PCIP Lowers Prices

News Release

FOR IMMEDIATE RELEASE May 31, 2011

Contact: HHS Press Office (202) 690-6343

HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance

The U.S. Department of Health and Human Services (HHS) today announced new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan. Premiums for the Federally-administered Pre-Existing Condition Insurance Plan (PCIP) will drop as much as 40 percent in 18 States, and eligibility standards will be eased in 23 States and the District of Columbia to ensure more Americans with pre-existing conditions have access to affordable health insurance. The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.

“The Pre-Existing Condition Insurance Plan changes lives, and in many cases, literally saves lives,” said HHS Secretary Kathleen Sebelius. “These changes will decrease costs and help insure more Americans.”

In 23 States and the District of Columbia, the PCIP program is Federally-administered. The remaining States operate their own PCIP programs using Federal funds provided by the Affordable Care Act.

Under the changes announced today, PCIP premiums will drop as much as 40 percent in 18 States where the Federally administered PCIP operates. These premium decreases help bring PCIP premiums closer to the rates in each State’s individual insurance market; in the six States where PCIP premiums were already well-aligned with State premiums, premiums will remain the same.

The changes announced today will make enrolling in the Federally-administered PCIP in 23 States and the District of Columbia easier. Starting July 1, 2011, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. Applicants will no longer have to wait on an insurance company to send them a denial letter. This option became available to children under age 19 in February, and this pathway is being extended to all applicants regardless of age. Applicants will still need to meet other eligibility criteria, including that they are U.S. citizens or residing in the U.S. legally and that they have been without health coverage for six months.

HHS also sent letters today to the 27 States running their own programs to inform them of the opportunity to modify their current PCIP premiums.

To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but un-enrolled. Several States have experimented with such payments with good success. This is a part of continuing HHS outreach efforts with States, insurers, providers, and agents and brokers to reach more eligible people and let them know that coverage is available. HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied.

Congress created the temporary PCIP program as part of the Affordable Care Act to help uninsured Americans with a variety of medical conditions get affordable coverage rather than be locked out of the system by insurance companies. In 2014 and beyond, insurers will be prohibited from denying coverage to anyone with a pre-existing condition and new competitive marketplaces called Health Insurance Exchanges will give people the opportunity to shop for the policy that best suits their needs. Millions of Americans also will receive tax credits to help make coverage affordable.

Enrollment in PCIP programs has begun to grow rapidly. In the period between November 2010 and March 2011, enrollment in all programs rose 129 percent to more than 18,000 Americans enrolled in PCIP.

“These changes will get more people covered,” said Steven Larsen, the Director of the Center for Consumer Information and Insurance Oversight. “We’re encouraged by recent increases in enrollment and we’re excited to build on these efforts and reach even more people.”

PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care and preventive health and maternity care. It limits annual out-of-pocket spending and does not carve out benefits the people need. Eligibility is not based on income and people who enroll are not charged a higher premium because of their medical condition.

To find a chart showing changes to PCIP premiums in the States with Federally-administered PCIP programs, visit www.HealthCare.gov/news/factsheets/pcip05312011a.html.

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov and click on “Find Your State.” Then select your State from a map of the United States or from the drop-down menu. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

Tuesday After the Long Weekend Edition

I could have used a few more days. But I think that would always be the case, no matter how long I had off -- I have years of exhaustion stored up. And the brain needs vacation. But alas, it's back to the grind. So here's the news:

The House will vote -- against -- raising the debt ceiling today in advance of a negotiation session with the White House. They will not vote in favor without major cuts to the deficit. Sen Mitch McConnell, GOP leader, says we all know Medicare will change consistent with the Ryan plan. Let's hope he's wrong about the WAY Medicare is going to change. A year ago, the GOP was screaming about how health reform would change Medicare; now they want to make it unrecognizable. But yes, there will be change.

For example, Medicare is changing how it pays hospitals, paying for how well patients do in the 90 days after a hospital discharge. Read how the new value based payment system will work. Maybe it would help if hospitals would respond to calls for help. Certainly, hospitals must try to reduce the number of hospital-acquired infections.

But for me, the most outrageous thing the GOP has done to date is to say there will be no aid to the victims of the Joplin, MO tornado without corresponding budget cuts. I understand the need to cut the deficit, but what are these folks to do? Read about the human toll in Joplin at my friend Susan Campbell's blog.

Maryland is on a fast track to implementation of health reform. Here's how it looks when it's working right.

Many states are switching Medicaid to managed care. Too bad those states didn't look at Connecticut, where managed care cost us more than $50 million extra - and we're now switching back to fee for service.

The NIH continues to run clinical trials to try to find new solutions to health care problems. Here are summaries of a few studies and their results.

30 years in and we're still learning from AIDS. It's affected 60 million people world-wide. But with money running low, what do we spend and who do we save?

Nurses play a critical role in delivery of health care beyond the hospital.

Emergency departments are popping up separate from hospitals.

Breaches of medical privacy may lead to new rules to keep data safe.

Pharma giant to give $5.7 million in poor countries. Um, does that include the US? Not that I'm against international aid, but I know there are so many poor Americans who need help paying for meds.

A medical journal is asking the authors of a paper on chronic fatigue syndrome to retract it. The paper linked CFS to a retrovirus.

An interesting study on how we remember, what we don't, and why.

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

Memorial Day Abbreviated Edition

I'm taking today off, but there were a few gems I couldn't ignore:

If we want the GOP to increase the debt ceiling, the Ryan plan to end Medicare as we know it must be on the table. So the GOP offers us a choice -- default on our debt and destabilize the world economy or trash Medicare and give people vouchers to make the insurance companies rich by forcing all the seniors to buy commercial health insurance. That's a heck of a choice to have to make. How do we get past this logjam?

GOP Governors who oppose health reform are working on getting exchanges ready to sell health insurance in their states, accepting millions of dollars of federal grant money in the process.

As more doctors join hospital staffs instead of private practice, the profession seems to lean to the left a bit.

Is it okay to deny a child medical care due to one's religion?

That's it for health news today. Let's remember all who serve -- and give thoughts and prayers (if you're so inclined) for our friends in Joplin, Missouri, who have nothing, as my dear friend Susan Campbell documents on her blog. Jennifer

Connecticut Insurance Premium Assistance Program (or why Shawn Lang kicks butt)

Through the tireless efforts of many people, with the leadership of the AMAZING Shawn Lang, Connecticut now provides assistance to AIDS patients to pay their health insurance premiums. It's funded by federal dollars. It costs less than the cost of AIDS drugs. And it's the right thing to do.

Congrats to Shawn and the army of others who worked to make this happen. Jennifer

Finally Friday Three-Day-Weekend Edition

What's better than a 3-day week-end, right? But first, the news:

Is Medicare the new third rail that can't be touched for fear of political death? I actually don't think so. People understand we need to make Medicare sustainable. We just don't want to do it at the cost of losing Medicare as we know it. The wonderful Jonathan Cohn explains here why all Medicare cuts are not created equal. Still, the GOP is standing firm on Ryan's plan to turn Medicare into a voucher program. They pledge to do better at messaging about their plan. And the Dems think it will be a huge boost in 2012.

And a new study shows that it's not just Medicare that Americans want to maintain; it's also Medicaid.

The Congressional Budget Office says that defunding health reform would threaten Medicare Part D (drug benefit) and Medicare Advantage. Yet another reason not to defund health reform.

And over 600,000 young adults are insured today under health reform, which allows them to stay on their parents' policy to age 26.

The GOP also wants to allow insurers to sell across state lines. However, Dems and consumer advocates oppose this because it would mean losing state coverage mandates. For example, if Connecticut requires insurers to cover the first $1000 of ostomy supplies each year and New York doesn't, an interstate policy would lose that special Connecticut protection.

Huge advances in fighting AIDS have been made, but at a time of world-wide budget cutting, will the funding be there to help pay for the meds that can get this disease under control?

Peter Orszag, former OMB Director, says he regrets not including a productive plan for medical malpractice reform in the health reform law. He says there should be standards that, if met, mean a doctor can't be sued. But does this Connecticut family deserve a $58 million malpractice award for negligence in childbirth, leaving a child with cerebral palsy?

Vermont's Governor signed their single payer health care law. It will take some time to implement, but finally, we will have an example of single payer in the United States. If it works, that may help us to advocate for expansion. Or maybe just move to Vermont.

Johns Hopkins receives $10 million to open patient safety institute. Sounds good.

Arizona wants smokers and obese people to pay a premium for Medicaid.

A new study questions treatment for heart disease, says raising "good" cholesterol by taking niacin doesn't improve heart health.

And that's today's news. Have a great day and a GREAT week-end. Jennifer

Thursday Themes

Well, the proposal for the new office is done and signed. Now we wait for the lease, and for the current tenant to move out. Should be in new digs by Labor Day. Totally psyched. In the meantime, though, it's all about today's news:

The Senate voted against the Paul Ryan GOP budget proposal that would have destroyed Medicare as we know it. Five GOP Senators voted with the Dems against it -- four because it goes too far, and 1 because it doesn't go far enough! Still, WaPo says the fact that most of the GOP stuck together despite the unpopularity of the proposal shows that debt reduction remains a major focus. But Tim Pawlenty, running for President, will propose his own plan rather than supporting the House GOP plan. He will offer people choices, including staying in the current plan.

The CEO of Blue Shield of CA -- a nonprofit insurer that's nothing short of brutal to its members -- released its executive salaries yesterday. The CEO of this nonprofit insurer made $4.6 million last year. Now that's the kind of nonprofit job we would all love to have.

Fifty percent of Americans have some personal tie to Medicaid. About 70% of seniors in nursing homes are on Medicaid.

This is really interesting. Doctors admit disruptive behavior in the workplace, using profanity, not cooperating with co-workers. Doctors also suffer from sleep deprivation. Think there's any connection between the two?

Meanwhile, ER docs say they order tests out of fear of being sued. And this is why I think there will be tort reform.

About 20% of young adults have high blood pressure and most don't know it. This is SO dangerous. Have check-ups and prevent a condition like this from getting out of control. Many experts believe prevention is the best way to control health care costs. So before you skip that check-up, think again.

Workers are more sedentary as we move from working in farms to working in offices -- yet another reason for the rise in obesity.

The Connecticut Senate passed the first of its kind paid sick leave bill, providing paid sick leave for employees of service industries with 50 or more employees. It now goes to the House and then the Governor, both of whom are expected to approve it.

And the Connecticut Insurance Department rejected a 35% premium rate increase -- good job!

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

Hump Day Headlines Abbreviated Version

I'm technically off from work today, so this is an abbreviated edition.

So here's an article about the new Commissioner of the Connecticut Insurance Department and his position on holding rate review hearings -- and my comments about the need for public access and transparency. As you know, I'm in favor of public hearings so that, when a rate increase is allowed, everybody understands why.

In the national news, a Democrat won a special election in upstate New York primarily by pounding the GOP position on Medicare. Is this a foretelling of 2012? The Dems sure hope so.

VP Biden appears to be making some progress in his negotiations with the GOP over the debt.

The Governor of Vermont is set to sign historic single-payer health insurance bill.

Those are the quickie highlights. Have a great day! Jennifer

Tuesday Tidbits

Blogger is acting weird again, so I don't know if this post will ever see the light of day, but here goes nothing:

A tornado isn't bad enough, but to have it hit a hospital -- I can't imagine the terror. Thoughts here for our own dear friend Susan Campbell, whose family home is near Joplin. Her family is safe, but she doesn't know about all of her friends, so she's flying home on Friday. Stay safe, Susan.

Scott Brown (R-MA) will oppose the Ryan Medicare gutting. Here he is in his own words. And the GOP is feeling the consequences of the Ryan plan to eliminate Medicare as we know it and replace it with vouchers. And the Dems are keeping Medicare front and center for 2012.

Meanwhile, VP Biden is leading a bipartisan group on debt reduction. And the GOP are going after domestic and foreign food programs. Yup, you read that right. Cutting the food program for women and infants, for a start. Or let's cut the FDA budget. And if we can't cut Medicare, how about cutting Medicaid for the poor and the elderly in nursing homes? And before anybody asks me how we're going to get the budget under control if we can't cut all of these programs, I'll answer you: raise taxes on the rich (reverse the Bush tax cuts) and get us the heck out of Iraq and Afghanistan, for starters.

Accountable care organizations are complex, created by 127 pages of regulations, and providers are nervous about some of the provisions. But this is one of the main vehicles for bringing down health care costs (I wonder if that has something to do with why providers are nervous?), so it's important that we get it right.

And now there are attacks on medical malpractice reform -- from the right!

A drug to cure hepatitis-C. Fabulous news.

More employers are offering health care in the workplace. Still, why do unhealthy people fail to take steps to get healthier? And yet, they do all kinds of things to LOOK better!

Childhood cancer. Two words that should never be uttered together.

A price break for AIDS drugs in 70 of the world's poorest countries.

A scary story about a device that's not FDA approved being implanted when a patient is unconscious.

Gastric bypass surgery not only helps lose weight, but it also may rid you of diabetes.

If you're the doctor onboard a plane when a passenger needs help, do you come to the rescue? Please say yes. And if you're a doctor who gets cancer, maybe a hug will help?

A group of doctors lists the top 5 ways to improve primary care.

A fitness test to measure heart health. Or better yet, a blood test that will reveal your health risks.

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

Monday Moaning

I really do hate Mondays. I could have gone back to sleep for awhile longer. Oh, well. Best get to the news:

Is it critical to raise the debt ceiling? Republican Senate Minority Leader McConnell says yes. Democrat Dick Durbin says yes.

Paul Ryan took aim at Newt Gingrich over his Medicare comments yesterday. Newt, of course, has done his best to repudiate his own comments, even going so far as to say they must never be quoted because he really didn't mean what he said.

Hospitals are worried about any Medicare, Medicaid cutting because their payments would shrink.

How the medical profession is reforming itself to improve quality while cutting costs.

Cash strapped states are cutting back on HIV/AIDS drugs. Over 8300 people are on waiting lists. This is tragic and wrong. And some states are cutting unemployment benefits, as well.

Ten percent of cancer patients don't fill prescription for expensive drugs.

Why are unhealthy people so reluctant to change their lifestyle? Easier said than done.

The feds say banning Planned Parenthood funding may deprive Medicaid recipients of benefits to which they are entitled. Not abortion, but contraception and other gyn care.

A story about the doctor behind single-payer health care in Vermont. Now, if only this could happen in about 49 other states!

Psychiatrists are finishing up the new DSM -- the manual of diagnostics that categorizes psychiatric disorders.

A Kennedy launches a "moon shot" to spur brain research.

Baby boomers are heavily into joint replacement. Hmmm. I think I'll keep the ones I have.

And that's the headlines for today. Have a great day! Jennifer

One Step From Disaster: This MUST Change

This can be your parent. This can be you. Is this the society we want?

Courtesy of Susan Campbell.

Jennifer

Finally Friday Edition

But I have a big day ahead, scouring the planet for the right office space for Advocacy for Patients. But first, here's the news:

HHS released regulations yesterday that require health insurers to justify rate increases of more than 10%. I haven't had a chance to read them in detail yet, but this sounds promising. The feds do not have the authority to block a rate increase, but they can be public about their finding that a rate is unreasonable, and they are providing grants to states to beef up their processes because they can and should block unreasonable rate increases. At the very least, the insurers' justification for the rate increase will be public. This is a huge step forward for consumers.

The GOP budget would not just hurt seniors in the future; it would hurt them now, says Secretary Sebelius.

The marvelous Pauline Chen writes about the problem with following clinical guidelines -- and forgetting to pay individualized attention to the patient.

Doctors use electrical stimulation to help a paralyzed man stand and even take a few steps.

And that's pretty much it for this morning -- a day full of news about things other than health care and even the budget! Nice for a change.

So have a great day! Jennifer

Next White House Disability Call

In order to help keep you more informed, we are hosting monthly calls to update you on various disability issues as well as to introduce you to persons who work on disability issues in the Federal government.

Our next call will be Thursday, May 26 at 3:00 PM Eastern.

I would encourage you to call in about five minutes early due to the large volume of callers.

If you received this email as a forward but would like to be added to the White House Disability Group email distribution list, please visit our website at http://www.whitehouse.gov/disability-issues-contact and fill out the contact us form in the disabilities section.

This month’s call will feature:

Secretary of Transportation, Ray LaHood

Assistant Secretary for Civil Rights, Department of Education, Russlynn Ali

Director of Federal Contract Compliance Programs, Department of Labor, Patricia Shiu

The call also will include updates on civil rights, health care, and fiscal/budget issues.

We strongly urge and ask that you distribute this email broadly to your networks and listservs so that everyone has an opportunity to learn of this valuable information.

The conference call information is below.

Dial in for listeners: (800) 230-1085

Title: White House Disability Call (use instead of code)

Date of Call: 05/26/2011

Start Time: 3:00 PM Eastern (dial in 5 minutes early)

This call is off the record and not for press purposes.

For live captioning, at the start time of the event, please login by clicking on the link below. Please only use this feature if you are deaf or hard of hearing.

http://www.fedrcc.us//Enter.aspx?EventID=1745291&CustomerID=321

World IBD Day

Today is World IBD Day. A day to reach out to your friend or loved one with one of these debilitating diseases. A day to share our hope for a cure. A day to say it's okay to talk about a disease that's really hard to talk about (sharing bathroom habits isn't exactly easy social conversation).

Today, let's make sure IBD is not invisible. Jennifer

Thursday Themes

Miss me? Took a day off from blogging yesterday, but I'm back, and here's the news:

A bipartisan group of Senators known as the Gang of Six that was negotiating on the debt lost a prominent Republican, Tom Coburn. This makes a deal that would include tax increases as well as spending cuts less likely. However, the remaining five say they are still working at it. Meanwhile, the GOP tries to say reaching the debt limit doesn't necessarily mean a default on our debt. And so the lack of urgency felt by the GOP and the voters is hurting the push to raise the debt limit, which the White House says is of critical importance. Seems to me that if we even come close to defaulting on our debt, our debt rating goes down, which makes it harder for us to borrow money, which makes it harder to fund our economy, which could strain and already fragile economy -- and that sounds pretty bad to me. Indeed, Speaker Boehner has admitted that the debt ceiling will be raised, much to the chagrin of the Tea Party.

And I know this isn't directly related to health care, but the Senate has blocked a repeal of oil subsidies. So it's okay to gut Medicare and Medicaid, but when it comes to the billions we give to oil companies, that has to be protected? Really?

Some states are working on a multi-state health care compact as an alternative to health reform. It would mean that the feds would turn over responsibility (and funding) for all government-funded health care to the states to run as they wish. I'd like more details on this please.

The Administration filed its brief in the 11th Circuit Court of Appeals, arguing that not requiring people to have insurance is like leaving the uninsured on the street after a car accident. Their argument is that, under the GOP alternative would penalize people for not having insurance by withholding health care.

Meanwhile, the Administration has created new pathways to establishment of Accountable Care Organizations -- networks of health care providers that will serve all of the needs of Medicare recipients as a way of reducing cost while improving quality. If you're interested, here's a brief set of FAQs on ACOs.

And employers face an 8.5% increase in health care costs in 2012 -- a burden they will pass on to employees in the form of higher deductibles and copays.

Medical malpractice reform seems bogged down. I predict it will be revived.

States are struggling to pay for aged and disabled community programs.

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

How Cool Is This? From the White House

Bureau of Engraving and Printing Launches EyeNote™App

to Help the Blind and Visually Impaired Denominate US Currency

The Bureau of Engraving and Printing (BEP) has developed a free downloadable application (app) to assist the blind and visually impaired denominate US currency. The app is called EyeNote™. EyeNote™ is a mobile device app designed for Apple iPhone (3G, 3Gs, 4), and the 4^th Generation iPod Touch and iPad2 platforms, and is available through the Apple iTunes App Store.

EyeNote™ uses image recognition technology to determine a note’s denomination. The mobile device’s camera requires 51 percent of a note’s scanned image, front or back, to process. In a matter of seconds, EyeNote™ can provide an audible or vibrating response, and can denominate all Federal Reserve notes issued since 1996. Free downloads will be available whenever new US currency designs are introduced. Research indicates that more than 100,000 blind and visually impaired individuals could currently own an Apple iPhone.

The EyeNote^TM app is one of a variety of measures the government is working to deploy to assist the visually impaired community to denominate currency, as proposed in a recent Federal Register notice. These measures include implementing a Currency Reader Program whereby a United States resident, who is blind or visually impaired, may obtain a coupon that can be applied toward the purchase of a device to denominate United States currency; continuing to add large high contrast numerals and different background colors to redesigned currency; and, raised tactile features may be added to redesigned currency, which would provide users with a means of identifying each denomination via touch.

More information is available at http://www.eyenote.gov/ or through email at eyenote@bep.gov.

More information can be found also at: http://www.bep.treas.gov/uscurrency/meaningfulaccess

Starbuck in Hot Water?

The U.S. Equal Employment Opportunity Commission (EEOC) has charged Starbucks Coffee Company with violating federal law by denying a reasonable accommodation to a barista with dwarfism and then firing her because of her disability. The employee had asked to use a stool or small stepladder to perform her job and Starbucks refused. The Americans with Disabilities Act requires employers to make reasonable accommodations to employees’ and applicants’ disabilities as long as this does not pose an undue hardship.

Here's a great excuse to skip that latte. Jennifer

Tuesday Tidbits

And so it's Tuesday once again. Let's check on the news:

I'm putting this first, before the budget, before Medicare, before health reform, because nothing is more important to those of us who are patients. Here's an article written by a doctor about how difficult it is to show compassion towards patients. Really? Yeah, really. This is a careful article about a subject that's obviously difficult for the author. And it explains a lot about what, as patients, we are missing in our relationships with our doctors.

The federal government hit the debt limit yesterday, although Treasury Secretary Tim Geithner has found "extraordinary measures" to keep us out of default until August, while the parties continue to butt heads over raising the limit. Congress is in recess this week, so there's not even anybody in Washington dealing with this. Shameful.

And on the day we hit the debt limit, Rep Ryan -- the architect of the plan to dismantle Medicare -- defends his plan as one that will save Medicare and the budget. His remarks come on the heels of Newt Gingrich's statement that it's "right wing social engineering." Ryan also blames health reform for the poor economy -- something that is contrary to fact. It's true that health care costs have doubled in the past decade. But health reform wasn't around for most of that.

Not that this is remotely surprising, but here's proof that the budget cuts hit the poor the hardest.

The states -- and particularly, those dominated by Republicans -- grapple with how to set up the health insurance exchange or marketplace mandated by federal health reform.

A study of Medicare beneficiaries shows that patients in rural areas are more likely to have surgery than those in urban and suburban areas.

Are you an organ donor? Here's a great story that shows you why you ought to be.

A new device may give first-responders longer to revive victims of heart attacks.

Telling doctors what things cost causes them to order less unnecessary tests.

Amazing advances in medicine are right on the verge of becoming reality. Being operated on by a doctor who's not even in the same room? Hmmm. Is this good?

Connecticut's Governor agrees to study the public option, create a cabinet-level office of Health Reform and Innovation.

Ob-gyns turn away obese women because they can have more complications.

Autopsies are becoming increasingly rare, which may be a missed opportunity to learn.

A plan to vaccinate 90 percent of children -- let's hope it's more than a plan.

Hernias in women can go undiagnosed and can be debilitating.

More disagreement on how much salt you should eat.

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

Nominate a Citizen Hero - From the White House

Dear Friends,

Last year the President honored 13 outstanding Americans with the nation’s second-highest civilian honor, the Presidential Citizens Medal. The individuals who received this award were Americans who set out to improve their country and their communities through extraordinary service outside of their day to day jobs. In 2010, President Obama asked Americans to participate in the nomination process and this year we are proud to ask for your help once again.

For the 2011 Presidential Citizens Medal we are asking you to look into your communities and nominate those everyday heroes who have performed exemplary deeds of service, including those who have demonstrated commitment to service in their own communities or in communities farther from home, who have helped their country or their fellow citizens through one or more extraordinary acts, whose service relates to a long-term problem, or whose service has had a sustained impact on others’ lives and provided inspiration for others to serve. Last year over 6,000 incredible leaders were nominated for their service, which often times goes unrecognized. The Presidential Citizens Medal offers a chance to thank those extraordinary stewards of service from across the United States.

For more information on the Citizens Medal as well how nominate an outstanding citizen, please read this letter from the President below and visit WhiteHouse.gov/citizensmedal http://www.whitehouse.gov/citizensmedal to watch the announcement video.

To nominate someone for the 2011 Citizens Medal, please review the criteria for this year’s medal http://www.whitehouse.gov/citizensmedal/criteria Additional awardees may be selected outside of the public nomination process. In order for the individual to be considered for the Medal:

* Nominees must be citizens of the United States
* The nominee’s service must have been performed outside of his or her regular job.
* Nominations must be received by Monday, May 30, 2011 at 11:59 p.m. EST.

All the best and happy nominating,

The White House Office of Public Engagement

__________________________________________________________________________________________________________________________________________________

The White House, Washington

Good morning,

Last year I asked the public to help identify outstanding Americans I should consider for the Citizens Medal, the nation's second-highest civilian honor. After receiving more than 6,000 nominations, I invited 13 outstanding Americans to the White House to receive the medal and be recognized for their service.

It's time to do it again.

Like last year, we're looking for Americans who have performed exemplary deeds of service outside of their regular jobs and provided inspiration for others to serve. You can view the full criteria and get started on a nomination here:

http://www.whitehouse.gov/sites/default/files/image/email_graphic_citizens.jpg

Now I know there are thousands of citizens out there who meet these criteria -- I read their letters every night, and I meet many of them in my travels around the country. I also know that many times their contributions go unrecognized. The 2011 Citizens Medal is a chance to recognize the everyday heroes in your community.

Here are a few examples of Citizens Medal recipients from last year.

Betty Kwan Chinn was homeless as a child in China and became mute. When she came to America, Betty found her voice and her calling. Today, she provides meals to the homeless in her community twice a day as expressions of gratitude to a welcoming nation.

Susan Retik Ger is a widow who lost her husband on 9/11 who found cause in educating and training Afghan widows and their children.

George Weiss, Jr. is veteran of World War II who founded the Fort Snelling Memorial Rifle Squad, a group of over 125 volunteers who have performed final military honors at over 55,000 veterans' funerals.

Their stories are powerful reminders of the impact an individual can have on his or her community and on the world. You can watch them tell their stories in a video gallery on WhiteHouse.gov:

http://www.whitehouse.gov/citizensmedal/2010

If you know someone like Betty, Susan or George, please take a moment to nominate them for the 2011 Citizens Medal before May 30.

Sincerely,

President Barack Obama

Monday Moaning

Again, sorry about the Blogger mess up. Hopefully, we are back on track. Here's the news:

Medicare will run out of funds in 13 years. This is sooner than previously predicted. But the panel that is supposed to try cutting costs can't find members to get started.

The economy hangs in the balance as the parties fight over raising the debt limit. The debit limit will be hit today. The parties have done this sort of dance over raising the debt limit before. Members of both parties are looking at the idea of automatic triggers if the debt doesn't come down. They tried this before. They hated it. But there is no question that the debt has to be tackled. But the GOP refuses to put taxes on the table -- they want all cuts, and no raising of revenue. So he's ready to cut a deal today, but only on his terms. And Minority Leader McConnell says this is an opportunity to cut the debt; he won't raise the debt limit without deep cuts in spending. The Dems agree that we have to address entitlements, but would not do it through privatization.

Health reform created a panel to address the shortage in primary care, but their funding has been blocked and they can't even convene a meeting due to politics. Meanwhile HHS has granted waivers from the medical loss ratio rule to Nevada and New Hampshire. They've also granted more mini-med waivers. These waivers are temporary, until 2014 when the full law is implemented.

Newt tries to position himself as the moderate Republican, opposing Ryan's Medicare plan. He says it's right-wing social engineering. But does he have an alternative?

Rhode Island Medicaid is block granted, but has it saved money? Umm, no. Still, many argue that this is an experiment that shows that block grants work.

Nursing homes seek exemption from the health law. They pay their employees so little and they don't include health insurance -- and don't want to have to. Really?

How to get your own medical records. There are some links in this article that you should bookmark, including one that includes the fees in every state.

A mom with breast cancer was denied custody of her children. This is not the first time I've heard of illness being considered in making custody decisions. Does being sick make bad parents? Of course not. So is this justified?

Social rejection is painful -- and not just emotionally.

UCLA's CEO succeeds by putting patients first. Duh.

Doctors in Italy say some people with lactose intolerance really have a psychological illness. I'm so glad I had a lactose intolerance test. Can't blame this one on my psyche.

We know chronic Tylenol use can harm your liver. But did you know it could also cause blood cancer?

Scientists find the genetic "switch" for obesity. So can they figure out how to turn it off?

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

As the Cost of Health Care Rises, People Skip Care

Insurance company profits are up as people skip care due to large copays and coinsurance that cost more than they can afford. Still, premiums continue to increase despite the reduction in health care utilization as insurers hedge against their prediction of a rebound in utilization rates.

Obviously, this is a disturbing trend. Jennifer

Blogger Mess-up

If you've been following this blog, you know there's a post missing -- Thursday's Themes -- and I did not blog today (Friday) because Blogger was down all morning. I suspect the missing post is lost forever. But never fear -- I will be back to my regular schedule on Monday, Blogger permitting.

Thanks for your indulgence. Jennifer

Aetna Cuts Rates Due to Health Reform

For all of you who said health reform would only increase health insurance premiums, get this. Aetna is reducing its premiums, at least in part due to the minimum loss ratio requirements of the health reform law. Remember the minimum loss ratio, the percentage of premium dollars spent on health care as opposed to administrative and other costs? I believe I told you I thought this would be the first piece of health reform that would result in lower premiums, and here you go, even sooner than I thought it would happen.

I'm telling you. Hang in with this law. Let it play out and be fully implemented. It's going to make things better. Not everything, not perfection, but a start. Jennifer

Tuesday Tidbits

Speaker Boehner has outlined his demand for a vote on raising the debt limit. Although the failure to do so would ruin not just our economy, but the world's, the GOP threatens to hold it hostage if we don't cut "trillions," including Medicare. They want at least $2 trillion in cuts. But the cuts can't reduce defense spending. And the conservative caucus in the House wants even more in cuts than Boehner. Some say Boehner is setting himself up for failure by setting the bar so high. The President will meet separately this week with Republicans and Democrats.

Oral arguments in the first appeals court cases attacking the health reform law will move forward today. There are two cases in the Fourth Circuit -- one that upheld the law and one that struck it down. We know the cases are going to the Supreme Court, but still, this is critically important. The court will decide first if the States have standing to challenge the individual mandate (since they aren't individuals and so won't be directly affected by the mandate) and then will decide whether the mandate is constitutional. And the Supreme Court is being set up for its decision being hailed as illegitimate, whichever way it turns out, or so says Politico.

What it's like to care for a spouse with dementia. I can't imagine, even after reading this.

The always wonderful Dr. Pauline Chen on revised medical school admission testing. What should be most important when choosing future doctors?

Birth control pills may dampen the chemistry of attraction between the sexes (or even within the sexes).

Charles Darwin was sick. With what, exactly?

House calls by nurse practitioners -- brilliant on convenience, but is it best for health?

Stop colon cancer screening at age 80? Really? Hmmm. But keep exercising, seniors -- it's the closest thing we have to a fountain of youth.

And that, my friends, is today's news. Have a GREAT day! Jennifer

Monday Moaning

Once again, may I say how much I hate Mondays? Oh, well. They keep coming anyway. So here's the news:

Now that it's pretty clear that Congress isn't going to repeal or defund health reform, the focus shifts to the courts. Oral argument in the 4th Circuit court of appeals is on Tuesday. The law will be defended by the Solicitor General's office, which is very unusual -- the SG usually doesn't appear in any court other than the Supreme Court.

It seems that perhaps Medicare is off the table in debt reduction talks, at least for now -- but Politico describes 4 ways in which entitlements may still figure into debt reduction. But after the 2012 election. And the Hill reports that Medicaid may be a better target than Medicare since the poor people it serves don't have the political clout that seniors have. And for many GOPers, health care is still on the chopping block. Kent Conrad's conservative Dem proposal may involve relatively small cuts to Medicare.

The Independent Payment Advisory Board (IPAB) is the main Medicare cost-cutting mechanism in the health reform law. It will make binding recommendations that will take effect unless Congress acts to block them, if costs go over certain thresholds. It will also release reports about health care spending, even in years when it's not triggered.

Despite a 2009 task force recommendation that women don't need annual mammograms until age 50, women in their 40s want the test.

The feds are cracking down on medical marijuana in states where it's legal.

Florida is about to become the largest state to shift Medicaid into HMOs. It was a disaster in Connecticut, not only financially, but in terms of access to care. We'll see how it goes elsewhere. Also in Florida, a report reveals elder abuse in assisted living facilities.

Vermont has passed single-payer health care. So now we'll see if it works.

And that's it for a light health news morning. Have a great day! Jennifer

Finally Friday Edition

And not a moment too soon. Here's the news:

It appears now to be certain that the GOP is backing off of its Medicare-cutting proposal. VP Biden met with bipartisan leaders for the first talks, as some GOPers disagreed with abandoning the plan to eviscerate Medicare. But the GOP leadership realizes that they will never get the Dems to agree to a deal on the Medicare cut. Secretary Sebelius said that the Medicare cut would drain seniors' savings and, as a result, they would die sooner. And 50 Dems signed a letter to President Obama urging him to stand strong on Medicare. Instead, the GOP is proposing long-term budget cuts with triggers that would force automatic cuts, none of which would take effect until after the 2012 election. Talks will resume Tuesday. Meanwhile, some Dems want hearings on the effects of the GOP plans for Medicare and Medicaid, keeping the spotlight on a very unpopular position.

The GOP also wants to convert Medicaid to block grants. Here's a debate between experts. Democrats and advocacy groups oppose this.

And the GOP chair of the House Ways and Means Committee also said health reform repeal is dead. He says they will now focus on repealing the individual mandate. Of course, many (if not most) health reform supporters say the system can't work without the mandate.

Speaking of health reform, groups have started to develop new labels for insurance plans so consumers will have a real understanding of what they're buying so they can choose plans in an educated way. Plans have to start by breaking down the costs of maternity care, breast cancer treatment, and diabetes treatment so consumers will have a better idea up front of what will be covered and what will not. This takes effect in March 2012.

Medical societies weighed in yesterday on how to fix the Medicare reimbursement rate -- a vexing problem that's been dogging Congress for awhile now. They also want to be able to balance bill seniors for the difference between what Medicare pays and what they want to charge.

Here's an interesting opinion piece that says that we are diagnosing people who years ago would not have been considered sick, and it's driving up health care costs. So what? Instead, people should suffer with symptoms but no diagnosis or treatment? Interesting.

The continued use of mercury in dental fillings came under attack at an FDA meeting.

A Maryland doctor who treats autism with a controversial drug has had his license suspended.

Naps make you more productive. So can I go take one now?

Have a great day and a great week-end! Jennifer

We Have To Change The World

How do we make the invisible visible? I talk to people with chronic illness every day who are homebound and paying a terrible price for their illness.

• A little kid being referred to truancy court because his school doesn't believe that he really has ulcerative colitis despite the fact that they have his medical records, which include a report of a colonoscopy that just can't lie.
• A woman who's had two strokes at age 30 and is having trouble navigating the Medicaid system, but we can't find anybody in her state to help her.
• A man who loses his insurance, can't afford to replace it, but will become disabled by dystonia if he stops treatment. Clearly, it's better for society if he keeps working, but society won't help him fund his medical care.

This is the world of the chronically ill. And it has to change.

I don't quite know how to change the world, but I'm committed to trying. A hunger strike was a drastic idea, I know, but that gives you an idea of how desperate I feel about getting this word out.

So what can we do? Well, I'm writing more -- both here and I'm working on something longer. I'm telling some more stories. I'm trying to explain how irrational insurance is. If you have a story that I can tell, please send it to me. My email address is patient_advocate@sbcglobal.net. I will not use your name in public, but I will try to make the horrors you live with mean something by using them to argue for change.

And then there is legislation. Every week now, Congress is voting on defunding of health reform. If you don't know how bad that would be for us chronically ill, then you don't yet fully understand health reform. Starting in 2014, if you earn up to 133% of the federal poverty level, you will get Medicaid. There will be an exchange, a marketplace where you can compare and buy insurance. And there will be subsidies for people who don't qualify for Medicaid that will make insurance more affordable. That will mean that people like the man with dystonia I mentioned above will be able to buy insurance. So contact your members of Congress and urge them to stand strong on health reform. It's not perfect, and we need to do more to control health care costs. But it's better than doing nothing.

And if you don't have a chronic illness, or if your illness is in remission, try to see the people around you who are suffering. Notice the twinge of pain in their faces. See the loneliness in their eyes. Do they need a ride to a doctor appointment? Maybe a hot meal? Maybe just someone to talk to?

I know -- I believe -- that we can change the world for the chronically ill. It's not going to be easy. But the first step is to step out of the shadows, talk about our experiences, make it okay to talk about being sick, make it real, not just for us, but for those around us. We have to do something. Please do what you can. Jennifer

Best Blogs for Crohn's Support

Nursingschools.net has released a list of the 40 best blogs for Crohn's disease support -- and this very blog is on the list, along with some of our other favorites, like Chronicbabe.

If you're a Crohn's patient -- indeed, if you have a chronic illness -- this is a really good list. Check it out. Jennifer

Thursday Themes

So the GOP is backing off of cutting Medicare -- suggesting that they start focusing on cutting federal employee pensions and farm subsidies, as well as medical malpractice reform and other cuts. It's great news that there seems to be room for negotiation. Oops! The GOP says they never meant to say that they were backing off the Ryan plan to eliminate Medicare as we know it. Geez -- I'm used to changes in positions from one day to the next, but in the time it took me to get from the NY Times to HuffPo? That's a new one.

Moving right along, VP Biden has his first bipartisan meeting on the budget this morning. Meanwhile, some GOP leaders challenge the White House to come up with a debt reduction plan. Um, that speech the President gave a couple of weeks ago, remember? And HuffPo reports that the outline of a deal to raise the debt ceiling is emerging, with a cap on federal spending and a trigger for both cuts and revenue increases are built into the deal. Don't ask me what this means -- it's way too early to tell. But the White House is working on a corporate tax reform proposal.

Here's a primer on Medicaid, Medicare and Social Security, in case you need to learn the basics.

The states filed their brief in the government's appeal from the Florida judge's ruling against health reform. They argue that Congress can't require people to purchase health insurance, and that, if that part of the law is struck down, the whole law must go. Oral arguments should be heard in June.

Community health centers are an integral piece of our health care puzzle. Here's a detailed discussion of the role they play -- very important reading.

Will Congress raise premiums for military health insurance, called Tricare? Not if the GOP has anything to say about it (and they do).

Physician groups will testify in Congress, demanding a five-year transition to new Medicare payment rules.

Medicare auditors have recouped $237.8 million in overpayments. Great job.

A lot of very popular drugs will be available in generic form soon, reducing cost significantly.

More on the ongoing struggle to understand chronic fatigue syndrome. There had been the belief that it was linked to a retrovirus, but a study released yesterday rebuts that.

The tough decisions patients have to make when faced with a new diagnosis -- here, a rare cancer of the eye. Such bravery.

Asthma rates rise sharply in the US.

Audit finds long wait times for breast exams. This is pretty outrageous.

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

Do You Believe This?

Just when you thought the GOP couldn't care about facts any less, here comes an analysis of Paul Ryan's GOP budget plan that explains that it's very similar to the health reform requirement that people buy insurance or pay a higher tax bill. Need I say more? Jennifer

If Not a Hunger Strike, then What?

As readers here already know, my sense of desperation for the plight of the chronically ill has escalated dramatically lately. Perhaps it was the World Health Organization report that says that chronic illness is the leading cause of death in the world, as well as in the United States. Perhaps it was the unprincipled loss of a life-and-death insurance appeal, or just the calls that come every day from people looking for the most basic services to maintain their lives. Perhaps it's all of those things and more.

I thought about a hunger strike to bring attention to the plight of the chronically ill until it became clear that I couldn't do that without harming myself. I'm still trying to come up with a plan -- something big enough to really make a difference in the lives of the chronically ill. Something that at least would make us visible.

My dear friend Susan Campbell has written about my quest to bring attention to chronic illness. She did a beautiful job, as I trusted she would, making me sound less crazy and more important than I am, and helping to get the word out. I'm very grateful.

Do you have ideas for what I can do to bring national attention to the plight of the chronically ill? I welcome your thoughts. Jennifer

Hump Day Headlines

Someone called here at 3:40 am. So I'm awake and miserable. Here's the news:

A bipartisan group of six members of Congress have stalled in their negotiations to craft a debt reduction plan. But conservative Dem Kent Conrad has come out with his own budget that eliminates tax deductions, lowers taxes, and cuts without eliminating Medicare. The details are too vague to report on -- or for me to take a position.

The GOP admits that attempts to defund health reform are playing to their base; they know they can't win. Still, they voted yesterday to eliminate funding to set up exchanges where consumers will be able to compare and purchase insurance. And today they will vote to eliminate funds for school-based health care.

And House Majority Leader Eric Cantor says rationing of health care by the insurance industry is better than rationing by government. Um, why?

The federal government says it will crack down on medical marijuana.

Would you choose your doctor based on price?

Should insurance companies pay for exercise plans, gym memberships? Some say yes.

Are low salt diets good for your health? Not so sure. Indeed, it might be bad for you.

That's all I have for you now, although it's so early that it may be that all the papers haven't fully updated yet. If I have time, I'll check back later and post updates. In the meantime, have a great day. Jennifer

Saving Money By Providing Care

I don't understand. Simple as that. I don't understand how anybody could be opposed to a law that will provide insurance coverage to over 32 million people who don't have it today.

I understand that we have huge debt in this country, but I'm not convinced that covering people is more expensive than sending them to emergency rooms. There are so many studies that show that when people with chronic illnesses can't afford the care they need, they skip care, and that allows their illness to spin out of control, getting much more expensive by the time they end up in the hospital on the taxpayers' tab. Indeed, although it's true that higher copays (meaning cheaper insurance) lead to people using less care, I haven't read anything that substantiates the view that that's a good thing. It's a whole lot easier and cheaper to treat a cold than it is to treat pneumonia.

How, then, do we bring down the cost of health care? A lot of smart people seem to think wellness programs and prevention are part of it, and I'm sure that's true. Smoking is bad. Obesity is bad. Lack of exercise is bad. And I'm a failure at most of those things, although I did quit smoking about 15 years ago or so. I mean to swim every morning, but I got an infection, and then there was ice and snow, and then another infection -- there's been an excuse for months now. I have to get myself back into the water, for sure. But the truth is that I am unable to swim hard enough and fast enough for it to be a real cardio work-out, and my joints hurt way too much for me to do anything other than swimming.

My weight? Well, we've been down this road before on this blog. It's a constant struggle just to stay at my current weight and not let it keep creeping up. My diet is so restricted -- no roughage, nuts, whole grains, fresh fruit or veggies -- it's very hard just to keep from gaining. And I have to say that so many of the people we help are overweight, as well, I discover when I read their medical charts. Interesting that most insurance doesn't cover bariatric surgery or nutrition counseling or diet programs. If it would really make us healthier, why not help us lose the weight by giving us the tools to do so?

But okay, let's assume we should all stop smoking and drinking, exercise, eat better. Is that going to cure Crohn's disease or multiple sclerosis or the whole host of chronic illnesses with which we struggle mightily? No, we need medical care, too.

And so we are back to what to do about the rising cost of health care. We know that our current system is badly broken. We know that we spend more on health care in America than most countries, but our health outcomes are lousy compared with the rest of the world. Clearly, we are doing something wrong. But it withholding care by making the prices prohibitive the right answer?

One thing that always interests me is that insurers don't actually respond to economic analysis. I can't tell you how often a patient will say to me "but if they let me have this surgery for $50,000 I can get off the feeding tube that is costing $50,000 a month." That assumes a level of rationality that is not there, does not exist.

I had a cancer patient who was so sickened from one chemo drug that she couldn't work, couldn't function. She found another drug. It worked to keep her illness in check. It had essentially no side-effects. It wasn't more expensive than the alternative the insurance company wanted her to take. How is it better for us as a society to have a disabled patient whom we now have to support entirely -- disability benefits, Medicare, free care at hospitals -- than it is to have a functioning patient whose disease is in remission?

You're going to think I'm nuts, but it's the truth. Pointing out to an insurance company that the treatment you seek is less expensive than the alternative doesn't change their minds. Maybe it ought to. Rather than worrying about the size of the clinical trials that support the use of the treatment the doctor prescribes regardless of cost, why not allow people less expensive options that are prescribed by treating physicians even if the treatment hasn't been as studied in as many people over as many years? If it's a wash on cost, why drive up the price of insurance by doing all of these reviews of treatments completely regardless of cost? Eliminate the need for insurance companies to staff with doctors and nurses whose job it is to second-guess treating physicians and you save money, no?

Look for more of these kinds of essays on this blog from now on. Because it's time for me to make sure that everybody else sees the piece of the world I see. Maybe then, people wouldn't be so quick to judge, to blame it on the patients. Maybe then, we would get that chronic illness affects all of us, if not directly, than through the costs on society. Maybe then, we would better understand the incentives that drive costs through the roof.

I promise you -- nobody wants more medical care than they need. If you think this is fun, think again. Patients aren't the ones who order health care or, most of the time, even request it. What we need is a society that supports us enough to get us the care we need -- nothing more, but also nothing less. I bet we'd save money just by doing that. Jennifer