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