Monday, July 9, 2012
Coping Conversations
I was interviewed by Dr. Bob Phillips for a radio show called Coping Conversations. You can listen to the interview here. Enjoy! Jennifer
Monday Morning Memo
I hate Mondays as much as I love Fridays. Oh, well. Onward and upward.
The GOP-led House will vote to repeal health reform this week. That means they would take your kids up to age 26 off of their parents' policies; they would reverse savings on prescription drugs for seniors; they would stop requiring insurers to spend 80-85 percent of premium dollars on health there, thereby reducing the amount premiums can be inflated for administrative costs, salaries, bonuses; they would stop requiring insurers to cover kids to age 19 with pre-existing conditions; they would eliminate the Pre-existing Condition Insurance Plan; they would reinstate lifetime and annual limits on benefits; they would eliminate external appeals. . . . I could go on. Of course, this is largely symbolic -- the Senate will not vote to repeal, and even if they did, the President would veto. Enough political theater. How about doing something to grow jobs.
As I've been saying since the Supreme Court decision, in states that opt out of the Medicaid expansion, there will be thousands of the very poor who are left with no health care. This is so because subsidies start at 100% of federal poverty level, so those under 100% not only won't have Medicaid, but they won't be eligible for subsidies, so unless they are lucky enough to have employer-sponsored insurance, they will have nothing.
Meanwhile, anti-reformers are preparing their next attack on the health reform law -- exchanges. Well, subsidies, to be exact. You see, the law says states create exchanges, marketplaces where people can shop for and buy insurance. But if states don't create an exchange, the federal government will step in for them -- and the law doesn't expressly state that the subsidies are available through federally-run exchanges. So the anti-reformers are developing a legal claim that, in fact, there are no subsidies in the federally-run exchanges. And that would leave even more people out than opting out of the Medicaid expansion.
Since the Supreme Court decided that the penalty associated with the individual mandate should be considered a tax, anti-reformers have been screaming about the alleged tax increase on the middle class. Turns out that, in fact, the biggest tax increase in the Affordable Care Act is the tax on Cadillac plans that starts in 2018.
Meanwhile, if Republicans take a majority of the Senate, they are planning to repeal as much of health reform as they can through the budget reconciliation process -- the same process used to push through the law -- which requires a majority vote for passage rather than the usual 60 votes. If you thought the Presidential election was the only key vote coming up for health reform, think again. But can they repeal parts of the law that don't deal with the budget, such as coverage of people with pre-existing conditions? Hmmm. Tom Daschle says the President must be re-elected for the ACA to survive. It certainly would help if pro-reformers also held the Senate. Mitch McConnell thinks the GOP has a 50/50 chance at winning a majority. But even if the pro-reformers hold the Senate, there will be plenty a President Romney would be able to do to kill reform.
For those of you on disability, Allen West is here to tell you that it's a modern form of slavery. That's right -- by fostering your dependence on Social Security disability, you are being robbed of your self-esteem and, thus, are being enslaved. Is this kind of craziness even worth repeating? For Mr. West to presume that your CHOICE to go on disability can be equated with the buying and selling of human beings into slavery -- wacko.
The highest Medicare costs are those spent on a small percentage of challenging cases, often near the end of life. Often these are not the elderly; they are people under age 65 on disability. How do we tackle the issue of health care costs without also tackling the moral issue of whether and when to withhold treatment? Is this a decision we can make as a society, or do we just leave it to the patient and his/her family?
The current state of our knowledge about the risks and benefits of hormone therapy. Whether to use it should be an individualized decision.
New numbers in elder care -- in the past 3 months, 39.8 million people over age 15 assisted a person over age 65 due to a condition relating to age. Most of them are middle-aged, caring for a parent, and 85% of them do not live in the same household as the elder.
New frontiers for cancer treatment. Whole genome sequencing. It may provide us with new answers to treatment.
Get this -- infants in households with dogs are less likely to get infections. In general, they are healthier and need fewer antibiotics.
And there you go, at least for this morning. Have a great day! Jennifer
The GOP-led House will vote to repeal health reform this week. That means they would take your kids up to age 26 off of their parents' policies; they would reverse savings on prescription drugs for seniors; they would stop requiring insurers to spend 80-85 percent of premium dollars on health there, thereby reducing the amount premiums can be inflated for administrative costs, salaries, bonuses; they would stop requiring insurers to cover kids to age 19 with pre-existing conditions; they would eliminate the Pre-existing Condition Insurance Plan; they would reinstate lifetime and annual limits on benefits; they would eliminate external appeals. . . . I could go on. Of course, this is largely symbolic -- the Senate will not vote to repeal, and even if they did, the President would veto. Enough political theater. How about doing something to grow jobs.
As I've been saying since the Supreme Court decision, in states that opt out of the Medicaid expansion, there will be thousands of the very poor who are left with no health care. This is so because subsidies start at 100% of federal poverty level, so those under 100% not only won't have Medicaid, but they won't be eligible for subsidies, so unless they are lucky enough to have employer-sponsored insurance, they will have nothing.
Meanwhile, anti-reformers are preparing their next attack on the health reform law -- exchanges. Well, subsidies, to be exact. You see, the law says states create exchanges, marketplaces where people can shop for and buy insurance. But if states don't create an exchange, the federal government will step in for them -- and the law doesn't expressly state that the subsidies are available through federally-run exchanges. So the anti-reformers are developing a legal claim that, in fact, there are no subsidies in the federally-run exchanges. And that would leave even more people out than opting out of the Medicaid expansion.
Ask yourself why so many people don't want poor and middle-class people to be able to afford health care?
Since the Supreme Court decided that the penalty associated with the individual mandate should be considered a tax, anti-reformers have been screaming about the alleged tax increase on the middle class. Turns out that, in fact, the biggest tax increase in the Affordable Care Act is the tax on Cadillac plans that starts in 2018.
Meanwhile, if Republicans take a majority of the Senate, they are planning to repeal as much of health reform as they can through the budget reconciliation process -- the same process used to push through the law -- which requires a majority vote for passage rather than the usual 60 votes. If you thought the Presidential election was the only key vote coming up for health reform, think again. But can they repeal parts of the law that don't deal with the budget, such as coverage of people with pre-existing conditions? Hmmm. Tom Daschle says the President must be re-elected for the ACA to survive. It certainly would help if pro-reformers also held the Senate. Mitch McConnell thinks the GOP has a 50/50 chance at winning a majority. But even if the pro-reformers hold the Senate, there will be plenty a President Romney would be able to do to kill reform.
For those of you on disability, Allen West is here to tell you that it's a modern form of slavery. That's right -- by fostering your dependence on Social Security disability, you are being robbed of your self-esteem and, thus, are being enslaved. Is this kind of craziness even worth repeating? For Mr. West to presume that your CHOICE to go on disability can be equated with the buying and selling of human beings into slavery -- wacko.
The highest Medicare costs are those spent on a small percentage of challenging cases, often near the end of life. Often these are not the elderly; they are people under age 65 on disability. How do we tackle the issue of health care costs without also tackling the moral issue of whether and when to withhold treatment? Is this a decision we can make as a society, or do we just leave it to the patient and his/her family?
The current state of our knowledge about the risks and benefits of hormone therapy. Whether to use it should be an individualized decision.
New numbers in elder care -- in the past 3 months, 39.8 million people over age 15 assisted a person over age 65 due to a condition relating to age. Most of them are middle-aged, caring for a parent, and 85% of them do not live in the same household as the elder.
New frontiers for cancer treatment. Whole genome sequencing. It may provide us with new answers to treatment.
Get this -- infants in households with dogs are less likely to get infections. In general, they are healthier and need fewer antibiotics.
And there you go, at least for this morning. Have a great day! Jennifer
Friday, July 6, 2012
Friday!!!
And who doesn't love Fridays?!!! Let's see what's going on in the world.
Will states opt out of the Medicaid expansion? The Supreme Court opened that door and now we anxiously wait to hear if anybody walks through it. Really? Leave the poorest of the poor without health care? Even when it's 100% federally funded? Why? Really, give me one good reason. According to the Agency for Health Care Research and Quality says Texas has the worst health care system in the country. And yet Texas would turn down billions in federal dollars to improve health care for the poor in Texas? Really?
Meanwhile, the House is moving forward towards a vote to repeal the law. Of course, this is symbolic political theater. The Senate won't pass it and the President would veto it if they did.
The Presidential campaigns are all about health care. President Obama is running on his great accomplishment and the fact that it was the right thing to do, even if not politically popular. Mitt Romney is trying to decide whether the mandate is a tax or not -- and having trouble distinguishing it from his Massachusetts mandate. Here's one voter who is grateful to the President for passing health reform. He says the law is here to stay, and I hope he's right.
Aetna and thousands of doctors in California are suing each other.
Is patient-driven care too much health care? Patients demand tests, treatments -- are they getting more care than they need? Some say yes. I tend to want as little health care as I can possibly get away with. I really don't understand wanting any more interaction with the medical community than is absolutely necessary. And I think most patients who have been really sick are very glad to take breaks when they can.
The ever-wonderful Dr. Pauline Chen writes about nursing -- a hard job, physical labor, injuries -- and when nurses suffer, patients suffer. As someone who has spent too much time in hospital beds, I can say that nurses make all the difference, one way or another.
What a wonderful thing -- a program called No One Dies Alone. That pretty much says it all.
I can't really imagine being without AC in over 100 degree heat. The health risk alone is huge, not to mention comfort. So it's no surprise that the elderly are turning up in droves at emergency rooms. I have to say, the 9 days we went without power last October? I'd far prefer having it happen then than in this kind of heat.
That's it for this morning. Have a great day and a great week-end! Jennifer
Will states opt out of the Medicaid expansion? The Supreme Court opened that door and now we anxiously wait to hear if anybody walks through it. Really? Leave the poorest of the poor without health care? Even when it's 100% federally funded? Why? Really, give me one good reason. According to the Agency for Health Care Research and Quality says Texas has the worst health care system in the country. And yet Texas would turn down billions in federal dollars to improve health care for the poor in Texas? Really?
Meanwhile, the House is moving forward towards a vote to repeal the law. Of course, this is symbolic political theater. The Senate won't pass it and the President would veto it if they did.
The Presidential campaigns are all about health care. President Obama is running on his great accomplishment and the fact that it was the right thing to do, even if not politically popular. Mitt Romney is trying to decide whether the mandate is a tax or not -- and having trouble distinguishing it from his Massachusetts mandate. Here's one voter who is grateful to the President for passing health reform. He says the law is here to stay, and I hope he's right.
Aetna and thousands of doctors in California are suing each other.
Is patient-driven care too much health care? Patients demand tests, treatments -- are they getting more care than they need? Some say yes. I tend to want as little health care as I can possibly get away with. I really don't understand wanting any more interaction with the medical community than is absolutely necessary. And I think most patients who have been really sick are very glad to take breaks when they can.
The ever-wonderful Dr. Pauline Chen writes about nursing -- a hard job, physical labor, injuries -- and when nurses suffer, patients suffer. As someone who has spent too much time in hospital beds, I can say that nurses make all the difference, one way or another.
What a wonderful thing -- a program called No One Dies Alone. That pretty much says it all.
I can't really imagine being without AC in over 100 degree heat. The health risk alone is huge, not to mention comfort. So it's no surprise that the elderly are turning up in droves at emergency rooms. I have to say, the 9 days we went without power last October? I'd far prefer having it happen then than in this kind of heat.
That's it for this morning. Have a great day and a great week-end! Jennifer
Thursday, July 5, 2012
By Grace or Luck -- A Call To Compassion
I was on Fox News yesterday morning talking about how best to get people with pre-existing conditions insurance coverage. You can watch it here. I look horrendous, but I made the points I wanted to make, for the most part.
By the time I got back to my office, I had received the following email:
By the time I got back to my office, I had received the following email:
You have a pre-existing condition, yet you feel you should pay little or no more than anyone else for health coverage. How is it that YOU aren't a "cheap rider" at the expense of the rest of us who are, by the grace of God or simply by luck, healthy???? And what else do you feel entitled to, by the way?Dave LukasekBokeelia, FL
I posted this on my Facebook page and people -- all well-meaning, trying to make sure my feelings weren't hurt, mad because someone was so rude -- responded pretty much in kind, calling Dave all kinds of names, and wishing that he gets sick so he's forced to realize the heavy burden we bear -- not just in the form of health insurance premiums.
And so it goes. As long as we talk to each other like this, we get nowhere. I guarantee you that Dave genuinely was offended by the things I said about needing a mandate to make sure that people who can afford health insurance but choose not to buy it are forced to pay their own way, if not by paying insurance premiums, then by paying a "tax" or penalty to the federal government, which spends billions of taxpayer dollars per year for uncompensated care -- care hospitals provide for which they never can collect payment. And while I think it's short-sighted of him -- after all, he could have a heart attack or get into a car accident today and then he'd be the one needing insurance but not being able to get it -- and while I never said I should "pay little" for my health coverage, we need to know that pretty much half of America feels the way Dave does.
It's sort of ironic that Dave acknowledges that he is healthy "by the grace of God or simply by luck," while not realizing that by that same grace, that same luck, Dave's health can be taken away from him just as easily, and he can become the one who's struggling to pay premiums, deductibles, copays, coinsurance, and all the expenses of being sick that aren't covered by insurance.
According to Wikipedia, compassion is defined as "the virtue of empathy for the suffering of others. It is regarded as a fundamental part of human love, and a cornerstone of greater social interconnection and humanism —foundational to the highest principles in philosophy, society, and personhood."
Dave is lacking in compassion. But so are we if we wish our misfortune on him -- or on anybody else. When we let anger overcome us, we lose sight of our better nature, our capacity for compassion. The response to Dave that I offer is compassion. What happened to Dave to make him this angry, that he would lash out so hatefully to a complete stranger?
All I know is that I don't want to hate Dave because that makes me just like Dave. And as much as his email is incredibly offensive, I know it comes from something broken inside him and has nothing much to do with me.
I kept thinking yesterday that it was ironic that this dialogue happened on July 4th, when we think about what makes America special. Isn't it that we are a country based on compassion? "Give me your tired, your poor, your huddled masses yearning to be free," right? We are about civil rights. We are about liberty, freedom, giving people a hand up when they're down. We care for our poor and disabled through Social Security, Medicare, Medicaid, TANF, food stamps. We support nonprofits that care for the homeless and the hungry and the sick. We are special because we are founded on compassion. It is deeply ingrained in us, in America.
It seems, though, that we have taken a wrong turn somewhere. People like Dave are mad as hell, and scared, too. They feel somehow that we who are sick, who advocate for an equal chance to live a decent life despite our misfortune, are asking too much. And we who are sick, or who are advocates for others who are, think people who don't "get it" are not just wrong, misguided, uneducated, uninformed, short-sighted -- we think they are bad people. They are not bad people. They are lacking in compassion -- they cannot see that there but for grace or god or luck go we all. When we respond to them so harshly, we, too, have lost our compassion.
What I hear from Dave isn't offensive as much as it is sad. What happened to Dave to make him incapable of compassion? It must have been bad. Maybe his business is going under. Maybe he's losing his house. I don't know what it is, but I know that Dave makes me sad, not angry.
I say we embrace the Daves of the world. First of all, meeting this level of vitriol with compassion would freak Dave out. The last thing he expects from us is kindness. Second, if we exercise compassion in the face of all the Daves, we keep from becoming Dave and that's really important. Third, I do not choose to carry around that kind of anger. I spent a good part of my life being really angry. It takes a lot of energy. And it's no fun. Anger harms not only the targets of our anger, but also ourselves.
Maybe -- just maybe -- if we respond with compassion, the Daves out there will be forced to see themselves in all their bitterness and realize that they are cheating themselves out of finding the good in people, the joy in life. Maybe, by our example, Dave can find compassion in his heart, as well.
I don't know all the answers. And I certainly am a deeply flawed human being who struggles to stay in touch with my compassion rather than my anger -- including anger at those who tell lies about health reform that feed people like Dave. But I know that if I lash out at Dave, he gets the fight he was spoiling for, and that makes his day. If, instead, I turn the other cheek, Dave will be caught off guard -- perhaps enough to force him to rethink things. And even if my compassionate response doesn't do a thing to change what's in Dave's heart, it does keep my heart pure.
Because compassion truly is the highest principle. It is a central component of love. Without which we are all Daves.
Just a thought. Jennifer
Wednesday, July 4, 2012
Watch Me!
No blog today, but watch me at 11:20 AM on Fox News. I'll be debating Merrill Matthews on whether high risk pools are a better alternative for people with pre-existing conditions than requiring insurers to cover them. Should be interesting! Jennifer
Tuesday, July 3, 2012
Another Quickie
So much to do; so little time. So so tired.
Florida Governor Rick Scott says Florida will not participate in the Medicaid expansion. And so my prediction -- Mississippi, Florida, Texas -- looks pretty dead on right now. See, these three states are the states from which we get the most calls, the hardest calls, the calls for which there are no answers. Because these states do nothing to help the sick and the poor now. Why expect them to do something for the poor next year or the year after? Even though it would come with billions of dollars of federal financial assistance. When are the people of Florida going to rise up and say NO? It scares me to think that the people of Florida may even agree that these poor sick people are not worthy of our compassion. Wake up, Florida. Ezra Klein says this is just talk, that the deal -- the feds pay for all of the Medicaid expansion and it phases down to 90% federal funding, but never lower -- is just too good. But if you know how bad it is in these states and you know they've done nothing so far to make a difference, then you know that they may well follow through on these threats. Rick Scott says the health reform law is devastating for patients. Are people in Massachusetts suffering? Nowhere near as much as people in Florida.
A tax or not? The Supreme Court upheld the individual mandate on the ground that it is within Congress's taxing power to require people who don't have insurance to pay a penalty. But is it really a tax? President Obama says no. The GOP says yes -- they're screaming about President Obama betraying his promise to the American people by imposing a new tax after he promised not to raise taxes on the middle class. But here's how weird American political theater is -- Governor Romney agrees with the President that it's not a tax. Why? Because he did the exact same thing in Massachusetts, so if it's a tax now, it was a tax then, and he doesn't want to be seen as having raised taxes. More signs of the complexity of Romney's anti-reform position. Why is he so against it now when he was so for it in Massachusetts? How will he answer that question?
And if it's a tax, can the GOP repeal it in the Senate with only 51 votes? That's what they're talking about. Vigilance, people. Where do your members of Congress stand on health reform? If you don't know, then you need to find out. And if you disagree with them, make your voice heard. A majority of independent voters want the GOP to leave it alone now that the Court has ruled. If you're part of that majority, I think you're going to have to speak a little louder -- they aren't hearing you.
Here's one worth watching. Premera Blue Cross (Washington state) has begun selling a policy that only covers generic drugs. The state Insurance Commissioner is trying to stop them, while their competitors are following their lead, making it harder to buy individual insurance with broad drug benefits. If this is a trend, it's really scary.
A medical puzzle. A woman starts to fall apart. Jet lag? Hectic life? When her doctors couldn't find an answer, they sent her to a shrink (of course). Sneddon's syndrome. Moral of the story? When you know you're sick, don't let them tell you it's in your head. And don't expect all the answers to come from the medical community, either.
Glaxo Smith Kline is paying $3 billion to settle a health care fraud case. Rooting out fraud continues to be one important way to deal with health care costs run amok.
I didn't need a study to tell me this. Treat your kids badly and you leave emotional scars. I'm not talking about what we think of as abuse -- I'm talking about spankings. Physical punishment causes mental illness.
Interesting - body rhythms help diagnose disease. Hmmm.
Kids born even two weeks early test lower in math, reading.
And that's it for today. Have a great one -- stay cool. Jennifer
Florida Governor Rick Scott says Florida will not participate in the Medicaid expansion. And so my prediction -- Mississippi, Florida, Texas -- looks pretty dead on right now. See, these three states are the states from which we get the most calls, the hardest calls, the calls for which there are no answers. Because these states do nothing to help the sick and the poor now. Why expect them to do something for the poor next year or the year after? Even though it would come with billions of dollars of federal financial assistance. When are the people of Florida going to rise up and say NO? It scares me to think that the people of Florida may even agree that these poor sick people are not worthy of our compassion. Wake up, Florida. Ezra Klein says this is just talk, that the deal -- the feds pay for all of the Medicaid expansion and it phases down to 90% federal funding, but never lower -- is just too good. But if you know how bad it is in these states and you know they've done nothing so far to make a difference, then you know that they may well follow through on these threats. Rick Scott says the health reform law is devastating for patients. Are people in Massachusetts suffering? Nowhere near as much as people in Florida.
A tax or not? The Supreme Court upheld the individual mandate on the ground that it is within Congress's taxing power to require people who don't have insurance to pay a penalty. But is it really a tax? President Obama says no. The GOP says yes -- they're screaming about President Obama betraying his promise to the American people by imposing a new tax after he promised not to raise taxes on the middle class. But here's how weird American political theater is -- Governor Romney agrees with the President that it's not a tax. Why? Because he did the exact same thing in Massachusetts, so if it's a tax now, it was a tax then, and he doesn't want to be seen as having raised taxes. More signs of the complexity of Romney's anti-reform position. Why is he so against it now when he was so for it in Massachusetts? How will he answer that question?
And if it's a tax, can the GOP repeal it in the Senate with only 51 votes? That's what they're talking about. Vigilance, people. Where do your members of Congress stand on health reform? If you don't know, then you need to find out. And if you disagree with them, make your voice heard. A majority of independent voters want the GOP to leave it alone now that the Court has ruled. If you're part of that majority, I think you're going to have to speak a little louder -- they aren't hearing you.
Here's one worth watching. Premera Blue Cross (Washington state) has begun selling a policy that only covers generic drugs. The state Insurance Commissioner is trying to stop them, while their competitors are following their lead, making it harder to buy individual insurance with broad drug benefits. If this is a trend, it's really scary.
A medical puzzle. A woman starts to fall apart. Jet lag? Hectic life? When her doctors couldn't find an answer, they sent her to a shrink (of course). Sneddon's syndrome. Moral of the story? When you know you're sick, don't let them tell you it's in your head. And don't expect all the answers to come from the medical community, either.
Glaxo Smith Kline is paying $3 billion to settle a health care fraud case. Rooting out fraud continues to be one important way to deal with health care costs run amok.
I didn't need a study to tell me this. Treat your kids badly and you leave emotional scars. I'm not talking about what we think of as abuse -- I'm talking about spankings. Physical punishment causes mental illness.
Interesting - body rhythms help diagnose disease. Hmmm.
Kids born even two weeks early test lower in math, reading.
And that's it for today. Have a great one -- stay cool. Jennifer
Monday, July 2, 2012
Monday Quickie
I'm not feeling well, and I'm behind in my work, so today will be just a quickie. I have to find a way to stop working from 4:30 am to 9 pm every night, as I have done for the past 3 weeks. For today, that means a quicker than usual blog post.
Cautious optimism in Texas as residents hope the State will do the right thing and participate in the Medicaid expansion and the rest of health reform. Governors in Nebraska, New Hampshire, and South Carolina are saying they won't participate because they can't afford the 10% that they would have to gradually start paying from 2016 to 2020 -- until then, it's 100% federally funded. Governors in Wisconsin and Louisiana say they will wait until after the November election before beginning implementation. Governors in Ohio, New Jersey, Mississippi are tentative. Florida says they won't implement either the Medicaid expansion or the exchange, although the feds will be setting up exchanges in states that don't set up their own. Choosing not to take federal money to cover the poorest of the poor will leave millions uninsured and hospitals will lots of unpaid bills as uncompensated care payments are phased out on the premise of universal coverage. So hospitals are urging states to accept the Medicaid expansion. The White House believes most states will accept it. I think it's up to us to make sure our state officials know we want them to take the billions of dollars of federal money to improve the health of the poorest residents.
Ted Kennedy's widow says he would have told us to roll up our sleeves and get to work on implementing reform -- and there is an awful lot of work to be done, even in states like Connecticut, that have been hard at work already. Indeed, in states that have done nothing to move towards implementation, it will be difficult to meet the law's deadlines.
Senate Minority Leader McConnell says covering 30 million uninsureds is not the issue. Really? I thought it was the only issue.
And if you're really a Supreme Court wonk, the reports that Chief Justice Roberts switched his vote about a month ago, deciding to vote to uphold the law are interesting. I suspect we won't know for sure until one of the sitting Justices retires and writes her/his biography.
There is other news, believe it or not.
California is moving Medi-Cal (Medicaid in California) to managed care, causing disruptions in service for the uninsured.
Sunscreen forbidden at school or camp. Are you kidding me? Really?
That's it for today. Have a good one. Jennifer
Cautious optimism in Texas as residents hope the State will do the right thing and participate in the Medicaid expansion and the rest of health reform. Governors in Nebraska, New Hampshire, and South Carolina are saying they won't participate because they can't afford the 10% that they would have to gradually start paying from 2016 to 2020 -- until then, it's 100% federally funded. Governors in Wisconsin and Louisiana say they will wait until after the November election before beginning implementation. Governors in Ohio, New Jersey, Mississippi are tentative. Florida says they won't implement either the Medicaid expansion or the exchange, although the feds will be setting up exchanges in states that don't set up their own. Choosing not to take federal money to cover the poorest of the poor will leave millions uninsured and hospitals will lots of unpaid bills as uncompensated care payments are phased out on the premise of universal coverage. So hospitals are urging states to accept the Medicaid expansion. The White House believes most states will accept it. I think it's up to us to make sure our state officials know we want them to take the billions of dollars of federal money to improve the health of the poorest residents.
Ted Kennedy's widow says he would have told us to roll up our sleeves and get to work on implementing reform -- and there is an awful lot of work to be done, even in states like Connecticut, that have been hard at work already. Indeed, in states that have done nothing to move towards implementation, it will be difficult to meet the law's deadlines.
Senate Minority Leader McConnell says covering 30 million uninsureds is not the issue. Really? I thought it was the only issue.
And if you're really a Supreme Court wonk, the reports that Chief Justice Roberts switched his vote about a month ago, deciding to vote to uphold the law are interesting. I suspect we won't know for sure until one of the sitting Justices retires and writes her/his biography.
There is other news, believe it or not.
California is moving Medi-Cal (Medicaid in California) to managed care, causing disruptions in service for the uninsured.
Sunscreen forbidden at school or camp. Are you kidding me? Really?
That's it for today. Have a good one. Jennifer
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