Friday, October 29, 2010
Bookmark us today! Jennifer
A few other tidbits:
Sick Californians forgoing care because of high deductibles, even though they have insurance. This is actually happening all over. In our chronic illness survey, although over 90% had insurance, Medicare or Medicaid, half have skipped care due to cost. When reform fully kicks in, out-of-pocket maximums should change this -- I hope.
Here's a piece on the power of Vitamin D. Not the kind of thing I normally post, but taking huge doses of Vitamin D has made a huge difference in my quality of life, so I thought I would share.
Have you planned ahead for your death? I know it's a hard subject, but it's important to make your preferences known.
How can technology help manage chronic illnesses? This article explores the possibilities.
And finally, I love this article -- Bernie Siegel on how to avoid a health care crisis in America. I guess I'm just a Bernie Siegel fan!
That's a good start on the day. Have a good one. Jennifer
Thursday, October 28, 2010
First, the brilliant Jonathan Cohn writes: What if the President had not pushed for health reform? Would we be a whole lot better off? Would the midterms look different?
Still, the health reform law is unpopular in key House districts, where some Democrats will lose seats because of their pro-reform vote.
Part of the opposition comes from people who are seeing their insurance premiums rise. Insurers are blaming this on health reform, but the people in the know say that's just plain false. Everything I've read -- much of which is discussed in previous blog posts -- says health reform is responsible for 1-2% of premium increases. The rest is due to rising costs, including executive salaries and bonuses.
While we at Advocacy for Patients take no position on voting for particular candidates, we very much favor health reform as a good first step towards expanding coverage, thereby reducing emergency room visits and medical bankrutpcy when all of the changes kick in in 2014. We hope that you will read and listen and think carefully before casting your vote. At the very least, ask what the repealers will do instead of health reform to stop rising premium costs and increase coverage. If they have no answers, is repeal without replacement a reasonable position? You decide -- and please vote. Jennifer
Have you gotten your flu shot yet? Fewer people are getting them, risking a very serious illness. Some people think we should skip them, but most experts disagree.
Electronic medical records will be great when all doctors can share, but we're a ways away from that happening just yet.
How real is the mind-body connection? What you think can affect how you feel. Indeed, meditation can change the brain, says the new field of contemplative neuroscience.
And here are some stress reduction techniques I'll be trying.
That's it for now -- a light health news day as the elections take over the news for the next few days. And please, vote. Jennifer
Wednesday, October 27, 2010
Don't take my word for it -- READ, listen, decide for yourself.
- Health reform is not government run health care -- far less so than Medicare, Medicaid, the VA system, and other government health programs.
- Nobody will interfere with treatment decisions -- at least not any more than insurance companies, who already decide what you can and can't have (if this is wrong, why do I file hundreds of insurance appeals per year?).
- Health reform is not what's driving up premium prices by huge amounts. In fact, premium prices have been increasing in the double-digits for years. Health reform is estimated to account for 1-2 percent of this year's increases. The rest is insurance companies grabbing what they can.
Those are just three of the things that, when I hear them, I want to scream because people are buying this, and it's just plain false. For me, this isn't about Republican or Democrat; it's about the people who call me in desperation, who would be hurt if health reform were repealed. So before you vote to repeal health reform, make an effort to find out the truth. Don't take my word for it; read and listen and learn for yourself. You may be very sorry if you don't. Jennifer
If you're afraid of cuts to Medicare, here's something to really fear -- vouchers, or the privitization of Medicare, proposed by Rep. Paul Ryan (R-WI). Or maybe just the dismantling of the safety net we have in America for people who can't manage on their own?
If you repeal health reform, what do you do about the still unsustainable status quo? Apparently, the ideas are few.
The NY Times reports that the health reform vote is putting some Democrats on the defensive. I continue to believe that if they did a better job of explaining the new law, they wouldn't feel they have to apologize for voting for progress, however imperfect. It's NOT government run health care -- indeed, it's far less so than Medicare and Medicaid. That's the right answer, not an apology.
Here's an interesting article about the IRS rules for what counts as medical care eligible for deductions -- NOT breast pumps, but astroturf for a family with an asthma sufferer?
And here's something I didn't know anything about until today -- a panel of doctors who make recommendations about how doctors should be reimbursed under Medicare.
In the run up to the elections, please read and learn and decide for yourself. Jennifer
Tuesday, October 26, 2010
- I sort of love this article -- why talking to your sister will make you happy. Had to send it to my brother. I'm not sure why it's in the Health section of the NY Times, but it is, so I'm posting it here.
- How doctors can help people diet effectively.
- How health reform is already helping people with pre-existing conditions get coverage.
- Somehow we are not getting the message across to seniors, who are worried that health reform cuts Medicare benefits. It doesn't. It trims the subsidies to private insurers that run Medicare Advantage plans, and cracks down on fraud, but there are no cuts to Medicare benefits.
- Patients are playing a greater role in their post-op care, says Wall St. Journal.
- And finally, here in Connecticut, there are calls for the firing of the State Insurance Commissioner. He rubber stamped Anthem's 47% rate increases. Now that there's so much opposition, including from the US Department of Health and Human Services, the Commissioner says there will be a rate hearing. But that came too late, as so many of us have been offended by his initial refusal to take consumers seriously.
I'm off today to a very sad funeral of little Evan, who died at age 7 after a brave and fierce four-year battle against neuroblastoma. No child should have to suffer, and no parent should have to watch their child die. Whatever you're doing today, no matter how down you may feel, look at your kids or your nieces/nephews or neighbor kids and feel lucky. Jennifer
Monday, October 25, 2010
HuffPost Health will be a clear and balanced resource to provide a comprehensive view of the state of health and health news in a given day. It will provide a forum for intelligent discourse and divergent but respectful points of view. HuffPost Health will empower you with state of the art information you can use to make informed and intelligent decisions that affect your life in meaningful ways.
In this spirit, HuffPost Health's articles and videos will include the best of evidence-based allopathic Western medicine (including drugs and surgery), lifestyle and functional medicine (including nutrition, fitness, stress management, supplements, and love and support), mind/body medicine (including mental and emotional health), women's and men's health issues, and integrative medicine (including complementary and alternative medicine).
In addition to personal health information, HuffPost Health will address health policy issues. At a time when there is more controversy than ever about the roles of government and industry in health care, HuffPost Health will provide a place to have a lively dialogue from a wide variety of perspectives that may transcend the usual liberal/conservative dichotomies.
Of course, I will continue to summarize and post links to articles of particular interest, but if you're a real health news junkie, you may want to check out HuffPost Health yourself, too! Jennifer
Runners are healthy -- but they get injured. So are they good risks for insurers?
How will the new law affect employer-based insurance? Seems like a lot of conjecture since we won't really know until at least 2014. But people are saying this will be the end of employer-sponsored insurance; employers will give employees "vouchers" to buy insurance on the Exchanges. Is that the worst thing that could happen? What's wrong with giving employees more options? Or will it not work out that way? I think it's too soon to tell.
Patients are starting to behave like consumers when deciding on medical care, comparing price before making decisions about care. Is this good or bad?
A wonderful story about the family caregiver of the year. Amazing woman.
You want malpractice reform when doctors are still operating on the wrong patient, the wrong body part? If someone did that to me, I would hope there would be no artificial limit on the amount of damages I could collect.
Putting your medical records online -- good idea? Here are the top three companies, with reviews of each.
Why are we expected to be brave in the face of chronic illness?
That should get your day started. Have a good one. Jennifer
Sunday, October 24, 2010
Friday, October 22, 2010
I met Mike McCready and his amazing wife, Ashley O'Connor, in 2005. I had not really listened to Pearl Jam before then, although I am enough of a rocker that I'd certainly heard their big hits on the radio or an occasional Saturday Night Live or Letterman performance. Mike and Ashley and I met in a hotel bar. They listened to me talk about what I was starting to do, helping patients with chronic illnesses -- at that time, my focus was on my disease, inflammatory bowel disease -- with insurance appeals and answering legal questions, all for free. I hadn't figured out how I was going to organize or raise money or anything; I just knew there was a real need and nobody was filling it -- and I knew I could do it if I could figure out the logistics.
Mike and Ashley encouraged me to start Advocacy for Patients with Chronic Illness. Indeed, they pledged to support Advocacy for Patients if I moved forward.
They have been true to their word. In 2006, when Pearl Jam played Hartford, I hung out backstage with Mike and Ashley, and then Mike and Ed presented me with a check for $21,171 -- $1 for each ticket they sold in Hartford. It was that donation that allowed me to start working at Advocacy full time.
In the years since, Mike and Ashley -- both themselves and through Pearl Jam's Vitalogy Foundation -- have kept us afloat. Because of Mike's support for our work, the Wishlist Foundation also has become a major supporter (and many of its members have become dear friends). The annual Flight to Mars benefit concert in Seattle has become a benefit mostly for Advocacy for Patients. Mike even brought me onstage with Pearl Jam this past May here in Hartford, dedicating a song to me!
Needless to say, I have become a major Pearl Jam fan. They are one of the greatest live bands I've ever seen -- and I've seen enough so that's a big statement. Their spirited music and spiritual lyrics -- their commitment to their fans -- puts them right up there with the best live bands ever -- Springsteen, the Stones, the Who. If you're a classic rock junkie like me and you haven't really listened to Pearl Jam, do yourself a favor and take a listen. You can even listen to Pearl Jam Radio free on their website.
Mike writes "How I choose to feel is how I am." He is, indeed, the real deal. Without him and Ashley, those of you who have needed my help would not have gotten it. Without Mike and Ashley, I never would have had the guts to take this risky plunge, starting a nonprofit despite being sick myself. Without Mike and Ashley, I never would have had the great honor of working for other patients, sometimes even saving a life, and hopefully improving the quality of life of thousands of patients over 5 1/2 years.
I love Mike McCready and Ashley O'Connor. It's not about the money; it's about the fact that the money speaks what's in their heart. They believe in what Advocacy for Patients does. They believe in me. And I have never been given a greater gift. Ever.
And so, on this the 20th anniversary of Pearl Jam's first gig together, I celebrate the mysterious forces that brought those five guys together into a cohesive ONE that is one of the best rock bands to ever exist. I celebrate my friends Mike McCready and Ashley O'Connor. I celebrate all of the Pearl Jam fans who have supported the band, which in turn has supported Advocacy for Patients. I could not be more grateful to Mike and Ashley, the other members of Pearl Jam, the Wishlist Foundation -- and the great good fortune that we all crossed paths in this life.
Happy anniversary. Here's to 20 more years together. Jennifer
I think, though, that in the give-and-take of politics and public policy making, it’s important to ask: What’s the alternative? What do we do if we don’t do this? And can we come up with a better way? No one claims to have the right answer, or the right solution, right down the line. In each one of the questions involving public policy and health today, in this legislation, and this act.
At the end of the day, the question is: How do we find ways to improve it? Not repeal it. We know the status quo is unacceptable. We know that we can’t do what we were doing for the last 20 years without serious repercussions regarding cost access and quality. We’ve got to find ways to make this better. I think this legislation is a good framework to do so.
The wonderful Dr. Pauline Chen asks whether, in taking precautions to treat drug resistant infections, do we lose sight of the person? All of her articles are well worth reading, so enjoy this one.
And here's a portrait of the costliest patients in hospitals.
WaPo reports on a 30 year jail sentence imposed on a doctor whose fraud in writing prescriptions for narcotics is linked to dozens of overdose deaths.
Here's more on yesterday's National Association of Insurance Commissioners' vote on the medical loss ratio rules (see yesterday's two posts for more detail). The Wall St. Journal says the new rule is particularly bad for insurance agents/brokers as their commissions were categorized as administrative costs, which will be limited by the new rules. The Department of Health and Human Services will review the NAIC's recommendations and then put out their own final regulations, on which we will have an opportunity to comment.
And HuffPo says enemies of big government health care are hypocritical when they defend Medicare against all attacks.
USA Today reports on the epidemic of diabetes taking hold in America. By 2050, one in three people will have it. We'd all better start paying more attention to how and what we eat.
That's a good start on the day. Enjoy! Jennifer
Thursday, October 21, 2010
Meanwhile, the Pre-existing Condition Insurance Plans that were created this summer are off to a slow start. Here's the story of a woman in California who paid her premium in August but still doesn't have coverage, although according to HHS, all of the other states that are running their own plans are up and running. About 20 states -- those who oppose reform, for the most part, have declined to set up Pre-existing Condition Insurance Plans, allowing the federal government to run those plans instead.
And here's a story of a brave woman who fought her health insurer after it left her with a $450,000 bill after her husband lost his battle with cancer. Amazing how people find ways to fight no matter what. Perhaps her story will inspire you a little on this Thursday afternoon. Jennifer
The medical loss ratio is in the news again today. Remember, the medical loss ratio is the portion of premium dollars that are spent on health care. The idea is to limit administrative costs to only 20-25% of premium dollars. Well, the National Association of Insurance Commissioners was tasked with coming up with rules for what counts as health care and what's administrative since there are lots of things that could be either. They are meeting in Florida this week, and are expected to vote on their proposed plan today. This is critical. Controlling the percentage of administrative costs is one of the first pieces of the cost control picture to take effect under the new law. Secretary Sebelius will review the Association's proposal before it becomes final.
In other news, the LA Times tells us how the new law affects college students, allowing them to stay on their parents' policies to age 26.
The Wall St. Journal says house calls are back! The medical team coming to you, plus using technology to deliver care by phone, email, and monitoring devices.
A small sampling to start the day. More later. Jennifer
Wednesday, October 20, 2010
There's a major problem with the Americans with Disabilities Act as relates to chronic illness. If you have an illness that meets the definition of disability -- your illness substantially impairs a major life activity, such as seeing, hearing, walking, bowel function, digestive function, immune function, etc. -- you'd think you can't be fired for being out sick, or being late to work. Unfortunately, that's not true. See, in addition to being "disabled," you have to be a "qualified individual." A "qualified individual" is one who can perform the essential functions of the job with or without accommodation. For most jobs, attendance is an "essential function." So if you can't make it to work on a regular basis, you aren't a "qualified individual" and, thus, you are not entitled to the protections of the Americans with Disabilities Act.
The exception, of course, is the Family & Medical Leave Act. If you work for an employer with 50 or more employees and you have been there for a year, you are entitled to FMLA leave -- up to 12 weeks of unpaid leave in a 12 month period. If you take FMLA leave, you can't be fired until you've used it all up. FMLA leave can be taken intermittently, a few days here and there. You have to provide a medical certification, but not your whole medical record. One you use up your FMLA leave, though, you can be fired for absenteeism.
I understand why employers -- especially smaller employers -- can't hold jobs open forever. In some cases, though, I think people could work at least part-time from home, and that would help a lot. But employers seem to be very aggressive even about FMLA. I spoke with a woman last week whose employer sent her for a second opinion when she asked for FMLA leave (she's taken FMLA leave before and her employer is clearly trying to squeeze her out). An employer can only ask for a second opinion if they have reason to doubt the medical certification, but that didn't apply in her case. Still, she's so worried about losing her job that she won't let me intervene. And I understand that.
I spoke to another person last week who was a sales rep for a company -- independent contractor rather than employee -- and he was fired after 23 years because he was sick and was servicing his accounts by phone and email rather than in person. Even though his production numbers stayed high, the company wouldn't let him stay on. Since he was an independent contractor rather than employee, the ADA and FMLA don't even apply.
The stories are all too common these days. Employers are laying off people left and right, so it's no surprise that they'd choose to lay off the people with attendance or other problems. But it's also so unfair to people with disabilities. The law is there to prevent this sort of discrimination, but when it comes to absenteeism, the FMLA is the only protection we have.
So yeah, this is Disability Employment Awareness Month. What I'm aware of is how unequally people with chronic illnesses are treated. Jennifer
Two new studies on how to make surgery safer -- always a good thing, obviously! More about these studies here, as well.
Scientists identify a gene that makes people more susceptible to alcohol and more likely to develop alcoholism.
That's it for now. Jennifer
Both the NY Times and the Wall Street Journal report on a different type of initiative for cancer patients. The Wall St. Journal says Unitedhealthcare will be paying doctors a set price for treating a cancer patient no matter what drug they use. The idea is to take away any incentive to use more expensive drugs. What if a patient needs the more expensive drug? The doctor has to eat the cost? The NY Times article is broader and talks about several initiatives by different large insurers. Apparently, an Aetna program found that when doctors stick to standard treatments, costs fall and patient outcomes do not change. If the more expensive drugs don't have any positive effects, is it okay to make it harder to get them? Again, what if you're the one patient who needs the more expensive alternative? Apparently, the doctors will check each other's charts and make sure nobody is skimping on care.
Innovative approaches to patient care are sorely needed. In every case, though, they must be balanced against patient care. The hard choices will be for the patients on the fringe, who don't respond to the less expensive treatments and need the more expensive drugs to function -- indeed, sometimes to live. This is all very interesting and rational until you're the patient who can't get what you think you need. I don't have all the answers and I applaud those who are trying to come up with solutions. But these programs need to be monitored carefully to ensure that we are not denying patients the care they need. Jennifer
Tuesday, October 19, 2010
Here is a GREAT Q & A about health reform, exposing some of the lies, explaining some of the details. We need a reality check once in awhile, and here's a very good one.
Here's an article about waiting times in doctors' offices and what to do about them.
The federal government has asked the Connecticut Insurance Department to reconsider Anthem Blue Cross's rate hikes, which are as high as 47%. This outrage is emblematic of the Connecticut Insurance Department's refusal to consider consumers when making decisions. They don't seem to be persuaded by the feds, either. Here's another piece on the same issue. The State applied for and received a $1 million grant to beef up their rate review process, and the feds want to know why, then, there were no hearings or transparency around these rate hikes.
And here's a little more local news. Medicaid managed care organizations reaping profits off of providing health care to the poor, while the State keeps writing the checks.
That's it, folks. Sorry it's so short, but check out yesterday afternoon's post, which is full of what's in the papers today. Jennifer
Monday, October 18, 2010
What's it like to live to 100 years old? Here you go.
Can we push ourselves through the pain, like the great athletes do? Should we?
Do you sit at a desk at work all day? Perhaps you should try standing -- a standing desk, that is.
More on my level, does exhaustion threaten your health? I thought so. "Your mood and your gut function" are intertwined. I knew that. Now, I need a doctor to prescribe me a month off!
A judge in Virginia says he'll rule on health reform litigation by the end of the year -- and notes he's just a stop along the way to the Supreme Court, no matter how he rules. And a new poll sees support for reform dipping BUT a greater number say they will vote to protect reform!
Just think -- you're now way ahead of tomorrow morning's papers! Jennifer
WaPo says switch up your CPR technique. The LA Times as well.
LA Times says the feds are investing heavily in elementary schools to prevent mental illness.
Here's another really important piece on selecting a Medicare Part D plan. Seniors and disableds, please take notice -- this is really critical advice.
Long term care insurance premiums soar -- and we get so many complaints on these plans not paying benefits at all -- I'm not sure this is money well spent.
That's it -- a short round-up to start off your week. Jennifer
Saturday, October 16, 2010
Here's really important advice on choosing a new Medicare Part D plan during open enrollment. Start to review plans now, they say.
Beware of miracle cures, says the FDA, according to USA Today.
In an interesting strategy, several Democrats running for office are asking for a chance to fix the health reform bill. Actually, I sort of like this approach. We all know health reform had to happen. We all know the bill that was passed is better than nothing, but still flawed. We need to focus on cost the next time around, now that we've addressed coverage. Rather than trying to turn the clock back and repeal -- since some of what's been done is absolutely right and good -- why not look forward to how to fix?
And the Wall St. Journal explains one of the benefits of electronic medical records -- one of the things, by the way, that health reform got right.
That's enough work for me on a Saturday. Enjoy the day. I know I will! Jennifer
Friday, October 15, 2010
I'm sure you've all read and heard that a bunch of big banks have had to stop foreclosures because it turned out the bank didn't do the paperwork correctly. Well, here's the thing. You have a right to force the bank to produce the original copy of your mortgage if they want to foreclose on that mortgage. Go to the clerk of the court and ask for help in serving a subpoena. Serve a subpoena on the bank demanding that they send someone to court with your original mortgage. When you all show up in court, ask the bank person to take the witness stand and produce the original mortgage. If they can't produce it, they can't foreclose. The original is the "best evidence" under the Rules of Evidence. Tell the judge the best evidence rule applies and the bank is required to produce the mortgage. The bank will beg for a postponement, but then they will have to go searching for the original mortgage. And if they can't find it, or don't have it because they bought your mortgage from someone who bought your mortgage from someone who bought your mortgage -- you WIN!
It's not hard. You can do it yourself. As I always say, Know Your Rights! Jennifer
Our friend Walecia Conrad writes a really helpful article on what to look for at open enrollment time this year.
USA Today says meditation helps depression and fatigue associated with multiple sclerosis. I suspect it helps depression and fatigue -- period!
Meanwhile, HHS Secretary Kathleen Sebelius urges states to push insurers into offering child-only policies despite the elimination of pre-existing condition exclusions. She says insurers have reneged on a previous commitment. So although she can't force them to offer these policies, she urges states to put pressure on insurers, as she is doing as well.
Finally, in Connecticut, Anthem is raising rates as much as 47%. The insurance Commissioner blames this on health reform, but there is no indication whatsoever that the provisions of health reform that have kicked in really cost anywhere near this much. And we know Anthem has been raising rates hugely each year for the last 5 years, at least -- our policy has gone from $440 per month in 2005 to $1165 per month today -- and health reform had nothing to do with that. The mandate to cover kids to age 26 existed in Connecticut before reform. Coverage of kids' pre-existing conditions already existed in group plans. In short, the changes so far have been modest, and Kathleen Sebelius has already criticized many insurers on a national basis for falsely stating that reform is the reason for rate increases this year. But the law leaves a lot in the hands of state Insurance Departments. And as long as we have an insurance Commissioner who's opposed to reform and refuses to crack down on these crazy rates, this will continue to happen.
And that's my morning news round-up. Have a great day! Jennifer
Thursday, October 14, 2010
The discussion was remarkable for several reasons. First, both speakers are really brilliant, and they have a tremendous grasp on what's at stake in health reform. They said, as I have said over and over in the last two years, that the status quo is unsustainable. Health care costs are growing like mad. Insurance premiums are becoming an ever-greater portion of each American's budget. And exclusions of coverage of pre-existing conditions were (still are) causing too much hardship. Something had to give.
The speakers don't agree on many things from there on out; one is a liberal/progressive and one is a conservative. So one likes the public option and one doesn't. One thinks reform falls apart without the requirement that everybody have insurance because you need the healthy people in the pool to balance out the sick people, and the other disagrees. They both recognize that we have only taken a first step -- addressing coverage -- and that we still have to address cost. The way Len Nichols put it was helpful to me -- he said we need a realignment of incentives so that we can get a handle on cost. We have 1300 insurers in America, he said, and we probably need about 200 of them. And patients have to be given incentives to get the right care at the right time the first time. And we have to shift from pay for volume to pay for value. All of this is way more complicated than it sounds. But, as Dr. Nichols said, we have to do it because we can't keep going the way we're going. We simply don't have a choice.
What was perhaps the most remarkable thing of all, though, is that this was a completely civil -- indeed, humorous at times -- conversation by two people who have honest, good faith disagreements about how to fix the mess we're in. None of the name-calling, accusatory, demeaning, and disrespectful rhetoric we've come to expect when people differ on this issue. Nobody threw a book at anybody. Nobody called anybody a socialist. It was a reasonable and reasoned conversation between two very smart, well-informed gentlemen who both want the same thing: a healthier, financially sound America. It is only through this sort of bipartisan discussion that we are ever going to get this right.
All the people in America who are screaming at each other need to take a lesson from these two gentlemen. We have to be able to talk this through. Both Stuart Butler and Len Nichols provided an example for us all. Jennifer
Stay tuned. Jennifer
On the good side, the feds took down a massive Medicare fraud scheme that used identity theft to collect money for services never rendered.
The LA Times reports on doctors using social networking to market their skills. The Times also reports that they've caught Wellpoint (Anthem) in yet further lies about their policy of canceling policies when they discover that the insured is sick, called rescission.
Do Americans really want to repeal the whole health reform law? This Republican pollster says no.
That's it for now. A light news day for health care. Jennifer
Wednesday, October 13, 2010
Until I looked at the Hartford Courant. Strangely, it's the only paper I read this morning that reported on a new report from the House of Representatives Energy and Commerce Committee that says that the four biggest insurers in the United States denied coverage to 651,000 people due to pre-existing conditions over three years. Those were people who applied for insurance and were turned down by Aetna, Humana, Wellpoint (Anthem), and UnitedHealthcare.
I later found an article on the same report in the Wall St. Journal. The way they put it is that these four insurers denied coverage to 1 in every 7 applicants.
And this, more than anything else, is why health reform ended up winning the day. We simply cannot have a large class of uninsurable people who are sick and in need of health care. Those are the bankruptcies. Those are the diseases that get so out of control that they end up in emergency rooms that can't turn them away like the insurers did.
The insurance lobby would have killed any attempt to force them to enroll people with pre-existing conditions without also being assured that they would get a bunch of healthy new enrollees to balance things out. And so we got the individual mandate that everybody buy insurance. But we couldn't force people to buy insurance if they couldn't afford it, so that's how we got subsidies. There are lots and lots of other details to the law, but this is its core.
And why is this number -- 651,000 -- not worthy of mention in the national press? After all, it's not just a number; it's people whose lives have been deeply affected by this.
I'm not surprised, but the number, to me, is jarring. A whole lot of people who wanted insurance, could afford insurance, but couldn't get insurance due to pre-existing conditions. And those pre-existing conditions include things as benign as high blood pressure even if controlled by medicine, or as astounding as a history of domestic violence.
Had the insurance industry really wanted to avoid reform, these are the people they had to find a way to cover. They didn't. We had to do something. 651,000 people said so. Jennifer
Tuesday, October 12, 2010
A new antibiotic-resistant bug found in India -- sounds scary, especially for those of us with suppressed immune systems.
Premiums and other out-of-pocket expenses will increase in 2011. When will the insurers start working with us to control costs? And don't let anybody tell you it's because of health reform. Large group plans that don't change dramatically aren't subject to most of the law's new provisions, so they're raising prices for the same reason they've done so over the past few years.
The first stem cell treatment is underway. If this works, it will revolutionize medicine.
Doctors learn it may be about more than medicine in this program to teach urban medicine.
Politico explains the role of state races on health care -- it's not all about repeal in Congress. It may also be about implementation on the state level.
An interesting crop today -- enjoy! Jennifer
Monday, October 11, 2010
An alternative to primary care docs or ERs, urgent care clinics.
Washington area hospitals shift to private rooms.
Tea Partier Rand Paul says wealthy should pay more for Medicare.
New poll shows how complicated Americans are -- we want smaller government, but we want Social Security and government regulation of fields like health care. Hmmm.
It's getting close to open enrollment season. The Wall St. Journal tells us what to expect.
And here's a really interesting piece -- a cure for autoimmune disease? Worth a try.
Saturday, October 9, 2010
There's lots more to read, but nothing big on health care. So enjoy the day! Jennifer
Friday, October 8, 2010
And an interesting piece of irony. One of the leading opponents to health reform is Alaska Senate Tea Party candidate Joe Miller apparently received Medicaid as a child. So government-run health care was okay for him but not okay for the rest of us? Hmmmm. (And this is not partisan -- I'd have posted this about a Democrat!!!).
Finally, USA Today says that 13% of kids WITH insurance are skipping health care due to costs. That's what you call under-insurance. Full implementation of health reform in 2014 can't come soon enough.
That's it. Seems like a light health news morning. But check back in later. Jennifer
Thursday, October 7, 2010
I am writing as a consumer representative to underscore the critical importance of the new appeals provisions, especially as they apply to self-funded plans.
Advocacy for Patients with Chronic Illness, Inc. provides free information, advice and advocacy services to patients with chronic illnesses nationwide in areas including health insurance. In particular, we file hundreds of insurance appeals each year all over the United States, with both fully-funded and self-funded plans. Thus, we have both expertise and experience that underscores the importance to consumers of the new appeals procedures.
I personally have been filing insurance appeals for fifteen years. During that time, by far, the most important consumer advance to have occurred is the advent of the external appeal. The cases we take are extraordinarily challenging, cases that no consumer possibly could pursue on his or her own. Most of them involve off-label uses of drugs or devices, or other tests or treatments that insurers claim are experimental or investigational. These appeals require research in the medical literature as well as collection and summarization of the patient’s medical history to show that all traditional treatments have been tried and failed. More often than not, we lose at each level of internal appeal; however, about eighty-five percent of the time, we win at external appeal based on an independent review. Thus, the importance of these independent reviews cannot be over-stated.
Many self-insured plans have adopted independent reviews as the final step in the appeal process, and these independent reviews have generated similar results. We have won appeals on independent review initiated by the plans for Chrysler and General Motors, as well as several smaller self-funded plans.
Indeed, this week, we won an independent review of the decision of a self-funded plan after a particularly protracted battle. About a year ago, a woman with occipital neuralgia who had tried all traditional therapies sought prior authorization for implantation of an occipital nerve stimulator – the only treatment she had not previously tried. She pursued all levels of appeal and lost at each one. During the final internal appeal, she had an opportunity to address the appeal committee, which urged her to seek a second opinion at a teaching institution. Thus, rather than pursue independent review at that time, she agreed to seek further medical advice. Upon so doing, the same treatment was recommended, and a physician at a teaching institution submitted a new request for prior authorization, which again was denied. At that time, the consumer contacted us and we agreed to represent her in her appeals. We did an extraordinary amount of research and submitted an appeal consisting of over 500 pages of medical records and medical journal articles. Our internal appeal was denied yet again. However, this time, we pursued the independent review. While that review was pending, the consumer became so ill that she reluctantly decided to take a disability leave from work. Later that same week, we got word that the independent reviewer had decided in the consumer’s favor. She now feels hope that she had all but given up on.
This is not an unusual occurrence. Indeed, on occasion, we have even waived internal appeals to go immediately to independent review, and have prevailed.
Without independent review, though, consumers enrolled in self-funded plans are left without recourse. We recently handled a case for a consumer with gastroparesis, paralysis of the stomach. Several years ago, she had undergone surgical implantation of a gastric electrical stimulator which had completely alleviated her symptoms. However, the battery died and she needed to have the battery replaced. Unfortunately, her husband’s employer switched to a different third-party administrator (TPA) in the interim, and the new TPA denied the claims related to battery replacement on the ground that the device was experimental/investigational because it was approved by the FDA under a humanitarian device exemption rather than full pre-market approval. Although there now is published medical literature spanning ten years demonstrating the efficacy of this device, and although we knew with certainty that the device worked in this case, the TPA denied the claim. We then appealed to the plan administrator, who said he would not even consider overturning the TPA. There was no independent review. This matter now is pending in federal court.
This is a particularly salient example because we have filed more than fifty appeals for the gastric electrical stimulator over a six-year period and we have lost only one appeal on independent review; in every other case, where an independent review was available (and even in most internal appeals), we have won. Had we had the opportunity for independent review in this case, we firmly believe that this consumer would not have had to seek recourse in federal court.
Due to the Patient Protection and Affordable Care Act (ACA) and the implementing regulations, the next time that consumer’s device needs a battery replacement, the entire scenario will be different. Not only will she have a right of independent review, but we contend that the TPA and plan administrator will take a more careful, reasoned approach knowing that an independent reviewer will be looking over their proverbial shoulders.
If, as we have heard, self-funded plans are complaining to you and Secretary Sebelius about the external appeal and interim procedures, it is for just this reason: They are afraid that, if their decisions are subjected to independent review, their noncoverage decisions will be reversed. If they were not afraid of that – if they were confident in the propriety of their coverage denials – they would have nothing to fear from external appeals. The fact that self-funded plans are complaining about these new requirements is evidence in and of itself that the new requirements are necessary.
We understand that you and Secretary Sebelius have found it appropriate to waive certain requirements of the ACA in special cases, such as limited benefits plans. However, this is not such a special case. Indeed, of all of the provisions of the ACA that are taking effect now, we would argue that this one will have the most immediate meaning for consumers. Thus, we urge you to stand strong with consumers on this point and move forward with full implementation of the new appeal rules and, in particular, independent reviews of decisions made by self-funded plans.
Jennifer C. Jaff
Here's more on the Michigan judge's decision to uphold the health reform law. And here's a little more. No doubt this will head up the chain -- in fact, next stop will be the Sixth Circuit, which is where I clerked for Judge Danny Boggs -- who is conservative (yes, I clerked for a conservative judge) and I suspect will look for a reason to reverse this decision. No matter, because it's going to the Supremes.
And that's it for today. Tune in tomorrow for more from the world of health care. Jennifer
A federal judge in Michigan has upheld a provision in the health care reform bill that requires uninsured individuals to buy health insurance. The judge found that the so-called individual mandate is within the power of Congress under the Constitution. Other lawsuits challenging President Barack Obama’s signature initiative are working their way through the court system
This is the Advocacy for Patients blog. Because I believe that any division of the public and private, the personal and the professional, are artificial divisions, I have shared a lot of personal content on this blog along with lots of information about health care and health reform. Many of you have commented about the more personal posts very favorably, and I appreciate how warmly you've received my own musings about my struggles.
However, this is, in the end, a business. Just because I believe that sharing my experiences as a patient with a chronic illness is helpful to other patients with chronic illnesses does not mean that anybody who visits this blog will understand why I'm bringing personal issues to work with me. And because we are a business, and a business has to make money, what other people think has to matter to me.
And so, at the urging of a very well-established gentleman who was kind enough to take a look at Advocacy for Patients and paint me a picture of some of my realities -- some of which are very hard for me to accept -- I am going to stop treating this blog as my personal journal, and instead focus on the business at hand.
That does not mean that I'll never write anything personal again. I'm sure I will; it's who I am. I love to write, and writing helps me think things through. And really, when you're trying to teach others how to cope with chronic illness, sometimes using yourself as an example is effective. I will always share what I learn about living with chronic illness. But that doesn't mean sharing all of my inner demons.
To those of you who have supported my journaling here, thank you. You have helped me more than you can know. Look for more personal things on my personal Facebook page. Who knows -- maybe I'll end up starting a personal blog. But from here on out, the Advocacy for Patients blog will be the Advocacy for Patients blog, not Jennifer's journal. I hope you understand. Jennifer
The NY Times reports that the federal government is creating waivers for limited benefits plans or "mini-meds." Although these plans provide very minimal benefits, I guess they are better than nothing until the subsidies are available for full-blown insurance in 2014.
A new huge website answering health questions, Sharecare.com, goes live today. But beware that a lot of the answers come from marketers.
Consumer reports lists the best health plans.
More on medical loss ratios. I know it's wonky, but it's one of the most important pieces of reform because it limits the amount of premium dollars insurers can spend on administration (versus paying for health care).
There are a couple of articles today on how opposition to health reform is influencing campaign donations. The LA Times tells us that health insurers are pouring donations into GOP campaigns; and Politico says doctor groups are funding campaigns of doctors running for Congress.
That's it for now. Jennifer
Wednesday, October 6, 2010
I'm reading Geneen Roth's Women Food and God, and it makes a very similar point. Indeed, most of the things I read that talk about how to feel better about yourself and your life make the same point, including all of the Eastern theology/meditation texts.
And so I will focus on the present and try to live here and now. Jennifer
The NY Times has an interesting piece on how health reform is upsetting the status quo -- a good thing.
Politico says that, although the health reform law contains strict prohibitions on the use of federal funds to pay for abortion, that's not good enough for some anti-abortion activists.
And Tom Daschle says that the reform law is still vulnerable (is this news?).
Some say Mitt Romney needs to apologize for his role in health care reform as Governor of Massachusetts if he wants to run for President in 2012.
Actually, it's a light news day in the health area today, following the last two very busy days. But check back later for afternoon updates, if there are any. And have a great day! Jennifer
Tuesday, October 5, 2010
Ellen thought I was trying to avoid talking about my weight and the fact that I'm not losing any. No, I don't think that's it, or not quite.
I feel trapped. I keep thinking of how well I did in Miami, swimming an hour a day, losing weight, getting tan and fit -- and I keep thinking: How can I do this now? If I swim an hour instead of a half hour, then I start my day later, then I don't have the time in the morning before the phones start ringing and people start showing up to ease into the day at my own pace. Everything feels like that -- like I have no wiggle room. I answer every email in the day I get it, every phone call the day it comes in. I don't stop working at night until everything I have to do is done. I start every day with nothing to do until I get medical records or a release or whatever else I'm waiting for from clients and doctors. I am afraid, if I let things pile up, everything will become overwhelming and out of control.
I know this feeling. I've felt it before. This is very old. This fear of letting things get even mildly out of control, of things piling up.
I'm driving myself so hard. It started when I started practicing law. I had to get there earlier than anybody else; leave later than anybody else; get more done in a day than anybody else. Not because I was better than anybody else, but because I wanted the approval of the man (yes, man) I was doing it for.
And so it snaps -- this is me taking care of my mother for my father, wanting to be my father's ally, his team-mate. I kept things running at home for him so everything would look okay to the outside world. So when I went to work for a male attorney, I did the same thing for him. And then the Attorney General, and I did the same for him. And since then, I have completely lost track of why I was doing any of this. I've just been driving myself into the ground. And eating for a whole rash of reasons, not the least of which was that I am so incredibly tired that the urge is to eat for energy.
My life has become about everybody but me. I care for thousands of people a year. I spare no cost. I get up at 4:30 am to read all the newspapers before I go swim so that YOU will have a blog post summarizing the morning's health-related news first thing, and the same on Facebook. I swim at 6 am, am finished, showered and dressed by 7:15 or so, and then I have breakfast and get to work. I work until there is nothing left to do. I even make sure Facebook's quiet before I log off at the end of the day. I'm nuts. I've driven myself nuts. This has to stop.
I feel so trapped. I have no idea how to practice law any other way. And so I feel trapped. If you've been reading my posts, you know I'm already making myself nuts about funding for next year. While it's good to look ahead, there's no reason to assume that there will be no new funding next year. Indeed, the more people know us, the more likely we are to get funded. So maybe I won't be able to hire Nicole full-time. So either she'll stay part-time or I'll hire and train someone else to work part-time. It can be done. The world won't fall apart. And if I swam a half-hour later and started my day a half-hour later, who's really going to complain? Indeed, if I had to allow the veneer of perfection to be broken and had to not be my Jewish-American version of Mother Teresa, what would happen? Really?
People like me don't change easily or quickly. I need to tap into some of the rebellious teen-ager in me. It's almost like I'm too well-behaved. I need to let myself do something really radical like swim an extra 15 minutes and see what happens.
I know I have to do something. Because I don't want to live like this. I want to be healthier. I want to enjoy my work and my time off. I don't want to feel trapped, like I have no choices. I have to give it a try. Somehow. Jennifer
Those of us who did not get the feeling of safety and protection as young children, whose parents were unable to give us what children need and deserve, are left with holes in our hearts. They're hard to plug up, these holes. They scab over and then get reopened, and even when they heal, they leave scars that will never go away. How many people are walking around with wounds and scars, remnants of a childhood that would stand Ozzie and Harriet on their heads? Sometimes I watch people for signs -- are you whole? What about you? If you're screaming at someone, I bet you have a hole in your heart. If you're hitting your child, a hole. Some holes make us nuts. Some even make us violent. But mostly, they never, ever stop hurting.
And that's where the cat comes in. Okay, I suppose it could be a dog, too, but there's something about an animal who asks for so little -- change the litter a couple of times a week, feed them a couple of times a day, no walking, no grooming -- low maintenance. Fish, turtles, birds don't work -- you can't cuddle them. Even hamsters are kind of small to plug up a craggy hole. But cats?
As I write this -- as every morning and often during the day -- Emily sits on my knee, perched where she wants to be, as close to me as possible. At all times of day and night, that cat knows exactly where I am, even if she's mad at me and giving me the cold shoulder. And when I leave the house, she waits anxiously at the top of the stairs for me to come back to her, where I belong.
I never felt like I belonged to anybody or anything until Emily. We are so bonded, such a pair of neurotics, we two. I have a routine; she has a routine. Throw either of us a curve and we're basket cases. We both look forward to the time each day when everybody leaves and it's just us two. She sits on my knee then, too, waiting for it to be dinner time, when she gets her Boar's Head baked Virginia ham (don't even try to pass off honey maple as the real deal), and then we go to bed, our favorite place to be, me resting my painful joints, Emily sitting on top of me faced out, watching guard lest anyone dare to tread on her person, me.
Nobody has ever loved me like Emily does. I suppose it's sad to think that one's greatest life love would be feline, but I'll take it however I can get it. Emily gets mad at me, but she never goes away, never would, never wants to leave me, never wants to see if there's a better person out there somewhere. And I know there will never be another cat like Emily. I suppose there will be other cats, but none like this one. Not ever.
I love you, Emily. Thanks for being my best friend. Jennifer
And finally, true mental health parity. About time.
An interesting study finds that sleep helps weight loss. Here's my problem.
Kathleen Sebelius asks Congress to set aside the partisan fighting and cooperate to implement the new health law as well as possible. Will they work together?
In 2014, Medicaid will expand to cover adults to 200% of the federal poverty level. How to manage the enrollment of all the new folks -- a challenge for the states.
Health insurers pour money into GOP campaigns. No comment!
Have a good day! Jennifer
Monday, October 4, 2010
And there's this piece on how hard it is to get pain meds, even if you have a legitimate need.
And here's the tale of a week at a very busy hospital in Brooklyn.
A take on the new Pre-existing Condition Insurance Plans.
The LA Times says whether parents follow doctor's orders for their kids often depends on what insurance they have.
Politico says the health industry is taking its money to the "other side," and what a GOP win in November would mean for health reform. Yet, some Dem candidates are campaigning against repeal.
The good of health reform, an opinion piece by Tom Harkin.
But be ready for a long re-run of the health reform fight after November, says WaPo.
Friday, October 1, 2010
WaPo reports that, for the first time in a very long time, the federal government is funding sex education that goes beyond "just say no." Even if you believe in abstinence, a lot of kids don't, so I support this shift in policy.
In other news, during the recession, the ranks of Medicaid enrollees swelled.
WaPo reports that scientists have figured out how to make an alternative to embryonic stem cells, which would avoid the whole moral/legal argument and allow this important research to continue. Great news.
And if you were following the news yesterday, there was a lot of talk of whether McDonald's will be dropping health insurance. No, it says. And HHS made it clear yesterday that it will work with so-called limited benefit plans to provide waivers from some of the law's new provisions. Personally, I don't much like these plans and think they should have to be improved rather than being given waivers, although I understand the argument to the contrary (some insurance is better than no insurance, but is this true since some insurance disqualifies you from charity care, and free meds?).
California's Gov. Schwarzenegger signed landmark legislation yesterday, making it the first State to take big steps towards implementing reform.
Finally, USA Today lays out the ways in which health reform will change your employer-sponsored insurance in 2011.