and rigorous review if we are ever to get a handle on premiums.

That's it. If I find anything interesting later in the day, I'll let you know. Have a good one. Jennifer

States Need to Beef Up Premium Rate Review

Connecticut needs to do more to beef up health insurance premium rate reviews, says a new report by the Kaiser Family Foundation. Many states don't really scrutinize rate increases. If we're ever going to get a handle on insurance premiums, we have to get the states to protect consumers, demand transparency, and scrutinize rate increases.

This is an important report, not only for Connecticut, but for all the states that need to do something to control premium increases. Jennifer

Jonathan Cohn: The Senate's Object Lesson

The always brilliant Jonathan Cohn on why repealing health reform isn't quite as easy as it may have sounded.

Jonathan explains this week's efforts to repeal the requirement that small businesses file 1099 forms for all vendors from whom they purchase goods or services over $600. The business community -- including me -- are concerned about how burdensome this is, having to file a 1099 for every office supply company, printer, copy service -- all of the things that any business must spend at least $600 per year on. But when the Senate tried to eliminate it this week, they were unable to do so. Sure, they could repeal, but they couldn't figure out how to "replace" the revenue that is estimated to flow from this provision. There were two proposals, but they both failed.

So if there's no agreement on how to address a provision of reform that is pretty universally disliked and that is very small in the greater scheme of things, how does the GOP think it will repeal and replace the whole law? Not so simple, says Jonathan Cohn. I agree. But then again, I almost always agree with Jonathan. Jennifer

Thursday Morning News

Is some health insurance better than nothing? Not according to Senator Jay Rockefeller and others in the Senate. These are the so-called mini-med plans, some of which pay as little as $2000 in benefits annually. The claim is that consumers don't understand how limited their plan is until they get hurt or sick. I've certainly had calls from consumers like that. But is the right answer requiring the plans to explain their terms, or getting rid of the plans entirely? All of this goes away in 2014 -- if health reform survives that long.

Then again, premiums for employer-sponsored health insurance grew an average of 41% from 2006 to 2009 (so not because of health reform). Further proof that the status quo was unsustainable. Here's the full report -- how did your state do?

Congress messed up on the food safety bill, adding a provision assessing fees on companies that have to recall food in the Senate when such provisions must originate in the House. So that means this will take a do-over that probably won't happen in the lame duck session. Will the new Congress be willing to act in a bipartisan way, even on something as universally lauded as food safety? Senator Harkin says it will get done this week. I'm not holding my breath.

Especially since the House has stalled the child nutrition bill that would have expanded free school lunches and established nutrition guidelines.

A new report says health reform doesn't do enough to curb prescription drug price increases, and offers some interesting ideas, starting with publicizing the actual prices insurers pay for drugs. Can transparency solve this problem?

And here's a poignant piece about elder care and the challenges of caring for elderly parents.

Have a good day! Jennifer

Hump Day Health News

Today is World AIDS Day. Here are some ways to commemorate the date. But here's a sobering statistic: More than half of all Americans have not been tested for HIV/AIDS. Really? What are you waiting for?

A judge in Virginia granted the government's motion to dismiss a lawsuit seeking to find the health reform law unconstitutional. He found that the law does not permit federal funding of abortion. So two judges have found the law to be constitutional. Two other judges, whose rulings are expected soon, expressed great skepticism at oral argument. That sets up the disagreement that will wind its way to the Supreme Court.

In a unique show of bipartisanship, the Senate approved the food safety bill. The House is expected to pass it before the end of the year. This should protect the public better from nasty things like salmonella.

Should we pay people to lose weight, stop smoking? Is monetary incentive the right thing to do to make people healthy? I don't think a dollar per pound would change the results of my weight loss efforts. What do you think?

Here's more about a new kind of insurance called value-based insurance. You get things we know have value -- preventive screenings, for example -- for free, but you pay more out of pocket for things that are of questionable value.

As you know if you've been paying attention, quite a while ago -- long before health reform -- Congress slashed reimbursement rates for doctors under Medicare. However, because the rate reduction was so big -- about 25% -- doctors threatened to leave Medicare in droves and seniors reacted predictably with worry. Since then, the effective date of the rate decrease has been delayed . . . and delayed . . . and delayed. Will the see-sawing itself cost Medicare a bunch of doctors? Apparently so, reports Arielle Levin Becker of the Connecticut Mirror. Is there a long-term solution? Maybe, but it's painful for everyone.

And that's your morning round-up. Have a good one. Jennifer