Monday, February 28, 2011

GOP Budget will Cost Jobs

According to Moody's Analytics, the GOP budget slashing will cost over 700,000 jobs.

Eric Cantor, 2nd in command in the House, said this may well be true, but the government should not be creating jobs if it means increasing deficits.

And there, my friends, lies the rub. If you pull money out of the economy, you will cost jobs. If you infuse money into the economy, you will increase the deficit.

Which matters more, jobs or the deficit? That is the question.

The Tea Party says the deficit. Progressives say jobs. Where are the rest of you Americans? Because now would be the time to speak up.

You can find your member of the House here and your Senators here. Jennifer

Rare Disease Day

Today is rare disease day. People around the country are celebrating the attention that rare diseases are (finally) getting in Congress and elsewhere. I am not celebrating.

Molly is 20 years old. Some of you already read about her last week when I had the privilege of being a guess blogger on Susan Campbell's blog. Molly has complex regional pain syndrome -- a rare disease. Her parents have taken her all over the world -- Mexico, Germany, and across the United States several times -- to try to find a treatment that would allow her to have some semblance of a life. They found the right treatment, but it's expensive and her insurance company won't pay for it. I appealed, and two out of three supposedly independent reviewers said there was insufficient evidence that the proposed treatment was more effective than standard treatment. But there is no standard treatment. Everything else has been tried and failed. And we know this works. I filed a complaint against the two doctors, but even if they find in my favor, it won't change anything for Molly.

That's what it's like to have a rare disease. If you are lucky enough to find treatment at all, you have to fight with your insurer when they say they only want large scale clinical trials. You can't have large scale trials when there aren't enough people to enroll in them, when the treatments are invasive, when the same thing works for some people but not everyone who has the condition or disease.

Having a rare disease means (1) it's hard to diagnose; (2) it's hard to treat; (3) even if y0u find a treatment for it, you have to fight with your insurance company to get it.

Then there are all the social issues -- nobody's ever heard of it. Nobody knows what it is. You have nobody to talk to because you've never met anybody else who has it. People look at you funny. Even your doctors don't know what to say, what to do.

Having a rare disease sucks. I love the fact that, when you compile all the rare diseases, you get to a huge list of 7000, so thousands of people have rarity in common. I'm not against celebrating that kind of togetherness. But tomorrow, when you go back to your usual life, will it have changed?

Let's answer that YES! Rare Disease Day should not be a once a year event. The slogan -- Alone we are Rare; Together we are Strong is true EVERY day, not just once a year. So let's not just think of this once a year; let's think of it every day, of the Mollies and Susies and Dons and Davids, the children, the adults -- all of us, every day, standing together, being stronger together than we are separately. Maybe -- just maybe -- together, we have a real chance at changing the lives of people with rare diseases. Jennifer

Be Careful What You Wish For

I thought it was a really bad move of the Obama Administration to ask the Florida judge that struck down the health reform law if he really meant for all implementation to stop. Because I think he's going to say yes.

And apparently I'm not the only one.

But today's comment by the President changes everything, I think. He said that he supports letting states opt out of health reform in 2014 if they think there's a better solution for their state. If that legislation passes, then every state has a way out of the individual mandate. Which means no state can argue that the individual mandate infringes on states' rights.

Which means there's no legal challenge any more. Bye-bye. Jennifer

Exemption for Christian Sharing Plans

Christian sharing plans are exempt from health reform. I get why -- we should allow religious freedom. But I had a case in which a participant in a Christian sharing plan was maxed out. It didn't cover long-term care or rehab. The family was desperate, trying to find an answer. One option was to join the Pre-existing Condition Insurance Plan (PCIP), which was created by the health reform law.

If the logic is that everybody has to have coverage to avoid free riders who don't buy insurance and whose expenses then become the burden of the taxpayers when they end up in a hospital, then why are Christian sharing plans exempt when their benefits are limited and their members may end up on the taxpayer's dollar?

I mean, I get religious freedom, but is that license to be less responsible than the rest of us? I would exempt a Christian sharing plan that really covers people in need, but not one that does not.

And how does this not beg the question of Jewish sharing plans, Hindu sharing plans, Muslim sharing plans? How does this not have us tied up in which religions are legitimate enough to get the exemption? Hmmm. Jennifer

The President Gives States Flexibility in Health Reform

The NY Times is reporting that the President is going to announce today that he will back legislation that will allow states to opt out of health reform if their state has a plan to cover as many people as the federal plan would have covered.

Doesn't this moot out the pending lawsuits? After all, any state that doesn't like the individual mandate can just opt out if they have a better way of accomplishing the goal of near universal coverage.

I'm not sure whether this is good or bad, but it's clearly an important move. Jennifer

Monday Moaning

I can't believe it's already Monday, but I'm determined to get back to swimming, so I'm up super early to get you the news:

In his weekly address, President Obama urged compromise, warned against a shut down. So do those who remember the shut down of 1995. And the short-term fix that was proposed by the GOP on Friday contains huge cuts, but it does not defund health reform.

What care is essential, that should be covered under even the most basic health insurance plan, as federal officials ponder? This should be the next big set of health reform regulations.

At the National Governor's Association, Governors differ on extent of flexibility they want the feds to give them in cutting or reshaping Medicaid. GOP Governors want block grants, chunks of money with little federal control. New York's Medicaid cuts are a boon to the union. Huh? Meanwhile, over 100 organizations urge the feds not to allow the states to gut Medicaid. Still, the states clamor for flexibility in dealing with budget crises.

Reducing the rate of hospital readmissions also is part of health reform. Some Maryland hospitals are penalized for poor marks.

Recognizing that mistakes will be made in medicine, a critique of the current malpractice system, which compounds the mistakes for some patients and some doctors.

Wound care may matter more than antibiotics. Learn how to change that dressing properly.

Here's a reason to work at the White House -- a personal trainer!

We've been hearing about needless lumpectomies and node removals -- this time it's the men, with needless prostate biopsies. Really? They say PSA doesn't predict cancer.

And that's the early morning news. Back later with updates if warranted. Jennifer

Friday, February 25, 2011

Finally Friday Edition

I'm getting a slow start this morning, so now I'm rushing to get you today's news. Here goes.

Half of Americans don't know if the health reform law is still the law. It is. It has not been repealed (that would take the President's signature) nor has a court said it can't be implemented. So for now, the law is still the law.

And implementation continues. There's a fight brewing in North Carolina, where Blue Cross wants to run the Exchange, which would not be fair to other insurers, nor would consumers have objective information about their alternatives.

Still, insurers raked in over $12 billion in profits last year. And HHS gave the states new funding for insurance rate review in the hope that it will help control the nonstop increases in rates.

Senate Democrats are trying to come up with budget cuts that will meet the demands of the GOP and avert a government shut-down. But since they won't eliminate funding for health reform implementation or family planning, it's unlikely that the GOP will agree. A lot of ground needs to be covered in the next week if the government is going to keep operating. Meanwhile, the White House is concerned that a shut down would slow the economic recovery. And the House GOP is working on a short-term extension of the deadline, but they are insisting on making big cuts even in a short-term measure.

The battle in Wisconsin is not just over state employee unions. It's also about deep cuts to Medicaid and medical care for low income residents. Still, the feds keep pumping Medicaid funds into the states, including new grants to fund prevention programs.

A new protocol for deciding who gets a donated kidney will favor younger recipients.

As mental health cuts mount, more psychiatric cases end up in jail.

And that's it for now. Have a great day. Jennifer

Thursday, February 24, 2011

Don't Believe Me -- Believe Goldman Sachs

Don't even believe Treasury Secretary Tim Geithner when he says the GOP budget cuts would cost jobs.

Now, no less an authority than Goldman Sachs -- not exactly a paragon of progressive politics -- says the GOP budget cuts would do real harm to the economy.

Then again, Goldman Sachs has had its own problems.

But still, how come we can't find any economists who think slashing the budget just for the sake of slashing the budget, without principled policy-based reductions, will be good for the economy? Jennifer

Thursday Themes

House GOP leaders propose a temporary spending measure that would cut $2 billion from the federal budget each week for 2 weeks. Dems respond that this is the same extreme budget cutting that they have already rejected. Is the threat of a shut down a negotiating tactic, to convince the Tea Party that the mainstream GOP has tried its best to cut the budget?

States are struggling to get ahold of Medicaid spending. The Obama Administration is asking states to do so without dropping coverage. New York proposes to cap annual increases, but to put much of the decision of what to cut in the hands of providers.

Jane Brody discusses a new report on how to better manage multiple chronic conditions. Advocacy for Patients submitted comments for this report. In a related piece, Dr. David Katz tells us how to be a smart patient.

Doctors remain skeptical of electronic health records.

The feds raided pain clinics in Florida in an effort to eliminate pill mills. But will this make it even harder for legitimate chronic pain patients to get relief?

Meanwhile, the case for palliative care gets stronger -- it prolongs life.

Children living on farms learn to fight off germs, decreases the risk of asthma.

A small study points to specific proteins in the spinal fluid of patients with chronic fatigue syndrome and chronic Lyme disease.

And that's the morning's news. Have a great day. Jennifer

Wednesday, February 23, 2011

Why Budget Cutting Doesn't Lead to Prosperity

Interesting article in the NY Times today explaining why budget cutting at a time when the economy is so fragile is likely to cause more harm than good.

It's really very simple. Two years ago, we were on the brink of a depression. Had the government not flooded the economy with cash in the form of stimulus spending, it would have been even worse. You don't pull money out of circulation at a time when the economy is anemic and needs an infusion of cash.

Today, we're still not out of the woods. And I am afraid that pulling money out of the economy will cause the double-dip recession that economists have been warning us about.

Not to mention where the cuts are. In Connecticut alone, the GOP cuts would mean:

• 2,923 jobs in Connecticut community health centers.
* $300,000 less for Maternal Child Health Block Grant programs by $300,000 in Connecticut.
• $900,000 less in teenage pregnancy prevention grants.
• $262,000 less in Community Mental Health Services block grants.
• More than $1 million in Substance Abuse Prevention and Treatment block grants.

And that's just health care-related spending.

The Tea Partiers, who want smaller government at any cost, will, I'm afraid, make things far, far worse. They would cut regardless of the consequences because they believe reducing the size of government is a good thing, no matter what. But what would they do for the sick people who can't get health care? If they think private philanthropy will step in, think again. I see no indication that pulling billions out of the US economy will stimulate charitable giving.

Arizona is cutting 250,000 people from Medicaid. Pennsylvania is cutting 42,000 people from a low-income plan that provided them with health care. Every state is looking for ways to cut Medicaid and other health care expenses. In Connecticut, that means Medicaid recipients will have to pay copays -- which means they'll skip health care entirely. It means poking real holes in the safety net, as I explain in a commentary published by the Connecticut Mirror.

So here's my question for the budget cutters out there: What do you want sick people to do when they can't afford insurance and can't afford health care, so they just get sicker and sicker until they end up in an emergency room, which is the most expensive way you and I could possibly end up having to pay their bills? Do you want the hospitals to turn them away too? Because they can't afford to absorb all the cost that government used to help with. So what? You want people just dying in their homes, in the streets? You want people in such agony that they can't work and cost the system way more by becoming disabled? What exactly do you want sick people to do?

Because until you answer that question, you have no business cutting budgets. Cutting budgets doesn't solve the problem; it creates a new set of problems. Until we have answers, we'd better tread lightly. Jennifer

Hump Day Headlines

I don't know about you, but I have an insane day today, so I'd better get right to the news.

A third federal judge from the District of Columbia has upheld the health reform law. That makes the score 3 to 2, in favor of constitutionality.

The White House says they're ready for a government shut down -- although they don't want one, contingency plans are in place. The GOP thinks it won't take the blame for a shut down, like it did in 1995. Roger Simon's not sure who has the most to lose if there's a shut down. Meanwhile, Senator Harry Reid has introduced a one-month extension at current spending levels, but the GOP wants more cuts even in a temporary bill.

Meanwhile, the Obama Administration is dispatching experts to states who are looking for help in cutting their Medicaid budget without dropping coverage. And they are telling us that Social Security reform is not part of the current budget debate. And HHS gave grants for community living to thirteen states, including some that oppose health reform.

But Pennsylvania terminated a health plan for low income adults -- that's 42,000 people without health insurance all of a sudden, and with nowhere else to go. And community health centers -- once thought immune from budget cutting -- will be losing a lot of funding in all the budget cutting, leaving people even fewer places to do.

Local and state officials are speaking out against the defunding of Planned Parenthood, helping to explain the important role Planned Parenthood plays in women's health.

And my favorite story of the day -- a health insurer has been fined $4.3 million for violating medical records privacy rules by failing to give consumers access to their medical records. Maybe now, when we request a copy of a file, we'll actually get it.

In a really important case, the Supreme Court held that vaccine makers cannot be sued for adverse effects. To make them liable would have crippled the vaccine making industry, they said. People with adverse effects can claim damages from a special fund established for this purpose.

This is interesting. Teachers in Wisconsin who are protesting the union busting moves of the Governor are getting doctor's notes to excuse their absences. What does that say about the doctors?

Teachers feed kids who come to school hungry, they say. Tragic.

Cellphone use affects brain activity. I doubt that will change anybody's habits, though.

And that's the morning's news. I'll be on the run most of the day, so have a good one. Jennifer

Tuesday, February 22, 2011

They're Talking

It doesn't mean the threat of a shut down is gone, but apparently Congress is trying to talk about the budget -- or at least buy until the end of March to do so.

Again, contact your members of Congress and let them know what you think should happen. Now's the time. Jennifer

Tuesday's News

I hope you had a nice day off yesterday. Today, it's back to the grind. Congress is on recess, so hopefully, they can't do too much damage!!! Here goes:

In GOP-led states, the health reform law is garnering varying responses. Some states are working on implementation and some are not.

Secretary Sebelius says she needs to make changes to the long-term care act that was part of health reform in order to make it viable.

The Social Security Administration is getting ready for a shut-down or possibly cuts. Good that they're planning. Politico tells us how a shut down could happen.

Meanwhile, Senate Dems back Planned Parenthood, will block defunding.

Medicaid turning to managed care to control health care costs. More here about long-term care managed care in Medicaid. Meanwhile, states are asking the feds for permission to cut their Medicaid programs to deal with budgets.

One patient's story, as they struggle with increasing health insurance premiums. Making the case for the individual mandate and pooled risk.

An effort to stem the tide of hospital readmissions.

Not all health info you find on the internet is reliable. Did anybody think it was?

How do you tell the difference between forgetfulness and Alzheimer's?

A medical mystery starting with a swollen ankle.

This is a really wonderful piece on what happens when the doctor's wife is the one with the diagnosis -- when illness hits close to home.

A smattering, then, with Congress out of session. So enjoy the interesting ideas pieces and have a great day. Jennifer

Monday, February 21, 2011

What should you say?

I sent out an email blast on Saturday night (same as two posts below) urging you to contact your members of Congress about the budget debacle happening in Washington. Several of you have asked you what to say.

I deliberately don't tell you all what to say because I don't want you to feel I'm putting words in your mouths. But here's what I have to say:

Health reform has done great things for thousands of people already -- kids with pre-existing conditions have insurance, and are back on their parents' plans; about 12,500 people are in Pre-
Existing Condition Insurance Plans; people no longer have to worry about lifetime caps on benefits. We've been working so hard on implementation, commenting on new rules for insurance appeals that make them more consumer-friendly; setting up rate review so insurance companies can't just keep raising rates.

We cannot lose all of our accomplishments, all of our hard work. Defunding health reform sets us back to the status quo. Thousands and thousands of people will lose out -- and we will never see the full effects of the law that we fought so hard to pass.

So point number 1: Do not defund health reform.

Point number 2: Don't you dare refuse to compromise so that the government shuts down. This is not what the American people wanted when they voted for you. They did not want to put an end to people getting their tax returns on time, their Social Security checks on time, all the services of the federal government -- shut down is not what we want. We want government to work better; we don't want it to stop working entirely.

And point number 3: Yes, take a hard look at the budget. Cut what you can. But don't cut the safety net for the aged, disabled, and poor. Put people to work updating our infrastructure -- roads, bridges, railways -- and invest in the future with technology.

Point number 4: And don't eliminate family planning so that we have an increase in unplanned pregnancies -- especially if you're against abortion, don't eliminate funding for family planning.

That's what I have to say. You can find your House member here. Your Senators are here.

What do you have to say? Jennifer

Monday Musings

It's President's Day and Advocacy for Patients is closed today. Then again, I worked enough over the week-end to make up for taking today off.

Read my guest blog on Susan Campbell's Still Small Voice.

And here's the news:

The GOP budget cuts may well mean a government shut-down. Now, the GOP heads home for a week to hear what the voters say. If you disagree with the slashing, the defunding of health reform in particular, contact your members of Congress and especially the Senate and let them know.

At the very least, urge them to adopt Nancy Pelosi's extension of the status quo until the end of March to avert a government shut-down and give Congress more time to negotiate. Some in the GOP seem to be signaling that they would accept this. Some in the Senate are optimistic. Those of us who remember the last shut-down know enough to want to avoid another. But can the parties agree on whether to take Social Security off the table?

What if the government shuts down? Read this for a forecast. And here's another.

The GPO didn't just defund Planned Parenthood -- they defunded the family planning program.

If the government avoids a shut-down, they will face hearings on how health reform came to be.

Advice from Wendell Potter, former insurance industry insider, on how to deal with insurance companies.

Medicine pursues a mind-heart connection -- heart disease and depression.

And that's it for early Monday morning. Hope you get to have the day off, too. Jennifer

Saturday, February 19, 2011

Of the Utmost Importance

Courtesy of my a good friend and DC insider, here's what the GOP House Budget does:

The House passed the FY11 CR with the devastating cuts to HHS programs last night. Now its onto the Senate. Here are the amendments of interest that were adopted on the House floor.............
o An amendment from Rep. Rehberg (R-MT) that prohibits federal funding from being used to pay any employee, officer or contractor to implement the provisions of President Obama’s health care law, stopping the Department of Health and Human Services from implementing the law.

o An amendment from Rep. King (R-IA) that strips funding for any provision of the President’s health care law.

o An amendment from Rep. King (R-IA) that prohibits the payment of salaries for any officer or employee of any federal department or agency with respect to carrying out the President’s health care law. (This amendment has virtually the same effect as Rep. Rehberg’s amendment.)

o An amendment from Rep. Emerson (R-MO) that bars the use of funds in the bill from being used to implement the individual mandate and penalties and reporting requirements of the President’s health care law.

o An amendment from Rep. Price (R-GA) that prohibits the use of federal funds from being used to carry out the medical loss ratio restrictions in the President’s health care law. These provisions require insurers to spend at least a certain percent of their premium revenues on medical care.

o An amendment from Rep. Gardner (R-CO) that blocks funds for Health Insurance Exchanges, a set of state-regulated health care plans offered under the President’s health care law.

o An amendment from Rep. Burgess (R-TX) prohibiting the use of funds for employee and officer salaries at the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services, created by the President’s health care reform bill.

o An amendment from Rep. Pitts (R-PA) that prohibits the funding of salaries for any officer or employee of the government to issue regulations on essential benefits under section 1302 of the President’s health care law.

o An amendment from Rep. Hayworth (R-NY) that prohibits funds for the independent payment advisory board.
They also de-funded Planned Parenthood and made over $61 billion in other cuts from discretionary programs that would be devastating to research at the National Institutes of Health, the Centers for Disease Control, and the Food and Drug Administration, among many others.

If EVER you were going to call your Senators and weigh in in favor of health reform (if you agree), now would be the time. Of course, they're on recess for a whole week due to President's Day, so the fight will happen the week of February 28. We are seriously looking at a government shut-down. Nancy Pelosi has introduced a continuing resolution that would fund the status quo through the month of March to avoid a shut-down, but I don't know if the GOP will go for it.

We are at crunch time, people. Be heard today. To find your Senator, go here. To find your House member, go here.

If you are on Social Security disability or are waiting for other government payments, understand that if this is not resolved by March 4, we will face a government shut-down. Make provisions for if your checks are late, which was one of the things that happened when the government shut down in 1995.

This is a really big deal. We can't afford to ignore it. If ever you were going to call your member of Congress, now is the time. Jennifer

Friday, February 18, 2011

If you need anything from the federal government, you better get it now!

POLITICO Breaking News

A high-ranking aide to House Minority Leader Nancy Pelosi (D-Calif.) told Democratic chiefs of staff that a government shutdown is more likely than not, according to attendees. Speaking at a regular meeting of the top aides to House Democrats, Pelosi's floor director, Jerry Hartz, offered up his assessment that the odds favor inaction before the government runs out of money, sources said. A shutdown would only happen if the House and Senate can’t reach a deal on the continuing resolution that expires on March 4.

For more information...

Finally Friday Edition

Another week, another . . . week. It never ends, does it? Well, here's the news:

The House GOP has begun the push to defund health reform, tacking a provision onto the continuing resolution needed to fund the government for the next 7 months. This sets the stage for a government shut-down since it's unlikely that the Senate will agree, and I like to think there's no way the White House will approve. Meanwhile, Speaker Boehner says he will not agree to a temporary extension of funding at current levels. Do you remember when the government shut down in 1995? I do and it wasn't pretty.

Meanwhile, the House GOP has voted to eliminate czars -- senior policy advisers to the President, including those on health care and disabilities issues. Since when does Congress dictate how the President staffs the White House?

And the House version of the repeal of the 1099 bookkeeping requirement has the middle class returning tax credits or subsidies that they may receive under the health law if their income increases in the middle of the year. This version goes to the full House, and if it passes, the House and Senate will have to negotiate a compromise. Although compromise doesn't seem to be happening much these days.

The Obama administration is asking the Florida judge who ruled against the health reform law to clarify whether he meant to suspend implementation pending review by the Court of Appeals and Supreme Court. I personally wouldn't have asked this question; it invites the wrong answer.

Rep. Grace Napolitano has introduced legislation that would provide mental health services in public schools. She has some celebrity support in the form of athletes who agree that services in the schools are needed. And two Senators are looking to expand Medicare's mental health benefit.

Texas is asking the feds for permission to reduce the scope of benefits provided under Medicaid. Not likely.

This week has meant a concentrated attack against the major provider of women's reproductive health care in American, Planned Parenthood. The GOP is looking to defund it as part of their budget attack. Just so you know, Planned Parenthood does a lot more than provide abortions. They are a full service women's health organization. The loss of this funding would mean an absence of resources for so many women.

Also on the women's health front, Michelle Obama is promoting breast feeding as a way to combat childhood obesity and promote child and maternal health. Michelle Bachman and other conservatives have a problem with that. Yesterday, Sarah Palin joined the fray. Apparently, what Michelle Obama suggested as a health measure is being construed as an attempt to inject government further into private lives. Come on, now. Did someone pass a law mandating breast feeding? No. It's just advice. And it's supported by science. Let it go.

A new study finds that psychotherapy helps chronic fatigue. Hmmm.

And that's today's news. Jennifer

Thursday, February 17, 2011

Afternoon Tidbits

I can't resist. There are some doozies.

The Governor of Alaska is simply refusing to implement health reform. It doesn't matter that it's the law. It doesn't matter that no court has enjoined its implementation. He's just not going to do it.

House Speaker John Boehner has drawn his own line in the sand, saying there will be no temporary budget deal; it's all or nothing. Um, nothing means a government shut-down.

As Arizona cuts 250,000 people from Medicaid, Minnesota expands its Medicaid program.

And there's been a HUGE nationwide Medicare fraud bust involving 111 people and over $225 million.

And that's what happened while you were working today. Have a great evening. Jennifer

Thursday Themes

I'm quite dejected today. We lost an insurance appeal that we really had to win. A young girl who's been all over the world for treatment. Only one thing works, but the insurer won't pay. We did an external appeal. One of the three external reviewers ruled in our favor; the other two said she could try "standard treatments." She's tried everything. I'm heartbroken. We pulled out all the stops. I know we couldn't have done better. What are people with rare diseases supposed to do when, even with insurance, we can't get them the treatment they need?

Life goes on, so here's the news.

House GOPers propose budget amendments that would defund health reform by refusing to allow any money to be used for any department or agency funded by the law. And Dick Armey's group, Freedom Works, advises the GOP not to fix health reform or do anything to make it more popular. They also advise against supporting any "collaborators" -- industries that helped make reform happen, and that they want to support full repeal, like the insurance industry.

This despite the fact that a majority of Americans are against defunding the law.

The GOP budget czar says he's going to propose "reforms" to Medicare and Medicaid. They still don't have a plan on paper, so no details for now. Indeed, when pressed for details, many GOPers punt back to President Obama, saying he has to come up with a plan.

The House Judiciary committee approves a plan for tort reform, limiting noneconomic damages to $250,000 and punitive damaages to $250,000.

Virginia's Attorney General, who is leading the charge against the individual mandate in the federal health reform law, says an individual mandate imposed by a state like Massachusetts is fine. For him, it's a state's rights issue.

Four states -- Florida, Tennessee, New Jersey, and Ohio -- have gotten waivers from some of the requirements of health reform because they had laws on the books that encourage the use of limited benefit plans. The waivers are temporary, until 2014, when affordable insurance is available on the Exchanges.

Seven states got grants to help build their Exchanges, the marketplaces where you'll be able to shop for insurance. Kansas, Maryland, Massachusetts, New York, Oklahoma, Oregon, Wisconsin.

But in the worst news of the day, HHS has told Arizona that it can't stop the state from ending a Medicaid waiver -- and that would drop 250,000 adults from Medicaid.

People are using less health care, and that's a trend that's here to stay. Higher deductibles and copays are making health care less accessible. And insurers are taking steps to deny coverage of costly tests and treatments (as in the case I just lost).

No surprise here, but a new study out of Pennsylvania shows that doctors order tests out of fear of lawsuits.

Could you have diabetes and not know it? Read here and pay attention.

And that's it for this morning. If you have insurance and your insurance is covering what you need, take a moment and pause today, and consider your great good luck. Because it could be you on the losing end tomorrow. Jennifer

Wednesday, February 16, 2011

From Families USA

The Republican leadership in the House of Representatives plans to “defund” the implementation of the Affordable Care Act as part of its efforts to repeal the health
reform law. Doing so would take away key benefits and rights needed by America’s
families, unravel a law that holds insurance companies much more accountable, and
add a trillion dollars to the federal deficit over the next two decades. At the same time,
those who support defunding or repealing the law intend to keep these very health
benefits and rights—which they enjoy courtesy of America’s taxpayers—for themselves:

Members of Congress enjoy government-subsidized health coverage for
themselves and their family members. Congressional promoters of repeal
would take away tax credits that will help make coverage affordable for hardworking
American families.

Members of Congress are sheltered from the threat of discrimination due to
pre-existing conditions. Congressional promoters of repeal would deprive
ordinary Americans of this very same protection.

Members of Congress, when faced with an insurance claim that is denied, have
a guaranteed right to appeal that denial. Congressional promoters of repeal
would deny many Americans a similar right.

These are just three examples. There are more, and we’ve outlined them below.

What Congressional Promoters of Repeal Will Take Away from
American Families—But Keep for Themselves:

1. Affordable health coverage
2. Guaranteed coverage, regardless of pre-existing conditions
3. A right to appeal claims that are denied by insurers
4. Protection against discriminatory premiums due to pre-existing conditions
5. A complete package of health insurance benefits
6. Guaranteed coverage that can’t be taken away
7. A prescription drug benefit with no coverage gap
8. Protection against catastrophic health care costs
9. A choice of easy-to-compare health insurance plans
10. Protection against unreasonable premium increases
11. Fair and equal premiums for women
12. Coverage for early retirees
13. Access to free or low-cost preventive services
14. Access to affordable care at clinics

To read the rest of the paper, go here. Jennifer

Wednesday's News

And here we go, folks. It's not enough to defund health reform. The GOP says they will include "entitlement reform" in their budget. In case you don't know, that means Social Security, Medicare and Medicaid on the chopping block. President Obama says that the reason he did not include entitlement cuts in his budget it because that will take months of bipartisan conversation; he is not saying he won't agree to the cuts. Is this a strategy to make the GOP come out with politically unpopular proposals?

Meanwhile, President Obama's budget is not without its pain. For example, here's what it means for the Centers for Disease Control. But the GOP budget -- even aside from entitlements -- is pretty harsh, and the President has threatened to veto it. Among other things, they want to cut funding for Community Health Centers. And they've already proposed 400 amendments to the President's budget. There's still talk of a government shut-down if the parties can't agree on at least a continuing resolution in the next couple of weeks. The IRS is asking for $119 million for health reform implementation. And here's a preview of the Health and Human Services budget, which focuses on medical innovation.

And Congress is still trying to work out the details on omitting the one thing everybody agrees should come out of the health reform bill, the 1099 bookkeeping requirement.

As you know, health reform will mean the construction of Exchanges or marketplaces where people can shop for insurance. But there are different ways to run an Exchange. Here's a piece on what Utah is doing. Basically, Utah lets any plan into the Exchange, whereas the Massachusetts model only lets plans that qualify under a set of criteria into the Exchange. States are debating which model is best for them. This is an example of the flexibility the federal plan gives to the States, says Kathleen Sebelius, HHS Secretary.

Next time I get a cold, I'm going to try zinc. They say it's better than chicken soup.

There are new heart health guidelines for women.

And that's today's early news. Have a great day! Jennifer

Tuesday, February 15, 2011

Tim Jost on Tax Credits

Tim Jost is one of the nation's strongest health reform advocates. Here, he writes about eliminating the 1099 bookkeeping requirement and urges that it not be done at the cost of the tax credits or subsidies that are going to help people afford to buy insurance on the Exchanges starting in 2014. Jennifer

Jonathan Cohn: Obama's Budget

Read the great Jonathan Cohn's latest piece on President Obama's proposed budget. Jennifer.

What the Obama Budget Means for People with Disabilities

More funding for special ed. More funding for workforce innovation. More funding for accessible technology. More funding for modified transportation systems.

Want to see the whole list? Go here.

Of course, this is the President's budget. It has not passed yet. So if there's something in here that you feel would be really valuable, call your member of Congress and let them know.

To find your Representative, go here. To find your Senator, go here.

Speak now or forever hold your peace! Jennifer

Question for You

I am speaking to the US Department of Transportation about disabilities issues -- chronic illness, specifically -- on Friday afternoon. This stems from my comment that those of us with invisible disabilities need more than wheelchair ramps to make the transportation system in America user-friendly. My immediate thought is clean restrooms. But what else do you need from the Department of Transportation?

Come on. Speak through me. Be heard. Jennifer

Tuesday Views - Budget Edition

It's all about the budget. President Obama is cutting, but the GOP says not enough and the left says too much. That probably means he's doing about right. The health care numbers are here. Most notably, the Obama budget would cover health reform implementation and the GOP would not. More on the Obama budget for health reform here. More on the GOP on health reform here. Expect a huge battle over this, one that threatens to shut down the government. But Obama pledges that there will be no cuts to Social Security. The Obama budget will speed generic drugs to market.

Here's a detailed run down -- The Obama budget postpones for 2 years the Medicare cuts to physician payment rates; there are initiatives targeting the drug companies; the 1099 bookkeeping fix is partly in; but the budget eliminates funds to children's hospitals to train pediatricians. The GOP budget will go after entitlements -- possibly Medicare vouchers. Obama also would increase funding for the National Institutes of Health, and for malpractice reform demonstration projects.

Health reform will result in insurance for 5 million uninsured Californians, says UCLA.

We're trying to move people from institutions to home, but there are over 300,000 people on a waiting list for a program that would do so. And it's hard living in the community on a Social Security check.

A push for clearer medication labels. Experts say this will help with medication adherence, which, in turn, will result in better health outcomes.

A five year study of recalled medical devices show that they received accelerated FDA approval.

Changes to intensive care may improve the health of patients when they leave the ICU.

Meditation and mindfulness may help your brain work better. And I know they contribute to your sense of well-being. Humor, music and spirituality may help your physical health.

Sleep's important, too. Women are more likely to be the one who gets up with the kids in the middle of the night. Do relaxation drinks work? The color of our computer monitors and TV screens may hurt.

Personally? I'm just tired. Have a good day. Jennifer

Monday, February 14, 2011

Monday Moaning

I'll be at the Legislative Office Building today testifying on several bills, including SustiNet, Connecticut's best shot a a "public option." I have to leave very early, but I set my alarm in time to give you this morning's news before I go:

President Obama's budget aims to correct the 25% cut in physician reimbursement rates by postponing it for two years and cutting payments to other providers to make up the difference. There will be a small increase for the Center for Medicare and Medicaid Services (CMS) so health reform implementation can continue. The GOP have said they intend to defund health reform, setting up for a big fight, with some prepared to shut down the government if need be in order to defund health reform. Tea Partiers also would cut funding for food programs for low income women and children. But so far, nobody is aiming to cut Social Security, Medicare, Medicaid -- yet.

Medicare Part D premiums go sliding scale, so those who can pay more do.

The LA Times says prepare for a good death with a living will and the right person to carry out your wishes. I agree.

States looking to cut budgets are eyeing retiree health insurance.

Concern for energy drinks and the risks they pose to kids. They're particularly bad for kids with medical problems. And kids who play outdoors have lower risk of near-sightedness.

And here are some clues for Celiac sufferers.

Some hospitals are not hiring smokers -- even people who smoke only on days off.

Have a happy Valentine's Day. And if you don't have a Valentine (like me), how about just picking Valentines at random and wishing them a happy heart day?! Jennifer

Friday, February 11, 2011

AHHHH -- Friday!!!

Mitch McConnell, Senate GOP leader, says he's not about to give up trying to repeal health reform. And our old friend Karl Rove is helping the GOP to plot health reform repeal. If the GOP picks up 4 more Senate seats in 2012, they will have a majority in both the House and the Senate. At that point, the only thing standing in the way of health reform would be a presidential veto -- assuming we still have President Obama in office. Okay, Karl, you've got my attention and I'm scared.

Donald Berwick, who runs the Center for Medicare and Medicaid Services, says health reform is helping the elderly and the poor. They're getting help with prescription drugs and preventive care, and premiums on Medicare Advantage Plans are decreasing. Still, he took a hard grilling yesterday at the House Ways and Means Committee.

The GOP says health reform is a job killer. The Congressional Budget Office says yes, health reform will reduce the number of people who have to work just to get health insurance. So health reform does not eliminate jobs that people want -- it only allows people who don't want to work to stop working. A job killer? I think not.

And in the interests of truth and accuracy, there's an anonymous email going around saying you'll pay 3.8% tax if you sell your house, and the money goes to health reform. Read and learn -- it's not true.

Enrollment in the new Pre-existing Condition Insurance Plans continues to lag behind predictions, although it's starting to pick up.

The marvelous Dr. Pauline Chen writes today about the importance of patient narratives, of stories. You really should never miss one of her essays.

Are you getting your vaccines when needed? There's actually a schedule for adult vaccines, and most primary care docs don't stock all the vaccine that's needed. Look into this.

Utah is going to seek a Medicaid waiver, a sliding scale of copays so those with slightly higher income will pay more.

Here in Connecticut, the legislature will hold hearings on our version of health reform, called SustiNet, on Monday. I'm preparing my testimony now.

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

Thursday, February 10, 2011

Thursday Themes

I think this week has an extra day in it. Nonetheless, here goes:

The big news in health care today is a study that shows that surgery performed in utero is the best chance for helping to treat spina bifida. Amazing.

In health reform news, a new study shows that any alternative to the individual mandate would leave many more people uninsured, and would not save as much money as the individual mandate.

The Obama Administration is extending health reform's consumer protections to college students with insurance through their school. The rule requires at least $100,000 in annual benefits starting on September 23, 2012.

The GOP is stumbling over medical malpractice reform, with some Tea Partiers opposing caps on noneconomic damages because that would interfere with the rights of states to set their own limits.

Meanwhile, GOP budget cutters are aiming for Title X, which provides funding for family planning. They don't want abortion, they don't want family planning . . . hmmm. This is really aimed at de-funding Planned Parenthood. In other words, it's really about abortion. But does it make sense?

At least equally problematic, States with budget crises are cutting health programs for the poor and disabled. South Carolina is eliminating hospice care from Medicaid. Washington State is cutting a program called Disability Lifeline. California is limiting Medicaid recipients to 6 prescriptions per month and 10 doctor visits per year.

Some Democrats are suggesting that Justice Clarence Thomas recuse himself from hearing the challenge to the health reform law because of his wife's role in the opposition. Won't happen. Meanwhile, 28 States are asking President Obama to foster faster review of the court challenges to health reform, going right to the Supreme Court and bypassing the courts of appeals.

If you have a flexible spending account, don't forget that you have to spend that money by March 15.

Strokes are becoming more common in the young and middle-aged, while declining in the elderly. And there's some indication that diet soda can contribute to the risk of stroke or heart attack.

And that's today's health news. Have a great day. Jennifer

Wednesday, February 9, 2011

Hump Day Edition

It's Wednesday and I'm tired. It's been a long week already, it seems. But we keep on doing our thing here at Advocacy for Patients, and that starts with the day's news.

As I posted last night, the GOP will seek to eliminate all funding for implementation of health reform in the continuing budget resolution that has to be passed by March 4 or the federal government will shut down. This promises to be quite a show-down, a game of chicken to see who blinks first. The Senate will not pass a budget that prohibits health reform implementation from proceeding, and the President will not sign it. That sets us up for a government shut-down. The last time the Republicans owned the House of Representatives, they brought things to a shut-down, as well. It didn't work out very well for them then. I don't know why they think the American people will be happy with no government services again. One GOP Congressman (Steve King) says defunding health care is like defunding the Vietnam War. He doesn't just want to defund implementation for this year; he wants to make sure no funding to implement the law ever sees the light of day.

Health reform has been transformed into a platform for anti-abortionists. Although the law is very clear in providing that no federal funding, including health insurance premium subsidies, can be used to pay for abortions. But that's not enough. There are several bills that would represent huge restrictions on access to abortions. They want to eliminate tax breaks for employers whose insurance policy covers abortion, and to forbid women from using money in a flexible spending account to pay for an abortion. They also want to prevent any insurance policy offered on an Exchange from covering abortions, even with private dollars. There's even a bill that would allow hospitals to refuse treatment to a woman even in an emergency situation. Is this really what the voters last November wanted the GOP to focus on? Democrats vow to block these laws.

A few freshmen Republicans who turned down federal health insurance benefits are struggling to pay their premiums and out of pocket expenses, as well as to find policies that cover pre-existing conditions. Their experience is causing them to rethink their opposition to the law.

The new Accountable Care Organizations, that allow health care providers to band together to care for patients and lower costs, present antitrust implications.

The appeals court in Cincinnati has set an expedited briefing schedule on the health reform challenge. This court is hearing an appeal from a Michigan decision upholding the law. Argument should be in May or June.

Meanwhile, the Obama Administration says it is standing firm with the individual mandate. If there was a better way to accomplish the goals of affordable health care for all, somebody would have come up with it by now, they say. Until someone does, the individual mandate will be defended by this White House.

Vermont's Governor proposes a single-payer health plan. I hope this happens; if one State shows how much money can be saved this way, single-payer may finally catch on more broadly.

A new study shows that, in some markets, one insurance company dominates, which restricts competition, thereby failing to drive down costs.

Another new study says that early breast cancers don't require removal of lymph nodes. Women who are treated early with lumpectomy and radiation survive at a rate of about 92% after five years, even without removal of lymph nodes.

Illinois is restricting HIV/AIDS drugs as part of their budget cutting.

Large employers increased wellness initiatives last year.

And that should keep you busy for a little while! Have a great day. Jennifer

Tuesday, February 8, 2011

GOP House Leader: We Will Defund Health Care

Eric Cantor, Majority Leader of the House of Representatives, pledged today that the GOP will defund health care.

And this is how they shut down the federal government. The Senate won't pass this. The President won't sign it. But by attaching it to a continuing resolution to fund the federal government through the end of the year, the House GOP are essentially guaranteeing that the federal government will not be funded -- and will shut down. Of course, they'll blame it on the Senate and the President. Neat trick.

So how about it, folks? Let's not fall for it. Jennifer

Connecticut Rejecs Managed Care for Medicaid

Connecticut's new Governor, Dannel Malloy, has announced that the HUSKY program -- which includes Medicaid and SCHIP -- along with the Charter Oak Health Plan will be transitioned out of managed care and into a self-insured model that will both save the State money and provide better care for members. Chronic disease management and medical homes will become part of the picture, and the State will expand the "Money Follows the Person" program, allowing seniors to leave nursing homes and find support in the community.

Although a lot of us were advocating for this for a long time, kudos and thanks go to Ellen Andrews and Sheldon Toubman, two tireless advocates who lived and breathed for this moment for the past 10 years. Jennifer

Harvard's Tribe on Constitutionality of Health Reform

In an op-ed, Harvard Law Professor Lawrence Tribe says that the Supreme Court will uphold the health reform law. He sees the legal issue as pretty clear. It's not about activity vs. inactivity, as the Florida judge said. Instead, it's about commercial activity vs. non-commercial activity. Since health care and health insurance undoubtedly are commercial activities, the Court, Tribe predicts, will vote in favor of the law's constitutionality.

Let's hope so. Jennifer

Tuesday's News

Good morning. Let's see what the day has in store for us.

Pro-reform organizations have put together a lobbying team of sorts to help message in ways that defend the new law. Democrats in Congress are charting a course, too; some are thinking about alternatives to the individual mandate. And Republicans are treading softly as they prepare the budget for the rest of the year, starting out, at least, without eliminating funding for health reform implementation.

And the Administration is sending a strong message to states that oppose reform and are refusing to implement, some while still taking implementation money. If the states don't implement, the federal government will, says the Obama Administration. The law leaves a lot for the states to do, but President Obama will not allow Americans to suffer simply because they live in a state that opposes reform. States continue to ask for more flexibility in implementation. But states ignore health reform at their peril.

Meanwhile, HHS considers changes to the CLASS Act, the long-term care plan that's included in health reform. There are concerns for its fiscal soundness, and Secretary Sebelius is listening.

And here's an interesting proposition -- early detection and treatment actually increase the rate of illness by over-diagnosing and treating people who would be just fine without intervention. Hmmm.

The FDA has approved iPAD radiology app -- fascinating and seemingly efficient.

This is a very difficult story -- an undocumented worker who became quadriplegic was sent back to Mexico against his will. Deportation at its harshest.

When should a doctor tell a patient he or she is dying? Here's a plea for greater candor earlier on.

Women derive twice the benefit as men from a heart pacemaker and defibrillator. And here are the signs of a heart attack. Having a heart attack changes one's life dramatically.

Safe injection sites lower the rate of HIV in Vancouver.

Read a fascinating interview with the matriarch of modern cancer genetics and the person most responsible for today's leukemia treatments.

Health care for executives? Some companies are taking special care of their key employees.

And here's some financial advice for young doctors who make good money but have massive student loans to pay back.

And here's a really interesting story -- a sick little boy who sends a robot to school for him, which allows him to participate as if he were there.

And last but most certainly not least, thank goodness, Hershey's study says chocolate is good for you. That's great news for us choco-holics!

Have a great day. Jennifer

Monday, February 7, 2011

Health Reform News Tidbits

Would we need to require people to buy insurance if insurance were more affordable? The experts are trying to think of alternatives to the individual mandate in light of last week's Florida court decision.

Meanwhile Republican Senator Orin Hatch thinks Justice Elena Kagan should recuse herself and not hear the challenge to the health reform law on the ground that she "must have" talked to people in the Obama administration about the constitutionality of the law when she was serving as Solicitor General. And, of course, that would almost guarantee that the law would be struck down.

Then again, say some, if the Court votes along party lines, it will greatly undermine the appearance of the Court as neutral and apolitical.

And more to come, I'm sure. Jennifer

Monday Morning - Already?

I'm so tired, and I have two major emergencies that I have to deal with today. I overslept and didn't swim. Just too tired. But it's time to get back to the grind, so here's the news:

In case you didn't catch it, Advocacy for Patients was quoted as an expert on insurance appeals in an article about chronic pain. But pharmacies are struggling to protect their stock of pain meds for fear of theft to sell them on the street.

Eight Attorneys General support the constitutionality of health reform. They are actively supporting the law and going full speed ahead with implementation.

As long-term care insurance becomes more expensive and harder to get, here's the Wall St. Journal's take on how to choose a plan.

School lunches leave much to be desired in terms of nutrition. Meanwhile, Michelle Obama aims at improving nutrition in restaurants.

Male doctors earn up to 17% more than women.

HIV is far more prevalent in African-Americans.

And that's all I can find for you this morning. Guess it's a light health news day. Check back later for updates. Jennifer

Friday, February 4, 2011

Meeting at the White House

Wow, what a day. I met with Kareem Dale, Special Assistant to the President for Disability Policy, and Jeffrey Crowley, Senior Advisor on Disability Policy. My "team" was the remarkable Janis Arnold, an Advocacy for Patients Board member and a wonderful social worker and advocate at Boston's Children's Hospital; the thoroughly glorious Wendy Shanker, author of the do-not-miss Are You My Guru? How Medicine, Meditation and Madonna Saved My Life; and the most articulate Jon Reiner, Crohn's patient and author of a forthcoming memoir of his ordeal with his illness.

Our meeting lasted about 40 minutes. During that time, we discussed the special challenges facing people with chronic illnesses, invisible disabilities. There was no question that both Kareem (he said "call me Kareem") and Jeff totally "get it," but our goal was to get them to spend a little time focusing on chronic illness today, and to ask them to include invisible disabilities when they talk about disability policy. We definitely accomplished that goal.

Janis talked about the experience of children who seek accommodations in schools. She gave wonderful examples -- IBD, Celiac, and transplants -- and very beautifully described the challenges these kids face in school, convincing schools to provide accommodations even if their grades are okay, and even if they're in remission, to plan for the inevitable. Wendy talked about her experience in the corporate world and how, when she got sick, she didn't know she had any rights, and felt that it was up to her to leave the corporate environment and make a new professional life for herself. Jon, who was well-aware of the Americans with Disabilities Act when he was in corporate America -- he worked for a time for a nonprofit that specializes in disabilities and the arts -- said that even knowing his rights, he felt he had no choice but to hide his illness as long as he could, and then leave when he couldn't hide it any more. All three were so articulate and persuasive. They clearly got that, with invisible disabilities, the whole human resources machine doesn't kick in like it does for people with visible disabilities, so nobody reaches out to us to tell us what our rights are. And they definitely understood the point that those of us with invisible disabilities have to confront a culture of disbelief -- the whole "but you don't look sick" phenomenon.

We were pleased to hear that the Department of Education is working on guidance and a "dear colleague" letter to schools about how the 2008 amendments to the Americans with Disabilities Act impact the rights of children in school. I was strongly urged to contact the Department of Justice Civil Rights Division if we have any cases we need help on; Kareem said he would tell them about Advocacy for Patients. And if anybody would like to be on the list-serve for disability issue, just send your email address to Kareem strongly urged us to disseminate that email address so that people can see first-hand what the Obama Administration is doing for people with disabilties.

This was a great day for me personally, and a truly remarkable day for Advocacy for Patients. Indeed, Kareem said he was going to invite us to events and so on, so I expect this is the first of what will be other similar trips. We at Advocacy for Patients owe Janis, Wendy and Jon a great debt of thanks for taking the day, traveling to Washington, and being such great spokespeople for the chronically ill.

They talked about chronic illness in Washington today, and that's a very good thing for the chronically ill. Jennifer

Thursday, February 3, 2011

You're on Your Own

I'm going to the White House tomorrow to meet with President Obama's Special Adviser on Disability Policy, Kareem Dale. I have to catch a 6:30 am flight out, so I won't be gathering the news for you tomorrow morning. Sorry about that. Just go ahead and read the NY Times, the Washington Post, the Los Angeles Times, the Wall St. Journal, USA Today, Politico, Huffington Post, The Hill, and Kaiser Health News for yourself! Happy reading.

I'll give you a full report on the White House trip as soon as I recover.

Have a GREAT Friday. Jennifer

Legal Scholars on the Constitutionality of Reform - Senate Hearing

Yesterday, Senator Richard Durbin convened a hearing before the Senate Judiciary Committee about the constitutionality of the health reform law. Several constitutional scholars testified that, in their view, the judge in Florida is wrong and the law is constitutional, including two former Solicitor Generals.

No doubt, we have not heard the last of this. Nor does it mean that the Supreme Court will uphold the law. The Supreme Court has acted contrary to the views of legal scholars in two notable cases, Bush v. Gore, in which the Court decided that George W. Bush won the 2000 presidential election, and Citizen's United, in which the Court struck down campaign finance laws that prevented corporations from making campaign contributions.

So hang on. It's going to be a bumpy ride. Jennifer

Jonathan Cohn: Health Reform's Costs

The marvelous Jonathan Cohn writes about the claims that health reform will cost money -- or save money. Explaining the premises on which the cost saving claim is based, Jonathan admits it's a wait and see situation.

However, he concludes, even if health reform doesn't bring down costs, it will result in nearly universal coverage and all the other protections in the health reform law. Jennifer

Advocacy for Patients' Sign-on Letter Gets National Press

A letter we authored about the new appeals rules, signed onto by 24 advocacy organizations, has garnered the attention of the insurance industry, as well as the national press.

Advocacy for Patients is having a very good week. First this, then our meeting at the White House tomorrow -- not bad for a tiny nonprofit in Connecticut! Jennifer

Thursday's Health News

So now that the Republicans in the Senate lost their vote to repeal health reform in its entirety, and the Senate, by a large bipartisan majority, got rid of the burdensome 1099 record-keeping requirement that everyone agreed had to go, perhaps they can get down to the business at hand, making the law as good as it can be for the American people. After all, support for full repeal is not as strong as the GOP says it is. Indeed, according to some polls, it's a pretty small minority. And the arguments against repeal, as made by four Democratic Senators, is very strong.

Of course, the opponents of the law won't give up on repeal. But now they'll focus on the courts, predicts WaPo. Some are in favor of asking the Supreme Court to take the case up immediately. But Charles Fried, President Reagan's Solicitor General and a staunch conservative, says the health reform law is constitutional. Still, Florida is returning a $1 million grant it received from the federal government to conduct premium rate reviews. So for those of you in Florida whose rates continue to skyrocket, don't blame reform; blame your State for refusing to do anything about it!

And the House will continue to try to deny funding for implementation. Indeed, the House GOP have some people worrying about a government shut-down over the budget. The current funding expires in 4 weeks. In addition to defunding health reform implementation, there's talk about entitlement reform -- starting with limiting the growth of Medicare. There's also talk about repealing the tax on medical device manufacturers.

Is birth control a preventive service that should be offered for free under health reform? The question is under consideration -- and is very controversial since the Catholic church opposes birth control. I predict the Administration doesn't pick this fight.

And that's where we stand as of this morning. Jennifer