Caught Between A Rock and A Hard Place

Caught Between a Rock and a Hard Place:
Too Sick to Work, Not Sick Enough for Disability
By: Nicole Netkin-Collins

In these lean economic times, we’re getting more and more calls from patients who believe they have been laid off because of their illnesses. Unfortunately, they may be right. But aside from a possible discrimination claim – which is very difficult to prove – being right doesn’t solve the resulting problem: how to obtain a reliable source of income moving forward, especially if you are sick. That’s the issue at the heart of the question: Should I apply for unemployment and/or disability benefits?

The answer varies depending on your circumstances. It is important to know, however, that you CANNOT apply for BOTH unemployment and disability benefits because you have to meet a different “standard” in order to qualify for either one. For example, to qualify for unemployment benefits, you have to be “ready, willing, and able to work.” This means that you’ve become unemployed through no fault of your own – i.e., you were fired (without cause – and what this means differs from state to state) or laid off – and once you get another job offer, you will be ready to accept it. To qualify for Social Security disability benefits, on the other hand, you need to prove that you are too sick to work at any job in the economy. This is a tough standard to meet; for example, even if you were a construction worker, you need to prove that your illness prevents you from working at even the most sedentary, desk job. As such, you cannot simultaneously be “ready, willing, and able to work,” in order to qualify for unemployment benefits, but too sick to work, in order to qualify for disability. You must make a choice: disability or unemployment. You can work or you can’t work.

Unfortunately, the decision isn’t very easy to make for most patients with chronic illnesses. For example, is a young woman with Crohn’s disease suffering from a flare too sick to work or is she “ready, willing, and able to work?” She might be too sick to return to work right away, but is she sick enough to be awarded disability benefits? Similarly, is a woman with food sensitivities, in addition to fibromyalgia and chronic fatigue syndrome, too sick to work or “ready, willing, and able to work?” She was laid off from a position that required her to visit people in their homes – a job that she no longer could perform as her sensitivities to foods increased, but she can work, provided she is accommodated. Yet, there are some days when she cannot get out of bed because of her fibromyalgia and CFS. Both of these women are too sick to work, but are they sick enough for disability? If not, what are they to do?

For some patients, temporary disability might be an option. However, there only are five states in the country that provide temporary disability and they are California, Hawaii, New York, Rhode Island, and New Jersey. If you live in one of these states and believe there’s a chance your illness will go into remission again – like the young woman with Crohn’s disease – you might be able to collect benefits for the short while that you’re sick, and then return to work when you’re better. The application process for temporary state disability takes less time than the process for Social Security disability – several weeks instead of several years – but the financial benefit is likely to be smaller than Social Security.

If you do not live in a state with temporary disability, you have to make a choice: Am I better off taking advantage of the short-term benefit of unemployment, or should I struggle financially in the short term in the hope of the long-term benefit of Social Security disability?

Ultimately, your decision is dependent on your situation. If you believe you’ll recover before the Social Security Administration awards you disability – again, the process can take years – unemployment might be the way to go. However, if you are too sick to work, then disability may be the right option.

I sincerely hope you never feel as if you’re too sick to work, but not sick enough for disability. If you do, though, and you don’t know whether you should pursue unemployment or disability benefits, please do not hesitate to call us.

Monday Musings

Sorry I'm so late today, but these are unusual circumstances, what with no power at home due to the storm. This will be a bit of an abbreviated version, but better than nothing, I hope.

Anthem BCBS of Maine is suing the state for refusing to allow rate increases which Anthem says is stopping it from earning a decent profit. Do states have the right to regulate insurance premiums? That's the question a court in Maine will have to decide. It could have significant implications nationwide.

Interesting piece by a doctor who wonders -- do we really want doctors with more compassion? Is this a fad, she asks? I certainly hope not, but it's interesting to read from a doctor's point of view.

Chronic insomnia raises the risk of heart attacks. Great -- another thing to lose sleep over.

A new study shows that doctors order roughly $6.8 billion in unnecessary tests. Wow -- that's a very big number. Blood tests, CT scans, MRIs head the list.

The White House is targeting prescription drug shortages -- about time.

And finally, HHS has finalized standards to track health care so as to help reduce racial and ethnic disparities. The idea is to figure out whose risks are greatest -- so that we can target solutions accordingly.

There's more. I'm sorry. I have to get home before it's dark so I can eat and feed the cat and get myself situated before I can't see. Have a great night -- and let's hope tomorrow's a better day. Jennifer

Finally Friday Edition

A week ago, I was headed to Florida. Now, we've had our first snow and my stress level is back to normal, meaning high. I suspect the news can only make it worse, but here goes:

The big news late yesterday: Medicare part B premiums are going up only $3.50 -- far less than was expected. Great news for seniors.

However, California seniors are up in arms at the closing of adult day care centers that will send many of them to nursing homes. More harm from budget cutting.

Speaker Boehner has rejected the Dems' $3 trillion deficit reduction plan, as expected. I don't know how we get past this logjam when the Dems insist on raising revenue and the GOP refuses to even consider it.

Meanwhile, with the expiration of stimulus funding, states' spending on Medicaid is through the roof. It threatens the continued viability of the program -- and without it, we have hoards of the poor with no health care. California has received federal approval to cut payments to providers as much as 10% -- which will make it even harder for patients to find a doctor who takes Medicaid (called MediCal in California). Of course, some of this might be addressed if we were better at rooting out fraud -- 17 doctors and pharmacists in California are accused of massive fraud.

We have to worry about all this budget cutting not only because people need health care, but because health care is one of the few sectors of the economy that has consistently created jobs.

The Wall St. Journal explains that it won't be so easy to repeal the health reform law. This may be true, but don't relax. If we lose coverage for people with pre-existing conditions, we might as well lose it all. And since that won't take effect until 2014, there's still time to repeal it before then. That would be a disaster for those of us with chronic illnesses.

This one's a little complex, but stay with me. Under health reform, Social Security benefits wouldn't count as income when applying for Medicaid, which is good for people on Social Security disability, for example. But it would allow some people age 62-65 to qualify for Medicaid even though they have income up to about $60,000/year. So Congress and President Obama decided to fix this by eliminating the provision, claiming the law was never intended to benefit middle class people. However, by eliminating this, they will take benefits away from many who can't afford any other coverage -- people on disability, for example, who are not yet eligible for Medicare. The House approved the "fix" yesterday. Now it goes to the Senate. Do we err on the side of covering too many or too few?

Meanwhile, support for the health reform law has hit a new low. People are frustrated that the key provisions don't take effect until 2014, so they've started to believe that the law won't do them any good. This really concerns me. We absolutely must have coverage for people with pre-existing conditions and subsidies that make insurance more affordable. Please don't lose faith.

This was so great. On Wednesday, I posted a link to a NY Times blog -- a puzzle -- a set of symptoms, and you had to decide what test to order and guess at a diagnosis. The patient had full body aches and pains, weakness in her legs, was shorter than the rest of her family, headaches, depression. Want to guess? Celiac disease! Wow -- isn't that something? An intolerance to grains can cause all of those symptoms. This was so much fun! I hope they do it again.

Massive disability pension fraud by 11 Long Island Railroad retirees costing about $1 billion. Now, think of the people with legitimate disability retirement claims and how much harder it's going to be for them to prove their cases. Fraud hurts all of the participants in the system.

A new study shows that aspirin may reduce colon cancer risk. Wow!

And that, my friends, is today's news. Have a great day and a great week-end. Catch you on Monday. Jennifer

Thursday Themes

Snow? Really? I'm definitely not ready. Let's see what's in the news to distract us from that forecast.

The Dems on the supercommittee have made an offer that would cut the deficit to $2.5-3 trillion, with $1 trillion coming from new revenue. This proposal included up to $500 billion in cuts to Medicare. The GOP rejected it due to the revenue hikes. The GOP offered $2.2 trillion in cuts without any new revenue. Some see this as a sign that at least the talks have gotten concrete and serious. Meanwhile, talks on the 2012 budget are not moving, and right now, there's only funding to November 18. Is this Congress capable of doing anything?

A profile of the lawyer who likely will lead argument in the Supreme Court against the health reform law. This is a serious legal mind. Too bad he's on the wrong side. The Supreme Court is expected to decide whether to hear the cases at its conference on November 10, but it's all but guaranteed that they will hear the appeals.

A House GOP report says health reform provides less benefit to married couples than to singles. Then again, Darrell Issa, the Chair of the Committee, has made it his mission to kill health reform and anything else associated with President Obama, so I take this analysis with a grain of salt.

Insurance giant Wellpoint (Anthem)'s profits drop 7.6% even though revenues continue to rise.

Get this. A 10 year old boy with psychiatric problems, including aggression and suicidal ideation, has been abandoned in a hospital -- his parents won't take him, children's services won't take him -- they've all just left him. How awful.

I love this. Teaching doctors to be mindful. A little meditation never hurt, did it?

Why is it hard to keep weight off? A new study shows that, when obese people lose weight, their metabolism slows and they show an increase in hormones that stimulate the appetite. So very hard, isn't it?

An annual chest x-ray fails to decrease the rate of lung cancer.

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

Hump Day Headlines

Start the day with a smile; you'll have a better day.

Now that we're all in a great mood, here's the news.

Congressional leaders are intervening with the debt panel, in fear that they will not meet their deadline. They're still stuck, with the GOP resisting calls to raise revenue and the Dems refusing a deal that doesn't include raising revenue. They are not engendering confidence, for sure.

UnitedHealthcare/Oxford has dropped its fight against having its rate filings made public in New York. I don't know how they could not be public -- they already are in most states. But this paves the way for other insurers, and will increase transparency in the industry.

Congress is deciding whether to ease rules on medical devices. Those in favor of easing the rules are backed by venture capitalists who invest in medical device manufacturers. But some devices -- have you been reading about the all metal hip replacements? -- do cause harm.

Medicare is cracking down on poor performing prescription drug (Part D) plans. They should move faster on getting these plans out of the system.

President Obama is asking community health centers to hire military veterans.

A CDC panel has recommended that boys also be vaccinated for the human papillomavirus, which is a sexually transmitted disease that can cause cancer.

This is a fun sort of "game." What test would you order for this patient? What do you think she has? If you're the first one to get it right, you win a prize!

Adolescents and young adults with cancer have trouble finding contemporaries going through similar experiences. Without others their age to commiserate with, they become isolated.

And that is the news for this morning. Have a great day. Jennifer

Tuesday Tidbits

Good morning! Back in Connecticut, back to the grind -- and back to the news!

Laughter is the best medicine! It may lower blood pressure, boost the immune system, and reduce depression.

Will the supercommittee curtail Congress's own spending? Those who say yes offer varying proposals. And what happens if the supercommittee doesn't reach a deal or, perhaps worse, reaches a bad one? Meanwhile, GOP governors are asking the supercommittee to reform Medicaid, perhaps converting it to block grants that will allow states to fashion their own programs. The GOP governors prefer block grants to President Obama's Medicaid plan, which would change the formula according to which states are paid by the federal government so all states receive the same rate. (For example, in CT, it's 50/50. In some states, it's 60/40, and so on).

Health reform supporters are taking back "Obamacare." Instead of using it as a perjorative, groups are sending the message Thanks Obamacare! Interesting strategy.

Health costs continue to rise, but wellness programs are starting to pay off in cutting costs. Both employers and insurers are offering incentives to promote healthy habits. Will prevention really reduce health care spending? What about those of us who are already sick?

Fascinating. Want an estimate of what your health care treatments are going to cost? Good luck -- the GAO couldn't get an up front estimate. If consumers are going to be intelligent shoppers, this must change.

Opposition to the merger of ExpressScripts and Medco heats up as many -- including me -- worry that it will drive up prescription drug costs.

What do you do about health insurance if you're only employed part-time? What if you're employed part-time and have a pre-existing condition? No easy answers.

A federal judge has blocked a Florida law that would have forced welfare recipients to pass a drug test.

Doctors do screw up. How can you protect yourself? Be vigilant. Be involved.

Now that the CLASS Act is dead, what will Americans do for long-term care? Continue taking care of their loved ones at home? We need a better solution. It appears that the federal government is not going to come up with one.

Have a lot of medical bills? Try negotiating. Many providers will take less than full payment if you talk to them.

The human papillomavirus is now linked to heart disease in women, too, in addition to cervical and other cancers. Get that vaccine if you haven't.

Should we test the anthrax vaccine in children? Hmmm.

This seems weird to me. A new study stressing the limits of breast cancer screening mammography. Indeed, possible over-diagnosis. I'm sorry -- but if it's me, I want the mammogram, no matter how much it hurts.

Medical school enrollment is on the rise -- great news in light of projected doctor shortages.

This is so clever -- GPS shoes for people with Alzheimer's. Whoever thought of this is genius!

States are targeting prescriptions by "pill mills." Abuse of pain meds by doctors and criminals makes pain meds less available for people who really need them -- a bad situation by any measure.

Taking vitamins and supplements if you don't have a deficiency not only may be a waste -- it may cause harm.

Looking for a warm drink as the chill begins to get under our skin here in the Northeast? Here are some health tips about what will be best for you.

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

Welcome Home

I just got back from Florida and had a few tidbits in my Inbox that I thought you might be interested in:

The Connecticut Coalition for Aging is taking a survey on the legislative issues seniors feel are most important. To take their survey, go here .

Have old meds you want to dispose of properly? October 29 is National Drug Take-Back Day. For more info, go here.

I hope I will have time to prepare a full blog post tomorrow morning. Stay tuned ..... J

Thursday Themes

My last blog post for the week -- I'm off to Miami to speak at the Crohn's & Colitis Foundation Florida chapter's educational seminar. So you're on your own for a couple of days -- after today's news, of course.

The supercommittee's lack of progress is starting to worry some on Capitol Hill. Not only do they have to come up with $1.2 trillion in deficit reduction, but they haven't even reached agreement on the baseline -- $1.2 trillion less than what? The definition of dysfunctional. And so they are starting to show signs of life, with public meetings scheduled for next week. But it's been a month since their last public meeting -- some say for good reason. They've received 180,000 suggestions from other members of Congress, lobbyists, advocates, and the public, so there's certainly no lack of ideas or public input.

Meanwhile, employers, municipalities, trade groups are trying to come up with their own health reform ideas to try to control costs.

Mitt Romney continues to be criticized due to Massachusetts health reform, which has resulted in near universal coverage. People critique it because it has not controlled costs. But the goal of the individual mandate -- which originally was a Republican idea, coming from the Heritage Foundation, according to Newt Gingrich -- was to fix the coverage problem first and then shift to cost. With those goals in mind, the plan has been a huge success. Why isn't Romney proud?

Innovation is key to controlling health care costs, so it's great to see states like Oregon coming up with their own tweaks to federal health reform care delivery mechanisms. Not only will Oregon lead in setting up accountable care organizations (which they call coordinated care organizations), but they want to grade their performance -- leading to the question of how a health care plan should be evaluated.

It should come as no surprise to learn that poor neighborhoods contribute to poor health. Better neighborhoods lower obesity and diabetes.

Some states are starting to count assets as well as income in determining eligibility for food stamps. Hunger in America is nothing short of scandalous. What justification can there be for making it worse?

Radiation treatment after breast cancer surgery greatly lowers the risk of recurrence, according to a new study. But some women with advanced breast cancer feel left out of the national dialogue on this disease, which tends to focus on cures.

More than one in ten Americans takes an anti-depressant. Are they over-prescribed, or are we really that depressed?

The government continues to increase recoveries from Medicaid fraud.

A cure for cystic fibrosis? Scientists believe they are getting close. So great.

Turmeric for joint pain? Worth a try.

And that's it for this morning. Have a great day -- a great few days. I'll be back on Tuesday. See you then. Jennifer

Hump Day Headlines

Reports are that the supercommittee isn't making much progress. They are half-way through the short time they were given to come up with a solution, and it seems that they are still pretty stuck, with the GOP refusing to budge on taxes and the Dems refusing to discuss entitlement reform unless taxes are on the table, as well. There's no lack of ideas, as members of Congress who are not on the supercommittee provide advice.

The federal government wants to relax regulations of hospitals that would save providers $1.1 billion per year. While this sounds okay, I always worry -- wasn't there a reason we passed those regulations in the first place? If so, won't somebody suffer if we eliminate them?

Hospital stays for heart failure have decreased by 30% in ten years, saving billions of dollars, and giving us cause for some optimism about our ability to reduce health care costs.

Here's some more on the awful story of a woman who held four mentally disabled people chained to a boiler in her locked basement. Breaks my heart.

There's an experimental malaria vaccine that appears to cut the incidence of the disease in half. What a great thing this would be.

And that's all I have this morning -- a light news day. Let's hope it's a good one! Jennifer

Tuesday Tidbits

Only Tuesday? Darn. Oh, well. Here's the news:

Massachusetts was the first state to go to universal health care to address coverage, and now they're focusing on cost. They are looking at becoming the first state to pay providers differently. They are considering a global payment system so they pay networks of providers to keep you well rather than paying for each service you get. I can't help being a little nervous -- providers may try to avoid "expensive" patients like those with chronic illnesses. Or they may try to avoid spending money by ordering that test or that treatment. But they would pay on a sliding scale, so the network of providers would get more money for taking on someone like me than they would for a healthy person. We have to do something about cost, and I think it's great that someone's out there experimenting, thinking outside the box. We need more innovation if we are going to get a handle on cost.

Indeed, we need patients to play a more active role in their own health care, to be informed decisionmakers and partners with their doctors.

There are other innovations happening. Blue Shield of California is giving teams of providers grants to try to deliver health care more efficiently.

The Tea Party is proposing its own deficit reduction plan this week, and repeal of health reform will be front and center. However, they've found that there's a lot less enthusiasm about making major changes to Social Security and Medicare. Funny, though -- they would tighten eligibility for Social Security disability. What ever happened to caring for our fellow Americans and all that?

Well, it's not in health reform, at least according to the GOP, which is already plotting full repeal of health reform if they take the White House and Congress next year. Your kid staying on your policy to age 26? Gone. The elimination of pre-existing condition exclusions for kids? Gone. The elimination of pre-existing condition exclusions for everyone in 2014? Gone before it happened. Health reform has already done some real good. You ready to give it up?

Here's what happens to people who can't access health care. Can you really read this and turn your back?

Medicare releases hospital patient safety ratings.

A doctor charts the path of HIV/AIDS back to 1900. Fascinating.

And is colon cancer linked to a particular bacteria not normally found in the colon?

With the CLASS Act all but dead, we revisit the issue of long-term care insurance and the fact that most of us have no way of paying for long-term care at the end of our lives. I think one of the reasons we don't think about long-term care is that we -- doctors and patients -- aren't very good at handling death. We simply aren't very good at dealing with the process of dying.

But the bruhaha around the CLASS Act is sort of confusing. The Administration says the long-term care plan is unworkable -- but they don't want to repeal it. The GOP of course would repeal any part of health reform they could. I think the issue is that the CLASS Act was projected to save $86 billion, so without it, the federal deficit increases by $86 billion. If the Administration didn't want to repeal it, though, why did they announce its demise?

How to pick a good therapist and good therapy for you.

Have you gotten your flu shot yet? I'm not kidding.

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

Outrage

Along the lines of the argument in the CT Supreme Court today about a disabled woman who was raped but who, according to the Appellate Court, should have found a way -- scratching, biting -- to communicate her "no," here's a story of 4 mentally disabled adults who were locked in a basement, chained to a boiler, using buckets for their own waste, in a space too small to stand up in.

If you are not outraged, something is wrong with you. Jennifer

Monday Musings

Monday already and a short week for me. I am speaking at the Crohn's & Colitis Foundation Miami educational seminar on Saturday, so I'm traveling on Friday -- and then staying an extra day to soak up a little vitamin D. But first, the news.

Medicare's annual open enrollment period started early this year -- so don't forget.

Some states are looking for more flexibility to push the health reform law even further. Oregon and Vermont will be ahead of federal timelines and want to do more -- Vermont is going for single-payer universal care. They will need federal waivers to do it, but I'll bet they get those waivers, just as some states have gotten waivers that allow them to do less than the law requires.

The supercommittee is weighing cuts to public health programs. Medical research. Disease prevention. It's so wrong. Even if you set aside health concerns, these are jobs! And a lot of these are among the automatic cuts that will occur if the supercommittee can't reach agreement. But so far, the supercommittee co-chairs appear to be getting along. I suspect that's easier when the work is being done in secret. Meanwhile, House GOP are readying for another budget showdown with conservatives in their own party.

As you know, the Obama Administration has pulled the plug on the long-term care portion of the health reform bill known as the CLASS Act. This week, HHS expects fall-out. The GOP wants a hearing on why it took so long for the Administration to end this plan. Others in the GOP say this is an indication of problems with the law as a whole. I can't really find a good explanation of why, but apparently, the CLASS Act was expected to represent nearly $100 billion in savings from the health care -- although it was killed largely because it was unaffordable.

Now that the Senate Dems didn't have the votes for President Obama's jobs bill as a whole, he's now starting to push pieces of it, starting with $35 billion for teachers and first responders.

How many of us spend time researching our symptoms on the internet? Doing so can cut the wrong way, creating fear where it's not necessary.

Today the Connecticut Supreme Court hears argument about whether a woman with disabilities met the definition of "physically helpless" when she was sexually assaulted. The Appellate Court said no -- she could have kicked or scratched or bitten. But we don't require healthy women to bite in order to claim sexual assault. The woman was unable to speak, and had to sign out on a communication board that she'd been attacked. But the standard for finding that she was assaulted may end up being higher than for a healthy woman. And that's just wrong.

Scans on your phone? There's an app for that, too. Very cool.

Nationally, Black babies are twice as likely to die as white babies. What a horrifying statistic.

Johnson & Johnson won a suit on Friday when court found that it adequately warned doctors about the risk of harm to tendons associated with the antibiotic Levaquin.

New guidelines from the American Academy of Pediatrics allows diagnosis of ADHD in children as young as 4 years old.

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

One More...

The White House today announced that it will not move forward on the long-term care insurance piece of health reform. They determined that they could not make it affordable and financially viable. This is sad for quite a few reasons -- but in particular, it makes me sad that this was near and dear to Ted Kennedy's heart and we couldn't make it happen for him. Of course, the GOP are thrilled.

And if you want to know about the Pre-existing Condition Insurance Plan -- affordable, comprehensive coverage for people with pre-existing conditions who've been without insurance for at least 6 months, go here, NOT here. The second website was made to look governmental and all that, but it's definitely not. It's run by GEHA -- called Government Employees Health Association, Inc. -- which is NOT a federal government agency by any means. Easy rule to live by: If it's not on Healthcare.gov, it's not part of federal health reform.

And that's it for me for this week. Have a great week-end. See you Monday. Jennifer

Finally Friday Edition

Medicare open enrollment starts tomorrow. Do not skip this opportunity to review your selections and see if you need to make changes.

The federal Court of Appeals in California ruled that insurers have to cover residential treatment for eating disorders the same as treatment for other medical issues under the state mental health parity law. There's been progress made in the courts of New Jersey, as well. I'm waiting for a decision in an eating disorder case -- they're heartbreaking and near impossible to win without going to court.

The House passed another bill prohibiting the use of federal health reform dollars to pay for any insurance policy that offers abortion. Not just no federal money to pay for the abortion itself, or even for the portion of the policy that covers abortion, which is already the law; but if the policy covers abortion even with private dollars, there will be no federal subsidy for the plan. Which means it will be near impossible to find an insurance plan that covers abortion, even with private funds.

The health reform law has nearly tripled the number of doctors practicing in rural areas, the National Health Service Corp.

Just as President Obama's jobs plan has been blocked by the GOP, Dems aren't likely to support GOP jobs proposals (which are all tax cuts for corporations anyway), leaving the unemployed with no answers and no support. Oh -- and the GOP plan also includes a repeal of health reform even though it has made the health care sector the strongest job grower in the economy.

And the next health reform lie? That the government will have access to your medical records. Not true. The government will collect claims data -- no names (not even doctors' names), no medical records, just what your health care cost -- to help find ways to be more efficient and economical. The government already has Medicare claims data, veterans' claims data -- but not medical records. This is just absurd, as the people telling this lie must know.

Medicaid cuts would hurt racial and ethnic minorities harder than whites.

Words matter. So do you want to be called a patient or a consumer? Should we call doctors physicians or providers? It's convenient to be able to talk about health care providers to include nurses, physicians assistants, and so on, but apparently some doctors don't like it. I always talk about our clients as patients -- unless I'm working with a coalition of advocacy orgs which tend to refer to them as consumers.

Vitamin B12 deficiency can hurt memory in older age.

Contact lens recall -- CooperVision brand. Does this mean you?

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

Thursday Themes

New study -- 1/4 of millionaires pay lower tax rates (not less taxes, but at a lower rate) than some in the middle class. So they are paying a smaller share of their income on taxes. What does this have to do with health care? It's all about the supercommittee and what will be cut -- Medicare, Medicaid -- as opposed to taxes that may be increased. We have little information about what the supercommittee is doing -- but we know enough to be worried. Here's a little more conjecture.

What would Mitt Romney do to health reform? Waivers to states who want out from under some of the requirements, but not a full repeal. My only question is this: can we require insurers to cover pre-existing conditions if we do not have a mandate? That's all. Because it's coverage of pre-existing conditions that is the do or die for me, with subsidies coming in a close second.

Medicare free wellness visits are going unused.

Health insurers want to put poor disabled and elderly into managed care plans. These are the so-called dual eligibles -- people eligible for both Medicaid and Medicare. This is the most expensive portion of the Medicaid/Medicare population. Their care and financing is poorly coordinated. But the claims that managed care would save money are undermined by the experience of states like Connecticut, which tried managed care and found that it cost way more than administering the program on their own.

Interesting piece on a doctor who got stuck with a needle, got Hep-C, and spent the rest of his life working towards a cure.

California Gov Jerry Brown vetoed a bill that would require doctors to tell their patients if they have dense breast tissue, making mammogram less effective.

Andrew Cuomo, Gov of New York, will reform agencies dealing with the disabled. Too many stories of neglect and abuse, "startling" the Governor and driving him to make changes.

Ginger may lower the risk of colon cancer.

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

Hump Day Headlines

The Senate was unable to garner the 60 votes needed to start debate on the President's jobs bill. Looks like they are going to cut it up in pieces and try to pass whatever parts of it they can. I heard a GOP-er on MSNBC last night who said he agreed with all the corporate tax breaks contained in the bill -- just nothing that will help the jobless.

There's a good reason the supercommittee is operating in secret. They can't even get to square one: how to count. What's the benchmark? In other words, if they have to cut $1.2 million, are they cutting from current law? If so, that will include projected revenue increases from allowing the Bush tax cuts to expire. But if the tax cuts are extended to the middle class, that would increase the deficit. And so they are mired in mud.

Health insurers in NY are required to post justification of rate increases online. They'll have to do this nationally starting 2012. But they claim the documents would release trade secrets and so they are asking to keep them secret. In which case the public will never know the amount of profit they are raking in.

Medicare Advantage Plans chase the elusive five star rating that gets them a bonus.

Massachusetts' Medicaid waiver -- part of its state health reform -- has to be extended, but the catch is paying providers enough to keep them serving those on Medicaid.

Do you take your medicine as prescribed? Doctors are finding technological ways to determine whether you're on schedule with your meds and to get you back in the game.

You're better off following dietary guidelines than taking vitamin supplements. Indeed, vitamins may increase the risk of death. And Vitamin E has been linked to prostate cancer.

Five cancers likely to push you over the financial edge -- lung, thyroid, leukemia/lymphoma, uterine and colorectal.

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

Tuesday Tidbits

Should the supercommittee be meeting in secret? People want transparency, but the committee says they want to be free of politicking. If they met in public, not only would lots of other politicians comment on every iota of a decision they make, but they themselves would have to start justifying their decisions. On the other hand, they probably need to think about how they're going to get other members to vote with them -- and the public can't really have a say if they don't know what to comment on. How does this weigh for you?

What if the individual mandate is struck down by the Supreme Court? What then for health reform?

What health reform pilot projects will work -- and what to do in the meantime?

16 states fall short of health reform requirements for health insurance appeals. They are Alabama, Alaska, Florida, Georgia, Louisiana, Massachusetts, Mississippi, Missouri, Montana, Nebraska, North Dakota, Ohio, Pennsylvania, Texas, West Virginia and Wisconsin. They have until 2012 to contract with 3 outside organizations to handle their external appeals -- or contract with the feds to oversee their program. Most of these states do have external appeals, but they don't meet the law's requirements. This is one of the really big consumer protections in the health reform bill, so it's good to see some enforcement when states fall short.

States are adding drug testing as a hurdle for benefits. I actually get this; we don't want to provide cash benefits to people who will use them to buy drugs. But what about the kids?

An app for people applying for disability benefits.

LA County adds free health care for the uninsured to help thousands.

An outside panel agrees with the government panel that says prostate screening does more harm than good.

What's the difference between a baby's brain that is learning two languages and one learning only one? Fascinating.

Do programs that pay people to lose weight work? I would love to give that a try. I don't know if it would work, but it sure is a powerful incentive.

How would you feel if you got cancer? Really bad cancer? I would stop working, start writing full-time, and spend every minute I have with Emily. Here's what another person is doing.

California requires coverage of controversial treatment of autism. They are also banning tanning beds for minors.

A new thought-controlled program for people with paralysis allows them to control robots with just thought.

Breast cancer (any cancer, any serious disease) is awful when you're dealing with it and going through treatment. But what about when the treatment ends? In another story, we read how cancer patients can benefit from rehabilitation. And in still another story, we read about the cost of cancer treatments.

That's it. Have a great day. Jennifer

Okay, Well, A Few Tidbits

The supercommittee is struggling, reaching deadlock and deadlines. Lobbyists who used to work for members of Congress on the supercommittee are having a field day.

The fate of the health reform law rests on 2012 races. If you have a pre-existing condition, you'd better hope that the President is re-elected and the Dems hold at least one house of Congress.

Healthcare workforce out-grows other sectors of the economy. And who said health reform was bad for job creation?

Although Florida opposes the health reform law, it is preparing its own exchange, which will allow small businesses (50 or fewer employees) to choose health insurance in an effort to encourage small employers to offer insurance to their employees.

The Postmaster General wants out of the federal employee health insurance plan. The post office already is a mess when it comes to benefits -- have you ever talked to a postal employee who got hurt on the job? It's not pretty. Take away their insurance? I'd rather give up Saturday mail.

The feds are cracking down on marijuana growers in California, where it's legal.

Want to learn about Adele's throat problem? Sounds nasty.

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

Monday Musings

No blog today. I'm trying to work only part of the day. The blog should be back tomorrow. Jennifer

New Tools on Healthcare.gov

New Online Tool Gives You More Information about Premium Increases

By Kathleen Sebelius, Secretary of Health and Human Services

Posted October 07, 2011

For too long, when it came to health insurance, consumers were left in the dark. In the past, insurance companies could often raise your rates without any transparency or accountability. Many insurers were under no obligation to give you any explanation as to why they felt an increase was necessary. Thanks to the Affordable Care Act, this is changing.

Starting today, you will begin to have more information about your health insurance premiums. This year, in every State and for the first time ever, the Affordable Care Act requires insurance companies to publicly justify their actions if they want to raise rates by 10% or more.

Today, we posted the first set of explanations from insurance companies. Right here on HealthCare.gov.

We’ll update the site with more information from other insurers as it comes in so you can see why insurance companies think they should raise your rates. On our website, you will also have the opportunity to submit comments and share your views on the proposed rate increase. Please send your comments to ratereview@hhs.gov.

At the same time, independent experts will determine whether or not the increase is reasonable.

This process is known as “rate review.” It makes the health insurance marketplace more transparent and holds insurance companies accountable. It promotes competition that can drive down costs. And we know rate review works:

• Oregon forced an insurer, Regence, to lower its request for a rate hike by nearly 10% for 60,000 enrollees after public hearings and scrutiny.
• Connecticut’s Insurance Department rejected a 20% rate hike by Anthem.
• North Carolina saved beneficiaries $14.5 million by reducing a rate increase request from the State’s Blue Cross Blue Shield plan.
• And, Aetna scrapped a proposed 19% rate increase in California after a close review found math errors that undermined the need for the hike.

Insurers are also now required to spend most (80% or 85%) of the dollars you put toward insurance on your care – instead of on advertising or big CEO salaries – so you can get more value for your money. This is known as “medical loss ratio.” If they don't spend at least 80 cents of every premium dollar you pay on your health care, they must refund the difference to you. Consumers will start receiving these rebates next year.

We, in partnership with States, are taking a good, hard look at why insurance companies are seeking to raise your rates, why your premiums might be going up, and making sure these decisions are public and justified.

This is just a start, and over time we will be posting these requests as they come in. Be sure to check back, though, as we’ll be updating the website regularly.

And if you see your insurance company’s rate and don’t like its reason for raising it, you may be able to take your business elsewhere. Check out your options on HealthCare.gov.

From the White House Disability Office

Good morning, Please join us for state-specific calls on Wednesday, October 12th, Thursday, October 13th and Friday, October 14th to talk about the American Jobs act and the FY2012 Budget. Below is dial-in information for each state call. If you require captioning for any of the calls, please email sfeuerstein@who.eop.gov and put the following in the subject line of your email-- "captioning required for state call" In the body of your email, identify the state call for which you need captioning services. These services only will be available for those who are deaf or hard of hearing. We will not maintain or provide transcripts of the calls. Please email us by Monday, October 10th no later than 5:00 p.m. Eastern in order for us to be able to arrange captioning services. You can also visit http://www.whitehouse.gov/issues/disabilities where you can keep up with what the Administration is doing for Americans with disabilities. Please circulate to those in the specific states that you know may be interested in these calls. If you did not receive this email and would like to be added to the White House disability distribution list to receive email updates and information, please email disability@who.eop.gov with your name, city, state, and organization. Call Times ALL TIMES ARE EASTERN Wednesday, October 12th: New York American Jobs Act Call 12 p.m. EDT Dial-in #: (800) 230-1093 Florida American Jobs Act Call FL 2 p.m. EDT Dial-in#: (800) 288-8976 Thursday, October 13th: Missouri American Jobs Act Call 10 a.m. EDT Dial-in#: (800) 288-8960 Minnesota American Jobs Act Call 10 a.m. EDT Dial-in#: (800) 230-1096 Illinois American Jobs Act Call 11 a.m. EDT Dial-in#: (800) 288-8968 Massachusetts American Jobs Act Call 1 p.m. EDT Dial-in#: (877) 258-1466 Maine American Jobs Act Call 2 p.m. EDT Dial-in#: (800) 288-8968 Colorado American Jobs Act Call 3 p.m. EDT Dial-in#: (800) 230-1085 Arizona American Jobs Act Call 4 p.m. EDT Dial-in#: (800) 288-8960 Michigan American Jobs Act Call 4 p.m. EDT Dial-in#: (800) 230-1092 Wisconsin American Jobs Act Call 5 p.m. EDT Dial-in#: (800) 230-1093 Oregon American Jobs Act Call 6 p.m. EDT Dial-in#: (800) 230-1059 Friday, October 14th: Virginia American Jobs Act Call 11 a.m. EDT Dial-in#: (800) 230-1092 Texas American Jobs Act Call 12 p.m. EDT Dial-in#: (800) 288-8960 Ohio American Jobs Act Call 2 p.m. EDT Dial-in#: (800) 230-1059 Pennsylvania American Jobs Act Call 3 p.m. EDT Dial-in#: (800) 230-1074 New Jersey American Jobs Act Call 4 p.m. EDT Dial-in#: (800) 230-1085 California American Jobs Act Call 5 p.m. EDT Dial-in#: (800) 230-1074 Montana American Jobs Act 6 p.m. EDT Dial-in#: (800) 230-1059 Stay Connected Please do not reply to this email. Contact the White House. The White House • 1600 Pennsylvania Ave NW • Washington, DC 20500 • 202-456-1111