Wednesday, August 31, 2011

You Say Goodbye; I Say Hello

When I started Advocacy for Patients in March 2005, I was deathly ill, in the midst of a life-threatening bout of Crohn's disease coupled with horrendously ignorant doctors. By that time, I had found the wonderful Dr. Ellen Scherl at Weill-Cornell/NY Presbyterian, and she saved my life, got me on track, got me to surgeon supreme Dr. Jeffrey Milsom, and I was on the right track. I had finished up the last of my big litigation files, and I was ready to turn to this new work full-time.

For the first 18 months, I didn't draw a salary, so I was still doing some paying legal work. Eighteen months after that, I hired Celeste, our first Administrative Assistant. She was wonderful to me, even after she had her gorgeous daughter Amieta. We set up a nursery downstairs and Celeste worked when Amieta slept.

But once Amieta got old enough to want to be out playing and exploring, it was time to change guards. Celeste's job went to her sister, Echo, who's done a great job of taking things to the next level.

Last March -- almost exactly six years after I started the organization -- we hired Nicole Netkin-Collins, our first full-time staff attorney. Nicole is great at writing insurance appeals, and she's learning more every day. She's going to be a great lawyer. She already has the passion and the smarts for it; experience will make her even better.

With Nicole here, though, plus law student interns, we simply outgrew my house. We'd taken up my home office, what used to be a guest bedroom, my den, and my dining room. All that was left was my bedroom and my livingroom. And with the volume of calls growing all the time, I had no home left; nowhere to hide. I haven't taken a vacation in more than 6 years. Even when I've tried to take a day off, there have been people here, phones ringing, craziness all around.

My stress level went through the roof and I was deeply depressed, feeling trapped, with nowhere to hide. It was then that my wonderful therapist Ellen Thomas told me that I had to make a major change in my life. I had to move the office out of my house.

This is scarier than it sounds. Our furniture in my house is built in -- it looks nice, but it can't be moved. Our computers are 5 years old, so no point starting at a new office with them. In short, moving meant starting from scratch. New furniture, new phones, new computers, a copy machine, file cabinets -- on and on. Not only is that alot to figure out, but it's very expensive. I have saved up some money over the years for this eventuality, but actually writing the checks is a whole different story.

But now, it's almost all finished. We are packed and ready to move tomorrow. The new furniture and phones are in and looking spiffy. The copy machine is in. The conference table and computers are installed tomorrow -- imagine, we'll have a conference table!

I've moved a lot of times in my life, from New York to D.C. to Vermont to Florida to Kentucky to Connecticut to D.C. and back to Connecticut. I've owned three homes. I'm not a novice to this. But nothing I have ever done in my life has prepared me for this move. Not only was it really hard to choose computers and phones and so on, but it also wasn't my money.

But most of all, this is the last step to creating Advocacy for Patients. It now will have a home independent of me. It can survive without me. And somehow, that makes me a whole lot calmer about things.

And I get my house back!

So it's an ending, but it's also a beginning. and I'm excited as can be.

If you're ever in the area, I hope you'll come visit and see what we've created. It's pretty darn exciting, if you ask me. Jennifer

COBRA Subsidy Ends Today

For people who were unemployed in or before May 2010, the federal government has been helping to pay their COBRA premium so they could keep their health insurance. However, today that money runs out, and many thousands of people will become unable to afford their health insurance. If they have a pre-existing condition, they may have nowhere to go. If they exhausted their COBRA, they are what's called HIPAA eligible as long as they enroll in a guaranteed issue plan with no more than a 63 day break in coverage. The guaranteed issue plan differs from state to state. If you need to know yours, email me your state at (after we move, so I have access to a computer to look it up). Your only other option will be the new Pre-existing Condition Insurance Plan, which is good and relatively affordable, but you have to go without insurance for six months in order to qualify. To find details about the PCIP in your state, go here.

If none of that works, you will have to piece together a patchwork quilt of coverage. You can find federally qualified health centers that are free or on a sliding scale by inputting your address here, which will give you a list of the clinics near you. To apply to get medication for free, go here, choose either brand name or generic, and then find your medication by letter of the alphabet. If you have to go to a hospital, try to go to a nonprofit (affiliated with an educational or religious organization or a governmental unit, like a county) and ask for the financial aid application. You may get your care for free, or at least on a discounted basis.

All of this changes in 2014, when health reform takes full effect and you can get help to pay for your insurance premium, and there are no more pre-existing condition exclusions. Assuming President Obama is re-elected and health reform is not repealed, of course. Jennifer

Hump Day Headlines

Well, tomorrow's moving day. Don't know whether you'll get a full news report for the next couple of days, so let's make today a good one. Here goes:

A GOP tax expert has been chosen as chief of staff to the super-committee, someone known to broker deals who's been around Capitol Hill longer than most elected officials. With any luck, this may signal GOP willingness to consider revenue raisers.

GOP Governors have released a list of 31 changes that would give them greater control over the Medicaid program. They want to be allowed to shrink their programs -- not allowed under health reform -- and convert it to block grants without mandatory coverages. This is SUCH a horrendous set of ideas, subjecting the poor to political whims.

Another awful idea -- change Medigap plans to increase the cost to consumers in order to stop consumers from getting more health care than they really need. I really think the people who come up with this stuff need to spend a month or two getting worked up, having every test known to man, trying medicine after medicine, turning oneself into a pin cushion -- who does that for fun? Do they really think that, by making care more expensive, they will deter only unnecessary care? That's nuts. People do NOT get health care for fun. People will skip medically necessary care if it becomes to expensive. And everybody loses.

Here's an interesting story for you. A new study ties health problems to foreclosure rates. Of course, part of that is because people who are broke also often are uninsured and don't take good care of their health. But stress is also a huge contributor.

With the rise of school-based health centers comes voluntary mental health screening for teens.

Poor sleep may increase your risk of high blood pressure. That explains a lot. And what should you do during your breaks at work in order to reduce your stress? Coffee is not the answer.

Can exercise help treat depression? Maybe -- worth a try, for sure.

And that's what I've got for you this morning. Have a great day! Jennifer

Tuesday, August 30, 2011

Tuesday Tidbits

Two days to the move and counting. The copier and fax are working. I actually have a couple of days now to just finish up packing and then we're out of here -- and I get my house back! I can't wait, both to move in and to have everybody else move out!

But first, the news.

Get ready for round 2, says the NY Times. Congress will be getting back to work next week and are expected to continue to pursue polarized agendas. The GOP will attack labor and environmental regulations they believe hurt jobs. They also want funds spent on disasters like Hurricane Irene to be offset by spending cuts. Geez, I hope this is wrong, because I don't think any of us out here can stand more partisan gridlock in light of the problems our country faces. It appears there won't be budget fights -- at least, until November, when we see what the super-committee has or hasn't done. Some report that liberals were the most vocal group at summer Town Hall meetings. The White House is finalizing a jobs plan, with tax breaks to employers who hire and funding for training new employees. For too many people, recession has become a way of life.

A new Kaiser Family Foundation poll found that most uninsured don't understand the health reform law or what it's going to do for them. They don't know about premium tax credits, the expansion of Medicaid. Only 30% believe they will benefit from the law. A majority of Americans oppose the law (that they don't understand), but it's not along party lines. As part of the law, starting Thursday, any insurance premium increases over 10% have to be justified by the insurer. But states are all over the map in getting their Exchanges (marketplaces) up and running.

Perhaps this partly explains the under-enrollment in the Pre-existing Condition Insurance Plan (PCIP). These high risk pools -- some offered by states, some by the feds -- have enrolled only 21,000 people. Why? The prices are pretty good in most states, but you have to go without insurance for 6 months to qualify. On the other hand, most people are satisfied with their employer-sponsored insurance.

Finally, what I've been waiting for. Eat more chocolate to protect your heart! It lowers the rate of heart attack and stroke. Now, that's my kind of science.

Speaking of eating, a California judge ruled that Blue Shield has to cover inpatient treatment for anorexia under mental health parity laws. We have a big case like this pending. I hope the reviewer reads this article.

Federal health care fraud prosecutions are on the rise, keeping pace with cost-saving estimates.

Doctors start thinking about how better to practice medicine. The second book they describe sounds particularly interesting. And intensive care units grow more friendly to patients' families.

Consumer Reports says that not all pharmacies provide the required information to patients.

Changes in microbiology are leading to much faster answers about outbreaks and illnesses. Scientists believe they are a step closer to understanding Lou Gehrig's disease.

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

Monday, August 29, 2011

Monday Musings

Emily (my feline friend) and I fared pretty well through the storm. Electricity is on. No flooding. That should mean the move is on schedule -- YAY! So onward ... with the news!

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Rev. Martin Luther King, Jr. Yesterday was the anniversary of Dr. King's "I Have a Dream" speech. This line is not from that speech, but it is the line from Dr. King that gives my life direction, that makes it clear to me that this fight I'm in is a civil rights struggle for people with chronic illness.

The storm did some major damage. Half of our state is without power from downed lines. The tides surged inland all along the shoreline. There's alot of damage all up and down the east coast, from North Carolina to Maine. Please stay away from downed power lines. Watch for flooding on the roads. Shelters are open in most towns and are serving hot food, coffee. Then again, if you're reading this, you probably don't need help -- but how about lending a hand where you see someone in need? Things were not entirely smooth for the disabled who should have been evacuated. And be careful cleaning up -- the risk of injury is higher after the storm.

The Basic Health Program -- one of the options under health reform -- puts health care within the reach of low income folks who make too much for Medicare but not enough to pay an insurance premium.

Anti-reform Governors have to decide whether to accept federal dollars to get their Exchanges ready, or take a chance that the feds will come in and do it themselves.

As summer comes to a close, the House GOP readies its negative agenda to eliminate regulations that protect the middle class, but that they claim hurt the (rich) people who create jobs.

I try to stay out of electoral politics, but when Texas Gov. Rick Perry says Social Security is a monstrous lie and a ponzi scheme, I think you ought to know. Mr. Perry also claims that malpractice reform has increased the number of primary care physicians in Texas, but PolitiFact says not so. Michelle Bachmann says the health law would mean the end for conservatives. Essentially, she says that if the law is allowed to take full effect, we will have socialized medicine, and no GOP-er will ever be elected again. Hmmm.

Fed Chair Ben Bernanke says we can't fix our economy without getting ahold of health care costs -- the highest in the world, without similarly good health outcomes.

Medicaid in many states is switching to managed care. Good for insurers -- or maybe not?

Does obesity qualify as child abuse? I say no -- but it does qualify as an eating disorder and should be treated as one.

Clinics in retail settings are booming. This is a great idea for minor ailments.

The story of a diagnosis - and telling a loved one.

Will the NightWave help you sleep? I got all excited -- and then I read the article.

Locally, the state Board of Education says Hartford has not done right by its disabled students and must do better. We know from our work that Hartford is not alone.

And that's it for this morning's news. Please be safe and have a great day! Jennifer

Friday, August 26, 2011

Finally Friday Edition

And the last Friday in my home office, assuming, of course, that we have power next Thursday when we're supposed to move and install computers. But the furniture goes in today -- WOOHOO!

But first, the news.

It's all about hurricane Irene today. Please stay safe. Have water, flashlights and batteries, nonperishable food, your prescriptions, cash all at the ready.

Why is the cost of health care so high? Doctors in the United States spent $80,000 EACH per year fighting with insurance companies, trying to get paid. This is HUGE. I understand that insurers need to make sure they are paying for medically necessary care, but this is extraordinary and it has to stop. There has to be a better way.

Former Republican Senator Bill Frist says the health reform law is here to stay. He believes the individual mandate is unconstitutional, but that the rest of the law will endure.

Meanwhile, where to the GOP candidates stand on health care? Here's a summary of each of their positions.

And elderly couple decided to stop eating and drinking and die when they were ready, and the assisted living facility they were in tried to evict them. Wow.

The National Academy of Sciences has reviewed vaccine safety and concluded that they are safe, and that they do not cause autism. The autism study was conducted by the Institute of Medicine.

And that's it. A slow news day. Have a great day! Jennifer

Thursday, August 25, 2011


Lake Geneva, WI – Legendary rock band Pearl Jam is celebrating its 20 Year Anniversary by hosting a festival concert series at Alpine Valley Music Theater, WI on Saturday, September 3, and Sunday, September 4. In honor of Pearl Jam’s momentous occasion, the Wishlist Foundation, a Pearl Jam fan nonprofit organization, will be hosting a pre-concert fundraiser on Friday, September 2, at Hemingways in Lake Geneva.

Wishlist Foundation hosts pre-concert fundraiser events across the globe to benefit organizations that Pearl Jam and its fans support. The September 2 fundraiser will benefit several local and national organizations in honor of each member of the band; Save the Turf Foundation and Tosa Skateboarders United for bassist Jeff Ament; Advocacy for Patients With Chronic Illness for lead guitarist Mike McCready; Guitars in the Classroom music education for drummer Matt Cameron; The Natural Resources Foundation of Wisconsin for rhythm guitarist Stone Gossard; Camp Hope for keyboard player Boom Gaspar and Honor Flight veterans organization for lead singer Eddie Vedder.

The fundraiser will feature performances by Cluthe/Lee, select scenes from the play “The Faithfull”, trivia contests, karaoke, Pearl Jam themed menu, five different bars, BBQ and s’mores cookout and more. Attendees can make donations at the event and receive incentive items like Pearl Jam inspired t-shirts, posters, wristbands, mouse pads and ticket albums and can enter raffles to win fan-donated Pearl Jam memorabilia. There will also be a silent auction that features autographed items donated by band members as well as items donated by our sponsors.

Conceived in 2004 and formalized in 2006, the Wishlist Foundation is a Pearl Jam fan nonprofit 501(c)(3) grassroots organization dedicated to supporting Pearl Jam’s charitable and philanthropic goals. Our ongoing mission is to utilize the collective ability of Pearl Jam fans around the globe to make a difference in the world. Since 2004, the Wishlist Foundation and Pearl Jam fans across the globe have together raised almost a half a million dollars to date through a variety of grassroots fundraising methods.

The festival weekend kicks off a series of commemorative events for Pearl Jam, including a ten city Canadian tour and their upcoming Cameron Crowe-directed film, Pearl Jam Twenty, which captures the band’s journey over its twenty years, along with an accompanying book and soundtrack album in September. A nine city South American tour is scheduled for November.

All ages are welcome to attend the fundraiser at Hemingways, N3270 County Hwy H, Lake Geneva, WI from 5 – 10 PM. For more information, please visit

Thursday Themes

I begin where I left off last night -- mad as hell. The Board of the Connecticut Exchange has been announced. Although the statute provides that no insurance company executives could be chosen, three slightly former insurance executives were appointed, and not one representative of consumers -- despite the fact that this is contrary to federal law. Arielle Levin Becker broke the story on the Connecticut Mirror. The Administration seems to be saying they couldn't find any consumer advocates with the necessary expertise. Yeah, right. Hello?!!!

And now to other news.

The debt panel is talking. Considering how fractured Congress has been lately, the fact that they're talking is in and of itself a sign of progress. But they still need to establish staff and their rules for meeting. The nonpartisan Congressional Budget Office says the budget cutting will do some good in bringing down the deficit -- but those savings would be completely offset if the Bush tax cuts for the wealthy are renewed again -- something President Obama has pledged not to allow.

Connecticut is not the only state that's bowing to the will of the insurance industry. California is debating a law to regulate health insurance premiums -- and it's running into opposition in the state Senate. And Michigan is moving to cut health coverage for state employees.

One of the provisions of the health reform law on Exchanges is that there have to be multi-state plans -- a Republican provision that progressives oppose for fear that this will circumvent state laws that require coverage of certain things, from overnight stays for mastectomies to ostomy supplies. Well, the National Association of Insurance Commissioners says no such luck -- multi-state plans will still have to comply with the law of the states in which they are selling insurance. This is an excellent, pro-consumer stance. See -- was that so difficult?

But the Republican in New York vying for the seat than Anthony Weiner vacated says he opposes health care for 9/11 workers. His campaign says he didn't mean it, though.

I'm sure you've all heard or read that Steve Jobs has resigned as Apple's CEO. It's due to his battle with a rare form of pancreatic cancer. We wish him comfort.

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

Wednesday, August 24, 2011

Connecticut Disappoints Consumers -- Again

The list of members of the Board of the Exchange has trickled out into the public realm today. Although our wonderful Healthcare Advocate, Vicki Veltri, is automatically on the Board, of all of the appointed members -- both Democrat and Republican -- there is NOT ONE consumer representative -- not one.

The federal Exchange regulations say, in the preamble, as follows: "Exchanges are intended to support consumers, including small businesses, and as such, the majority of the voting members of governing boards should be individuals who represent their interests." 76 Fed. Reg. 41872 (7/15/2011). I don't know about you, but that surely reads to me as though there should be -- oh, I don't know, maybe ONE consumer representative on the Board? Maybe one public official could have appointed someone who would join Vicki Veltri in expressing the consumer point of view?

Even worse, although the statute says flat out that insurance company representatives cannot be on the Board of the Exchange, in fact, there are three (slightly) former insurance industry executives on the Board. Nobody on the Board is in favor of a public option, although here in Connecticut, the SustiNet Board is supposed to be studying the feasibility of a public option. In short, the deck is stacked against consumers. Apparently, nobody in Connecticut's government read the federal regulations.

In short, those who had the authority to appoint members of the Board of the Exchange have betrayed the trusts and undermined the interests of Connecticut consumers, thousands of whom are going to be purchasing their insurance through the Exchange. Nobody (besides Vicki Veltri) on the Board knows the obstacles consumers face and will speak for them. This is a travesty.

For those of you Connecticut consumers out there, now would be a really good time to get mad. Jennifer

Hump Day Headlines

Well, the phones are in, so the move has officially started. I can't wait to see the furniture on Friday -- that's when it will start looking like an office. But first, the news....

The supercommittee (now being called the debt panel) is made up of 12 members, 6 Dems and 6 GOP. Here's an outline of who's there and what they're likely to want to do. I hear their staff is already at work. Members are preparing their constituents for the unpopular decisions they're about to make. Former Senator John Danforth says the real problem with the economy is the cost of health care. I'm so worried about what I fear will be serious cuts to Medicaid and Medicare.

Meanwhile, the Administration may give states a second chance to start up their own Exchanges (marketplaces). Only 11 states have taken federal money to set up their Exchange. So the feds are thinking about a "partnership" Exchange run by states and the feds together. Bottom line is that the feds do not want to have to operate Exchanges in 40 states.

Unsurprisingly, the insurance industry has commenced a lobbying effort to try to get the tax on insurance plans repealed. It goes into effect in 2014 and is expected to generate $8 billion in revenue.

Medicare is going to test a new payment system that bundles payments to doctors, other providers, to pay for a health care "episode" rather than being paid for each individual doctor visit. Meanwhile, states are trying to get people to stop going to the emergency room, while hospitals are inviting them in.

Here's another report on the impending bankruptcy of the Social Security disability system, as people who are out of work flock to get benefits.

Here's something to look forward to -- Michelle Bachmann is going to release her own health care plan in the coming weeks.

High salt and inactivity are bad for your brain. For awhile, I had gotten into the habit of eating a Lean Cuisine for dinner -- low-cal and quick/easy. By the end of the week, my ankles and feet were like footballs. Since I've gotten sick again and am now eating pretty much only soup, the swelling is better. That's my lesson on eating too much salt. Now, what to do about all the Lean Cuisines in my freezer? And what to eat instead -- if I ever get past this flare, of course? Bill Clinton became a vegan. I think I could live without most meats, but no eggs or cheese? I don't think there would be much left that I can eat. Nutrition is a constant battle for many of us with chronic illnesses.

Have high cholesterol? Try soy and nuts to help lower it. Oatmeal, too!

Women sleep better than men and, thus, are healthier. If only.

And that, my friends, is the morning news. Have a great day! Jennifer

Tuesday, August 23, 2011

Tuesday Tidbits

Good morning! And here's the news -- sort of a hodge podge today:

Congress is still on recess -- interesting that they're shying away from town halls this year. I suppose that's because they know how unpopular they ALL are right now. Then again, when you advocate creating tax loopholes for your highest donors, there's going to be some fall-out.

Another GOP Governor -- Idaho -- accepts federal funds to establish a health insurance exchange (marketplace). I guess they don't hate health reform that much. Rick Perry says no for Texas, however. I got two calls yesterday, back-to-back, from people in Texas who can't find health insurance. Indeed, Texas has the lowest insurance rate in the US. I guess Mr. Perry isn't concerned about them. Even Mississippi is on track to open an Exchange on time. What's happening in your state? Call or write your Governor and ask whether you will have the benefit of an Exchange -- or whether the federal government is going to have to come in and do it for you.

Specialty tiers. If you have one, you know what I'm talking about. To save money, insurers are creating specialty tiers of drugs, with monthly copays in the thousands of dollars. The copay assistance programs are turning people away already, saying they've exhausted their funds for the year. Thousands of people with serious illnesses are going without their medications. Statutes have been proposed in many states to stop this practice, but so far, the insurers have won. Of course, they are blaming it on the pharmaceutical manufacturers. How about not worrying about blame and instead worrying about fixing the problem?

Some health insurers refuse coverage of injuries that occurred while intoxicated. And keep reading to the last Q & A -- your screening colonoscopy will NOT be free if the doctor finds anything -- a polyp -- at which point it's no longer just "screening." This is VERY important -- we're already getting calls about this.

How to find the right doctor. Invaluable advice.

I love this -- philosopher counselors, therapy through Aristotle. This is tailor-made for me!

Hospitals are treating heart attack victims much faster -- great news. Over 90% of patients who needed angioplasty got it within the recommended 90 minutes. And marriage helps people recover from heart surgery.

You've got to laugh. A new study finds that bisexual men are ... well ... bisexual. Really? Someone funded that research? They couldn't have just taken the men's word for it?

Wait and watch -- good medical advice? Sometimes.

Huge breakthrough in ALS (Lou Gehrig's disease) -- may lead to a treatment breakthrough.

Seems there's a big problem with hip implants -- the metal on metal kind. Think twice.

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

Monday, August 22, 2011

Can Health Reform Get a Fair Shake?

Here's an article in the New Yorker that argues that Supreme Court Justice Clarence Thomas and his Tea Partier wife Virginia "Ginni" Thomas are determined to bring an end to the health reform law. Pretty convincing, if you ask me.

Does Justice Thomas have a conflict of interest? So far, he's given no indication that he's not going to sit on the health reform case when it makes its way to the Supreme Court. Let's hope it's a dissenting opinion he's writing. Jennifer

Monday Musings

The move really gets going this week, starting with phone installation tomorrow. But first, the news:

Social Security Disability, bursting at the seams, is running out of money. More people are applying because they're out of work and can't find a job. This is forcing people to try for disability. As a result, the program is going to run out of money by 2017.

The President's jobs plan -- which hasn't been announced, but which is expected to include extension of unemployment benefits and payroll tax reduction, along with infrastructure projects that need to be built anyway -- is already being met by GOP opposition. Maybe you should at least wait until he gives the speech to bash it?

Meanwhile, the fear of Medicare and Medicaid cuts by the super-committee continues. All six GOP members voted in favor of Paul Ryan's budget, which would have changed Medicare to a voucher program, and favor converting Medicaid into block grants.

The Susan B. Anthony List continues its lawsuit claiming that the health reform law allows federal funding of abortion. A judge found that it does not. I'm telling you -- it does not. The Exchange regulations contain several pages that make sure no federal funds can be used for abortions. And yet this group continues to abuse SB Anthony's name by continuing this campaign.

The first of these two questions is about how health reform will help the disabled. A concise explanation of the individual mandate and why it matters so much.

Celiac disease is on the rise in the US -- or is it just that people are getting diagnosed more often now? Regardless, the symptoms are serious. This is not just another food allergy. Read.

The delay in passing a budget and releasing funds has caused problems for over 500,000 people suffering with HIV/AIDS.

This is a really interesting story about what happens when health care providers try to team up. The health reform law encourages this sort of alliance, but someone forgot to tell the Federal Trade Commission?

It's almost flu shot time. Don't skip it. That's not me; that's the CDC saying that. Especially pregnant women and health care workers.

One Baptist preacher is preaching a healthy diet in the deep-fried Delta. Good for him! And good for Bill Clinton, a vegan.

Farmers' markets are popping up everywhere -- a good thing, or too much of a good thing? In this part of the country, not too much.

A whistleblower in the NY State Disabilities agency is being disciplined harshly.

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

Friday, August 19, 2011

Finally Friday Edition

Two weeks from today, we will be in our new offices unpacking, trying to learn the new phones and computers, and making the place our own. Until then, lots to do. But first, the news:

In this summer's town halls, Dems are stressing the GOP's refusal to make any changes in the tax code to raise revenue. The President pledges to introduce a proposal of job stimulus and deficit reduction in September. But nervous Dems say he has to get bolder on the economy.

GOP super-committee member Upton says he will not agree to cuts in Social Security for seniors currently receiving payments -- leaving the door open to cuts in benefits paid to those of us who aren't quite there yet.

As health care costs continue to rise, employers are shifting more of the cost to employees. When I read things like this, I feel like 2014 just can't come fast enough -- and if we lose the health reform law before them to either a court or President Obama not winning re-election, what then?

Some members of Congress and others question the number of low income children receiving disability benefits under Supplemental Security Income (SSI).

African-American scientists are less likely to get research grants from the National Institutes of Health. Really? We think we're come a long way with an African-American President, but apparently, the message hasn't trickled down.

An experimental drug has succeeded in extending the lives of obese mice. Similar drugs are in clinical trials on human subjects.

And that's all I have for you. The lightest news day ever. With Congress on recess and the President on vacation, there just isn't a lot going on. Maybe that's a good thing -- sometimes, less is more.

Have a great day! Jennifer

Thursday, August 18, 2011

Thursday Themes

Two weeks from today, we move -- but miles to go before that. Of course, it's one client emergency after another, so I just keep getting further behind in my work no matter how many hours I put in. Oh, well. I guess we'll review the news -- one thing I can get done.

The super-committee has a huge job ahead, with the pressure to make a deal and the partisan rancor that has characterized all debates. The President is going to make a major jobs speech after Labor Day, and he's going to call on the super-committee to include jobs programs as well as deficit reduction. Details of the President's jobs plan are leaking -- he wants tax cuts for employers who hire workers, new spending for roads and construction, coupled with even greater deficit reduction than the committee is required to make. The House GOP is already criticizing the President's plan for not being specific enough. Um, maybe wait until he actually outlines his proposals?

Yesterday, the government issued proposed regulations to require health insurers to make standard-form disclosures of all aspects of their policies so consumers can compare and make intelligent choices. The key is it has to be in plain language, which is great. Now, how to distill all the critical information about a policy in four pages?

The health care sector has been one of the few industries to continue to grow during the recession. Will cuts to Medicaid and Medicare undermine that pro-jobs economy?

There's a shortage of drugs that is leading to unscrupulous price gouging. However the Wall St. Journal notes a trend in "repurposing" drugs -- using them to treat conditions other than those for which they were FDA approved. However, they missed mentioning the fact that insurers routinely decline coverage for this sort of off-label use. And members of Congress are concerned about the proposed merger of Express Scripts and Medco -- would it save money, or would it just give them the monopoly power to control the market's prices?

That's it for today. With Washington on recess, there's less chatter -- and as far as I'm concerned, that's okay with me. Have a great day! Jennifer

Wednesday, August 17, 2011

Hump Day Headlines

On the run this morning -- way behind in work due to the move, so trying to crank stuff out. First, the news:

There isn't much going on on Washington during recess. President Obama is still on his bus tour. He now says he's sending a jobs package to Congress in September, and he dares the GOP to block it. As if they haven't already shown they aren't scared of him. The GOP candidates amuse, with Rick Perry accusing the Fed Chairman of treason and Michelle Bachmann thinking it was Elvis's birthday when it was really the anniversary of his death. The US Chamber of Commerce -- bastion of conservative views -- urges the super-committee to go for a grand bargain including a reform of the tax code. But what will the super-committee do to Medicare and Medicaid? That's the question.

If we lose the individual mandate, we may well lose coverage for pre-existing conditions. That's really what the big deal in the courts is all about.

Under health reform, there will be a standardized form consumers can review to compare insurance policies and make informed choices. The draft of that form is supposed to be released today. We will be taking a close look to make sure it's as consumer friendly as the law intends it to be.

If states don't start up their own Exchanges (insurance marketplaces), the feds are supposed to run a federal one. Except there's no money for that purpose.

More doctors' offices become "medical homes," but what does that really mean? Read our friend Arielle Levin Becker's excellent discussion.

Apparently, Facebook had a policy that exempted drug companies from having open walls where people could comment. Facebook has now removed that exemption, and drugs companies are leaving Facebook. Buh-bye!

A Crohn's patient's Remicade costs $6300, but the hospital bills for $38,000 and then discounts the bill for insurance. And that's just one example of how health care prices are inflated and then discounted. This is all to keep up with government-mandated discounts for Medicare and Medicaid -- BUT when you're private pay, you don't get the discount -- you get the whole bill for $38,000.

Comparative effectiveness research tests new therapies to see if they work any better than the old ones, and to see where the new treatments fit into our arsenal to combat illness.

Experts declare that addiction is a brain disease. Now, they need to figure out how to cure it.

And that's the news. Off I go to work on an emergency insurance appeal. Have a great day. Jennifer

Tuesday, August 16, 2011

Tuesday Tidbits

Well, we have keys. Every day, another step towards our move. Exciting and scary, both. Anyway, first, the news:

President Obama is on his bus tour, slamming the GOP for not budging on tax reform and revenue enhancement. Warren Buffet -- one of the wealthiest Americans -- says please tax me! Still, 39 GOP House members published an editorial in Politico today blaming the Senate for not passing their extreme budgets that would end Medicare as we know it and make health care that much further out of reach for millions of Americans. Meanwhile, the lobbyists are gearing up for the super-committee.

The great Jonathan Cohn explains what's at stake for Medicare in the super-committee. Brilliant analysis.

Politico also says the fate of the health reform law will be decided just before the 2012 elections. I'm not sure -- it depends whether the Obama Administration gets the whole 11th Circuit to hear the case before it goes to the Supreme Court. That would slow it down some.

Medicaid pays less for prescription drugs than does Medicare. According to the NY Times, that's because Medicaid discounts are set by law, and Medicare prices are negotiated by private insurers and drug companies. Did you need any more proof that Congress should allow Medicare to negotiate drug prices?

The last time you were in the hospital, did you see your doctor or a hospitalist you've never met before? I hate the trend towards hospitalists, but it appears to be unstoppable.

Do you know how to store your medication? Read this and make sure you're taking precautions.

I love this -- nurse navigators helping patients to make the health care system work right.

Doctors have to report child abuse, but is it always the right thing to do? I read this story and it didn't make me stop and think. Of course, you report. But what gets me are the schools that report a parent for neglect when child misses school because he's out sick -- with a doctor's note. That's really not okay.

A California legislator held a health care town hall. Unlike the screaming fests of two summers ago, it was a place for people to air concerns and for officials to educate them about how health reform implementation will help them.

Big hospital chains hire lobbyists to fight curbing Medicare spending on hospice services.

Do you lie to your doctors? Apparently, many do. How can they help us if we don't tell them the truth?

Home health aides are in demand as people stay out of hospitals and nursing homes as long as they can.

A debate over whether to use CT scans to screen for lung cancer. As best I can tell, the down-side is money and perhaps a few false positives.

Recent advances in cancer research have been really meaningful. Exciting.

For women in menopause, all of the self-help tricks don't work very well. Hormones may be the only solution?

And there you go, off to start your day fully informed. Have a great day! Jennifer

Monday, August 15, 2011

Analysis of 11th Circuit Opinion

Sorry it took me so long to slog through all 304 pages of the 11th Circuit Court of Appeals decision striking down the individual mandate that is part of the health reform law. I could give you a long and detailed summary, but that would probably be boring and most of you wouldn't bother reading it. So let me give you the whole mess in a nutshell:

The Constitution says Congress has the power to regulate commerce. That's called the Commerce Clause. And it's vague, as are most parts of the Constitution -- which is why courts every day are called on to interpret it.

There are two "book-end" cases defining Commerce Clause analysis. In Wickard v. Filburn, a farmer grew wheat on his own land. Congress passed a law saying nobody could grow more than a certain amount of wheat to control the commercial flow of wheat. But our friend Filburn bent the rules a bit and grew some extra for his own personal use. The Supreme Court said that was not okay. Even though Filburn wasn't sending the extra wheat across state lines (and, thus, into commerce), by growing some for his own consumption, he was buying less, and so his personal use affected commerce. If Filburn's own wheat was enough of an effect on commerce, where does the Commerce Clause end? What law could Congress NOT pass under the Commerce Clause?

In US v. Lopez, the Supreme Court defined that other end. Congress passed the Gun Free School Zones Act, making it a crime to possess a gun in a school zone. The Supreme Court said that prohibiting possession of a gun in a location that could not possibly cross state lines or have any effect on anything crossing state lines, so Congress did not have the power under the Commerce Clause to support this prohibition.

The question in the health reform cases is this: Is Congress's passage of a law that requires uninsureds to get insurance or face a penalty more like Wickard or Lopez? Two out of three judges said it's more like Lopez because ... well, I'm not sure. It's not commercial? But uncompensated care costs about $43 billion. It's not interstate? Okay, maybe, but doesn't it affect interstate commerce? But there was evidence that the costs are shifted to hospitals who shift them to insurers who shift them to consumers in the form of higher premiums (both the 2 judge majority and the 1 judge dissent agreed on this much). Here's really what they said: People who are uninsured and don't pay their bills are mostly people who wouldn't be affected by the mandate because they're either illegal aliens or really poor -- or, for the most part, they are healthy people who simply don't want to buy insurance and aren't worried about getting sick. And healthy people who don't use health care are not in interstate commerce and, thus, their conduct can't be regulated. Congress could pass a law saying the minute they show up at the hospital emergency room, they can be required to buy insurance, but as long as they're healthy and don't need health care, they have a right not to buy insurance.

The dissent said it's ridiculous to say that we have to wait until the damage is done -- a charge is incurred and now we all have to pay for it -- until Congress can fix the problem.

And so now we see. The Sixth Circuit voted 2-1 the other way. We're waiting for the 4th Circuit. And we'll see if the government asks for reconsideration by all of the 11th Circuit (more than just 3 judges) or if it goes right to the Supreme Court, as the plaintiffs would like.

That's probably more than you ever wanted to know about the Commerce Clause, but when you hear about this stuff on the news, just remember Filburn's wheat and you're all set. Jennifer

Monday Musings

How is it that Saturdays and Sundays are so short? Today starts the moving count down. Have to start packing, getting vendors scheduled, getting stuff done -- less than 3 weeks until move day. Can't wait! In the meantime, the news:

Scary economic times. Low interest rates don't seem to be helping. They're talking lay-offs on Wall Street. I don't know how you stop a recession without pumping money into the economy -- and the GOP in the House will never allow that now. The tools that helped in 2008 appear to be gone today. The President needs to come up with some ideas. Meanwhile, he says Congress needs to do something. He starts a three-day midwest bus tour today. Something tells me this is a bad idea. Meanwhile, the great Warren Buffet again steps forward and says "Tax me!"

Did anybody else notice that there's only one woman, one Latino and one African-American on the super-committee? Will the lack of diversity change the outcome?

Watch out for this one, folks. More and more, I'm reading that Congress may limit Medi-gap policies to make it more expensive for seniors to seek health care -- so they will seek less health care. Those who advocate for this seem to think people have fun going to the doctor and they do it not based on need, but based on -- well, they have nothing better to do or something. We don't need an incentive to go to the doctor less often. Indeed, I get so many complaints about doctors that it's a fair bet that most of us avoid doctors as much as humanly possible. But some think we need an incentive to seek less health care -- so make it impossibly expensive. Cruel and crazy, as far as I'm concerned.

As you know, a 3-judge panel of the 11th Circuit Court of Appeals struck down the individual mandate portion of the health reform law. What happens next? The feds can request reconsideration from the entire 11th Circuit to rule, and then it's on to the Supremes. We should have a decision from the 4th Circuit soon, too.

Three sets of regulations were released on Friday: one to explain how people will apply for the tax credit through the exchange (marketplace), one that says how the tax credit will work, and the third that will facilitate Medicaid enrollment through the exchange. All told nearly 600 pages -- haven't quite finished reading them yet!

If you've been admitted to the hospital recently, you've probably seen a hospitalist -- not your regular doctor, but whoever's on call. Does it save money? Not really, because you end up spending more once you're out of the hospital.

Baby boomers are not prepared for their need for long-term care.

Connecticut insurers have to cover the cost of bone marrow compatibility testing for transplants.

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

Friday, August 12, 2011

More on the 11th Circuit

I have not finished reading all 304 pages of this decision. However, although the court struck down the individual mandate, it upheld the expansion of Medicaid, and it held that the rest of the law besides the individual mandate can move forward. So it's not quite as devastating as the media is making it out to be. I will try to complete a more detailed analysis in the near future. Jennifer

11th Circuit Court of Appeals Strikes Down Individual Mandate

POLITICO Breaking News
The 11th Circuit Court of Appeals has ruled that the health reform law's individual mandate is unconstitutional but that the rest of the law can stand.

For more information...

I will get ahold of the full opinion asap and then give you more info. Obviously, it's good that the rest of the law was upheld, although there are real questions about how the law can work without the individual mandate.

But perhaps the most important thing about this is that we now have a difference of opinion between the 6th Circuit, which upheld the law, and the 11th Circuit, which has now stricken down the individual mandate. A split between or among the Circuits is a basis for a petition for review to the Supreme Court. It's hard to imagine that this won't end up at the Supreme Court. Depending on the briefing and oral argument schedule, we could even have a decision by the end of the next term (June 2012). One way or another, this will be an issue in the 2012 Presidential election.

More later when I have more information. Jennifer

Finally Friday Edition

Wow -- try moving offices AND still doing your job full time. It doesn't quite work. Oh, well. Only three more weeks. And until then, the news ....

The markets are still going nuts. Mitt Romney says he wouldn't raise taxes as President, even on corporations, because "corporations are people too," said the man who would be King. Now that Nancy Pelosi has named her picks, the super-committee is all set -- here's detail on their background. Is the committee make-up a recipe for gridlock or compromise? Interestingly, the way the law works, if the super-committee doesn't come up with the whole $1.5 trillion in deficit reduction, the trigger -- massive spending cuts -- kick in only as to the difference between what the super-committee does and $1.2 trillion. So, for example, if the committee agrees on $800,000 in deficit reduction, the trigger would apply to the remaining $400,000.

Standard & Poor's says that part of the reason it downgraded our credit rating because of the skeptics who didn't believe how serious a default would be. Thank you, Michelle Bachmann.

The GOP Presidential field debated last night. Not much about health care, but a lot of inaccuracy. Michelle Bachmann gets her own fact-checker since she's so good at rewriting history. The candidates did go after each other a bit, making for good theater. Romney is still taking heat over health reform -- too bad he can't just tell the truth, that roughly 98% of people in Massachusetts have insurance, and everyone can get insurance, some with government help. Too bad he's running away from something that really worked.

Town Halls are popping up while members of Congress are on recess. Voters are telling both Dems and GOP to fight harder for what they believe in. Pretty interesting -- not compromise, but fight harder. Hmmm. No question they are angry, though. The President is urging voters to ask their members to work together, to compromise. And Dems are urging the President to get more involved.

Will Wisconsin's ultra-conservative Governor Scott Walker implement health reform? He's the only remaining GOP Governor to accept early innovation funds to create an insurance exchange (marketplace). Meanwhile, HHS Secretary Kathleen Sebelius is highlighting the fact that every Exchange will offer a nationwide (actually, multi-state is what it says) insurance plan(s) that allows people to access a nationwide network of doctors.

When there are tough medical decisions to be made, it seems that patients would just as soon have the doctor decide. Not me. I cling to my autonomy, no matter how sick I get.

A new -- definitely experimental -- cancer treatment, the hot chemo bath. Doesn't sound pleasant to me, but whatever works with this afwul scourge. Just don't expect your insurance company to pay for it.

Finally, Kaiser Health News has gathered some suggested week-end reading. I don't know about you, but I need a break from this stuff on the week-ends. But there are some interesting pieces here -- how the new rules prohibiting medical residents from working 30 hour shifts is working; a profile of the architect of the health reform law, MIT's Jonathan Gruber.

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

Thursday, August 11, 2011

Pelosi's Picks

House Minority Leader Nancy Pelosi has tapped her three choices to serve on the deficit reduction super committee: Reps. James Clyburn, Xavier Becerra, and Chris Van Hollen. Pelosi vowed to appoint Democrats who would protect entitlement programs and push for revenue increases. All 12 committee members are now in place with Pelosi's announcement.

These three are very strong liberal picks. Does that make compromise more or less likely? I'm hoping it means both sides have to compromise rather than just one. Jennifer

Thursday Themes

It's scary times, watching the stock market go up and down, wondering when it will end, how it will end when our "leaders" don't seem to be interested in compromise. The GOP has named it's representatives on the super-committee, but in order to get a deal, one member of either party has to cross party lines and vote for a compromise. Do you think they remember how to compromise? It doesn't look great. The committee is stocked with seasoned veterans. Some say that bodes well for the chance of success. It's going to mean changes to Medicaid and Medicare. Meanwhile, it keeps us transfixed on the debt and not focused on jobs or stimulating the economy. We really need the President to come out with a proposal and fight for it. Here's a profile of the committee members and who funds them. The Republicans are happy with their choices. Upton is all about cutting health care spending. Some liberals are worried that John Kerry may give up too much in entitlements. Toomey is the "de facto" voice of the Tea Party. Deficit hawk Alan Simpson blasts pretty much all of them. Connecticut's own John Larson calls for a super-committee on jobs, too. Gotta love him.

Should the President be going on vacation in the midst of all of this? Part of me says it's unseemly to see him spending $50,000 per week on a rental in Martha's Vineyard when so many people are hurting. Part of me says vacations are important times to recharge batteries (although how would I know? This is just something people tell me). If he comes back energized, it will be worth it.

Nonprofit hospitals are cash-strapped and face their own threat of credit rating downgrades. And states are cutting health care to children.

Here are smartphone apps that help you to relax, meditate, and calm your weary self.

A new report looks at patterns of health care spending by people with private insurance. Very different than the patterns of spending by people with public funding for health care (Medicare, Medicaid).

There's a new treatment for leukemia that shows some promise. Every time I read something like this, I'm optimistic -- if they find something that works for one illness, maybe it will hold clues for others.

A pastor and 2 others were found guilty of Medicare fraud in the amount of about $14 million from false claims of selling power wheelchairs.

And that's the news on this solemn day. Make it a day that counts. Jennifer