Friday, December 30, 2011

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

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

Wednesday, December 28, 2011

Hump Day Headlines

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, December 27, 2011

Tuesday Tidbits

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

Friday, December 23, 2011

Essential Health Benefits Guidance

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.


Holiday From Chronic Illness

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

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

Thursday, December 22, 2011

We have a deal!

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

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

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

Wednesday, December 21, 2011

Hump Day Headlines

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

Monday, December 19, 2011

For Ellen

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

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

Saturday, December 17, 2011

Payroll Tax Deal Cut

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

Friday, December 16, 2011

Essential Health Benefits

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

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, December 15, 2011

Thursday Themes

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

Wednesday, December 14, 2011

Hump Day Headlines

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

Tuesday, December 13, 2011

I'm Back! Tuesday Tidbits

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

Monday, December 12, 2011

No blog today

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

Friday, December 9, 2011

Advocacy for Patients in the Supreme Court

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