Americans Oppose Health Reform -- But Don't Know What It Says

A Kaiser Family Foundation poll released today finds Americans pretty nearly split on the health reform law, although the majority of them want it either expanded or maintained rather than replaced or repealed. These strong views are held despite the fact that most Americans don't know what the law entails.

HuffPo offers the following analysis in a longer piece you can read here:

For example, despite the best efforts of the Obama administration and Democrats in Congress, many Americans say they are unfamiliar with some of the key provisions of the law affecting Medicare. That lack of familiarity (or confidence) is even higher with seniors. Specifically:

• Only 45 percent of adults and 42 percent of seniors say that the health reform law will "gradually close the Medicare 'doughnut hole.' "
• Only 36 percent of adults and 21 percent of seniors say the law will "eliminate co-pays and deductibles for many preventative services under Medicare."
• Only 47 percent of adults and 37 percent of seniors know the law creates "an expert panel to recommend ways to reduce Medicare spending if costs grow too rapidly."

Meanwhile, large numbers of Americans continue to believe the health care law affects Medicare in ways it does not. For example:

• 31 percent of adults and 22 percent of seniors say the law "allow[s] a government panel to make decisions about end-of-life care for people on Medicare" -- another 20 percent of adults and 31 percent of seniors are unsure.
• 48 percent of adults and 35 percent of seniors say the law will "cut benefits that were previously provided to all people on Medicare."

Really. People still believe in death panels. Unreal. I mean, really, if you're going to take a position for or against something, shouldn't you know what it says and does? I know I'm preaching to the choir -- my readers have the facts! Jennifer

Let's Have the Real Conversation

The health reform debate has been brutal, focusing on everything from "death panels" (no, they do not exist) to the constitutionality of a requirement that everybody purchase insurance (with subsidies if they need them) or pay a (small) penalty. Accusations of a government take-over and rationing of health care are repeated over and over, no matter how false they are. In the end, it seems to me that we're not having the conversation that underlies all of this: What's the proper role of the federal government?

Some people are in favor of small government. They would go so far as to privatize Social Security and Medicare. They think the market can fix pretty much any problem that arises, with perhaps a little help from state governments. The funniest Tea Party sign I've seen is "Take Your Government Hands Off My Medicare." This is funny because Medicare is a federal program completely created and run by the federal government, and the vast majority of people -- even most small-government advocates -- do not go as far as Paul Ryan would, by ending Medicare as we know it and, instead, providing people with a voucher that they could use to buy private insurance. But there are many within the GOP who believe that providing incentives, like high costs, for people to use less health care would be a good thing because it would bring the costs of health care down.

A couple of reality checks. First, Connecticut tried to shift responsibility for running its Medicaid program to private HMOs. It cost far more that way because government has lower administrative costs. Second, there are, by now, several studies that show that when people don't get the health care they need, their illness spirals out of control and they end up costing far, far more than early and adequate health care would. So making medical care more expensive will cost more in the long run. People who don't take their medication because they can't afford copays are likely to get sicker, and that just costs more.

But setting reality aside for the moment, others (like me) believe that the federal government has a role in ensuring that people get the health care they need. First, we believe that health care is a basic right, like food and shelter. Second, we look back at the civil rights struggle, the women's rights movement, and we know that, while some states will protect individual rights -- like New York, where you can buy health insurance even if you have a pre-existing condition -- others will not -- like Mississippi, where the state refuses to even allow consumers to file external appeals seeking review of insurance company denials of coverage. In those instances, the federal government has been the agent of change.

For me, health care is a civil rights issue. For conservatives, it's not. For me, we gave states and the private sector plenty of time to try to fix health care, get affordable insurance for all, get control of costs. For conservatives, any solution should be found in the private sector. I listen to the voices of people who can't get care every day. Conservatives listen to industry (both health care and insurance), which feels that they are being squeezed by health reform. Indeed, conservatives might look at Advocacy for Patients with Chronic Illness and say that we are a private sector nonprofit performing a function for people who otherwise cannot afford this type of help, and that we show that the private sector will respond to people's needs. I think the government should be funding lots of organizations that help people access health care and health insurance.

The whole health care debate comes down to whether you like big government or small government, whether you believe private markets will correct problems or you believe it sometimes takes government intervention. So why isn't that what we're talking about?

And that's my point. We should be having a deep and meaningful debate over the proper role of government. The debt ceiling debate isn't so much about whether we need to increase taxes or whether spending cuts are enough on their own; it's about whether you believe that the federal government needs more income so that it can do more, or whether it's okay to simply shrink the size of government and assume the private sector will pick up the slack. Small government types think the federal government should exist for defense, mostly, not for social programs. I could not disagree more.

I think the American people are smart enough so we could be having the right conversation, the conversation about what's really underlying the whole controversy. Rather than scaring people into believing in fictional death panels, or arguing to courts that the individual mandate in unconstitutional because it regulates inaction instead of action, we should be talking to each other about our philosophy of government. Because until we have that discussion, we're really just talking past each other, so deadlocks like the one over the debt ceiling will continue to occur.

People are angry and afraid based on lies they've been told, knowingly, deliberately. Nobody really believes there are death panels in the health reform law -- at least, nobody who's read it. They keep saying it when what they mean is that they don't like health reform because it's an expansion of the federal government. That's a fair point -- one with which I completely disagree, but at least it's honest. And until we have the honest and straightforward debate we need to have in this country, we can expect to keep banging our heads together over non-issues. We can expect to get nowhere.

I believe how one feels about the size of government depends a lot on your experience. I am sick. I spend a crazy amount of money on health insurance and health care. I talk to people with chronic illnesses all day long. I hear tragic stories. I like to believe that at least some of the people who are against health reform would change their minds if we would all stop screaming so loudly that we drown out any serious discussion. Since we're not getting very far with the present level of discourse in America, how about we try having the real conversation we need to have about the role of the federal government. I don't know how that conversation would end, but I know that, by avoiding it, we are getting nowhere. Jennifer

Thursday's Themes

I think this is one of those weeks that has an extra day in it. Oh, well. I very much appreciate your feedback on the blog content. I will try to start weaving some opinion in with the news -- although it's sort of there on the bigger issues. Here goes:

The first Court of Appeals to rule on the health reform law has upheld it. Two of three judges found that the individual mandate is within the federal government's Commerce Clause powers, which allows the federal government to regulate anything that affects commerce in any way. One of those two is a Republican appointee who clerked for Justice Scalia -- the first Republican judge to find that the individual mandate affects commerce, rejecting the distinction between regulating activity and regulating inactivity, i.e., the failure to buy health insurance. There was one dissenter. Two other Courts of Appeals have heard argument and will be issuing a decision, and then the Supreme Court is expected to hear the cases and resolve any disagreement. Boy, does that make me nervous. But some say this opinion was a real blow to the conservative case.

The President appears to be fully engaged in the negotiations over the deficit. He has stated his conviction that there must be revenue raisers as part of the deal. He wants to close loopholes for oil and gas companies, hedge fund managers, and other corporate interests. He said yesterday that the Dems are willing to compromise by cutting spending in uncomfortable ways; the GOP has to meet them half way. So far, the GOP has flatly rejected the President's proposal, so where does this go next? The House is on recess. The Senate is on recess next week. And we're only a month away from hitting the debt ceiling. The refusal of the GOP to compromise at all is indefensible, in my opinion (you wanted opinion, right?). The President also wants to create some job stimulus, extending the payroll tax cut for another year, giving loans for infrastructure repair and putting people to work. That, in my opinion, is what we need. In a flagging economy, this is not the time to take money out of the system. This is the time to pump money into the system and create jobs. In my opinion.

Ezra Klein says that the fact that the President went public with his call to the GOP for compromise is a signal that talks have broken down. While talks were ongoing and a deal was possible, the White House was restrained, not commenting even when the GOP walked out of VP Biden's negotiations last week. He's hit a brick wall.

And just when we hit that brick wall, the Dems finally have agreement among themselves on a budget. It's along the same lines President Obama takes -- no cuts to Medicare, Medicaid, Social Security, but a "fair" (their word) deal that involves raising revenue as well as cutting spending. Seems sort of strange to me to be announcing that they finally have a budget when we're on the verge of collapse and their principles are the same ones VP Biden and President Obama have been relying on during months of negotiations. But it does cut about $4 trillion from the deficit, and that's a good step.

I think people really don't understand the debt ceiling issue. If we don't raise the debt ceiling, interest rates will rise and our deficit will, therefore, balloon. Many government agencies would be shut down entirely. This is not the issue on which the GOP ought to be drawing a line in the sand. If deficit reduction was really their concern, they would get past this hurdle and then fight the fight over the 2012 budget and beyond. But not over the debt ceiling.

Some in the GOP say the debt ceiling's no big deal -- we should just use whatever money we have to pay down the debt. But then who pays the salaries for our military, federal employees? Who pays Congress's salaries? Oh, wait -- a great idea -- let's stop paying members of Congress unless they actually do their job! (Hey -- you wanted more opinion).

Oh -- and the GOP also wants to amend the Constitution to require a balanced budget. Understand, folks, that that would mean shifting major costs to the states, which are already broke. Medicaid, Medicare, public works, on and on, the federal government would have to cut far beyond anything on the table now. But wait -- doesn't a balanced budget look at both sides of the equation, spending and income? And doesn't that again mean taxes are on the table? Be careful what you wish for, GOP. And by the way, amending the Constitution takes a long time because it has to be ratified by the states. So that won't help the current problems. I'm tired of symbolic moves when so many people have no jobs and no health care.

Politico declares that Congress is simply dysfunctional. That's pretty clear. The question is what do we do about it?

Meanwhile, a study showed that the Paul Ryan budget plan -- you know, the one that ends Medicare as we know it -- would actually increase health care spending. And seniors would be the ones footing the bill. Really?

The Department of Health and Human Services studies health disparities. Yesterday, they added sexual orientation to the disparities they will study. I got a call just this week from a young guy who was in the ER getting treated, and when a doctor asked if he was gay and he said he was, all treatment ended and he was sent home. So seems to me that it's right to look at disparities based on sexual orientation.

And please take your medicine. The failure of adherence to medication orders costs us a lot of money in increased health care spending. It costs less to deal with the situation up front and relatively inexpensively. This is the best argument there is for reducing drug copays. It would save money, not cost more.

And that's how things look to me on this Thursday morning. Have a great day! Jennifer

Breaking News: Appeals Court Upholds Health Reform Law

POLITICO Breaking News
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A panel of judges for the 6th Circuit Court of Appeals has ruled that the health reform law's mandate that everyone buy insurance is "a valid exercise of Congress's authority under the Commerce Clause." The decision came in the lawsuit filed against the Affordable Care Act by the Thomas More Law Center. It is the first time a federal Court of Appeals has ruled on the constitutionality of President Barack Obama's signature legislative achievement.

Relieving Pain in America: A Blueprint

The Institute of Medicine published a report today on chronic pain and, in particular, the ways in which we have to improve our treatment of it. Here's a press release from a number of important organizations describing and endorsing the report -- as we would have done, too, had we known about it. Important reading for anybody struggling with chronic pain.

I have heard enough stories of people treated like drug addicts whenever they present to an emergency room complaining of pain. We have to find better ways to understand and treat pain in America. Jennifer

Washington, D.C., May 16, 2011—The following statement was released today by a broad array (see list below in alphabetical order) of consumer, health professional and advocacy organizations upon release of a major new Congressionally-mandated study by the Institute of Medicine (IOM) of the National Academy of Sciences aimed at improving pain care, education and research.

“As organizations representing millions of Americans who suffer from chronic pain, of health professionals who care for these Americans, and of researchers and educators working to improve the care and treatment options available to these Americans, we are united in our enthusiasm for the IOM’s attention to this issue and by the release of this landmark report that identifies pain as a major public health problem.

Millions of Americans will be reading the findings and recommendations of this report with great interest. One of every four American adults suffers from chronic pain, more than the number afflicted by cancer, diabetes and heart disease combined. Pain is the leading cause of visits to health care professionals. The economic costs of chronic pain in added health care costs, lost productivity and lost income is enormous. The toll in human suffering, much of it potentially unnecessary, is of even greater concern to people with pain and their families.

We thank the Congress for commissioning the highly respected IOM to study this problem and develop recommendations on how to improve pain research, care and education. And we thank the IOM, and in particular the distinguished panel of experts on this Committee, for their hard work and for sending a clear message to our government and our people that pain is a major public health problem that deserves much greater attention and focus.

While we are still carefully reviewing its findings and recommendations, we hope that this landmark report sounds the siren call for greater attention to pain issues by both public and private sector policymakers and by the nation as a whole. We hope the recommendations of the report lay a clear path toward much needed improvements in pain research, care, education and treatment."

American Association of Nurse Anesthetists

American Academy of Pain Management

American Academy of Pain Medicine

American Chronic Pain Association

American Headache Society

American Pain Foundation

American Pain Society

American Society of Anesthesiologists

Boston Scientific Corporation

CFIDS Association of America

Cephalon, Inc.

Citizen Advocacy Center (CAC)

Coalition4Fibromyalgia

Endo Pharmaceuticals

Hospice and Palliative Nurses Association

National Fibromyalgia and Chronic Pain Association

National Vulvodynia Association

P.A.N.D.O.R.A.

Rocky Mountain CFS/ME & FM Association (RMCFA)

The Endometriosis Association

The Neuropathy Association

The TMJ Association

U.S. Pain Foundation

Dear Reader: Your Opinion Matters

Dear Reader:

I'm writing to see if I can get your input on where to go with this blog. As you know, I spend more than an hour very early every morning reading a load of newspapers to bring you health-related news. Sometimes I also bring you opinion, and sometimes more informational/educational pieces, like my analysis of the new appeals regulations that I posted a week or so ago.

What I don't know is how many of you are reading, and whether you find the blog helpful and/or interesting. Is it helpful for me to bring you the news every morning, or would you prefer more opinion pieces or longer pieces explaining various health policy issues? What would you like to see on this blog?

I'd appreciate your feedback. If you don't need me to gather the news for you, then I can write more about policy issues and perhaps some of our cases, trends that we are seeing, and so on. But if you like getting the news every day, please let me know and I'll keep at it.

In short, it's time to hear from you about what you want. Please leave comments here or on our Facebook page. And if you don't comment, I'm going to assume you're not reading. So if you care what direction this blog goes in, now's the time to speak up. Thanks! Jennifer

Hump Day Headlines

Another day, another news round-up. Here you go:

I begin with the height of arrogance. One freshman Senator says that he will object to and withhold consent from doing ANY business in the Senate until the deficit is cut. He finally allowed business to proceed, but this shows that one Senator can grind government to a halt. Craziness, if you ask me.

An interesting piece on the Tea Party, read in the context of the debt ceiling debate. The premise is that the Tea Party is based on what they're all against -- big government -- but they're not of one mind when it comes to what they're for.

Joe Lieberman and Tom Coburn proposed a new set of cuts to Medicare -- and top Dems have rejected it.

This is all part of the continuing negotiations about raising the debt ceiling. The GOP remain determined to do it with entitlement reform and spending cuts, with no revenue raisers. The Dems remain determined to have a combination of cuts and new revenue. If they deadlock and can't move past this point, we will hit the debt ceiling and interest on our debt will increase, ballooning the deficit. What a mess. Some Dems are so frustrated that they are raising the question of whether the debt ceiling is even constitutional. And some say the Dems are not drawing lines in the sand like the GOP is, so they may not get the deal they are after. They are upset with President Obama for not explaining the debt crisis well enough to the public. The GOP are saying the August 2 deadline is not a hard time limit, and the President is not acting like there's a huge rush, according to some.

Meanwhile, the Dems are considering shifting costs of Medicaid to the states -- which will, in turn, shift those costs to beneficiaries, the poorest of the poor, the elderly. Understand how dangerous this is. If they did this, the states would insist on being able to reduce Medicaid eligibility, and they would charge copays and maybe even premiums to people who can't afford them. Those people would then go without health care. And that would make them sicker -- and far more expensive to treat. Opposition to these cuts is crystalizing.

The Administration has begun to roll out a national prevention strategy to shift focus from treatment to prevention. Although I agree that prevention is critical, there are so many illnesses that cannot be prevented. I hope this shifting focus doesn't hurt us.

Half a million seniors are seeing lower drug costs due to health reform. A good thing, most definitely.

The Robert Wood Johnson Foundation has rolled out a directory of health care quality reports that will help you decide where to go for treatment. The idea is to give consumers localized information on measures of health quality.

Insurers may start buying hospitals to cut health care costs. Interesting if this becomes a trend.

The Obama Administration has shelved its plan to use "secret shoppers" to see how hard it is to get in to see a doctor. Too bad. This sounded like a good idea to me. Apparently, doctors complained. Duh.

Doctors say that a device commonly used in spinal fusion is based on faulty research, assailing their colleagues for research infected by a conflict of interest. The allegation is that they did not report adverse events.

A new study finds that mammograms save lives. Have you had yours?

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

Tuesday Tidbits

Big day today. A new contract, new work, some money that will help with the move. Before that, though, here's the news:

The President stepped into debt reduction discussions yesterday. He's saying there must be revenue raisers -- at least closing loopholes for corporations and the very wealthy. They're talking about oil and gas subsidies, depreciation of private jets, a limit on deductions for the wealthy, and changing the way businesses account for inventory. GOP leaders say no deal. Who's going to budge? Meanwhile, the House Dems -- who have no power to pass anything -- are upset that the President isn't working more closely with them. And the White House has said that they won't insist on ending the Bush tax breaks for the wealthy as part of this deal. But the American Medical Association would like to include changes in the way the government pays doctors as part of the debt deal. And hospitals are running ads opposing cuts to Medicaid and Medicare.

As states set up Exchanges (marketplaces where you will buy insurance), big money flows to consultants with the know-how.

The great Dr. Pauline Chen introduces us to a doctor who now heads up the Epilepsy Foundation -- and who has epilepsy himself.

Although we tend to think of hospitals when we think about malpractice, medical errors can occur in outpatient settings, as well.

Latina women are the most likely to feel unwell; researchers try to figure out why.

Health surveys are hitting the web and cell phones in an effort to find people without landlines.

Concierge medicine may be great for those who can afford it, but what about the rest of us?

A woman with ADHD shakes off the stigma, makes a life.

Cardiac rehab should involve intense work-outs, or so they say.

Fewer minors are smoking, study says.

Post-menopausal women who take calcium supplements are at risk for kidney stones.

Humans want to fly. I get this. I wouldn't mind being able to get from here to there without planes, trains, and automobiles. Sadly, we're not built for it.

And that, my friends, is it for this morning. Off I go. Have a great day! Jennifer

Monday Moaning

Have I told you I hate Mondays? But this particular Monday isn't bad since our own Nicole Netkin-Collins is going to be sworn into the Bar today, and we're surely excited about that! Not that anything else could eclipse that, but here's the news:

The President will start his debt reduction talks today after VP Biden's talks broke down over tax increases. Nobody's quite sure where Sen McConnell stands, although he has said he's against tax increases, including closing loopholes. The GOP appears to be firm on the issue of taxes. VP Biden says the Administration won't let the middle class bear the whole burden of deficit reduction. But the GOP is adamant on opposing tax increases. The GOP may prefer cuts in military spending than tax increases. But Americans remain split on whether to raise the debt ceiling -- something that makes me wonder if they truly understand what not raising the debt limit would do to interest rates and the economy in general.

For those of us supporting health reform, defending the law against baseless attacks appears to be a non-ending story. It's hard when the most important changes won't take effect until 2014, so we don't have huge victories to point to.

The Obama Administration is going to call doctor's offices to see how hard it is to get an appointment with a primary care doctor. They'll also see if there's a difference between access for people with insurance and access for people with Medicaid or Medicare. This should be interesting, eh? Especially with so many of us wondering what ever happened to the family doctor.

A private sector partnership says health reform let them join together to reduce cost. But providers really can't stand the Medicare Independent Payment Advisory Board, which would kick in with cuts to Medicare if costs rise. Secretary Sebelius is adamant, though, that the IPAB will not lead to rationing.

Will people die earlier under health reform? WaPo gives that fiction three Pinnochios.

Google kills Google Health. It was supposed to be a place to store your medical records. But nobody's using it, so they're shutting it down. What does that mean for the future of electronic medical records?

Diabetes is on the rise. And we are getting better at treating it. But 2 out of 3 deaths worldwide are from noncommunicable diseases like diabetes, cancer -- and all other chronic illnesses.

An amusement park in -- of all places -- Texas caters to the disabled. And wilderness trails in New Hampshire are accessible by those with disabilities. Good for them.

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

Jonathan Cohn: Report was Garbage Science

Okay, so he didn't use the words "garbage science" -- that's my colorful phrase. But Jonathan Cohn explains why the McKinsey report that said that 30% of employers would drop insurance coverage for their employees was wrong and misleading. He explains that reliable studies have shown that the majority of employers will, indeed, maintain their health insurance plans.

And then he explains why that might not be the best solution for all of us. Single payer health care or a system like what exists in the Netherlands would be better. Maybe health reform will lead us to those kinds of solutions.

But the health reform law will NOT result in a mass exodus from employer-sponsored health insurance. Now you can rest easy. Jennifer

Finally Friday (YAY) Edition

Wow -- what a week! I'm fried. But there's one more day, so here's the news:

Eric Cantor (GOP House Majority Leader) walked out of the debt reduction negotiations yesterday, saying the issue of taxes has to be resolved before he can have further discussions. He said the House does not support tax increases -- period -- and the Dems are insisting on a combination of spending cuts and revenue raisers. The GOP says it's time for President Obama to get involved. No doubt they want him on the record as supporting tax increases going into the next election. On the other hand, Ezra Klein thinks this is about GOP in-fighting as neither Cantor nor Speaker Boehner wanted their fingerprints on a deal that would raise taxes. That puts Boehner in the hot seat -- if he can cut a deal without tax hikes, he's the darling of conservatives; if not, he's going to be criticized loudly by the Tea Partiers. Either way, this is really bad leadership. Forgive me if I'm annoyed that, with our economy on the brink, it's still all about politics.

On the substance, HuffPo reports that Dems are considering offering cuts in payments to Medicare providers in exchange for tax increases. The idea is that it's better to cut payments to providers than to cut benefits. But if you cut payments to providers, fewer of them will participate in Medicare, making it harder for beneficiaries to find doctors. Here's an outline of what kinds of cuts can be made to Medicare without adversely affecting consumers.

The Supreme Court ruled in favor of pharmaceutical companies in two cases. First, they said generic drug makers can't be sued for failing to warn consumers of the risk of their drug. Generics bear the same FDA label as the brand name and they can't change it, so, the Court said, the labeling can't be blamed on them. Second, they said that Vermont could not prohibit data mining -- taking pharmacy records and using them to figure out which drugs to market to which doctors. Pharmacies sell data showing what doctors prescribe. The info does not include patient identifying information, but it lets the drug companies know what to pitch to which doctors. The Justices said this is a free speech issue and, thus, Vermont could not curtail it.

The move to electronic medical records is slow, says Politico. This is a central initiative in the health reform law, but doctors and small hospitals are having more trouble getting up and running than anticipated.

And here's the administration's defense of the Medicare Independent Payment Advisory Board, which is supposed to make recommendations to Congress, which would be binding unless Congress voted against them, on tweaks to Medicare that will save money. Kathleen Sebelius attempts to convince readers that this will not involve rationing, and of course, she's right. The IPAB's recommendations will only take effect if Medicare spending is out of control and Congress doesn't act.

And that's this morning's news. Have a GREAT Friday! Jennifer

New Appeal Rules -- Comprehensive Guide

I have prepared a comprehensive guide for consumers explaining the health insurance appeals rules under health reform, including the new rules that came out yesterday. I hope that it will help you in understanding and navigating the system.

Still, if you have questions, you know where to find me. Jennifer

Thursday Themes

I'm still reeling from the late release of the appeal regulations yesterday. Haven't quite made it through the 100+ pages of material (isn't there a shorter way to say some of this?). But I'll take a break to bring you the news:

Here's some press on the appeals regulations. This piece explains some of the highlights. More on the new rules (in addition to a quote from me) is here.

The debt reduction talks seem to be getting more complicated, with Dems requiring jobs programs like spending on our broken infrastructure, and GOP signing a pledge to vote against any plan that doesn't involve major cuts. Dems are worried that the White House will concede too much to the GOP, slashing social programs with no tax increases. But the GOP is relentlessly pressing for huge cuts. House Dems warn that Social Security cuts are a non-starter. And lawmakers not directly involved in the talks are getting restless, wanting to know where things stand. And spending caps would hurt the elderly and the poor in the form of huge cuts to Medicaid and Medicare.

Meanwhile, new figures came out on Medicare's unfunded obligations. The GOP say this supports an overhaul. But they ignore the fact that the numbers are FAR worse if health reform is repealed. And now, the GOP are bashing President Obama's Medicare cost-cutting plan, which relies on an independent advisory board to make suggestions for changes to the benefit package.

A bipartisan bill would provide stronger home health benefits under Medicare.

A brave woman, Marsha Linehan, who works with the mentally ill "came out" and told her own story of struggling with mental illness. It meant a lot to her patients to know she was one of them. And now you know why I openly talk about my illnesses.

More young adults are living with diabetes.

A young boy dies from sudden unexplained death from epilepsy (SUDEP), and his Dad takes on a mission to make it better for others. Stories like this amaze me.

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

Appeal Regulations

As promised, the amendments to the earlier regulations about insurance appeals came out today. I must say that, although I am not thrilled, it's nowhere near as bad as I had feared. The following changes are significant, in my view:

1. Federal external appeals -- for plans subject to federal external appeals, those appeals are limited to issues involving the exercise of medical judgment and rescissions (retroactive policy cancellations) -- NOT contractual or legal issues. That seems to exclude coding issues, whether prior authorization was required, and certainly contract interpretation questions.

2. The threshold for deciding when notices have to be translated is no longer 10% of employees at a firm who speak a language other than English; it's now 10% of people in a county. The upshot is that notices have to be in English and Spanish only except for 6 counties in the entire US, where there is more than 10% Chinese, Tagalog, or Navajo, and even then, people have to request the translation.

3. Urgent care claims are decided in 72 hours not 24.

4. Content of notices -- Diagnosis and procedure codes are not included in notices and will not be provided unless requested, so you have to know to ask (and you now do).

5. The 16 minimum consumer protections with which state external appeal laws have to comply with are relaxed until 2014. The changes are as follows:

• Exhaustion is no longer unnecessary because the issuer/plan fails to comply with the rules except where the failures to comply are de minimis (minimal)
• The deadline for filing external appeals was 120 days, now 60 days
• The independent review organization was assigned randomly; now impartially
• No requirement that the claimant be allowed 5 days in which to submit additional information to the external reviewer.

There are over 100 pages of rules here, so there may be a few that I haven't picked up on during my first read, but that's the basic gist. The changes are relatively technical, but they affect your rights. So if you have a question for me, ask in the comments and I'll either answer individually or blog on it. Thanks. Jennifer

Hump Day Headlines

Well, the new appeals regulations didn't come out yesterday, so they are expected today. Word is it's bad news. I'll be back with the details later. But for now, here's the news:

And now, $2 trillion is cuts is not enough to satisfy the deficit hawks. Sometimes I think nothing will satisfy them other than eliminating the federal government -- except for their jobs, of course. Meanwhile, the GOP is split on whether to accept a short-term raising of the debt limit if a deal has not been reached in time, with the Senate favoring it and the House opposing.

Contrary to a questionable study released last week, a study released yesterday says the health reform law will stabilize employer-based health insurance coverage. The law will provide tax breaks to small businesses who provide coverage, too, so it will help small employers provide insurance.

The health reform law also is allowing doctors to spend more time with patients enrolled in Medicare, for whom annual check-ups are now free.

Under the health reform law, plans could apply for waivers if compliance with the law before 2014 -- before there are exchanges and subsidies to help people buy insurance -- would essentially change the character of the plan. So many mini-med plans -- McDonald's plan that covers $1000 per year, period, for example -- got waivers from the requirement that annual benefit limits be no less than $750,000 this year. The theory was that a mini-med plan was better than nothing, so instead of ending those plans now, waivers were granted until 2014, when there will be subsidies to help people buy "real" insurance. Well, two genius GOP members of Congress say these waivers are a sign of the health law's failure. So if there was no flexibility under health reform, they'd be screaming about that. If the health reform law had killed mini-med plans, they'd have screamed about that. But allowing some flexibility through a waiver system? They're screaming about that. I hope you aren't listening.

There is a flaw in the health reform law, though. In passing a provision that doesn't count Social Security benefits as income for Medicaid eligibility that was supposed to help the poor disabled, the law inadvertently covers several million early retirees. Clearly, this needs to be fixed, and it will be.

The GOP has opposed a plan to allow Medicare to negotiate drug prices with pharmaceutical companies -- until now. A House Republican has signed on. This could be a critical piece of the debt reduction plan, allowing Medicare savings to be realized without cutting benefits.

Starting next March, insurance plans will have to provide more easily understood information about the costs and benefits of the plan. Focus groups are already testing prototypes.

Premium prices for the Pre-existing Condition Insurance Plan go down next month. It's a decent option if you can afford it and you haven't had insurance for 6 months.

Is redundant paperwork the biggest waste of health care spending? Some think so.

Coupons for low cost health care? Really? Coupons? Whatever works, I suppose.

Medication compliance is a really big deal. Nearly three in four Americans don't follow doctor's orders, sometimes due to cost, sometimes due to forgetfulness, sometimes due to their own judgment as to what works and what doesn't. Well, now there's a new tool that doctors can use to predict who will have compliance issues. These are people who would benefit from follow-up phone calls and other reminders.

Supreme Court Justice Sonia Sotomayor speaks out about her stuggles with childhood diabetes. Thank you, Justice Sotomayor, for making it okay to talk about invisible illnesses.

Cigarette packages will soon be adorned by some truly gross photos to help make the point about the harms of smoking.

The Connecticut Insurance Department has approved a 39 percent increase in MetLife long-term care insurance plans. And the Commissioner says we don't need rate review hearings?

And that's it for now, but I expect I'll be back later to tell you about the appeals regs. It's not going to be pretty. In the meantime, have a great day. Jennifer

Tuesday Tidbits

I was supposed to have today off, but we hear that the next set of regulations on health insurance appeals is coming out today, and we hear that the industry managed to convince the feds that they needed a whole lot of breaks, so I'm not expecting to be happy about it. Unfortunately, they're not posted this early in the morning, so I'll do a quick take on the news:

Remember that study that said 30% of employers would drop health care for employees under reform? Well, it turns out there were a few problems with the study and the way it was conducted.

It seems the folks in Washington finally realized they don't have a lot more time to negotiate over debt reduction before the debt limit is reached and we're in full-scale crisis mode. Still, a leading GOP-er says they now want a 10 year deal! If you don't understand the debt ceiling, here's a good explanation.

The AMA affirmed its support for the individual mandate yesterday. They know how important it is for their patients to be insured.

Here's a piece on insurance appeals. These are the easy appeals, a coding error, not the kind of appeals we do. Since nearly 1 in 5 claims is processed incorrectly, you should know how to handle these kinds of claims, too.

Loyalty and long-term commitment are good for your health. Who knew?

I don't really understand this, but maybe you do. A complex math theory is helping in the fight against HIV.

And that's a quick view of today's news. Have a great day. I'll be back later with news on the appeal regulations. Jennifer

Monday Moaning

I thought I couldn't hate Monday more than usual, but after such a disappointing week-end, having to miss Eddie Vedder due to the amount of time I'm spending in the bathroom these days, I really hate today more than usual. But as always, here's the news:

The GOP is ready to take the pressure off -- instead of a solid increase to the debt limit, a short-term fix, postponing the hard work until the Fall. Why? What gets better in the Fall? A failure here means skyrocketing interest rates.

This week, in the debt reduction talks, changes to Medicaid and Medicare will be discussed. What are the wars in Iraq, Afghanistan, Libya and more really going to cost us in health care?

Imagine how many jobs we could create if we invested in our crumbling infrastructure.

Interesting piece -- four ways Dems and GOP have reached health care consensus.

No more waivers from the health reform requirement that phases out annual caps on benefits. HHS will stop accepting requests for waivers on September 22, and those waivers will last through 2013.

The health reform law's long-term care insurance option. Helping seniors stay at home longer.

Hospitals are courting primary care doctors. Instead of private practice, work on staff at hospitals along-side specialists. This allows primary care docs to play the role of care coordinator that is so critical.

You live longer with cancer if you have more education, a study finds. The least educated die 2.5 times faster than those with college educations.

Are we over-using CT scans? Medicare says yes. The AMA says no.

NY City police department has a hearing test and bans hearing aids. I understand the need to hear, but why ban hearing aids?

Returning soldiers have respiratory problems.

A consensus grows to make amends for forced sterilizations -- but with budget crises, will there be money to pay compensation?

And that's the start to the week. Have a great day. Jennifer

Finally Friday Edition

Well, that was a late night in New York and I'm dead. I hope today goes quickly. Meanwhile, the news awaits:

Mental health care is always the first to go, the poor cousin of medical care. But then something happens -- a patient stops taking his meds, kills his caseworker -- and people start wondering where the system failed. Must it take a death to get us to think about providing care to people who are so ill?

VP Biden's debt reduction talks are continuing, and they are said to be productive. They plan to start working around the clock next week until they have a deal. Biden describes the talks as focused now on the nitty gritty details and deal cutting. Hopefully, he can do better than the House GOP, which passed massive cuts to food assistance to woman, infants and children.

Ezra Klein explains how better care coordination, especially for people who are very poor and very sick, would help cut the cost of Medicaid. And Paul Ryan -- the architect of the plan to end Medicare as we know it -- says he's willing to compromise and change his Medicare reform plan.

The Obama Administration released a plan called the National Prevention and Health Promotion Plan to try to prevent illnesses and promote healthier lifestyles. Haven't had a chance to read it yet but it sounds like a laudable pursuit. The plan would award grants to community-based health care programs. This is part of health reform, and if it works, it should bring down health care costs.

Med students are beginning to become more enthusiastic about primary care -- which is a very good thing in light of projected shortages of primary care docs.

You know that study that came out last week that said 30% of employers will stop providing health care coverage when reform takes effect? Well, Senator Baucus -- not exactly a left-winger -- says that it conflicts with many other studies, and he wants to know the survey's methodology to see if it's sound.

California has a new law that would set inmates free on a "medical parole" if they are too sick to commit a violent crime.

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

Thursday Themes

This evening, I will be speaking to the IBD support group at the Jill Roberts IBD Center at Weill-Cornell Medical Center/NY Presbyterian Hospital. So if you're interested, drop by. In the meantime, here's the news:

And here's my story of the day. A Massachusetts man gave notice that his wife had cancer and he would need to take some leave. He asked for a modified schedule. Instead, he was fired. His employer is not subject to the Family and Medical Leave Act because there are fewer than 50 employees. It's a brutal world out there. When people call me to ask about requesting accommodations and FMLA leave, I always warn them -- some employers would rather risk being sued than keep a sick employee. Disgusting, but reality.

The parties are still talking about raising the debt ceiling, reporting that meetings are productive, but giving no specifics. It does appear that cuts to food programs have been eliminated. But GOP policy disagreements complicate the negotiations. Still, the talks are inspiring optimism in the business community.

A bunch of Dems prepared mailings to constituents opposing the GOP cuts to Medicare. But the GOP refuses to let them send them. Meanwhile, a GOP Senator says President Obama has abdicated leadership on the problem of saving Medicare.

And an advisory group proposes that Medicare crack down on the use of imaging studies; Medicare may require prior authorization for imaging like CT scans and MRIs.

Ezra Klein shares this: 80 ways health reform changes health care in America. Interesting.

Two opinions on the Exchanges where we will be able to shop for health insurance: One thinks they will be good for consumers and the other thinks they're doomed to fail.

GOP Presidential hopeful Jon Huntsman's record on health reform when he was Governor of Utah. Detached, they say.

Children on Medicaid are turned away by doctors and made to wait longer to see specialists, says a new report. And states are pushing President Obama to allow them to drop people from Medicaid entirely.

Women's life expectancy is decreasing, at least in part due to smoking and obesity. Births are down, too, presumably because of the economy.

Did you know oxycontin was reformulated to make it harder to snort or inject to try to deter abuse? Apparently, it didn't quite work.

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

This Deserves its Own Post

As the New York Times reports, the federal stimulus money that helped States pay for Medicaid during the recession, when so many people were added to the Medicaid rolls, is about to dry up. The feds surely aren't going to pump more money into the system; all they talk about these days is deficit reduction. So what will States do? Cut. Who will it hurt? The poor and the elderly in nursing homes. In other words, people who don't vote.

As if it were not bad enough that sick people are struggling; even those with insurance have intolerable deductibles and copays, so much that people are skipping doctor visits, tests and medication. As if it were not bad enough that people with pre-existing conditions still have very few options for getting insurance that covers their illness. Now, the States will clamp down on Medicaid.

People will suffer. Where are our priorities? Jennifer

Hump Day Headlines

So, let's see what goodness the news has in store for us today:

We're into the Presidential campaign, and while we do not endorse any candidates, we do take positions on health policy. Two nights ago, the GOP candidates "debated." It was more like a love-fest, and a promise from all of them to repeal health reform. We strongly oppose such repeal. So far, reform has already helped thousands of people -- kids who can stay on their parents' policies, about 20,000 on the Pre-existing Condition Insurance Plan (a GOP idea), closing the Medicare drug benefit doughnut hole -- but the real changes happen in 2014. If we repeal the law before then, we will never see what happens to our health and our economy when people with pre-existing conditions are covered, subsidies help the middle class buy insurance, there is a minimum basic coverage, and out of pockets costs are capped. Maybe, when it's all implemented, we will find areas that need tweaking. But the status quo before the health law was passed was horrible, with premiums rising and fewer and fewer people being insured. Now, we're starting to see insurers reduce premiums (Aetna) and pay rebates (CA Blue Shield). We needed to do something, and what we did was a compromise that includes many GOP proposals, even though, in the end, they voted against it. Let's see how it plays out. If it does like in Massachusetts, where there's near 100% insureds, we will have taken an important positive step -- not the be all and end all, but better than nothing.

With the economy slipping, Washington should be looking for ways to cut the deficit while adding jobs. VP Biden's group is in heavy negotiations while the GOP in the House continue to cut basic food assistance to woman and infants. Dems are still saying there will be no cuts to Medicare. Indeed, they say that a lot. Meanwhile, GOP members demand ... you guessed it ... cuts to Medicare. VP Biden expects a deal by the end of this month. That would be good, because the Federal Reserve Chairman is warning that the failure to increase the debt limit would be very bad for the economy.

The GOP thought the Obama Administration was giving waivers from the provisions of the health reform law that increase annual benefits limits in a biased manner, to help unions and other Dem friends, so they requested a GAO report -- and the GAO says the waivers have been granted in a proper and unbiased manner.

Health savings accounts are growing even though the health reform law should be cutting back on them with medical loss ratio rules and

GOP Governors want changes in the Medicaid rules that allow them to cut their programs and, thus, cut their budgets.

Connecticut state employees are voting on budget-cutting proposals, including a shift to value-based health care. Here's a great explanation of the value-based health care program by our friend Comptroller Kevin Lembo.

I love this. A laughter club. I bet it is a great boon to health. I think I need to start one of my own.

And here's an important question: Where does a patient's responsibility for their health begin? We certainly know that better informed patients and careful medication management can reduce costs.

Most malpractice cases involve problems in hospitals, so most focus on addressing medical errors pertains to hospitals, too. It's time to focus on medical errors in the outpatient setting, as well.

Childhood diseases return as parents refuse vaccines. This could get scary.

The FDA has issued new rules on sunscreen.

Are we still arguing about public breast feeding? I guess so.

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

Tuesday Tidbits

I slept in this morning to see if it would help my gut (I think it did), so this is late, and quicker than usual.

When kids graduate from high school, they also usually graduate from pediatric to adult health care, which can be a difficult transition, especially for kids with chronic illnesses.

Medicaid advocates say cuts to the program would hurt kids. And they would, indeed, as well as elderly in nursing homes.

Be careful with ambulances. If they're out of network, you pay, even if they take you to an in-network hospital. And you don't always have a choice of what ambulance to use, so be careful about this.

The CDC says doctors are over-prescribing. As if I needed more than my 13 prescription drugs to tell me that.

Americans are overweight, and overweight is the new normal. Yes, I know.

Memory training helps improve intelligence, says a new study.

Middle aged women who have their first child later in life have worse health than others, a survey says.

Fewer people are dying after surgery in the Medicare program.

The new lupus drug gets mixed reviews. I'm sad about this.

And that's all I have time for right now. Have a great day. Jennifer

Monday Moaning

After a sick birthday week-end, not too thrilled to be up and running (and I mean running ... to the bathroom). So here's the news:

Paul Krugman on why Medicare saves money. So, he says, we shouldn't raise the eligibility age or do anything else that reduces the number of people who get health care from Medicare because it's the most economical way to get health care. Dem Congressman agrees that Medicare is our opportunity to save money, so eliminating it would be worse.

Larry Summers -- back in private sector -- says we need to pump more money into the economy and further decrease payroll taxes to get the economy back on track.

Enough playing around on the debt limit. It's time to get down to business.

This is SUCH an important story. People with disabilities are on waiting list for critical, basic care. You don't know it until you're there, but there aren't enough personal care assistants, residential placements, or even nursing home beds in desirable areas. What are people supposed to do?

Nurses keep sights on health overhaul.

What to say -- and what not to say -- when addressing a sick friend or relative. This is a GREAT one - don't miss it. And how to address a mom with a sick baby.

The LA Times Answers Readers: What if a provider ignores your advanced directive, and can you get hospital prices ahead of time?

A judge in New York who resolved medical malpractice cases before they get to trial.

And that's it -- unless you want to see lewd pics of Anthony Weaver, smiling pics of Gabrielle Gifford, or news about the Tony Awards, all of which you can get in lots of other places!

So have a great day. Jennifer

Finally Friday Edition

We made it! Friday's finally here. Let's start the day off with the news:

It's kind of pathetic when the best news you can give about the debt limit is that the negotiators have agreed to meet at least 3 times next week. It seems they're getting the fact that the economy is faltering at least in part because there is no agreement on the debt limit and the budget. They did finally talk about revenue yesterday, with Dems making it clear that if you are going to cut the budget deeply, you must also eliminate tax breaks for oil companies and some corporate pork. And House Dems are calling for the expiration of the Bush tax cuts as part of a plan to address the deficit -- something President Obama already has committed to.

41 Senate Dems tell President Obama to stand firm on big cuts to Medicaid. That means Medicaid block grants cannot get enough votes to make it through the Senate.

It's sort of surprising for me to say this, but Sen. Joe Lieberman is working on a plan to reform Medicare that involves raising more revenue and cutting benefits in a thoughtful way -- raising the eligibility age, adding some modest copays, but also imposing an out-of-pocket cap so nobody goes broke. We know we need to change the system. This is far better than privatization. Joe may have something here.

Even in states that oppose health reform, plans to set up Exchanges are under way.

Doctors get bonuses for fee-for-service volume, not for good health outcomes. Maybe changing that would adjust their priorities.

Amazing what people can do. Here's a severely disabled man who is getting prosthetic arms so he can compete as a bike racer. Awesome.

If you live in Florida, you may have a hard time finding a flu shot.

Why do people gain weight when they stop smoking? It turns out there's a scientific explanation in that nicotine stimulates the part of the brain that tells you when you've eaten enough.

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

Thursday Themes

Yesterday was oral argument in the 11th Circuit Court of Appeals on the health reform law. Questioning was pretty sharp and lively. The judges did seem skeptical of the constitutionality of the law, but it will be months before we get a decision, and when we do, it will be headed to the Supreme Court. So this is far from over. Here's an explanation of the arguments from the wonderful Jonathan Cohn.

Americans are torn over raising the debt limit. Large numbers are concerned about default, but a smaller number wants to raise the debt limit despite that. A majority of respondents said they support raising the debt limit while also shrinking the size of government. But another ratings agency warned that it would downgrade America's credit rating if the debt it not paid. A very large payment is due on August 15. If that payment is made, the credit rating comes down, and interest rates go up, which costs us a lot more money to borrow. I don't see how anybody could think this is a good result. VP Biden continues his bipartisan negotiations. And what used to be the gang of six -- now a gang of five -- also continues to try to make headway on a compromise.

A new rule would inform patients of who had looked at their medical records. I like this idea. I want to know which doctors, others accessed my records.

Five US Senators have requested an investigation of physician-owned distributorships, middleman entities that allow surgeons to profit from the medical devices they use on patients.

Strangely, that's all I have for you today. So have a great day! Jennifer

Hump Day Headlines

Ah, it's Hump Day of Birthday Week. Have an appeal hearing in the AM and a new intern starting. So better get the news gathering out of the way. Here goes:

The GOP has finally made its ransom demand for increasing the debt ceiling: $2.5 trillion in cuts. How many government employees will lose jobs? How many citizens will lose services? When you take that much money out of an ailing economy, doesn't it weaken the economy? The GOP is still working on trickle down economics, with members proposing tax CUTS when the debt is so huge and we're trying to cut the deficit. It didn't work for Reagan, it's never worked, and it won't work now. Still, GOP Speaker Boehner accepts a check from the government for more than $2000 per month for expenses -- without any kind of showing that he's spending it on legit reimbursable items. And GOP freshmen have spent big on offices. When do they tighten their belts? Think I'm being to harsh by calling it ransom? Larry Summers says the GOP is holding us hostage, so I'm in illustrious company. Americans are concerned about raising the debt limit, but also about defaulting on our debt. But in case the stalemate can't be broken, the GOP is considering a short-term increase to the debt limit. Meanwhile, the White House says the Senate jobs bill costs too much, although it agrees in principle with its aims. You just can't have it all!

Ezra Klein has a really interesting piece on health care, showing that the US spends more than most countries -- even those with government-funded insurance or health care -- and shows that the GOP plans for privitization of Medicare have been tried with Part D and shown to fail. The health reform law has a different strategy, but it's never been tried on a huge scale before. And the one thing that might fix the problem -- single payer health care -- is something we can hardly talk about in America. And there's opposition even among Dems to the health reform tools that are aimed at controlling costs in Medicare.

The feds made $40 million available to states for chronic disease prevention under health reform yesterday.

30% of employers may drop employer-sponsored health insurance in 2014 when health reform takes full effect. But many of these are the employers like McDonalds that provide limited benefit plans (called mini-meds) that provide as little as $1000 per year of coverage.

Blue Shield of California -- a brutal "nonprofit" insurer that has been criticized for massive rate increases in recent years, says it will cap earnings and pay rebates to policyholders.

The largest nurses union rallied for health care funding yesterday at the US Chamber of Commerce building. The Chamber of Commerce opposes health reform.

Death rates among African Americans are way higher than for whites. The federal government is trying to address this disparity. About time.

Here's an interview with Don Berwick, the head of the Centers for Medicare and Medicaid Services and, in my view, one of the health care visionaries of our time. The GOP won't confirm his nomination, so he was given his job in a recess appointment that will expire soon. I sure hope we don't lose him.

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

Tuesday Tidbits

A day sort of off today, so a quick update on the news. And no, I am not going to say anything about Anthony Weiner other than that I'm not going to say anything about him:

Premiums are starting to come down, and we will see more of this due to health reform. This is due to the medical loss ratio rules that require insurers to spend 80 or 85% of premium dollars on health care, thereby limiting administrative expenses. But out of pocket costs continue to be a problem for cancer patients -- indeed, for anybody with a chronic illness.

Yet another poll shows Americans opposed to the GOP plan to gut Medicare. But conservatives are pushing the GOP to stand firm on the debt ceiling. And Dems are adamant that they won't accept cuts to Medicare. They want Medicare off the table in debt ceiling talks. There's even a new ad blasting the GOP for trying to dismantle Medicare. Talking about Anthony Weiner might be preferable to talking about this mess.

The GOP may push for a two-year budget so we don't have to go through this every year. Part of me thinks that would be great.

In anticipation of tomorrow's oral argument in the 11th Circuit Court of Appeals on the health reform law, over 150 state legislators have signed a letter supporting the individual mandate.

In a pathetic move, the Connecticut legislature gutted the premium rate review bill, allowing the Attorney General and Healthcare Advocate to call for "symposiums" on rate increases. But they also passed the Sustinet compromise bill, along with a bill to open the state employee plan to other pools of people -- municipal employees, nonprofits.

Doctors oppose a New York law that requires them to discuss end-of-life care with their patients. This is a little strange to me, unless it's just that they don't want to be told what to do since most of them probably do it anyway -- and the ones who don't probably should.

Hospitals are trying to address the problem of low staffing and bad care on nights and week-ends. They're also trying to reduce the rate of hospital re-admissions using a "virtual" nurse named Louise!

Learn the early warning signs of a migraine and you may be able to stop it before it starts.

And that's all I have -- except Anthony Weiner is an idiot. Unfortunately for me, he's an idiot I really admired. Ugh. Well, have a great day! Jennifer

Monday Moaning

I hate Mondays. New intern starts today. Have two appeals to finish and the lease to comment on and get over to the landlord's lawyer. Better get going with the news:

Paul Krugman on the GOP's plan to end Medicare as we know it. Read it and weep. Here's a set of alternatives that would fix Medicare without sticking it to the elderly and disabled. We know the Dems favor standing strong on Medicare, but where do they stand on Medicaid? So far, they are pretty quiet. VP Biden is still working with a bipartisan group on debt reduction, but the GOP are adamant about not raising taxes, and the Dems are adamant about not dramatically changing Medicare. Medicare remains a particular point of disagreement. The GOP has blasted the Dems for trying to keep Medicare out of the debt ceiling talks. Is this a stalemate that will result in a default on US debt? Freshman GOP don't believe we'd default -- they think we'd just spend less, and that would be good. So for them, there's no incentive to figure this out.

The states are slowly building their Exchanges, marketplaces where you will buy insurance starting in 2014. Surprisingly, though, Alabama is moving forward. Connecticut's lack-luster exchange bill is on its way to the Governor for signing. Meanwhile, although the GOP still favors repeal, they've yet to come up with a plan to replace health reform.

David Lazarus explains why the Pre-existing Condition Insurance Plan hasn't enrolled more people (you have to be without insurance for 6 months) and why health reform is so critical for people with pre-existing conditions.

Connecticut passes the first paid sick leave law in history, ensuring that employees in service industries have the ability to earn up to 40 hours of paid sick leave per year.

A horrible story about the death of a developmentally disabled boy that highlights the flaws in the system.

Two new drugs may be a major victory in the fight against skin cancer.

It's summer, so pick a bug repellent.

And that's it for Monday morning. Have a great day -- or at least as good a day as you can for a Monday. Jennifer