Advocacy for Patients with Chronic Illness

Hump Day Headlines

2012-02-01T02:47:00.002-08:00

Okay, then. Time for today's news:

The cost of caring for chronic illness: $1.5 trillion per year. That's three-fourth's of the nation's health care spending. So what are we going to do about it? That's the $1.5 trillion question.

Breast cancer surgery guidelines are unclear. If margins aren't completely clear of cancer cells after lumpectomy, is a second surgery necessary or not? Meanwhile, Susan G. Komen for the Cure has decided to defund Planned Parenthood, which provides breast cancer screening and education. They say it's because Planned Parenthood is under investigation (by one very anti-choice legislator), but the Senior VP they hired last Spring has been a vocal opponent of choice for years. Disgusting, if you ask me. Women's health organizations need to be standing together.

Enrollment in Medicare Advantage Plans is up, and premiums are down by about 7%. See -- the "cuts" to these plans that were part of health reform hasn't hurt seniors a bit.

When making treatment decisions, how much should quality of life matter? I think it means everything.

The CLASS Act -- long-term care, part of health reform -- has been abandoned for the time being as being unaffordable, but still, the White House wants it on the books. The House GOP will vote today to repeal it, but Dems will stick by it in the hope that, with it on the books, we can figure out how to make it affordable in the future.

A court has blocked cuts to the Medi-Cal program that were approved by the Obama Administration. A great win for the people of California.

Minnesota legislators continue their fight over the health insurance exchange, with the legislature split over whether to implement this key piece of health reform.

The FDA has approved a ground-breaking drug to treat the underlying cause of cystic fibrosis. Awesome. But it costs about $300,000 per year. The pharmaceutical manufacturer has a patient assistance program to help pay for it.

The Brazilian Blowout (hair straightening) uses formaldehyde. Are we that vain?

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

Tuesday Tidbits

2012-01-31T03:17:00.001-08:00

Big meeting with the Insurance Commissioner today, but first, the news:

People with pre-existing conditions are stuck in high risk pools until 2014 -- assuming the health reform law still stands by then. Although the Pre-existing Condition Insurance Plan that was part of health reform provides comprehensive benefits at a reasonable cost, you can only enroll if you've gone without insurance for six month -- so if you were in a state high risk pool, you can't switch to the better, cheaper PCIP unless, of course, you're willing to go without insurance for 6 months, which is a fast track for bankruptcy for people with pre-existing conditions.

Obama Administration lawyers filed their second brief in the Supreme Court's health reform case -- this one on the issue of whether the rest of the law can survive if the individual mandate is struck down.

Aetna has followed WellPoint and will be providing extra payments to doctors to manage and coordinate care in New Jersey and Connecticut. These are the kinds of innovations we need to try to see if we can drive down cost.

New websites allow you to search for side effects of medications. One company is called AdverseEvents. The other is Clarimed. They do charge to sign up for them, but the charge may be worth it.

What's a nurse to do when the patient is violent? Did you know that physical assault is the third most common fear nurses have?

Acupuncture helps control pain. The idea isn't to abandon traditional therapy; it's to supplement it with acupuncture. Interesting. I do know some patients who swear by it.

Utah is considering a surcharge on Medicaid recipients who smoke cigarettes.

Strokes are becoming more common in young people.

An interesting new book says we under-treat the poor and over-treat the wealthy. So what's the solution?

Unexplained high fevers can be a sign of something serious, so don't ignore them.

Fascinating new research on how we humans came to be as we are, and to populate the earth.

An interview with a researcher who has spent his life trying to understand the immune system.

Doctors are migrating to providing services that are lucrative, like cosmetic surgery, which is never covered by insurance. I don't know -- if I were having plastic surgery, I think I'd want an expert plastic surgeon.

A medical mystery that took years to solve, and in the end, no real answers.

Art as a way to deal with emotional trauma due to domestic violence.

Here in Connecticut, the public option - SustiNet -- is still here and its proponents are still pushing.

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

Monday Musings

2012-01-30T04:09:00.000-08:00

Mondays just come around too fast for me, and I have a busy week this week. So I better get going. Here's the news:

Congress needs to get serious about extending the payroll tax cut, unemployment, and the deferral of the Medicare physician reimbursement cuts. The GOP claims there will be quick action. Of course, there's still no agreement about how to pay for any of this.

Texas will not get a waiver from the medical loss ratio rules that are intended to help bring down premiums. Medical loss ratio is the percentage of premium dollars spent on health care. Health reform says that must be 80 or 85 percent. States were allowed to request waivers if the new rule would destabilize the state's market for health insurance. Texas made a request and the feds said no. Which is good because Texas is one of the states where we hear about the most suffering.

Your blood pressure should be taken in both arms, and if there's a significant difference between the two, that may be a symptom of vascular disease. A very inexpensive way to guard against a killer -- good advice.

Doctors, hospitals still make too many simple mistakes -- as simple as failing to wash their hands. The associated costs are part of the reason for high health care spending.

The Obama Administration's ruling that contraceptives have to be made available by all health plans is getting some push back at Catholic colleges. The church itself is pretty upset, as well. No surprise here.

More about Wellpoint's plan to compensate primary care doctors more to pay for care management. This is a really important experiment at innovation. Will care coordination pay off in the long run? I bet the answer's yes.

You want to know why your Crohn's disease (or any disease related to inflammation) gets worse when you're stressed? Here's a study that shows that stress activates the immune system, causing inflammation. The suggested response? Avoid relationships that are difficult and contentious. Yeah, right.

The wonderful Dr. Pauline Chen writes about how advertising affects the medications we take.

A new diabetes drug injected once a week wins FDA approval.

Here's why states are cracking down on pain meds -- dealers are getting so creative that they are opening their own pharmacies. And so the people who really need meds can't find a legit doctor to prescribe them. What a mess.

A group of workers at the FDA are suing the agency for monitoring their personal email. They were looking for communications with Congress. As a general rule, no employee has a right to privacy when using a work computer. Keep that in mind.

A blog may be therapeutic for teenagers. I know it is for me.

Caffeine may alter estrogen levels, although its effect is different depending on race and the researchers don't fully understand why.

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

Finally Friday Edition

2012-01-27T02:24:00.000-08:00

No matter how fast I work, there's always too much to be done. But first, the news:

Getting caught in the broken health care system, finding care to be elusive. This woman is scheduled for cataract surgery, but her insurance company and the hospital haven't reached a contract, so the insurance company won't pay for the surgery. This story is mild. I've been working with a man who's scheduled for a liver transplant and, for awhile, the insurer was saying he couldn't have it where all of his doctors are because they hadn't reached a deal on reimbursement rates. We finally got it resolved, but these are the kinds of pot-holes that mar the health care system in America.

Wellpoint (Anthem Blue Cross) is trying a new system of paying doctors that will increase reimbursement rates to primary care providers dramatically in the hope that this will improve patients' overall health. We need to watch this innovation and see if it helps to curb costs.

The House GOP is waiting to see what the Supreme Court does before making any more efforts to repeal health reform. We're all waiting for this. Meanwhile, a majority of Americans expect the Justices to vote based on ideology rather than law. Very sad.

Providers are supposed to switch to ICD-10 codes this year, but doctors are lobbying Congress to put it off. The change would be very expensive, as they go from 13,000 codes to 68,000 codes.

The General Accountability Office says Medicare Advantage Plans are still raking it in. More cuts?

An investigation in California found that nursing homes were making serious errors in dispensing prescription drugs. This is really scary.

About 7% of Americans have the human papilloma virus in their mouths, indicating it is spread by oral sex.

Bill Gates donated $750 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Here's how pharmaceutical companies use symptom checklists to get you to try their drugs.

Do you think it's legit for NY City to use this doctored photo in an anti-diabetes ad?

Remember Erin Brokovich? She's now investigating a mystery ailment affecting teens near a possible contamination site. Great!

And interesting study shows that a virus that affects e coli bacteria found a new way into thriving after its usual pathway was closed off. The point is that it was resilient and wouldn't stay dead.

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

Connecticut Excludes the Disabled -- Again

2012-01-26T04:08:00.000-08:00

Connecticut is well into the planning stages of health reform implementation. That means setting up a bunch of advisory committees, including committees that will give consumers a voice in health reform. Since we have worked so hard on health reform on both the federal and state levels, we hoped to be on the Health Reform Consumer Advisory Board. Indeed, according to the official vote tally, we were among four people voted first by the Health Care Cabinet. However, we were not selected.

Instead, Jeannette DeJesus, the Governor's Special Advisor on Health Reform, chose people further down on the list. She claimed to have done so in the name of diversity. However, since I am a person with a disability under the ADA, and there are no other people with disabilities on the Committee, you'd think that including me would have promoted diversity, no?

Apparently not in Connecticut. Jennifer

Thursday Themes

2012-01-26T03:18:00.000-08:00

And another day of news:

The House GOP says that it will offer an alternative to health reform after the Supreme Court rules on the constitutionality of the existing law. Instead of requiring coverage of pre-existing conditions, they will offer those of us with pre-existing conditions high risk pools -- extraordinarily expensive, poor coverage, limited choices, and not "insurance" so not regulated. Thanks, but no thanks.

The new Center for Medicare and Medicaid Innovation is expected to release its report today documenting the experiments in care delivery and financing that it is funding now to help find ways to cut the costs of health care.

The Obama Administration released long-awaited regulations for school lunches, which are intended to help fight childhood obesity. If only someone had done this when I was a kid.

A horrible story about a woman whom North Carolina decided should not have children, so she was forcibly sterilized. In the United States this happens? Are you kidding me?

And you think you waited a long time for disability benefits? Here's a story of a man who waited from 1950 to today!

Learn about what it's like to live with hemophilia. The challenges are remarkable.

Pharma has been focusing more on treatments for rare diseases -- finally!

Here's some good advice -- make appointments for health screenings for the year now so they're on your calendar, not to be forgotten.

The CDC has failed to determine the cause of Morgellon's, a rare skin disease.

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

Hump Day Headlines

2012-01-25T03:37:00.001-08:00

It's a good thing that I recorded the State of the Union because I got in bed and fell asleep immediately after a very satisfying dinner with my Dad and his significant other. So I can't tell you yet what the President said, although I can tell you that he didn't say much about health care. But I can do as I do every day and give you the health news:

Here are the health-related excerpts from the speech. "I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny your coverage, or charge women differently than men. ..." Sounds good to me.

Under health reform, each insurer is required to produce a summary of benefits and coverage in a uniform format so people can understand and compare plans. Yesterday, several consumer advocacy organization asked the President to stand firm on that new rule, despite industry criticism.

Remember when everybody said fixing the payroll tax cut, unemployment and the Medicare reimbursement rate cuts was going to be easy? Well, now the headline reads "the two sides are far apart." Why aren't I even slightly surprised?

HHS Secretary Kathleen Sebelius says health reform will continue even if the Supreme Court strikes down the individual mandate.

The American Psychiatric Association is considering adding "grief" as a mental health disorder. It's a type of depression. I can buy that.

Ever hear of brown fat? Well, apparently, brown fat burns calories like crazy, and cold weather can stimulate that. I think I'll move my office outside for the winter.

A lovely story -- the best man donates a kidney to the bride. Now, that's a wedding gift!

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

Tuesday Tidbits

2012-01-24T03:44:00.000-08:00

A whole day without a computer malfunction. Of course, my computer will never be the same. Can't even get the colors right. But it works. And here's the news:

The number of people without insurance rose again in 2011. While young adults were more likely to be insured, baby boomers are feeling the pinch, as are those earning under $36,000. What we can see from our work is that people are unemployed, can't afford COBRA, have no options with pre-existing conditions, and can't get Medicaid in most states without a child living in the household. It's a hard world out there.

Some states are not moving forward with exchanges, taking a wait and see approach to the Supreme Court and the Presidential election. If they bet wrong and can't get up and running in time, the feds will take over their exchange and they won't be happy with that, either.

The Supreme Court rejected a request for debate over whether Justice Kagan should hear the health reform law in the face of claims of conflict of interest from her work as Obama's Solicitor General.

John Stewart interviews HHS Secretary Kathleen Sebelius on health reform. I'll try to find video later. (Update: video is here).

The Patient Centered Outcomes Research Institute came out with its draft priorities on Monday and didn't chose particular diseases -- instead, they focused on broad topics such as comparing medical options.

As we come to realize that we may not need all of those tests for things like bone density, how do we know what's legit and what's not?

Women rate their pain higher than men. Why? Are they really in more pain? Is it all subjective? The guess is that there's a biological difference -- more things we need to try to understand.

When is stress good for you? It's good to get the surge of adrenaline, the juices flowing, the motor running -- but when it is too much, and how do we turn it down?

Pre-diabetes, when you can see it coming and maybe even stop it.

Should we be funding alternative medicine to see if it works, or is it a waste of dollars?

Hospitals are offering free parking, discount shopping, all to woo patients.

Long-term care insurance -- is it for you? It's definitely not for everyone. Is it right for you?

Food allergies are not as rampant as we thought, and they change over time. But allergy to the cold? That's actually real!

A new, broader definition of rape to include male victims.

A stem cell study shows promise in treating macular degeneration.

Older people benefit from virtual brain exercise as well as physical exercise.

Childhood obesity NOT due to those vending machines?!!!

"Cupping" -- sort of like acupuncture -- begins to catch on in America.

That's it. Have a great day. Jennifer

Breaking News?

2012-01-23T07:57:00.000-08:00

I don't know if this should really count as breaking news, but...

POLITICO Breaking News
-------------------------------------------------
The Supreme Court has denied a request for debate over whether Justice Elena Kagan should recuse herself from the health care reform case due to be argued in March.

For more information... http://www.politico.com

Of course, any other decision would have subjected each of them to this sort of inquiry in this and other cases, so of course, they decided no on this. J

Monday Musings

2012-01-23T04:23:00.000-08:00

For some reason, Gabrielle Giffords's decision to resign has me all teary. So here's the news, minus comment:

The State of the Union is tomorrow. Everybody already hates it.

Should health insurance be required? Read two views.

Obama Administration rules that contraceptives are covered for free under health reform. Religious employers have a year to get on board. They're going to sue.

The GOP pushed Obama to make a decision on the Keystone pipeline. He made a decision: NO. But Speaker Boehner says he may try to get it attached to the payroll tax cut again.

Should doctors communicate via email? Yes, but only if the emails end up in the patient's medical record.

Student with autism is beat up on video and nobody steps in to help. Disgusting.

How to be a good patient and make your doctor like you. I'd add one more: Never show up with something they can't figure out or fix.

Advocates demand clarity about charity care. Some people don't know it exists or they can apply for it. Nobody knows the standards you have to meet to qualify for it. It's a mess, and it must be made transparent.

In effort to grow, Catholic Hospital Systems pares its ties to the church.

The rich get fancy hospital rooms.

New nursing training.

Study of chelation therapy to combat heart disease continues despite the lack of indication that it works.

Studies funded on "energy healing." Should we be funding studies of alternative treatments? Here's one you can skip -- coffee enemas.

Exercise caution when choosing health apps.

A certain treatment improves the chances of brain tumor patients.

Statins might fight breast cancer.

That's all. Have a great day. Jennifer

New Guidance on School Anti-Discrimination Laws

2012-01-20T05:26:00.001-08:00

Yesterday, the US Department of Education issued new guidance on how the 2008 Amendments to the Americans with Disabilities Act impact the reach of Section 504, which is the law that requires that students with disabilities be provided with reasonable accommodations.

This new guidance states that a student need not have a problem with the "major life activity" of learning; substantial impairment of any of a whole host of major life activities is sufficient to establish that a student has a disability under Section 504. The guidance also confirms that, for a student with an episodic illness, if it would be disabling when flaring, it's considered a disability under Section 504 at all times.

In addition, the guidance makes clear that, even if the student doesn't need special education and related services, the school may have to provide accommodations -- use of an elevator for a student with a lung disease; the ability to make up assignments without penalty if a student has missed a lot of school; and so on.

In other words, we were right all along about what we've been saying to school districts. Now, we have additional ammunition to prove it. Jennifer

Finally Friday "Oh, man" Edition

2012-01-20T02:34:00.000-08:00

Oh, man. I spent over $1000 fixing my work computer after it was attacked by perverse malware, and now I can't log on remotely from home, which means something's wrong on the work computer STILL. Oh, man.

And yet, I'm still here with the news.

Some glitches, some failures in the health reform law. The big deal is that Congress failed to include any appropriations for consumer assistance programs all over the country that were supposed to help people find insurance and even appeal insurance denials. Many of those programs are struggling, and Texas has complete closed its program. Then there was the 1099 reporting requirement and a glitch on Medicaid eligibility, both of which were fixed. And the CLASS Act -- long-term care -- has been deemed unaffordable for now. Those are relatively small issues, although the consumer assistance programs are critical. How Congress could have cut funding for something so critical and relatively inexpensive -- $30 million for all 50 states per year, which is a drop in the federal budget bucket -- I don't understand. Oh, man.

The Congressional Budget Office finds that some of the early pilot programs to improve care and cut costs in Medicare have not had any positive effect. Oh, man.

Lack of dental coverage sends patients to the ER for pain. Most people -- including me -- don't have dental coverage. Many go years without seeing a dentist, waiting until they are in pain. Then they go to an ER, which isn't going to do much with a dental problem. Oh, man.

The American Psychiatric Association is tinkering with its definition of autism -- and that may mean kids don't get the treatment and support they need. This is an outrage. It's APA statements that preclude many people from getting insurance coverage of residential treatment programs already. Now autism? Oh, man.

Suicide rates among active duty soldiers are at record highs. We owe these folks the treatment they need before things get this far. Oh, man.

Johnson & Johnson will pay $158 million to settle a case brought by the state of Texas for improperly marketing Risperdol to Medicaid recipients. Big pharma -- oh, man.

Washington Adventist Hospital denied visitation to a same sex partner. Visitation -- that's all. Oh, man.

A new drug combo for Hep C holds promise. And a new program for encouraging HIV testing called Testing Together encourages screening. A good oh, man (just a slight difference in tone).

Food stamp recipients challenge their critics to walk in their shoes. Newt Gingrich has been pounding them, as have others. I often say I wish anti-health reformers would sit in my chair for a day and hear what I hear, the secret tragedies of America. So I get this. Oh, man.

Many teens who got pregnant say they didn't know they could, so they didn't use birth control. Sounds like a failure of education to me. Oh, man.

The Connecticut Health Insurance Exchange board is muddling along, making major decisions without input from consumers. Oh, man.

And that's it for this morning. Let's hope next week is better than this one has been. Oh, man. Jennifer

Thursday Themes

2012-01-19T02:46:00.000-08:00

Well, my computer is finally rid of the virus and I'm here in the office at 5:47 am, so I might as well do the news:

States are running out of money for the Pre-existing Condition Insurance Plan -- the plan that allows people who've been without insurance for 6 months to sign up for affordable, comprehensive insurance. States are looking for some reassurances from the feds about where 2013 funding is going to come from. Of course, this was one of the Republican pieces of health reform, so in a well-functioning Congress, there would be bipartisan support for continued funding. But we have anything but a well-functioning Congress.

Nearly half of Americans live in a household that receives government funding.

Many with mental illness go without care. We need to deal with this. Insurers deny coverage even when people are violent and very disturbed. Providers throw drugs at patients. But often, care is entirely elusive -- one of America's dirty little secrets.

A three year old girl in New Jersey is being denied a kidney transplant because she also has a "mental disability," according to her parents. If this is true, it's a travesty that should concern us all.

Vermont is moving forward with its plan to have single-payer health insurance, with a strong bill creating an exchange that is bold and forward-moving.

Kaiser Permanente is going to use safer, more eco-friendly IV equipment. Of course, since (in our humble experience) they refuse to cover anything more expensive than the flu, I'm not sure how much that will help patients.

There are new questions about whether regular bone density tests are really necessary after a diagnosis of osteoporosis, considering how slowly that disease progresses.

Nearly one quarter of changes to people's intelligence is linked to their genetics. Still, lifestyle is the main influence on how the brain ages.

Abortion rates are higher in countries where abortion is illegal.

Connecticut's Office of the Healthcare Advocate recovered over $11.46 million for consumers last year. If ever there were an argument in favor of consumer assistance programs to help consumers fight their insurance companies, this is it.

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

Hump Day Headlines

2012-01-18T02:58:00.000-08:00

Wednesday already? YAY! So here's the news:

Congress is back. As you may recall, they punted for a short-term fix on three issues -- payroll tax cut, Medicare reimbursement rate hike, and extended unemployment benefits. They seem optimistic about wrapping this up quickly. You wanna bet?

Don't understand health reform? Have questions? Watch this short video. All will be revealed!

What will the Supreme Court do on health reform? The answer isn't as clear as we all once hoped it was. My fear of what happens if we lose the promise of insurance despite pre-existing conditions takes my breath away.

Young adults are making gains under health reform, mostly because they can stay on their parents' policies to age 26.

The Supreme Court has 2 Medicaid cases that could transform the program. First, as part of the health reform case, 26 states challenge the law's Medicaid expansion, even though it will cost them nothing to start with and little thereafter. Second, a California case already argued centers on whether states can be sued because their Medicaid program isn't in full compliance with federal law. These cases, taken together, could result in a Medicaid program in which states have free reign -- and depending on the state, that could be really bad for some.

The CLASS Act -- part of health reform that would create long-term care insurance -- has been deemed to be unaffordable for now, according to the Obama Administration, but they want to keep it on the books to revisit another day. The GOP is pushing to get rid of it entirely, though.

Tiered insurance. You heard it here first. If you go to one hospital, it's free. If you go to another hospital, you pay 10 percent. If you go to a third hospital, you pay 20 percent. These policies are being sold in Massachusetts as great cost cutters, but do they really save money? Mostly, they're incredibly confusing.

A new drug may treat colon cancer if all alternatives are exhausted.

Diagnostic errors highlight the need for a second opinion.

A heartbreaking decision, but one that brings life. Just read.

Obesity rates have leveled out -- stopped increasing, but no decrease, either.

Check out this video. If you haven't been to the doctor in awhile, this is a cautionary tale. GO TO THE DOCTOR!

Paula Deen just "came out" about her type 2 diabetes -- and now she's a pitchwoman for a diabetes drug. She couldn't have gone public simply to raise awareness? She's not even changing her on-TV fat-laden cooking style. It's all about the green for Deen.

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

Tuesday Tidbits

2012-01-17T03:29:00.000-08:00

I did take the day off yesterday -- could have kept sleeping, but there were 10 messages on my voicemail at work, so I guess it's good I came to work. First, the news:

Under health reform, insurers and employers have to pay to screen kids for obesity and to counsel those who need it. But how best to help kids who are overweight? Few models exist.

Mitt Romney and health reform -- getting the facts straight.

The Obama Administration is set to require drug companies to disclose payments to physicians. Good.

A new groups will set priorities for Medicare Coverage. Called the Patient Centered Outcomes Research Institute (PCORI), the Institute will give out $3 billion in grants for comparative effectiveness research -- are more expensive treatments really better? Good question. My concern is that different things will work for different people, so while some people may not need the expensive option, some will, and I'm afraid that this research won't allow for that flexibility.

A study shows that patients like being able to read their medical records.

An achy calf may be deadly deep vein thrombosis. Take it seriously. And see an expert in vascular medicine to make sure you get the right care. (Disclosure: I am biased. My brother runs the Vascular Center at Mass General -- so just read the article for yourself.)

Nearly 1/3 of Americans take an aspirin every day -- and that could be doing more harm than good.

What if the doctor is wrong? A good reason to get a second opinion.

Problems in the gut may lead to other problems, some in the brain. Fascinating. Bacteria in the gut may lead to depression and anxiety. Wow.

And deep brain stimulation may also help depression and other illnesses. We got this device for a young man with Tourette's syndrome and it was a life saver.

A DC cardiologist is developing an app to tell if you're having a heart attack.

Brand name drugs may be no better than generics.

Crossword puzzles may hold keys to the subconscious mind. Hmmm -- I always feel pretty conscious when doing crossword puzzles!

Researchers in Israel report that there may be a new weapon against super-bugs thought to be resistant to antibiotics.

Workouts have their limits -- as they should. But not everybody observes those limitations. But don't skip your winter workouts.

Is there an upside to depression? Skepticism is warranted.

The US is launching war on Alzheimer's. Good.

Understand your thyroid gland -- it's small, but it does a big job.

Food myths and truths are revealed in a new book.

Paula Deen goes public with her Type 2 diabetes. And she's cooking differently, too.

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

Finally Friday Edition

2012-01-13T03:00:00.000-08:00

And another long week-end ahead. I don't usually take off when my office is closed, but this week, I think I will. Still tired from my medication incident, so I can use some extra time for me. But first, the news:

Let's start with good news -- Americans are living longer. But it's all about what you do with that extra time, isn't it?

Yesterday, as previously reported (below), the Obama Administration found rate hikes by Trustmark to be unreasonable, ordering the company to either rescind them or justify them. This is just one way the health reform law is starting to combat high insurance premiums.

A new study shows, though, that premiums could rise as much as 25% without the individual mandate.

A group of patient advocates has asked the Department of Health and Human Services to extend the deadline for comments on the essential health benefits proposal (which would allow states to determine which benefits are essential).

Cigna and Weill Cornell Physicians of New York have agreed to team up to create a new care delivery model, an accountable care organization, with registered nurses performing care coordination tasks.

What's the role of pharmacists in health reform? To encourage people to comply with their medication regimen, which saves money in the long run.

California has county health plans -- a public option of a sort -- profiled today by Kaiser Health News.

Vitamin D levels decrease one marker of inflammation (c-reactive protein), but too much may cause an increase in CRP. How much is enough? Vitamin D has been essential to me in dealing with my Crohn's.

CVS Caremark will pay $5 million to consumers for deceptively advertising costs of medication through one of its Medicare Part D plans.

A new test might someday help spot lung cancer in its earliest stages.

Swedish doctors replaced a cancerous windpipe with an artificial one.

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

Health Reform Holds Insurers Accountable for Rate Hikes

2012-01-12T10:48:00.000-08:00

News Release

FOR IMMEDIATE RELEASE
January 12, 2012

Health insurance premium increases in five states have been deemed “unreasonable” by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced today.

After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.

To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care law of 2010) to determine whether premium increases of over 10 percent are reasonable.

"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Kathleen Sebelius. "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases. It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."

In these five states, Trustmark has raised rates by 13 percent. For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.

In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases. Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.

Examples of how states have used this authority include:

In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.
In Pennsylvania, the state held Highmark to rate hikes ranging from 4.9 to 8.3 percent, down from 9.9 percent.

Today’s announcement comes the same week that a report showed that health care spending has grown at remarkably low rates. According to an analysis done each year by the Centers for Medicare & Medicaid Services, U.S. health care spending experienced historically low rates of growth in 2009 and 2010. A recent study released by Mercer Consulting also showed a slow-down in the average employee health benefit cost to businesses.

The Affordable Care Act includes several policies, including rate review, to continue this slow growth. By fighting fraud, better coordinating care, preventing disease and illness before they happen and creating a new state-based insurance marketplace, it helps keep health care cost growth low.

For more information on the specific determinations made today, please visit http://companyprofiles.healthcare.gov/

For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/

###

Thursday Themes

2012-01-12T04:32:00.000-08:00

Well, turns out my crappy feeling yesterday was an adverse reaction to a new drug. Back to the drawing board -- but a good reminder. If you're taking a new drug and you start to feel unwell, consider whether it's the med doing the damage. The adverse reaction I had was not listed on the label, but when I told my doctor, her response (via email) was STOP! But it's up to us to identify those symptoms and reach out to our doctors and ask -- and not take any more of the medication until we get a response.

And after that cautionary tale, here's the news:

Nearly 500 state legislators will file a brief today in the Supreme Court urging the Court to uphold the individual mandate -- including legislators from the 26 states challenging the law.

Yesterday, the Supreme Court heard argument in a case that asks whether state employees are entitled to the protections of the Family and Medical Leave Act. Let's hope they get this right. Because here's one they got wrong. If you work for a religious institution, you may not have any rights under the Americans With Disabilities Act or other anti-discrimination laws, according to a Supreme Court decision handed down yesterday. The ruling will NOT apply to people who don't do religious-oriented work, but this teacher -- who gave religious instruction for 45 minutes each day, and the rest of her day was spent on secular teaching -- was a "called" teacher, and that was enough for her to fall into the "ministerial exception." This is a huge step backwards for people who work for religious institutions.

5% of patients account for HALF of the health care costs in America in 2009. About $90,000 per person in the top 1%, which accounted for 22% of health care spending. Who are these folks? Women. Elderly. White. People "in poor health" -- people with chronic illnesses.

A report shows that narcotic prescriptions rose sharply in New York and the New York Attorney General is using it to support a narcotic tracking system. Watch out, New Yorkers. If you think it's hard to find a pain management doctor now, and if the experience of other states is any indication, this can cause you real problems. Write your state's Attorney General NOW and make sure that the law includes protections for legitimate pain patients.

Should doctors consider cost when making treatment recommendations? The American College of Physicians says it's the only ethical thing to do. Read what doctors think.

Medicare Advantage Plans are using gym memberships to entice enrollees -- is that cherry-picking the healthy patients, which is against the law?

Medical schools are starting to teach alternative medicine. Wonderful!

A hormone secreted during exercise may explain why exercise helps to fight obesity and diabetes.

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

Hump Day Headlines

2012-01-11T04:17:00.000-08:00

It's Wednesday, so here's the news:

We all know about the Supreme Court's case challenging the individual mandate. However, yesterday, 26 states filed a brief challenging the authority of the federal government to require the states to expand Medicaid. It wasn't a good sign when the Supreme Court agreed to consider this question and I'm nervous -- this is so critical for people who can't afford insurance even with a subsidy. In most states, childless adults who are not on Social Security disability cannot get Medicaid. The Medicaid expansion, set to take place in 2014, was supposed to change that, ensuring that poorer adults also would be covered. But Medicaid is funded jointly by the feds and the states, although the feds would pick up the cost of the expansion at least early on. Of course, states can opt out of participating in Medicaid at all, but the states argue that isn't much of a choice since Medicaid is so critical to the health of millions of Americans. This could be the sleeper issue that really hurts health reform.

The Wall St Journal is taking a poll -- should doctors communicate with patients via email? So far, the votes are overwhelmingly yes.

Marijuana does not impair lung function like tobacco does, says a new study.

Americans are stressed, but getting used to it. We've adapted. Hmmm.

This is really interesting. An interactive tool that allows you to calculate your life expectancy so doctors, patients, and families can make better, more informed treatment choices.

Decorative water walls -- you know, those fake indoor waterfalls -- pose a health threat to patients with low immune systems. One appears to have been the trigger for an outbreak of Legionaire's disease.

One in six adults is a binge drinker. This is some serious drinking -- more than once a week, and about 8 drinks at a time.

And that's it -- a slow news day, at least in health care. Have a great day. Jennifer

Tuesday Tidbits

2012-01-10T03:31:00.000-08:00

Nausea really sucks. But the news keeps coming. Here you go:

David Lazarus of the LA Times says President Obama should be taking a harder line on health reform implementation rather than letting the states do what suits them. I tend to agree.

US healthcare spending rose only 3.9% in 2010 -- the second lowest increase on record as people avoid health care during the recession. So health reform did NOT result in a spike in cost.

And here's a new book on health reform written by the architect of the law, Jonathan Gruber at MIT. It's a book for consumers in comic book form -- like a graphic novel except it's non-fiction.

The research arm of health reform is also getting more play these days. It's all about helping consumers make informed decisions.

What happens when a patient really "owns" his/her own medical record? Doctors worry, but a study is underway to see how it goes.

A diabetes patient talks about the way people respond to her. I think you could take pretty much any chronic illness and it would be about the same. People who don't have it don't "get" it. Do you know about spoons? Read here. This works pretty well. Another study says diabetes can affect jobs and wages for young people. Why do employers even know about it? They aren't allowed to ask.

Meanwhile, post-menopausal women who take statins for cholesterol run a higher risk of Type 2 diabetes.

What personality traits lead to obesity? This is fascinating -- I just have to completely change who I am and I'll be thinner!

Some doctors want a credit card before they will see you. Is going to the doctor like going to the store to buy something? I don't know -- this feels weird to me.

What happens to a relationship when one partner has a brain injury? Tears and courage.

Guess what? Nicotine gum, patches don't work! But you're tough; you can do it. And nicotine patches may boost memory in people with mild cognitive impairment. So it's not for nothing!

Exercise may help Parkinson's patients.

Our friends at New Haven Legal Assistance have sued the Connecticut Department of Social Services for failing to process Medicaid applications in a timely manner. Great job.

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

Is Express Scripts your Pharmacy Benefit Manager?

2012-01-09T14:42:00.000-08:00

If so, apparently they have not reached a contractual agreement with Walgreen's, so you no longer can fill prescriptions (including refills) at Walgreen's. They're probably going to keep negotiating and this may change, but as of today, you cannot fill a prescription at Walgreen's. Jennifer

Monday Musings

2012-01-09T03:24:00.000-08:00

A bit of a struggle this morning. I'm tired. But work comes first, and so here's the news:

As I told you on Friday, the US has filed its brief in the health reform case. As you know, the main part of the case challenges the requirement that people buy insurance. One of the individual plaintiffs is a woman who said it was her right to self-insure rather than buy insurance. The US has been saying all along that folks like these end up shifting the cost to the public. While the case has been pending, the woman racked up a lot of bills -- including medical bills -- and filed for bankruptcy protection. Which served to prove the point that the US has been making all along. It is NOT okay for people to shift the cost of health care to the taxpayers, and the best way to make sure that doesn't happen is to require them to buy insurance. This was one of the most convincing parts of the government's brief. Meanwhile, over 100 Republicans and economists filed an amicus (friend of the court) brief arguing that the Supreme Court should strike down the entire law if they find the individual mandate to be unconstitutional.

The health care sector continues to add jobs.

What's it like to be hearing impaired? Read and maybe you'll understand.

A run of thefts in pharmacies, looking for narcotics.

Hope for people with cystic fibrosis.

A small study shows that deep brain stimulation may help people with bipolar disorder.

Robotic devices help paralyzed people.

Poor sleep worsens health in kids with type 1 diabetes.

Should young people be getting obesity surgery? Is caffeine a weight loss aid?

A virtual cadaver for medical students to learn on.

The answer to last week's guess the diagnosis quiz from the NY Times. And once again, a reminder that we should not rest until we find answers to our medical problems.

That's it for this morning. Have a great day. Jennifer

Health Reform Brief

2012-01-06T13:57:00.001-08:00

The US Department of Justice filed its brief on the individual mandate in the Supreme Court today. In case you are dying to read all 60 pages, here it is. If there's anything remarkable or unanticipated in it, I'll let you know -- after I've read it. Jennifer

P.S. -- Well, I've read it and it's really remarkably good. It's straightforward, clear, concise, and convincing. There were no surprises, at least in my view. If you're curious, give it a quick read. It's not overly technical -- just skip over the citations. I know I'm convinced, but that's no surprise, I trust. J

Finally Friday Edition

2012-01-06T02:43:00.000-08:00

No long week-end this week. Oh, well. But there's still the news:

Most hospital errors go unreported. That's fairly shocking to me considering the number of adverse events that ARE reported. You really should consider taking steps if you are going into the hospital. I just read a new book call the Patient's Checklist. It helps you to remember all the things you need to know to make sure you get in and out of the hospital no worse off than when you began.

How health reform helps to control health care costs, by HHS Secretary Kathleen Sebelius.

The first round of briefs is due today in the health reform Supreme Court case. According to some experts, it will be critical for the government to explain not only why the individual mandate is within Congress's powers, but what the limit on those powers is.

The feds -- both Congress and the White House -- cut funds for heating assistance right at the start of winter, just before they left town for their holiday break. This is an outrage. It's not even a lot of money, as things go. And if you think it's not a health issue, wait until people start getting sick and have no heat.

Collaborative care -- employers, insurers, providers all working together -- may be a more efficient, effective health care delivery system.

States are asking for more funding for the Pre-existing Condition Insurance Plan, which covers people with pre-existing conditions until 2014, when insurers won't be able to exclude people with pre-existing conditions any more.

Arizona passed a law allowing the use of medical marijuana. The (pretty nutty) Governor sued to try to stop it from taking effect. A court threw out her lawsuit.

A Massachusetts court has found that the State cannot exclude legal immigrants from a state health plan. The court based its decision on the State Constitution, so how much this will affect other states is hard to say. But this brings Massachusetts another step closer to truly universal health care.

Shame in filling a prescription? When faced with alleged drug shortages of controlled substances or ADHD drugs, patients have to run in circles to get their meds, and some feel shame for needing them.

Is being fat a destiny? Recent articles, summarized by USA Today, discuss. I particularly recommend the NY Times article from last Sunday's NY Times Magazine.

Some employers are banning smokers from the workplace. Not just smoking, but smokers!

A hepatitis C vaccine is hopeful, but years away. A potential herpes vaccine falls short.

A recent dust up over a study reporting a way to make bird flu airborne raises the question -- how close are terrorists to being able to spread a communicable disease?

Can yoga wreck your body? Surprisingly, yes.

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

Thursday Themes

2012-01-05T03:15:00.000-08:00

It's Thursday already and that's a good thing. Here's the news:

Private insurers are profiting from increase roles in Medicare and Medicaid. Despite the poor economy, health insurance is a very profitable business. This is so despite the fact that fewer employers are offering coverage, and those who do are charging employees more for it.

Here's another one of those NY Times puzzles -- guess the diagnosis. I'm totally hooked on these. In this one, one of the doctors is an old friend and colleague of my brother's (Jeff Olin), which really makes me curious. Can't wait for the answer!

HIV/AIDS is increasing within the Navajo Nation, at a time when they are decreasing in the general population.

Food allergies are an increasing problem, and vigilance is required. Not only do you have to be careful about what you eat, but you also have to prepare for slip-ups.

A new study shows that even a small gap in insurance compromises the health of a diabetic. I'm certain the same can be said of other illnesses, as well.

HHS rejected Kansas and Oklahoma's request for a waiver of the medical loss ratio requirement. This means insurers in those states will have to spend 80 or 85 percent of premium dollars on health care. Good.

A whistleblower suit accuses a nationwide hospice company of cycling patients through nursing homes and hospice to maximize profit.

A new study says that, although heart attack victims in the US will spend only 2-3 days in the hospital after the attack, they are more likely than patients in other countries to be readmitted to the hospital within the next month.

Drug shortages are an increasing problem due to hoarding and price gouging.

Will electronic monitors of caloric intake help people lose weight?

Due to concerns about resistance to antibiotics, US officials are further restricting the use of antibiotics in livestock.

The FDA has ordered a study of surgical mesh used to treat urinary incontinence in women due to many reports of injury.

And there you go -- a lot of news for a Thursday. Have a great day! Jennifer

Hump Day Headlines

2012-01-04T03:18:00.000-08:00

Good morning! Let's get right to the news:

Think your medical records are safe, private? Read this harrowing tale.

Under health reform, starting now, there's a $1 annual fee on all private insurance to fund comparative effectiveness research -- research that shows whether one treatment really works better than another. The GOP are complaining. They think this will lead to rationing. However, as we know, private insurers already "ration" to the extent of paying only for things they believe will work.

The American College of Physicians is taking the position that doctors should consider cost effectiveness when ordering services.

Adult day care centers keep seniors out of nursing homes -- but struggle for funding.

The Hartford has come up with a new life insurance product, a rider that allows the insured to draw down on their policy to cover the cost of chronic illness -- an alternative to long-term care insurance.

HHS has chosen 73 "innovation advisors" who will work with the Centers for Medicare and Medicaid services to foster innovation in medicine.

Research shows chiropractic and exercise are better than pain meds for neck pain. I've also read over the years that chiropractic can cause strokes. I don't know for sure, but I'd be careful and make sure you're seeing a reputable chiropractor.

And that's it for today -- a light news day. Have a great one! Jennifer

Happy 2012

2012-01-03T03:17:00.000-08:00

And here I am in the office at 6 am so I can bring you this blog every day. One of my New Year's resolutions is to stop coming to the office at 6 am. That may mean a change to this blog -- maybe I won't read 8 newspapers per day; 4 or 5 would probably do. Anyway, we'll see how it goes. For today, it's the norm -- here's the news.

Expect 2012 to be a year in which we talk alot about Medicare. With the boomers joining the ranks, we can't afford to sustain what we have, some argue. But others says we must hold the line firm.

The Government Accountability Office found that the Department of Justice is not doing a good job policing standardized testing companies to ensure that disabled test-takers have the accommodations they need.

Some states are working on getting their Exchange up and running in time to sell insurance effective January 2014. But in states that are refusing to comply with health reform, there should be a federal fall-back Exchange -- but will it be ready?

The Pre-existing Condition Insurance Plan continues to be a great option for people who've gone without insurance for 6 months. It's grown to about 6000 in California alone.

10 provisions of health reform take effect in 2012. Not the really critical ones, but they may help affordability and care coordination.

California Blue Shield settled a lawsuit that requires them to pay $2 million for dropping people when they found out they were sick. A similar suit against Anthem still is pending.

When nurses catch compassion fatigue, watch out. If you've ever been in the hospital, you know that the key is a pleasant, caring nurse. But could you keep that up every day?

Smokers are paying more for health insurance. An incentive to stop smoking? We hope so.

There's a shortage of ADHD drugs. Hundreds of people are complaining to the FDA every day. Ritalin and Adderall are affected. The Drug Enforcement Agency set manufacturing quotas on these drugs to try to avoid street use, but the result is that kids don't have their meds. Along the same lines, although not mentioned in the news, Salix Phamaceuticals has stopped manufacturing brand name Colazal. They have a new, equivalent med coming out shortly that they thought would be FDA approved by now. But the FDA has held up the new drug approval, and this is leaving Crohn's and colitis patients without brand name meds.

Insured Americans share healthier habits than the uninsured. I suspect that's largely because insured Americans as a general rule are employed and/or financially sound.

Two new books are good for patients. Confessions of a Surgeon tells most of us who've been through surgery what we already know -- surgeons just do surgery, and nothing else. But the Patient's Checklist sounds really interesting -- a way to make sure you are getting appropriate and safe care. I was contacted last week to see if I'd read an advance copy and review it for you, so I'm waiting for it to arrive so I can get into it. And here's an interesting piece by a surgeon that makes me never want to go near an OR again.

New thoughts on treating anorexia nervosa.

Connecticut cans Medicaid managed care in favor of the old fee-for-service model, as other states experiment with managed care. Those states ought to look at how much money we lost to the private insurers running managed care.

Hundreds of patients linger in New York City hospitals because they have nowhere to go. They are illegal immigrants or don't have insurance or any type of support system. Of course, hospital care is the most expensive option, but Medicaid won't cover their stay in a nursing home, so hospital care is their only option.

And that's it for today. Have a great start to 2012! Jennifer

Happy New Year's -- If We Make It So

2011-12-30T04:55:00.000-08:00

I feel like I'm supposed to have something smart to say -- something about bygones and starting anew. I'm not sure I have anything really big to say, but as always, I'll share my thoughts and see what comes of it.

It's been a huge year for Advocacy for Patients. Nicole Netkin-Collins started in March as our first full-time staff attorney. We couldn't be happier to have her. It means we can serve more people and -- if I can get my priorities straight -- it should mean that I don't work 15 hour days all the time. Me and my priorities, putting work before all else? Well, that's going to require more work, on the agenda for 2012.

We also moved out of my house into real offices. I love our new offices, really. They fit us so well. Everything worked out just great. We're comfortable there. We're home. Every day, I walk in and smile knowing I created a space for us that really suits us to perfection.

We had a lot of good wins, and some pretty big losses, as well, as we continue to battle with insurance companies. We're pretty successful at insurance appeals for things that are well supported in the medical literature. For example, Nicole won a huge appeal to get IV lidocaine for a patient with complex regional pain syndrome, which was very exciting. But since we take the hardest cases, where the medical records don't firmly support a diagnosis or the medical literature doesn't support the treatment in question, it's an uphill battle. We win some, but the ones we lose are heart-breaking, not only for the patients, but for us.

We've had more employment cases this year than ever before. We suspect that, in this economy, when employers are laying people off, they like to start with people who take a lot of FMLA leave or need reasonable accommodations. We also continue to have way more school cases than is justifiable -- schools still threatening to send sick kids to truancy court, stupid things like that.

We did a tremendous amount of policy work this year. We spent a lot of time working with national consumer groups on health reform implementation. Our role is the biggest when it comes to the new appeals rules because we have such broad experience in filing insurance appeals in many different states. We've also weighed in on the Exchanges, and have been working hard to improve the Exchange set up here in Connecticut. We also filed an amicus ("friend of the court") brief in the Supreme Court in the health reform case.

In addition, we published our first paper on our chronic illness survey.

And with all of that, we even broke even on the year -- a tremendous accomplishment in a year of such growth.

2012 will be a challenge. It will be the first full year in which we have to pay for all of that growth. We're off to a decent start, but in 2012, I have to work on my fundraising skills, for sure. Also in 2012, we are serving on the advisory committee for the Connecticut Health Survey, and the consumer advisory committee for FAIR Health, which you really should check out if you haven't already. Finally, it is possible for consumers to get information on "usual and customary" rates, which allow us to fight when an insurer wants to pay a miniscule portion of an out-of-network service.

Perhaps the most important thing that will happen in our little corner of the world is the Supreme Court's decision on the health reform case. Briefs are due in the next month or so (ours was the first one to be filed), and oral argument is at the end of March. We should have a decision in June. If the law remains intact, we will have coverage of people with pre-existing conditions, along with subsidies to make insurance more affordable, in 2014. If the law is struck down -- or perhaps even if only the individual mandate is struck down -- we may lose the most important advancement the law has ever made for people with chronic illnesses.

And then there will be the Presidential election. While we stay out of electoral politics, we strongly support health reform. Even if the Supreme Court upholds the law, an anti-reform President could take away coverage of pre-existing conditions before 2014 rolls around -- a huge loss for people with chronic illnesses.

But most of all, 2012 will mean another 1500+ clients who battle chronic illness in one way or another. Some of them will bring us joy; some will bring us loss and pain. But we continue to feel privileged to do work that matters.

William James said life is worth living because we are free to make it so, from the moral point of view. In other words, as long as we can be a positive influence in the world and on each other, we can give our lives meaning. Nicole, Echo and I do that as best we can every single day, with every email and phone call we get. But we can do better. We all can. Don't shy away from the homeless; know that it could just as easily be you. Don't judge those less fortunate; it's not their fault they got sick, which for too many people leads to unemployment, financial ruin, foreclosure, isolation.

Make it your New Year's resolution to warm your heart to those in need. Small government is all well and good in theory; but people need care, shelter, warmth, and we need to continue to press our elected officials to help make sure our basic needs are met -- for all of us. And if you're reading this thinking that if you can make it, why can't everyone else? It's because not everyone has the capacity for reinventing themselves; not everybody can bounce back; not everybody has friends and family for support. We humans have different skill sets; not everybody has the ability to scrape together a life that has gone to ashes. Instead of thinking that others should tough it out like you do, try imagining doing that without your skills, family, friends, energy. Feel compassion for those less fortunate. Make it your New Year's resolution to develop that warmth in your heart if you don't already have it.

I've said it before and I'll say it again: If everybody did whatever they can do, the world would be a far better place. So join with us and, in 2012, do whatever small deeds you can to make the world a better place, or at least not make it worse! You'll find that doing good is far more of a gift to yourself than it is to others.

Happy New Year. Jennifer

Hump Day Headlines

2011-12-28T03:11:00.000-08:00

And it's already Wednesday -- YAY! And it's a very light news day. Hey -- is everybody but me on vacation? What am I doing here at 6 am? Oh, well. Might as well get to it.

Five pieces of health reform took effect in 2011. (1) a huge crackdown on fraud, which has brought in billions of dollars; (2) kids under age 26 can stay on their parents' policy; (3) a 50% reduction in prescription drug costs for seniors; (4) preventive care is free; and (5) the Pre-existing Condition Insurance Plan, an option for people who can't get insurance on the private market. Although we wait until 2014 for the really big stuff, these accomplishments are not for nothing!

State governments, with federal funds, have added 1.2 million children to health care coverage of some kind since 2008. It's mostly CHIP, the Children's Health Insurance Plan, which is funded by the feds and the states.

Weight loss programs will be covered by Medicare starting in January, so get ready for a flood of marketing to doctors and patients.

All metal hip replacements are failing at an alarming rate and expected to cost all of us billions of dollars. It's not too often that a medical device failure makes the top of the front page of the NY Times, so you can bet this is for real.

A doctor's dilemma -- confidentiality unless you're going to hurt yourself or someone else, in which case confidentiality is out the window.

An operator of group homes for the developmentally disabled in NY took a TON of money from the state while declaring bankrutpcy, not paying taxes.

That's it -- that's all I can find. Have a great day! Jennifer

Tuesday Tidbits

2011-12-27T02:52:00.001-08:00

Well, I'm here, but at least it's a short week. And here's the news:

I have to start with this. Smiling may improve your health. For real. It reduces the risk of stroke. You will make better wellness choices. I don't know if I believe this. But I do believe that smiling helps you feel better. And it's free. So why not give it a try.

One in five Americans is juggling medical bills. And many of them have insurance. I hope 2012 begins to address this.

The economy hasn't been as bad for our members of Congress as it has been for the rest of us. The earnings gap between us and them has grown. And now, with only two months to come up with a deal on the payroll tax, unemployment and the Medicare reimbursement cut, things on the Hill are as acrimonious as ever.

The GOP has been chanting "repeal and replace" about the health reform law since it was passed -- but there's still no plan for a replacement. Because there's no expert anywhere who believes we can fix the problem without covering the uninsured, and there's no way to do that without mandating coverage of pre-existing conditions, and there's no way to do that without an individual mandate and subsidies. Shout repeal all you want, but understand that, if you do that, you leave 50 million people without insurance -- and rising.

And here's a profile of the lawyer who will be arguing against the health law's constitutionality in the Supreme Court.

Last week, we heard that an experiment on flu could have been dangerous by making the flu airborne. Well, it's still controversial. The claim is that it teaches terrorists to do something most of them don't know how to do.

A new, better pain med has some worried that it will increase abuse. I'd like to know why it isn't good to get people out of major pain. If there's abuse, stop the doctors causing it, but stop blaming it on patients who are in pain.

New hope for patients with MS? Wouldn't that be wonderful?!

Hospitals -- usually quick to use new technology -- have not started using iPads and other tablets.

Are house calls making a come-back? I would LOVE this.

Gastric banding has complications. Be an informed patient.

The older you are when you gain weight, the more of the weight is fat. Thanks. I needed to know that.

And there you go. Have a great day. Jennifer

Essential Health Benefits Guidance

2011-12-23T08:58:00.001-08:00

As you know if you read this blog, rather than establishing an essential health benefits (EHB) package, as the health reform law directs it to do, the Department of Health and Human Services has proposed to permit states to establish the EHB by choosing a "benchmark" plan. That means no national standards, no uniformity, and lousy coverage in states that are not consumer friendly when it comes to health insurance.

We have submitted our comments to the Department. You may read our comments here.

Jennifer

Holiday From Chronic Illness

2011-12-23T04:51:00.000-08:00

You can't help but run into talk of family gatherings, travel, opening presents, eating -- living in the holiday season is vital, active. It's no wonder some of us with chronic illnesses feel left out. After all, we can't eat normally. We are in pain. The New Year doesn't bring us a clean slate. And all we want to do is sleep. We are isolated and alone.

But I don't think it has to be that way. I challenge you to celebrate the holidays in your own ways. Naps are great, and everybody naps on the holidays, so don't feel left out; enjoy a warm winter's nap. Can't go out for the holidays? Bring some cheer in. For me, it's as small and simple as putting Emily's holiday collar on her -- red velvet with rhinestones for the girly cat. It reminds me that it's a special time of year and brightens up my mood immediately. Can't eat the big, fancy meals? Treat yourself to one of your favorites -- a cupcake, a bowl of homemade soup -- whatever feels special to you. There's wonderful holiday music that always cheers me up. I'm Jewish, but I'm a sucker for a good Christmas carol.

And if you really can't find anything to rejoice about, think about how much worse it could be -- think about those who lack a home or a bed or hot food or anybody who cares about them. If you're able, volunteer at a soup kitchen -- that will make you feel very lucky. If you're not able, pick up the phone and call someone you know who's also sick and alone; two of us together is better than two of us apart.

I will look back on 2011 as the year I really learned the value of positive thinking. I've always known that coping strategy is the key to living with chronic illness. The glass half full. All I have rather than all I'm missing. But I never really got it until this year.

My friend Ashley O'Connor always says "it will work out. It always does." This was the year I decided to believe her. I moved Advocacy for Patients into new offices with no clue how I was going to handle our increased expenses. But we've been here for four months and we will still break even on the year. I have no idea how it happened, but it did. It always does.

So when people ask how I am these days, I try to remind myself to say "great," even when that's rarely the case. Strangely, I have found that, by just saying that, it sort of comes true -- I feel happier when I act happier. Laugh. Sing. Smile. You don't need anybody's help to do those things. You don't even need a reason. Just do it and see if it changes how you feel. I bet it does.

Life's tough, for sure. Even if I sit or lie really still, I'm in pain. I'm so tired I could cry -- not sleepy tired, but bone tired. I lost a dear friend this week. I got bad test results. I'm not going to have any time off over the holidays. We can compare lists of things we have to be miserable about.

But I also have a cat who loves me. I have a lovely home that's warm and clean, even if it does need some sprucing up. I have a great office. I have work I love. And I have the great privilege of being able to touch a life here and there. There is no greater reason to celebrate.

So don't wait for good fortune to find you. Make it. Hang a garland. Phone a friend who's alone. Eat a cookie. Write a letter. Smile. You may have to pretend at first, but you'll be surprised at how fast it becomes genuine.

Because in our hearts, we aren't sick. In our hearts, we are alive and free and loving. In our hearts, we can take a holiday from chronic illness. I hope you will give it a try.

Ashley's right. It will work out. It always does. Some how. Believe. Jennifer

Finally Friday Edition

2011-12-23T02:26:00.000-08:00

One. More. Day. And then a 3 day week-end -- YAY! But in the meantime, the news:

The House GOP finally agreed on a 2 month extension of the payroll tax cut, unemployment, and the Medicare reimbursement hike. The House will try to pass this with unanimous consent today; if there is objection, he'll call the whole House back in session next week for a vote. Politically, the victory goes to the Dems, and President Obama in particular; he needed to not back down this time. But really, the winners are the American people, who won't face a tax hike on January 1. However, the unemployed will take a hit as the 20 week Extended Benefit Program ends. Dems call this a necessary concession. I'm not buying the necessity of it.

South Carolina accepted a $1 million grant from the federal government to look into creating a health insurance exchange, but there's word that, instead, they used the money to try to get around creating an exchange. The state justifies this on the ground that it opposes health reform. Um, then you can't take the money.

A Christian school in Colorado has sued the Obama Administration for requiring coverage of contraceptives under their health insurance plan.

The GOP is going after AARP for making money off of the insurance products it promotes, including its very popular Medigap plans sold through UnitedHealthcare. They are questioning the group's tax exempt status.

The feds are adding funds for the Pre-existing Condition Insurance Plan in California and New Hampshire, where enrollment is higher than expected.

The rate of Medicare spending growth has slowed, but enrollment is about to expand dramatically as the baby boomers hit age 65.

It's been 40 years today that Congress passed the National Cancer Act, and many cancers are now chronic illnesses rather than death sentences.

A study linking chronic fatigue to a virus has been retracted due to faulty study protocols. Back to the drawing board.

The developmentally disabled in NY State's care have been heavily dosed with antipsychotic drugs. This needs to change -- now.

A medical school like Hogwarts? Dr. Pauline Chen writes about Vanderbilt Medical School, where a student wellness program aims to alleviate stress by encouraging students to have some fun and relaxation.

Sort of wacky. A guy in California offers his services as a sperm donor via the internet. He doesn't get paid for it. He says he's just being a pal. The FDA says he's a sperm donor bank. Hmmm.

And that, my friends, is today's news. Have a great day -- and a wonderful holiday week-end. Jennifer

We have a deal!

2011-12-22T14:56:00.001-08:00

POLITICO Breaking News
-------------------------------------------------
Speaker John Boehner announced Thursday night that he had reached a deal to extend the payroll tax break for two months, averting a January tax increase for 160 million Americans. The deal will be cleared on Friday on a voice vote in Congress. While Republicans made a major concession in agreeing to the two-month deal, they won agreement to tweak some technical aspects of the payroll tax for businesses. As part of the deal, Senate Majority Leader Harry Reid will appoint conferees to negotiate a long-term agreement.

Breaking News

2011-12-22T13:33:00.000-08:00

The House GOP are holding a 5 pm conference call to discuss what appears to be a short-term deal on the payroll tax, unemployment, Medicare reimbursement rate deadlock. Earlier today, Senate Minority Leader Mitch McConnell called on the House GOP to pass the 2 month extension with a "tweak" to the Senate version that memorializes Congress's commitment to negotiate a full-year deal after the 1st of the year.

Stay tuned for new developments. Jennifer

Thursday Themes

2011-12-22T02:59:00.000-08:00

All h*ll has broken loose in Washington over the fate of the payroll tax cut, unemployment extension (which actually would reduce the number of weeks a person can be on unemployment), and delay of the reductions in Medicare provider reimbursements. Congress has gone home for the holidays while President Obama stays in Washington and hopes that someone comes back to cut a deal. The House GOP refuse to bring the two month extension to a vote; instead, they held a vote on whether to reject the proposal and begin negotiations -- but the Senate was already gone, the deal was too complicated to get done by the end of the year, and even most of the House left town. Most of the blame -- even coming from Republicans -- is on the House GOP. Even the Wall Street Journal editorial board warned that the GOP might be handing the President his re-election if they did not cut a deal. The President and Senate Dems are imploring the GOP to pass the two month extension and allow time for deal-making. The GOP has rejected their pleas. No matter who you blame, it appears unlikely that these issues will be resolved before the end of the year. And that means the payroll tax cut would expire, meaning most of us will see a pay cut in our first check of 2012 -- and that could harm the economic recovery. And House Tea Party freshman don't care about the politics; they are dug in. In my opinion, the real loser here is Speaker Boehner, who can't get the radicals on the right to compromise.

Anxiety increases as substandard silicone breast implants were placed in tens of thousands of women, and they are rupturing at an alarming rate. These implants were not used in the United States, but the French government is deciding whether to recommend removal from 30,000 women. What a mess.

People with heart rates over 70 are at a greater risk of heart problems, says a new report.

For the developmentally disabled in Connecticut, a shift from public residential treatment to smaller, private community-based care.

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

Hump Day Headlines

2011-12-21T03:04:00.000-08:00

Trying to get back in the swing of things, so let's start with the news.

As you know, the Senate passed a 2 month extension of the payroll tax, unemployment, and the delay of Medicare provider reimbursement cuts. However, the House has refused to even hold a vote on this deal, instead voting to reject the bill and name a conference committee to work out the details. Three million people could lose unemployment benefits if this isn't resolved. And most of Congress has left Washington, leaving no hope of a resolution before the end of the year. Nice that they have a couple of weeks off for the holidays, isn't it? (sarcasm). Speaker Boehner says House Republicans are "on call" for negotiations. But that's hard to maintain when they've left the area and gone home. The President, though, has postponed his annual trip to Hawaii for the holidays, staying in Washington to try to work on a solution. Who will blink first? John McCain says this battle is harming the Republican party.

More about the decision to allow states to define "essential health benefits," the basic package that all insurance has to include if it will be sold through the exchange. This is a tough one. There are huge benefits to national standards in states that are against reform and not particularly consumer friendly. In other states -- like Connecticut, where we have laws requiring coverage of a lot of things like overnight stays for mastectomies and $1000/year of ostomy supplies -- using a state standard would ensure that the plan will be generous.

Meanwhile, the Supreme Court has scheduled three days of oral argument in the health reform case -- March 26 to 28. They've broken up the argument by issue. Day two will be the day when they review the individual mandate and, thus, probably the most important part of the argument.

Did hedge funds have inside information during negotiations on health reform that allowed them to capitalize on the rejection of a public option? Wow -- it doesn't get more cynical than this.

Thirty-two groups have been chosen as "pioneers" to test the new accountable care organization structure. ACOs are intended to promote care coordination and, thus, improve patient outcomes, thereby saving money. Very exciting prospects here.

Immigrants can receive dialysis, but if they need a transplant, they're out of luck. Dialysis costs $75,000 per year. A transplant costs $100,000 and then dialysis no longer is necessary.

A patient loses trust in her doctor due to his ties to pharmaceutical companies.

As Medicare starts assessing penalties for hospital readmissions, hospitals in poor areas will be hardest hit. They can't afford their meds, and that lands them in the hospital more often. It would be so much cheaper to find a way to pay for their meds.

A government panel has asked a medical journal not to publish all of the details of its experiments with the flu out of fear that terrorists will learn from it.

Patients with mental health and substance abuse disorders become counselors for each other. Who better to understand?

When terminally ill patients ask how long they have to live, most often their doctor can't know, finds it hard to say, and is often wrong.

Would reading your medical records improve your health? Patients say yes; doctors aren't so sure.

Wisconsin Governor Scott Walker cut cancer screenings for uninsured women. Love that Christmas spirit. (more sarcasm)

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

For Ellen

2011-12-19T15:22:00.000-08:00

Ellen Payne Osborn was an Advocacy for Patients client, but she was much more that that to me; she was my friend. Many of you already know the "Brad Pitt story." Before I hardly knew her, I heard she was dying to meet Brad Pitt. She was going to be 26 years old and was already very sick. I managed to get word to Brad's personal assistant Ozzie, who became one of our most treasured friends together. Brad and Jen Aniston treated Ellen to a trip to LA where Ozzie made sure she had nothing but the best. It was when she was in Jen Aniston's dressing room when George Clooney bounded in, sat down next to her, and said "and who are you?" Ozzie had set it up perfectly. That's how Ozzie is.

That was 10 years ago. Today, Ellen took her last breath.

I can't begin to imagine the number of minutes we spent on the phone together during those intervening 10 years. Although she was wheelchair-bound, she had to have a pair of red Manolos. I found some on ebay in her size for Christmas one year. She never walked in them, but she wore them. Every single day of her life -- including surgery days -- she put on her make-up and wore something styling. And no matter what -- even lying in a hospital bed -- she made everybody around her laugh. Always. I never spoke with her without laughing.

Ellen sometimes felt like a sister, sometimes like a daughter, always like a friend. I can't imagine life without her in it. Although now I know is time for her wonderful husband Kent and her BFF's to mourn, I, too, miss her already.

We promised each other we would go shopping in New York together. It was on her bucket list. So Ellen, just wait for me, okay, and we'll find Heaven's version of Madison Avenue and charge up a storm, just you and me and your red Manolos.

I'll be taking a break from blogging the news, at least for tomorrow. But she'd kick my butt if I stayed away for long, so I'll be back as soon as I'm able. Until then, say a prayer for Ellen. If ever anybody deserved safe passage to the hereafter, it's you. Jennifer

Monday Musings

2011-12-19T03:11:00.000-08:00

It seems like the week-ends only get shorter. But we have two holiday week-ends coming up, so something to look forward to. And here's the news:

Craziness over the payroll tax cut. There was a deal on Friday -- a two month extension of the payroll tax cut, unemployment and the delay of a major cut in Medicare reimbursement that included speeding up the GOP-favored Keystone Pipeline. But Speaker Boehner says not so fast. He doesn't want a short-term deal and his members liked it even less. But the Senate is supposedly out of session until after the holidays, so if the House doesn't pass the Senate version, does that mean we start the year off with reversion to the regular payroll tax as in years gone by? That's how the White House is painting this -- take the deal or take responsibility for having no tax cut. But the deal increases fees on housing mortgages and refis -- how is this a good thing for the already flagging housing market? And Senate Minority Leader McConnell -- who cut the deal, with the blessing of Speaker Boehner -- now says maybe Dems should be open to alternatives, although Senator Reid says he's not reconvening the Senate over the holidays. Of course, that's not the GOP's objection, but it is a concern. This should be interesting.

In a potentially disastrous move, the Department of Health and Human Services has proposed allowing the states to set their own Essential Health Benefit package, the floor for what all insurance must cover to be sold through the Exchange starting in 2014. Not only does this transfer massive power to Exchange boards, but it allows states like Mississippi and Florida to be stingy when setting requirements. But surprisingly, this proposal hasn't brought the strong opposition I would have anticipated from the advocacy community.

Meanwhile, although some states are moving things along, there are questions about whether they will make the deadline for creating an exchange, and whether the feds will be ready to step in if the states aren't up and running. This is a real worry. There's a lot to do between now and 2014. And the health reform law will be under fire in the election, at the Supreme Court, and in Congress in 2012 -- it will be a tough year for those of us who are committed to coverage of people with pre-existing conditions in 2014. And as long as healthcare execs are the highest paid CEOs, we aren't going to make the progress in controlling costs that we should be making.

A medical practice in California is now charging $350/year for administrative expenses. If you want them to take care of your prior authorizations, provide medical records when needed, fight with your insurance company for you, you have to pay this extra fee. Is this a sign of the future? Ugh.

The painful cycle of eczema -- a nasty chronic skin ailment.

And that's it for today -- a slow news day, perhaps a sign of things to come as we move into the holidays? No news is good news!

Have a great day! Jennifer

Payroll Tax Deal Cut

2011-12-17T05:39:00.001-08:00

So the Senate has agreed on a payroll tax deal, extending the payroll tax cut until February -- but the President has to live with moving forward on the Keystone pipeline. Personally, I think that deal stinks. If the President was going to have to look weak on this by caving on the pipeline, the Dems should have gotten the whole year's payroll tax deal. But the deal includes extended unemployment as well. And now we have two months to see what other totally unrelated concessions the GOP can bleed from the Dems to extend this through the year. Jennifer

Essential Health Benefits

2011-12-16T06:48:00.000-08:00

As you know, under the health reform law, the Secretary of the Department of Health and Human Services is required to design an "essential health benefits" package that will serve as the standard for minimum coverage by insurance sold through an exchange. These are the services that all insurance will have to cover.

Today, Advocacy for Patients submitted detailed comments to the Secretary with our recommendations for the essential health benefits package. You can read our comments here. Jennifer

Finally Friday Edition

2011-12-16T02:36:00.000-08:00

WOOHOO!!! If I get through the next 12 hours, I will have made it through the hardest week ever, albeit a little the worse for wear. So let's get to the news:

Lawmakers have agreed on a spending bill, averting a government shut down. Here are details on the HHS budget. No final decision on the payroll tax and unemployment yet, but they're now talking about a short-term extension rather than a full year. But is it good to cut the payroll tax that finances Social Security? Last year, when this first passed, I warned that this could threaten the Social Security trust fund, and now some others are expressing that concern. In any event, the parties are about $90 billion apart on the payroll tax and unemployment, so they are talking about a two-month deal.

And there's still the huge cut to Medicare reimbursement rates to doctors if Congress doesn't act before the end of the year. This cut would wreak havoc on doctors and patients. But postponing the cut further is very expensive. This would be included in a two-month deal to extend the payroll tax cut and unemployment benefits.

As expected, Paul Ryan released a new plan that would change Medicare by providing a fixed amount of funding per patient, with the patient choosing either traditional Medicare or private insurance. And Dems and advocates resoundingly rejected it. The plan doesn't tell us how seniors are supposed to pay to fund their own health care.

The Obama administration has rejected Florida's request for a waiver of the medical loss ratio rules (which would cap the amount of administrative costs that could be included in insurance premiums). Considering what we see in Florida -- horrible lack of health care and health insurance -- I'm really glad about this decision.

You know I love Dr. Pauline Chen's columns. This one is about what happens to doctors when they get sued -- and 1 in 4 surgeons is currently being sued and 99 percent of doctors will experience being sued at least once in their careers, despite the fact that most medical errors to not result in legal action. This is stressful and expensive for doctors. But I have to say, what about the patients who were harmed by medical errors? Sure, some of these lawsuits are ridiculous, but there are bad doctors who deserve to be sued. Where's the right balance -- the never-ending question.

Health care costs are a key worry for those nearing retirement. Personally, I don't think most of us will ever be able to afford to retire.

The federal government will not fund any more research on chimpanzees.

The health effects of rape are wide-ranging.

A recall on heart defibrillator leads -- if you have a defibrillator, check with your doctor to see if yours is on recall.

There's a real possibility of a nursing strike in Manhattan as the union fights with hospitals over cuts to health benefits. Not a good time to be in a New York hospital. Meanwhile, the Obama Administration has proposed rules that would provide wage and overtime protection for home care workers.

Here in Connecticut, a push is on to reform the long-term care system to accommodate more seniors in the community and out of nursing homes.

Brain stimulation may help stroke victims recover.

Again, I'm trying to stay out of electoral politics, but when there's something you should know, I will provide it. And here's something you should know -- Newt Gingrich's former policy on health care, which is very much like what he's now criticizing. If he'd stop changing his mind, I might actually not be so scared of him.

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

Thursday Themes

2011-12-15T03:21:00.001-08:00

Longest. Week. In. History. Oh, well. Let's check out the news.

Gridlock deadlock on the budget, payroll tax cut extension, unemployment extension, dealing with the major cut to Medicare reimbursement rates because the GOP keeps tacking policy riders onto these bills. Speed up the Keystone pipeline. Travel to Cuba. Abortions in DC. Cut unemployment benefits and federal employees' pay. Means-test Medicare. The White House now wants another short-term budget extension because of all the policy measures attached to the GOP bill, but instead, the House GOP released a massive $1 trillion spending bill. Dems want the payroll tax issue resolved before the budget, but the federal government runs out of money TOMORROW. Dems have dropped their call to pay for the payroll tax cut with a surcharge on millionaires to try to start negotiations, but the two sides are pretty far apart. GOP Senate leader Mitch McConnell won't even let the House payroll tax bill come to a vote, preferring to stall things. Sens. Reid and McConnell met with Speaker Boehner yesterday; Boehner can't negotiate with Reid without angering his members, so it looks like it's up to the Senate to come up with a compromise that can pass the House. What's the end game going to be?

Opponents of health reform are praising the Obama Administration for relaxing some of the rules, waiving the elimination of annual and lifetime limits for mini-med plans, granting waivers of the medical loss ratio requirements in some states. Consumer advocates (like me) are not happy.

As doctors switch to using more technology -- electronic medical records, for example -- they face more distractions and focus less on the patient. I know my wonderful PCP stopped listening to me when a computer turned up in the exam room, but the only way he could use it was to have his back to me. Stupid and thoughtless -- a problem screaming out for solutions.

A bipartisan plan to restructure Medicare, providing a fixed amount the government will pay per person. So people with chronic illnesses with greater medical needs will go broke? Really? This is just the Paul Ryan voucher plan redux.

The Social Security Administration has commissioned an outside review of its disability system amidst complaints that benefits are granted to some who don't need them and denied to some who do. This could be great if it's taken seriously enough.

Nearly 1 in 5 women in America say they have been victims of sexual assault. That's a shockingly high number. Equally (or perhaps more) shocking is a census figure -- nearly 1 in 2 Americans is poor.

Hospitals are trying to control readmissions, even when that cuts into their bottom line.

Statins -- cholesterol meds -- appear to be useful in battling serious flu.

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

Hump Day Headlines

2011-12-14T03:06:00.001-08:00

Only Wednesday? Really? Oh well -- I guess we might as well check out the news.

As you know, there are 3 issues that have to be resolved in the next week or so. First, the extension of the payroll tax cut; second, extension of unemployment benefits; and third, the 2012 budget. Well, the House passed a payroll tax extension, but it contains several "poison pills" that will make it impossible to pass in the Senate, and if it did, the President would veto it. It includes speeding up an oil pipeline from Canada to Texas, block air pollution rules, freeze the pay of federal employees, increase Medicare premiums for people earning over about $85,000/year, eliminate some portions of the health reform law, restructure unemployment so the max would be 59 weeks instead of 99 -- in short, it would do a lot of things that have nothing to do with a payroll tax cut. In addition, if Congress doesn't get its act together and pass a 2012 budget, the federal government will run out of money on Friday. The Dems are still pushing for a payroll tax cut extension that would be paid for with a surcharge on income over $1 million. The general consensus is that this House bill sets the stage for last minute negotiations, and it gives the GOP some leverage. Will the Dems cave again?

Medicaid is responsible for an ever-increasing portion of state spending. With people who are unemployed and have lost their health insurance, it's no wonder that Medicaid is growing. The feds are allowing more and more states to move to managed care, with private HMOs administering the program, but they are tying this approval to improved performance.

A new strategy for catching Medicare fraud up front, before the dollars are out the door. Great move.

Doctors have mixed feelings about health reform, with those under age 40 supporting and those over age 40 opposing. Interesting.

Health reform has allowed 2.5 million young adults to get health insurance. The provision that allows kids to age 26 to stay on their parents' policy has become one of the strongest early provisions of the health reform law.

Remember the CLASS Act, the long-term care insurance part of health reform? A while back, the Administration acknowledged that it is not economically feasible, so they put it on the back burner. Well, some bipartisan lawmakers have come up with an alternative. We'll have to see where this goes.

Hospitals are making sales calls on doctors, just like the pharmaceutical industry does. Interesting.

The Hartford Courant has called for the addition of consumer voices on the health insurance exchange board.

A new New York law bans mandatory mail-order pharmacy benefits, as a boost to small pharmacies. People still have the mail order option, but insurers can't force it on them.

Aid for childcare has dropped, just when people need it the most, in order to stay employed.

Some nonprofits in New York are raking in huge amounts from the state for home care to the disabled. This is how people scam the system and then blame the disabled for being so expensive.

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

I'm Back! Tuesday Tidbits

2011-12-13T03:15:00.000-08:00

Good morning! I made it through my colonoscopy and upper endoscopy, only a little the worse for wear. Now, let's get down to business and the news:

The GOP bill to extend the payroll tax cut includes not only extended unemployment benefits, but it also would repeal portions of the health reform law that crack down on doctor-owned hospitals, which tend to be more expensive for insurers. It also would disqualify millionaires from unemployment and food stamps. There should be a vote in the House today. But according to Politico, neither party has the votes they need to pass this by the end of the week. And then there's the 2012 budget bill, which is being held up as leverage to get the payroll tax through. But here's a scary one -- the GOP is looking to take back health insurance subsidies -- which don't start being paid until 2014 -- to pay for the payroll tax cut. If you want affordable insurance, you need to be against this move. Speaker Boehner says the payroll tax cut will pass. He says most of the bills pay-fors were once supported by the President. But the White House says pushing the Keystone pipeline forward is a deal-breaker. Hospitals say the GOP bill will involve big Medicare provider cuts, and they are not happy.

Don Berwick, the visionary who recently stepped down from a position as head of the Centers for Medicare and Medicaid Services says we should not be blaming Medicare and Medicaid for high health costs -- it's about the health care delivery system, which is in desperate need of modernization.

Our friends at the National Alliance for Mental Illness (NAMI) urge the Secretary of HHS to consider our most vulnerable when deciding what should be included in the essential benefits package.

The General Accountability Office says health funding in the stimulus has created new jobs.

Drug shortages are harming people, including many with cancer who need their chemo drugs. The reasons are complicated and a bit uncertain.

Child homelessness is up 33% in 3 years. This is tragic. We must do better.

Diverticulitis may not require surgery, as new uses for drugs are discovered. Now, try getting your insurance company to pay for them!!! Meanwhile, bariatric surgery may be helpful for teens, but many insurers exclude them.

A doctor explains why it's worth it to spend money to try to save a life. Some say it's a waste when the person dies, but Dr. Bach says no.

Six months ago, I had never heard of PANDAS. Then it was written up in one paper ... now another ... and then today, the Wall St. Journal. It's a condition in which strep throat causes OCD and tics in kids.

Coffee may cut the risk of endometrial cancer in women. This coffee thing makes me nuts -- it's good for this and bad for that. I think this is just one of those things we're supposed to do in moderation.

I saw this yesterday -- a gene therapy has been used to treat hemophilia. The science is new and studies have to be completed, but what an exciting possibility!

Do you eat raw cookie dough? Read this and think again.

And there you go, your morning fix. Have a great day! Jennifer

No blog today

2011-12-12T02:00:00.001-08:00

I'm getting ready to go to New York for a colonoscopy and upper endoscopy, so I can't do my usual blog today. I'll be back hopefully tomorrow, or Wednesday at the latest. Thanks. Jennifer

Advocacy for Patients in the Supreme Court

2011-12-09T13:00:00.000-08:00

Connecticut-based Advocacy for Patients with Chronic Illness files “Friend of the Court” brief in the United States Supreme Court Health Reform Case

Stating that “universal guaranteed issue, community-rated insurance is the promise of equal access to health insurance and, thus, health care for the chronically ill,” Connecticut-based Advocacy for Patients with Chronic Illness has asked the United States Supreme Court to uphold the health reform law’s requirement that everybody purchase insurance because that requirement is essential to obtaining coverage of people with pre-existing conditions.

Jennifer Jaff, the group’s Executive Director, stated that the health reform law creates a three-legged stool that will guarantee people with chronic illnesses can purchase insurance.

First, the law requires coverage of people with pre-existing conditions. The brief states:

Requiring insurance coverage of people with pre-existing conditions arguably does more to advance the cause of people with largely invisible chronic illnesses than any other law, including the Americans with Disabilities Act. 42 U.S.C § 12010, et seq. Some of us who are disabled will regain our health and our ability to contribute to society by working and earning our way. Others of us will be rid of unimaginable suffering and fear. Nothing Congress is empowered to do would provide more critical legal protection to people with pre-existing conditions, including chronic illnesses.

To achieve this goal, though, Congress had to construct the second leg, requiring people to purchase insurance to ensure that there would be healthy people in the insurance “pool” to control the cost of insurance; as well as the third leg, the affordability provisions, including community rating and advance payment tax credits (subsidies), to ensure that the cost of purchasing insurance would not be more than Americans can afford.

Using stories of some of the real people who have approached Advocacy for Patients for help, the brief seeks to illustrate the harm to chronically ill Americans of not having accessible, affordable health insurance.

· a woman with hepatitis C and cirrhosis of the liver who was laid off from her job of fourteen years. Her insurance was terminated coincident with the termination of her employment, as is the norm. She had to get her weekly injection of interferon, but she had not yet received her COBRA notice and hence was not HIPAA eligible, and she had no way to cover the cost of this injection; the provider would not treat her without active insurance.

· a woman with a genetic illness that affects her blood’s clotting who has been unemployed for two years, and although she exhausted her COBRA benefits, she cannot afford her state’s guaranteed issue option, which would cost more than $1000 per month, and is no longer HIPAA eligible. She was rejected by Medicaid for having $30 too much in her bank account.

· a young man called because the local county hospital told him that he probably has Crohn’s disease, but he could not receive a definitive diagnosis – and, thus, treatment – without a colonoscopy, which he cannot afford.

· a woman with reflex sympathetic dystrophy (also known as complex regional pain syndrome) who was diagnosed after her insurance went into effect, but the insurer took the position that she had to wait a full year before any services for her pre-existing condition would be covered.

· another woman wrote for her friend whose husband lost his job and, thus, his insurance; her friend has lupus and cannot afford any health care, without which she will die.

“Health insurance reform is a civil rights issue for us,” says Jaff. “It marks the end to legal discrimination against people with chronic illnesses, who cannot buy insurance for any amount of money.” The brief strongly urges the Court to find that the law was well within Congress’s power to regulate insurance by requiring coverage of pre-existing conditions, and to execute laws necessary to exercise that power, including the requirement that everybody purchase insurance.

The brief was co-authored by Michael D. Lieder of Sprenger & Lang, PLLC, in Washington, DC. The full text of the brief can be found here. For further information, please contact Jennifer Jaff at (860) 674-1370.

P.S. - The Connecticut Mirror writes about the brief here. J

Finally Friday Edition

2011-12-09T02:30:00.001-08:00

And so, at last, it's Friday! Tomorrow is rest, Sunday is prep day, and Monday are scopes. But first, the news:

The GOP payroll tax cut plan is out. Despite President Obama's veto threat, it's tied to the Keystone Pipeline and rolling back environmental regulations, while paying for the tax cut with increases in Medicare premiums for the rich, shrink the size of the federal workforce, and end food stamps and unemployment for millionaires. And everybody knows it can't pass the Senate. Meanwhile, a Dem proposal, that would pay for the tax cut with a surcharge on incomes over $1 million also was rejected by the Senate. Can Congress get anything done before the end of the year? Speaker Boehner has a tough time getting the votes in the House without spending cuts. But eliminating government jobs in a jobs bill? Really? And there are Dems that support the Keystone pipeline (oil from Canada through the US). But does that belong in a jobs bill?

There's also the impending massive cut to Medicare's reimbursement rates if Congress doesn't act by the end of the year. The GOP has put together a deal to delay the cuts for 2 years by repealing unspecified portions of the health reform law and increasing Medicare premiums for high income seniors.

And then there's an extension of unemployment benefits, which also runs out at the end of the year. Protesters call on Senator Lieberman to make this happen.

Some GOPers are trying to force Justice Elena Kagan to recuse herself from hearing the challenge to the health reform law, which would all but guarantee that the law is struck down. They say she worked on the legal strategy for the law when she was Solicitor General, and they've demanded documents -- calendars, notes -- so they can comb through them for support. However, Attorney General Eric Holder says this violates separation of powers, and they should be requesting those documents as part of the court case rather than through the executive branch.

The Department of Health and Human Services rolls out $1.4 million in grants for school-based health clinics. However, states have cut Community Health Center funding -- critical safety net health care for the poor and uninsured.

The President defended Secretary Sebelius's decision to limit the sale of the morning after pill so that kids can't buy it without a prescription. Meanwhile, an FDA advisory panel recommends stronger warnings of blood clots for contraceptives Yaz and Yasmin. However, they back the overall benefits of these birth control pills.

The Pentagon opposes a mental health program for the National Guard. This is so despite an increase in suicide rates among the Guard.

Don Berwick's first speech after leaving the Centers for Medicare and Medicaid Services takes on his opponents, blasting the phony "death panel" accusations, and noting that those who say he favors rationing are also in favor of major cuts to Medicare and Medicaid. He says Republicans are the real rationers.

Which states spend the most on health care? Here's your answer.

The great Dr. Pauline Chen tells us about a web-based campaign to raise funds for cancer prevention using social media. Fabulous.

Night shift work may raise the risk of type 2 diabetes in women.

Right in the middle of a recession, Connecticut's Department of Social Services asks the feds for permission to cut Medicaid for low income adults -- because enrollment is expanding greatly. This would leave low income adults without access to health care.

And that, my friends, is the news. Look forward to a big deal post later in the day. In the meantime, have a great day! Jennifer

Thursday Themes

2011-12-08T03:09:00.001-08:00

Brrrr. It's definitely winter in Connecticut this morning. Still, we have the news:

Politics is ruling the day on the payroll tax cut, as well as other year-end business, with leaders threatening to stay in session over the Christmas holidays if need be. But nobody's even pretending the that this is not about politics and the Presidential election. The President has warned that he will veto a bill that ties the payroll tax to the Keystone Pipeline. Indeed, he said any effort to tie the payroll tax to another, unrelated matter will be rejected. The President is meeting with House Dems today. He also has said he will forgo his Hawaii vacation if the issue is not resolved. Speaker Boehner says the GOP is working on their own proposal. Speaker Boehner is trying hard to find a solution that his own party can live with. Meanwhile, Congress is trying to finalize a deal on the 2012 budget; the current temporary funding measure expires on December 16.

Secretary of Health & Human Services Kathleen Sebelius rejected the FDA's recommendation to make the morning after pill available at any age. Right now, girls age 16 and 17 still need a prescription for it, while others do not. The FDA recommended lifting the age restriction. No HHS Secretary has every publicly overruled the FDA before. Meanwhile, the White House is still pondering a regulation that will provide an exception for religious objections to the requirement that contraceptives be provided for free -- should the exception cover any employer with any religious affiliation, or just churches?

Interesting patent case. Prometheus labs developed tests to help doctors calibrate the proper dose of 6 mercaptopurine (6MP) and azathioprine. Then the Mayo clinic came up with a test for the same thing. Prometheus says this is patent infringement. Mayo says this is medical research. The Supreme Court will decide.

A scientific panel has found few environmental triggers for breast cancer. Meanwhile, two new breast cancer drugs are in the pipeline with promising results. These drugs, when used in combination with other drugs, appear to slow the progression of disease.

Crowded emergency rooms drive patients to thriving urgent care centers. This is a good thing; urgent care centers often can provide the help needed but for far less money.

California plans an overhaul of its mental health system.

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

Hump Day Headlines

2011-12-07T03:52:00.000-08:00

Went out to dinner with a friend last night. The food definitely did not agree with me, which is why the news is a little late this morning. But here goes:

They're still bickering over the payroll tax cut. The GOP is split on what to do. Some say they this would worsen the deficit; others say the party that's been pushing cutting taxes for the rich can't deny a tax cut to the middle class. Here's a helpful graphic that shows the competing positions. The President gave a rousing speech yesterday in Kansas calling for a return to middle-class values. He said that income inequality is the defining issue of our time.

Among the issues that must be dealt with by the end of the year is the scheduled huge cut to Medicare physician reimbursement. The hope had been for a permanent "fix" rather than another delay, but the House GOP says no way.

Medicare enrollment is skyrocketing. The deadline for enrolling has been extended for anybody who contacts one of the organizations that enrolls people by the end of the day today. You can call 1-800-633-4227 or call the Medicare Rights Center at 1-800-333-4114. As long as you at least leave a voicemail by the end of today, you can still be enrolled until midnight on Saturday.

Contrary to the belief that the Presidency adds years onto your life, a new report says that Presidents live longer than most men of their age.

The FDA could decide today whether to lift age restrictions on the "morning after pill," which would mean bringing it from behind the counter to the public shelves of the pharmacy.

Believe it or not, that's all I have for you today. Not a whole lot of health news this week, it seems. Oh, well. Maybe that's a good thing. Anyway, have a great day! Jennifer

Health Reform at Work

2011-12-06T07:52:00.000-08:00

A great story about the good health reform has done. But read the comments -- so hostile, so uneducated, so baseless. When are we going to learn to be more compassionate, not to mention informed? Jennifer

Tuesday Tidbits

2011-12-06T02:51:00.000-08:00

This week already feels too long. I think it's anxiety about my scopes next Monday -- or more specifically, the prep on Sunday. But before that, the news:

A bipartisan proposal would extend the payroll tax cut and provide funding for roads and bridges -- the best way to create jobs in this economy. But will it pass? It's once again paid for by a tax surcharge on income over $1 million. This appears to be the only tax cut the GOP is against, although both Mitt Romney and Newt Gingrich support it. The GOP plans to offer their own proposal today, paying for the cut by cutting federal employee wages, cut Medicare for the wealthy. According to Politico, this is all posturing before the final push next week. Meanwhile, GOP Senator John Kyl says the only way we keep the payroll tax cut is if we renew the Bush tax cuts. Yup, those big tax cuts that favor the wealthy -- and that nobody has ever even tried to pay for.

Did you know that Medicare penalizes people who don't sign up when they first become eligible? It's really important to know how Medicare works if you're near eligibility. Also, Medicare is going to allow its data to be used to rate doctors and hospitals.

The health reform law is changing behavior - for the better. The Part D doughnut hole is a lot smaller. People are going for free preventive care. Meanwhile, a bill has been introduced that would allow cameras to broadcast the Supreme Court arguments on the health reform case.

A Senate panel today is hearing testimony on the proposed merger to ExpressScripts and Medco, two massive pharmacy benefit managers. Keep your eye on this one, folks -- this may dictate how you get your meds for the rest of your life.

A patient was removed from the liver transplant list because he uses medical marijuana. This is thoroughly outrageous! They say it's because marijuana might cause a problem post-transplant, but the drug counseling they want to force on the patient has nothing to do with mold; it's purely about treating medical marijuana -- prescribed by a physician -- as a street drug.

The shortage of nurses may be ending, as more nurses join the workforce.

Some employers base health insurance costs on salary -- you get paid more, you pay more. The wave of the future? Hmmm.

Understand the aging brain and take care of what you've got.

Should the "morning after pill" be available over the counter, on open shelves, so you don't have to discuss it with the pharmacist?

I'm not sure I buy this. This article says left-handed people have a greater chance of ADHD, mental illness. I know some pretty impressive left-handed people. Hmmm again.

And that's today's news -- another slow news day. Have a great one. Jennifer

Medi-Cal to Provide Enhanced Mental Health Services

2011-12-05T14:09:00.000-08:00

For Immediate Release

Monday, December 5, 2011

Contact: Vincent Eng

+1 703 981 6636

media@healthlaw.org

Settlement Puts Community-Based Mental Health Services for Foster Care Children on the Medi-Cal Menu of Services

Agreement in Katie A. will provide mental health services to California children in, or at risk of entering, nation's largest child welfare system

Los Angeles, CA - Federal District Court Judge A. Howard Matz today approved a landmark agreement between advocates and the state of California that will provide intensive home- and community-based mental health services for children in foster care or at risk of removal from their families. The agreement in the class-action suit Katie A. v. Bonta comes nine years after the case was first filed.

Under the ground-breaking settlement, California will make two types of mental health services, "Intensive Home-Based Services" and "Intensive Care Coordination," available to certain children under Medicaid. The state will also determine what parts of "Therapeutic Foster Care" services are covered under Medicaid and provide that service to certain class members.

"These services will ensure that thousands of Medicaid-eligible children obtain access to the mental health services they need to live in a family and succeed in school and later life," said Robert Newman, attorney for the plaintiffs, from the Western Center for Law and Poverty.

The settlement also requires California to improve its system of care for providing mental health services to foster youth by coordinating decision-making among state and local agencies, improving guidance to mental health care providers, and developing a consistent team approach to meeting the needs of eligible children and youth and their families.

"This agreement will improve children's access to mental health care and lower government costs. But, the hard work of doing what is promised in the Agreement remains," stated Patrick Gardner, an attorney with the National Center for Youth Law.

Implementation of the Agreement must be achieved within 3 years, a relatively short period of time for such a large statewide system. "We commend the state for agreeing to an accelerated schedule for getting these services in place," said Kimberly Lewis, an attorney with the National Health Law Program. "We will be doing what we can to ensure that the state is successful in meeting its deadlines."

Judge Matz also noted the aggressive timetable, and made a commitment to assure that deadlines would be met "without any extension." The first milestone in the Agreement is completion of an implementation plan within 6 months.

"The settlement brings California into line with modern mental health practice," stated Ira Burnim, of the Bazelon Center for Mental Health Law. "We are delighted to see the process begin that will put into place a system that will address the mental health needs of thousands of California's most vulnerable children."

The children in the plaintiff class are represented by the Western Center on Law and Poverty, the National Center for Youth Law, Bazelon Center for Mental Health Law, Disability Rights California, the American Civil Liberties Union of Southern California, and the National Health Law Program.

The Settlement Agreement can be found here.

Judge Matz's Stipulated Judgment Order can be found here.

###

Founded in 1969, the National Health Law Program works with and on behalf of limited-income people, people with disabilities, and children to improve their access to quality health care and to enforce their legal rights to health. NHeLP works with courts, government agencies, and Congress to ensure quality health care for the most vulnerable members of our society.

www.healthlaw.org

Monday Musings Already?

2011-12-05T03:14:00.000-08:00

Monday already? Oh, boy -- another long and busy week ahead. But first, the news:

Congrats to our friend Mike McCready for running the Las Vegas half marathon to benefit Crohn's disease and ulcerative colitis.

On his way out of office (see Friday's post), Don Berwick said 20 to 30 percent of health spending is wasteful. We have to find a way to get that under control.

Rumor has it that Senate Majority Leader Harry Reid will announce a compromise on the payroll tax cut extension today that will pay for the tax "in a serious way," whatever that means. John Boehner may make his own proposal -- and there may be a package that includes extending unemployment and further delaying the huge cut to physician reimbursement rates under Medicare.

A health reform lawsuit plaintiff has her case mooted out, meaning she's no longer a small business owner and instead, she'd be eligible for subsidies to help her pay for health insurance, thereby negating her claim that she'd somehow be harmed by the law.

Juan Williams says neither Mitt nor Newt can get away with claiming they were against a health insurance mandate. It would be interesting if we had a GOP presidential candidate who favored the mandate, no?

HHS did not change the medical loss ratio (percentage of premium dollars spent on health care) despite the National Association of Insurance Commissioners' vote to shift agents/brokers to the health care side instead of administration. This is great news. The final rule also requires public disclosure of how health care dollars are spent.

Can strep cause an illness characterized by tics and obsessive-compulsive disorder, called PANDAS? I have 3 insurance appeals pending involving PANDAS, so I say yes.

Cancer patients who are obese or have type 2 diabetes have a worse prognosis than others.

More exercise means better sleep.

Med students wash their hands, but the habit decreases as they get more experience.

A patient safety expert has his own brush with the medical establishment -- and was pleased.

And that's it for today -- a light start to the news week. Have a great day. Jennifer

Thanks and So Long to Dr. Don Berwick

2011-12-02T08:10:00.001-08:00

President Obama's choice to run the Centers for Medicare and Medicaid Services (CMS), Donald Berwick, was opposed by Republicans who alleged -- inaccurately -- that he is in favor of rationing health care. Thus, the President made a recess appointment which, by law, can only last one year. Today is Dr. Berwick's last day. To read about his top five accomplishments, go here.

We here at Advocacy for Patients wish to thank Dr. Berwick for his public service. He has made a major contribution to health care in the United States -- one that will continue to pay benefits for many years to come. Jennifer

Finally Friday Edition

2011-12-02T02:18:00.000-08:00

Wow -- what a long, strange week it's been (homage to the Grateful Dead). Crazy busy. We did 11 intakes yesterday alone! I'm going to need more lawyers and bigger offices if this keeps up! But first, the news:

Dems are very focused on extending the payroll tax cut, paying for it with a surplus on the 350,000 Americans who earn over $1 million per year. However, in the Senate, the GOP blocked a vote on the measure -- and the Dems think this is a political advantage, demonstrating that the GOP favors the wealthy. The Senate also rejected a GOP proposal to pay for the cut by reducing the size of the federal workforce. There's a second GOP proposal that would pay for the tax cut by making millionaires pay for Medicare. In my opinion, the only advantage to be gained here is on behalf of the American people. Playing politics has gotten us nothing but gridlock. And there's still the matter of extending unemployment benefits before the end of the year; if they don't, an estimated 1.8 million Americans will lose their benefits. Politico says the GOP is getting ready to cave on the payroll tax, unemployment, and the remaining 2012 budget bills. The Hill says the GOP is split, with rank-and-file bucking leadership on these issues. We'll see -- it would be nice if Congress could end the year by actually doing something.

Over 2400 people have signed a letter to the Department of Health and Human Services urging them to reject the Institute of Medicine report on essential benefits. At issue is the essential benefits package, which will set a floor for what insurance must cover. The IOM focused a lot on cost and urged HHS to ensure that insurance is affordable. The 2400 people who signed this letter say the IOM's approach would cause great suffering by limiting benefits. They also alleged that many on the IOM committee have conflicts of interest in that they work for insurance companies.

Connecticut's own Kevin Galvin has asked the Secretary of HHS to intervene in Connecticut's fight over the composition of the Exchange Board. Many of us are very disappointed that there are three former insurance industry executives on the Board and no consumer reps. We are working on various strategies to deal with this. Kevin is at the forefront, as he has been throughout the years we've been fighting for health reform. Bravo Kevin!

Enrollment in Medicare Advantage Plans continues to grow. There was speculation that health reform would hurt these plans, but it doesn't seem to have happened.

The NY Times has featured a story about the Freelancers Union, which offers health insurance to independent contractors and freelancers in New York State, and is branching out in the coming year, creating co-ops around the country. We've been telling people about this organization for years. I just wish they were in all 50 states.

Yesterday was World AIDS Day, and the President celebrated with a pledge to increase funding for AIDS research and treatment.

Although it's illegal to sell your organs for transplant, a court has said it's okay to sell your bone marrow for stem cell harvesting. The Court said it's more like giving blood than giving an organ.

The wonderful Dr. Pauline Chen has written about doctors as poets. Does poetry make doctors better at their job? Fascinating.

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

Thursday Themes

2011-12-01T02:57:00.001-08:00

A rush this morning -- an early meeting outside the office and piles of work to be done. So here's the news, fast as I can:

Big shock -- the parties are split on extending the payroll tax decrease. The GOP wants to pay for it by freezing the pay of federal employees and gradually shrinking the federal workforce; the Dems (and a handful of GOP) want to pay for it by raising revenue from a surtax on incomes over $1 million. Meanwhile, Dems are also pushing for an extension of unemployment benefits before they run out at the end of the year.

States are moving towards setting up their health insurance exchanges (online marketplaces, essentially), including some states who are suing to strike down the law. Now, 29 states have accepted exchange planning grants from the federal government.

Hospitals are hiring as health reform continues to drive job growth in the health care sector.

Will there be Supreme Court recusals in the health reform case? The left wants Clarence Thomas out because his wife's job is to oppose health reform and he "forgot" to report her income on his financial statements for many years. The right wants Elena Kagan out because she was Solicitor General when the law was passed and they allege -- with no evidence -- that she participated in designing the legal strategy to defend the law. My prediction: Both will hear the case.

Fewer children lack health insurance now, with 1 million kids getting insured in the past three years. Health reform has been a key to getting this done.

The Governors of Rhode Island and Washington have asked the federal government to reclassify marijuana so that it can be used legally for medical purposes.

New York City wants to get meds to people with HIV sooner to stop the spread of AIDS.

Here's a troubling one. Cedars Sinai Medical Center is going to eliminate all psychiatric services. It's already hard enough to get insurance coverage of psych services; now, they will be harder to find, even if you have the money to pay for them.

Highmark (Blue Cross) and UPMC (the largest health care provider in the Pittsburgh area) are battling over provider reimbursement rates. State legislators are considering stepping in to referee the fight.

Should you be able to sue for emotional distress when a federal agency discloses your health information to another agency? The Supreme Court heard argument yesterday, so we'll have to see where they end up.

A Medicare anti-obesity plan raises questions about how to treat obesity. Now, doctors can be paid to provide weight-loss counseling, but most of them are not trained in how to do so. I say obesity is an eating disorder and should be treated as such.

Wheelchair accessible taxis will begin to be available in Connecticut, but advocates -- including our friend Michelle Duprey -- are still fighting, saying the number the Department of Transportation has approved is still too low to meet demand.

And there you go -- in record time, and I don't think I missed anything! Have a great day! Jennifer

'Tis the Season

2011-11-30T06:34:00.000-08:00

Dear Friends:

As you know, Advocacy for Patients provides FREE help to people with chronic illnesses nationwide. Whether it's a health or disability insurance appeal, an employment discrimination matter, a kid whose school isn't helping them battle through a bout of illness -- really anything related to chronic illness -- we work for free. It just feels wrong to charge someone in crisis; if we charged, many of the people who need our services would have nowhere to go. So providing services for free is a basic piece of our work ethic.

People ask me all the time how we get our funding. It's true that we do get a few small grants, but they are small, and they tend to fund special projects rather than our ongoing work. The people who fund our day-to-day work are clients, families, friends. We run on the $50 and $100 checks people write to us. Really.

This year, we had to hire a second lawyer to keep up with demand, and then we had to move into commercial office space because we ran out of room in my house. That means we're over budget and under income. It also means that we have to raise a lot more next year than ever before.

If you read this blog every day, if you've used our services, if you've recommended us to a friend or family member, or if you just plain like what we do, please take a moment and show your support today. Even if you can only give $10, it will help more than you know. You can donate through PayPal from our website, here. Or you can send a check to Advocacy for Patients, 195 Farmington Avenue, Suite 306, Farmington, CT 06032.

I don't post major public requests for support very often. The fact that I'm doing now is not out of choice; it's out of necessity. Without your help, we cannot keep doing what we do. So please, give generously. Thank you.

Jennifer

Hump Day Headlines

2011-11-30T03:01:00.000-08:00

Had a lot of fun speaking at UConn Business School last night. Today's an ordinary day, though, so we start with the news:

First, the payroll tax cut. The NY Times points out that the GOP is in favor of extending the Bush tax cuts for the wealthy, but they're against extending the far less expensive payroll tax cut unless it's paid for. The Dems have proposed paying for it with a tax on incomes over $1 million. Some GOPers seem to be willing to consider extending the payroll tax cut, but they want to find other ways to pay for it. They say taxing millionaires will hurt small businesses.

Many states that oppose the health reform law are taking federal money to implement it. Here are some specifics. A touch hypocritical, no?

Eric Cantor has praised President Obama's pick to run the Centers for Medicare and Medicaid Services, Marilyn Tavenner. Surely, this is a strong sign that she will sail through the confirmation process.

Only 28% of Americans with HIV are receiving optimal therapy. This is scandalous, no?

Kids are being fed in schools as their parents are laid off and can't afford to feed their families. While I'm glad the schools are stepping in, I'm disgusted that it's come to this.

The YMCA -- one of the nation's largest day care providers -- is promoting healthy living standards with nutrition and exercise.

Hallucinogens and other street drugs are being tested for medical uses. Hey -- when you're sick, whatever works!

Medicare is going to start paying for obesity prevention as a way of trying to cut overall costs. Along those lines, it's a struggle to get obese kids to lose weight. I know -- I was one, and here I am, still obese (although I hate that word), still struggling every single day.

A women's health clinic in Rome, Georgia provides free care to those in need.

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

Need Help Getting Around?

2011-11-29T10:49:00.000-08:00

Message from Metro Taxi:

Beginning in December, Metro Taxi will launch a fleet of brand new wheelchair accessible taxicabs that are spacious and comfortable. The individual using the wheelchair is secured in the front passenger position next to the driver. This newly-produced taxi, the MV-1, will be in addition to our existing accessible taxis. We will provide service to our current territory, which covers Branford, Bridgeport, East Haven, Guilford, Hamden, Meriden, Milford, New Haven, North Branford, North Haven, Orange, Stratford, Trumbull, Wallingford, West Haven, and Woodbridge.

The MV-1 taxi was designed to be an accessible taxi and is not retrofitted. Metro Taxi, because of its concern for the environment, chose to have these vehicles come factory-equipped powered by Compressed Natural Gas (CNG), a U.S. produced alternative fuel with much lower carbon emissions. The MV-1 is the state-of-the-art in accessible, environmentally friendly transportation. Metro Taxi has brought them to Connecticut.

For more info, contact Kris Barber, Disability Advocate, at kris@metrotaxict.com.

Tuesday Tidbits

2011-11-29T02:55:00.000-08:00

Gonna be a super busy day, ending with a talk at UConn Business School, which should be fun. But first, the news:

The Dems are moving on extending the payroll tax cut. They propose to pay for it with a tax on people earning over $1 million, so the GOP is against it -- big surprise. This is all kind of silly because the payroll tax goes into the Social Security trust fund, not the general treasury, so the issue of paying for it is really a non-issue. But this is our Congress.

Will the Supreme Court allow arguments in the health reform case to be televised? Probably not -- but if they do, you know I'll be stuck to a TV screen that day.

Medicare payments to doctors are set to drop by about 39% on January 1 if Congress doesn't act to delay the cuts, as they have done several times before. If they don't, look for more and more doctors to refuse to participate in Medicare -- a huge blow to a critical program. In good news, it appears that President Obama's nominee to take over the Centers for Medicare and Medicaid Services (CMS) is being well-received, even by the GOP.

Want to know what the automatic cuts are that will kick in because of the supercommittee's failure to reach an agreement? There's some pain in it for everyone.

A cure for AIDS? The stories of two patients suggest this may be a reality. Wouldn't that be awesome?!

States are being cautious in setting up exchanges in light of the possibility that the Supreme Court will strike down the law. Some states are moving ahead; others are waiting. My bet is that this part of the law does not get struck down. States should be moving. Meanwhile, the feds have denied applications for waivers from Indiana and Louisiana, who wanted out from under the medical loss ratio requirements (percentage of premium dollars spent on health care). Good decision.

I've been keeping away from campaign news, but this one is too good -- What do Obama, Romney and Gingrich have in common? They all favored health reform, including the individual mandate!

Four drugs case the most hospitalizations in older Americans -- Coumadin, insulin, and other blood thinning and diabetes meds.

Is your dentist over-treating you? I've thought this about mine for a long time.

A medical mystery, a diagnosis -- and then what?

Has a medical test result of yours ever gotten lost? I don't think this has ever happened to me, but I'd sure be unhappy if it did.

Tips on avoiding getting sick this winter. Number one: wash your hands.

Geriatricians -- under-utilized, ignored, but really important. They believe in having end of life discussions openly and frankly with patient and family.

Music therapy can retrain an injured brain. It's not bad for a healthy one, either!

Generic Lipitor goes on sale this week. Read the instructions.

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

Monday Musings

2011-11-28T03:06:00.000-08:00

I am thoroughly bummed about being back at work. I think I'd have been in really good shape with another couple of days. But you gotta do what you gotta do, so here I am, in the office at 6 am, trying to psych myself up. Will the news help or hurt? We're about to find out:

We're back to the fight over whether to extend the payroll tax cut. You've been paying less than the norm of FICA tax throughout 2011. Will this cut be extended to 2012? We may find out later this week, but the GOP is already saying it didn't lead to job increases, so no reason to extend it. If it's not extended, you'll pay about $1000 more in tax in 2012 than you did this year. Some GOPers say it will pass. Others say no way.

And then, of course, there's still the rest of the 2012 budget to agree on. Five agencies are set for the year, but the rest are only funded through December 16. Can Congress agree on anything?

Okay, you can be scared now. A bipartisan group of members of Congress are favoring providing Medicare beneficiaries with a lump sum to buy Medicare insurance rather than providing it through the government. A gift to the insurance industry. And if you think you'll get coverage of the same things through insurance that you get through Medicare, think again. This is a disaster. We must speak up and be heard on this one.

Meanwhile, because the GOP blocked the appointment of the most qualified person on earth to run the Center for Medicare and Medicaid services, Dr. Donald Berwick, he steps down this Friday as his recess appointment expires. This is a huge loss for America. The GOP claimed he was in favor of rationing health care. He never said that. He is a visionary and has launched several pilot programs to test new health care delivery systems during his tenure in office. It's a shame that we will lose his inventiveness when we need it the most. The President has nominated Berwick's deputeee, Marilyn Tavenner, whose experience lies in management rather than policy.

A fight over who should hear the health reform case. Should Clarence Thomas recuse himself from hearing the challenge to the health reform law because his wife is an active opponent and he "forgot" to report his wife's income for several years? Should Elena Kagan recuse herself from hearing the case because she was Solicitor General when the law was passed and some claim (without evidence) that she engaged in discussions of legal strategy to support the law? No way will one be recused without the other; doing so would ensure a victory for the other side.

Safety net hospitals lack electronic medical records, which means doctors have to hope they guess right about a patient's medical history. They say they are flying blind. I do not want my doctor flying blind, ever.

A push towards state regulation of insurance premium rate hikes in California. This needs to be national.

Taking too much Tylenol (acetaminophen) can harm your liver and ultimately kill you.

The growth in school-based health clinics. Making sure kids have a place to go to get free or discounted care.

Three confirmed cases of swine flu. Have you gotten your flu shot yet?

Employers are creating incentives to prod employees to improve their health, stop smoking, lose weight.

Doctors are being paid by pharmaceutical companies. Can you say conflict of interest?

A candid and poignant story about living with severe mental illness. Really, not so different from living with any chronic illness -- baby steps, one at a time.

Success means borrowing other people's expertise, not trying to do it all yourself. I have trouble with delegating, but at times, you have no choice. Anybody know how to build an App for Advocacy for Patients?!!!

Medicare open enrollment ends on December 7. Please don't forget. This year's doughnut hole is a lot smaller due to health reform. So pick your plan wisely and look forward to reaping some of the benefits of health reform.

And that's how our week begins. Have a great day! Jennifer

Turkey Day Edition

2011-11-24T05:28:00.000-08:00

No news today -- just thanks. I am grateful to every one of you who reads this blog. For the most part, I don't know who you are, but every once in awhile I get an email from someone I don't know telling me they've been following my blog -- so I know you're out there.

I understand chronic illness from the perspective of a patient and from the perspective of someone who tries to help others with chronic illnesses. I understand 24/7 pain, nausea, and fatigue that is overwhelming.

But I still believe that every one of us has something to be thankful for. A friend. A family member. The sun. A pet (I am most thankful for my Emily). Waking up in the morning. Sleep. A home. A bed. A doctor. A child's smile. The randomness of it all. Acceptance.

So today, focus on the one thing in your life that you are thankful for, and let everything else fade away, just for today. Just today.

Have a wonderful Thanksgiving. I am thankful for you. Jennifer

Thanksgiving Eve Edition

2011-11-23T03:35:00.000-08:00

One. More. Day. But first, the news.

There's a lot of commentary on the failure of the supercommittee. Conservative groups are pleased because it means the GOP stood strong on tax increases. Others say the supercommittee members had the worst week in Washington. Some say the supercommittee was doomed from the start. A Gallup poll says Americans are split on whether to blame GOP or Dems.

Politico says the Medicare genie is now out of the bottle, meaning that it's becoming politically acceptable to talk about ways to cut Medicare spending. The devil here is very much in the details. But no question that health care is on the chopping block.

The President has switched gears from the supercommittee to an extension of the payroll tax deduction. Expect your paycheck to shrink if this doesn't pass by the end of the year.

The GOP is pressing Justice Kagan to release records in an attempt to show that she was involved in planning legal strategy for health reform when she was Solicitor General. Of course, if they were to succeed in getting her off the case, they surely would win the case. An end run around the Constitution?

Really bad news. The National Association of Insurance Commissioners has voted to urge the feds to include agent/broker commissions on the health care side of the medical loss ratio equation. The medical loss ratio is the percentage of premium dollars spent on health care. Plans have to spent 80% (individual) or 85% (group) of premium dollars on health care or they have to pay rebates to members. The remaining 20 or 15% represents administrative costs. Until yesterday, there was agreement that agent/broker commissions were on the administrative side. Yesterday, NAIC voted to move them to the health care side, which undermines the effort to curtail rate hikes. Bad news for consumers.

The US spends 2.5% more on health care than other countries, and we aren't getting a lot of bang for our buck.

Interesting piece -- emergency doctors warn of challenges in different payment models like medical homes. If a primary care doctor is being paid per episode rather than for each individual service, where does the ER doc come in?

A compelling story of a family's journey into long-term care for a 52 year old who suffered brain damage when he was a child.

If you're like me, the fat gene runs in the family. But that doesn't mean you can't conquer the demons.

Giving thanks helps your psychological outlook. And so, dear readers, I give thanks for YOU!

Have a great day, and a wonderful Thanksgiving. See you next week! Jennifer

Day Two of Three Edition

2011-11-22T03:16:00.000-08:00

Two more days -- I know we can make it! But first, the news:

The supercommittee waited until after the markets closed yesterday to announce that they would not be able to come up with a deal by tomorrow. We, the people, are disgusted, but not surprised. As you know, the law had a trigger, so if the supercommittee failed, there would be an automatic $1.2 trillion in cuts taking effect in 2013, after the election. The President had faith that the GOP would never agree to the revenue raisers that a real deficit cutting plan requires, so he decided to leave it up to the voters. And now, we get to see the blame being cast in both directions. World markets tumbled, so hold onto your hats for the US market reaction today.

The supercommittee's failure doesn't mean there will be no more talk of Medicare and Medicaid cuts; it means the discussion has to be different -- but brace yourself, because it's going to happen.

The next battle? Stimulus provisions that will expire at year end. You may not remember this, but you've been paying less in FICA tax this whole year. If Congress doesn't act, you'll go back to your usual tax rate, which will increase your taxes about $1000 over the year. In addition, the extension of federal unemployment benefits will expire.

And then there's the "doc fix." Medicare payments to doctors are set to decrease by about 30% at the end of this year. This cut has been postponed many times. Will it be postponed again? Not a lot of time to figure this out.

Insurers are worried -- rightly -- that the Supreme Court will strike down the individual mandate, but leave the rest of the law intact. As I will keep explaining until I'm blue in the face, if you want to cover people with pre-existing conditions -- expensive people -- you need a pool that also includes healthy people, which is why the individual mandate was creates. And to have an individual mandate, insurance must be affordable, which is why subsidies were created. Everybody agrees pre-existing conditions should be covered. But you can't be for that and against the mandate. You just can't.

Being thankful improves health, so teach your kids to be grateful. There's your Thanksgiving gift from me (and WaPo).

Some are looking to Medigap plans to try to curb Medicare spending. They believe that people with supplemental plans that pay their copays use more health care than they need. As miserable as it is to get involved with the health care world these days, I don't believe this for a second.

More employers are using high-deductible health insurance plans. That just means more people will go without health care, moving us in the wrong direction. Indeed, health costs are falling due to the recession.

AIDS deaths are new infections are down worldwide. Wonderful!

New clinics are a real alternative to the emergency room.

A judge in the Bronx has devised a model that he hopes will fast-track medical malpractice cases, making them less expensive.

The elderly get less pain medication in emergency rooms.

Patients turn to the internet to raise money for health care. While I think it's a shame that it's come to this, I'm heartened by the fact that people do give.

Truckers working on their health. Next thing you know, they'll be serving tofu at truck stops! But seriously, I think it's great.

Thin people are at greater post-surgery risk. Hmmm. The researchers don't know why.

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

Supercommittee Folds

2011-11-21T13:59:00.002-08:00

Politico just announced that the supercommittee has ended its work without reaching a bipartisan agreement regarding the nation's debt.

In a statement released Monday shortly after U.S. financial markets closed, co-chairs Rep. Jeb Hensarling (R-Texas) and Sen. Patty Murray (D-Wash.) announced that they had "come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee's deadline."

Despite their panel's failure, the two co-chairs tried to sound optimistic: " Despite our inability to bridge the committee's significant differences, we end this process united in our belief that the nation's fiscal crisis must be addressed and that we cannot leave it for the next generation to solve."

Feds Find Insurer's Rates Too High

2011-11-21T13:59:00.001-08:00

News Release

FOR IMMEDIATE RELEASE
November 21, 2011

Contact: HHS Press Office
(202) 690-6343

Health insurer charging unreasonable rate increases

Affordable Care Act shines a light on insurance company rate hikes, helps keep money in the pockets of Americans

Everence Insurance of Pennsylvania is charging small businesses unreasonably high premium increases according to the first federal rate review under the Affordable Care Act, the U.S. Department of Health and Human Services (HHS) announced today.

“We hope that by publicizing the excessive premium hikes, we will empower consumers,” HHS Secretary Kathleen Sebelius said. “By shining a light on unjustified premium increases, we will hold health insurers accountable like never before, and help keep money in the pockets of Americans.”

Today’s announcement marks the first of many reviews that HHS will perform in addition to insurance rate reviews already being done by states. Proposals to raise rates by 10 percent or more will be reviewed.

The HHS review has found that Everence’s 12 percent rate increase for small businesses in Pennsylvania was excessive. After reviewing the rate, independent experts determined the choice of assumptions the company based its rate increase on reflected national data rather than reliable and available state data. These assumptions resulted in an unreasonably high premium in relation to the benefits provided.

“We have called on this insurer to immediately rescind the rate, issue refunds to consumers or publicly explain their refusal to do so,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services.

Companies can either reduce their rate hikes or post a justification on their website within 10 days of the rate review determination.

For more information about this rate review and to find rate increase information in your state, visit: http://companyprofiles.healthcare.gov/

For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/

###

Day 1 of 3 Edition

2011-11-21T03:14:00.001-08:00

Only a three day week this week, so let's make it a good one.

All signs are that the supercommittee has failed. They plan to announce their failure today. The deadline is Wednesday, but at this point, the parties are just blaming each other for failure rather than trying to come up with a midnight solution, although some won't say it's over 'till it's over. The GOP would not agree to a deal that raises taxes -- and at some point, making the Bush tax cuts became a GOP condition that the Dems could not agree to. The Dems would not agree to a wholesales restructuring of Medicaid and Medicare. In other words, the supercommittee failed for the same reasons the President and Speaker Boehner failed months ago. How will this failure affect the markets? Ezra Klein says no biggie since there will be automatic cuts in 2013 instead. More on how the markets may react -- or not.

After the election, though, expect cost cutting -- and expect a focus on health care.

Meanwhile, southern states like Georgia are working to set up exchanges even though they oppose the health reform law, just in case the Supreme Court upholds the law.

A tale of two recusals? Justice Thomas is being asked to recuse himself from hearing the health reform law case because his wife is such an ardent, vocal opposer; Justice Kagan is being asked to recuse herself because she was Solicitor General under President Obama and may have had a hand in shaping legal strategy. My prediction: Neither of them will sit this one out.

A fascinating move by the Supreme Court, which has appointed two lawyers to argue positions that nobody agrees with. One will argue that the law can stand even without the individual mandate; the other will argue that the mandate cannot be challenged until it takes effect. And here's a sort of decision-tree that helps explain the health law cases.

As the Department of Health and Human Services finalizes regulations on the essential benefits package -- the things that must be covered by plans participating in state exchanges -- there's quite a rift forming over whether birth control should be provided free of charge. The Catholic church is looking for a broad exemption for churches, schools, nonprofits -- anybody with a "conscientious objection." Is that fair to their employees and their employees' dependents who will be covered under those plans?

Hospitals are looking for ways to save money without sacrificing care. Can medical cost cutting improve care?

The FDA has revoked approval of Avastin for breast cancer, saying it's not effective enough to justify the risks.

Drugs used for psychotics are prescribed for kids in foster care at an alarming rate.

Last week's quiz -- multiple endocine neoplasia (MEN) Type !

Want to become a morning person? Here's how.

If you remember when Our Bodies, Ourselves came out, you're old like me. It's turning 40 this week! Oy.

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

Finally -- Finally -- Friday Edition

2011-11-18T02:34:00.000-08:00

I feel like this week is more like two weeks. Then again, working 60 hours in 4 days could make you feel that way. Well, at least there's only one more day to get through before I get to snuggle with my cat and get some rest. But first, the news:

Congress passed a budget bill funding 5 agencies for all of 2012 and all of the federal government through December 6. It's long on law enforcement, short on funds for local governments. And they slashed funding for construction of housing for the poor by 38 percent.

The supercommittee doesn't appear to be making any progress. If they fail, what happens? WaPo says nothing. I've read previously (see prior blog posts) that there's a real fear about how the markets will react. That's actually my biggest concerns. The automatic cuts that would be triggered do not take effect until 2013, so that's plenty of time for Congress to undo the deal if they choose. As for tax increases, the GOP is still not where it needs to be, but people are talking about not whether to raise taxes, but how. Progress? With so few days left, it's hard to say. People in the know are pretty pessimistic. Indeed, Politico reports that talks are on the brink of collapse. According to The Hill, the GOP want President Obama to intervene.

USA Today says the supercommittee is looking at ways to cut the cost of treating "dual eligibles" -- people with both Medicaid and Medicare -- whose care is often fragmented and always very expensive. The thought is to move them into managed care. I'm so wary of these privatization "fixes" -- managed care was a huge waste of money in Connecticut's Medicaid program. I'm not convinced that handing a problem over to private insurance companies solves anything.

With a few weeks left of open enrollment, a new report shows that Medicare copays for brand name drugs are going up, a lot.

California and disability advocates have reached an agreement that will keep adult day healthcare centers open. Good work.

We are not doing enough for kids' heart health, says a report that focuses on diet, cholesterol, and exercise.

And last but not least, here's my op-ed on why consumer representatives are needed on the Board of the Connecticut Health Insurance Exchange.

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