Health Care 2013: March 2013

Saturday, March 30, 2013

Obamacare Won't Affect Most 2012 Taxes, Despite Firm's Claim

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Friday, March 29, 2013

Pennsylvania Tightens Abortion Rules Following Clinic Deaths

March 28, 2013

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All Things Considered

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A police car is posted outside the Women's Medical Society in Philadelphia, on Jan. 20, 2011. Dr. Kermit Gosnell, accused of murder, performed abortions in the clinic.

Matt Rourke/AP

A Philadelphia doctor who performed abortions is on trial for murder. Kermit Gosnell, 72, is accused in the deaths of a female patient and seven babies who the prosecutor says were born alive. District Attorney R. Seth Williams laid out the case in disturbing detail in a grand jury report last year.

When authorities raided Gosnell's clinic in 2010 they found squalid conditions: blood on the floor, the stench of urine and a flea-infested cat wandering through the facility.

In court, Gosnell's attorney said his client is unfairly being held to standards one might expect at the Mayo Clinic. A jury will decide Gosnell's fate, but what is clear now is that state regulators were not doing their job.

"Unfortunately and tragically in Pennsylvania, facilities were going uninspected for years," says Maria Gallagher, a lobbyist with the Pennsylvania Pro-Life Federation. Gosnell's clinic went 17 years without an inspection, according to prosecutors.

"As for Dr. Gosnell's case, there were admitted failures in oversight at the department," says Aimee Tysarczyk, press secretary for Pennsylvania's Department of Health. But now the agency is inspecting abortion clinics regularly and making sure they meet state standards.

In 2011, the Gosnell case was mentioned frequently as Pennsylvania's General Assembly passed a law that put stricter requirements on abortion clinics. Now most clinics in the state are held to the same standards as outpatient surgery centers. That means abortion clinics must have doors and elevators that can accommodate a stretcher in case something goes wrong.

For some clinics, such as Planned Parenthood of Southeastern Pennsylvania, that meant expensive remodeling.

"Overall the cost was about $450,000 to get two of our facilities into compliance," says CEO Dayle Steinberg. The nonprofit had to install hands-free sinks. Tile floors were torn out and replaced with seamless floors that are easier to clean. The clinic's heating and air-conditioning system was upgraded and a new room was built to house sterilization equipment.

Steinberg says her organization already had a low rate of complications � less than one-tenth of 1 percent. She contends Pennsylvania's new requirements did nothing to improve services for women at her clinics.

"They were thinly disguised as improving patient safety, when really it was about increasing the cost for abortion providers � hoping that some of them wouldn't be able to afford it," Steinberg says.

Enlarge image i

An undated photo of Gosnell released by the Philadelphia District Attorney's office. Gosnell, who catered to minorities, immigrants and poor women at the Women's Medical Society, was charged with murder in the deaths of a patient and seven babies.

The author of the legislation that put the tougher regulations in place disputes that.

"This is all about patient safety," says state Rep. Matt Baker. "We made it clear that we weren't going to arbitrarily and capriciously shut down abortion clinics."

Abortion opponents were not the only ones supporting Baker's legislation. State Rep. Margo Davidson says her 22-year-old cousin, Semika Shaw, died of sepsis and infection after an abortion at Gosnell's clinic. Davidson delivered an emotional speech on the Statehouse floor in 2011.

Dedicating her vote to Shaw, Davidson said she hopes the law will safeguard the health of women seeking abortions, "so that never again will a woman walk into a licensed health care facility in the state of Pennsylvania and be butchered, as she was."

Now that the law is in effect there are five fewer abortion clinics in Pennsylvania, though it's unclear whether the stricter regulations were the only reason they closed. That leaves 17 other providers in the state. Backers of the law say now if a woman enters a clinic in a poor neighborhood � or a rich one � she can be assured it is meeting a basic standard of care.

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Saturday, March 23, 2013

Doubts Raised About Cutting Medicare Pay In High-Spending Areas

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“Protect our Health, Not Their Wealth” Rally in Albany

Wednesday, March 20 – 60 people rallied in front of Albany Medical Center under the banner, “Protect OUR Health, Not THEIR Wealth.” Speakers and protesters called for “No Grand Bargain” – Hands off Medicare, Social Security and Medicaid,” “Scrap the Cap on Social Security,” “Oppose Privatization of our Public Hospitals and Nursing Homes,” and “Single Payer, Improved Medicare for All.”

A broad coalition representing nurses, physicians, medical students, labor unions, senior citizens, faith groups, grassroots organizations, and Occupy Albany – the driving force behind the event, joined the rally.

Sponsoring organizations:
New York State Nurses Association
Public Employees Federation
Physicians for a National Health Program – Student Chapter
Single Payer NY
Capital District .Area Labor Federation
Albany Central Federation of Labor
The Labor Religion Coalition
Capital District Alliance for Universal Healthcare
Statewide Senior Action
Citizen Action
MoveOn
Occupy Albany

Additional participating unions: AFGE, SEIU, NALC

Friday, March 22, 2013

States Urged to Expand Medicaid With Private Insurance

From the New York Times –

The White House is encouraging skeptical state officials to expand Medicaid by subsidizing the purchase of private insurance for low-income people, even though that approach might be somewhat more expensive, federal and state officials say.

Ohio and Arkansas are negotiating with the Obama administration over plans to use federal Medicaid money to pay premiums for commercial insurance that will be sold to the public in regulated markets known as insurance exchanges.

Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in the option since Gov. Mike Beebe of Arkansas, a Democrat, received a green light from Kathleen Sebelius, the federal secretary of health and human services.

Valerie Jarrett, a top White House aide, has been a catalyst in talks with Ohio and other states.

The idea of using �premium assistance� to buy private insurance for new Medicaid beneficiaries is a sharp departure from the 2010 health care law, in which Congress expanded Medicaid to cover the poorest Americans and assumed that people with higher incomes would obtain private coverage through the exchanges.

In many states, Republicans are trying to create a hybrid of the two alternatives, taking federal money for the expansion of Medicaid but using it to help people buy commercial insurance instead.

State Senator Jonathan Dismang, a Republican from central Arkansas, said the idea appealed to him because it would �use the markets to provide better health care and to increase competition in the health insurance industry,� which could drive down costs.

The Arkansas Medicaid director, R. Andrew Allison, said the state had obtained �conceptual approval� from Ms. Sebelius to use Medicaid money to help low-income adults enroll in private insurance through the exchange in 2014. This arrangement, he said, could double the number of people in the exchange, to perhaps 500,000, while shrinking enrollment in the traditional Medicaid program.

The idea appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid.

�We supported the expansion of Medicaid before this idea came up, and we are more excited now,� said David W. Wroten, the executive vice president of the Arkansas Medical Society. �Providers of all types would be paid at private insurance rates, and that will help recruit physicians for Medicaid, especially in rural areas.�

Advocates for beneficiaries are torn. On one hand, they want to provide coverage to as many people as possible, and the use of private insurance may be the only way to entice Republicans to support the expansion of Medicaid.

On the other hand, they say, private insurance will often be more costly than Medicaid, in part because it pays higher rates to health care providers. They said they feared that higher federal costs would fuel demands in Congress for cutbacks in Medicaid.

In addition, many advocates prefer Medicaid because it has strict limits on co-payments and deductibles and provides benefits that may not be available in commercial insurance. These include long-term care, dental services, medical equipment and even personal attendant services for some people with severe disabilities.

Federal officials said state Medicaid programs could provide these extra services as a supplement to private insurance.

In Ohio, Gov. John R. Kasich, a Republican, wants to expand Medicaid, citing the biblical injunction to help �the least among us.� He wants to provide coverage through private insurance for many of the new beneficiaries, including those with incomes from 100 percent to 138 percent of the poverty level ($11,490 to $15,856 a year for an individual).

Greg Moody, director of the governor�s Office of Health Transformation, said Ms. Jarrett called Mr. Kasich in late January and indicated that the Obama administration was receptive to his ideas. Federal and state officials are working out the details.

�Every day I am a little more encouraged that we can put together a package that is compelling to the State Legislature and can be approved by the federal government,� Mr. Moody said.

Erin Shields Britt, a spokeswoman for the federal Department of Health and Human Services, said, �Our goal in working with states has been to be as flexible as possible within the confines of the law.�

In Florida, state legislators rebuffed a proposal by Gov. Rick Scott, a Republican, to expand Medicaid, but are exploring alternatives that would use Medicaid money to help people buy private insurance.

The 2010 health care law generally required states to make Medicaid available to people under 65 with income less than or equal to 138 percent of the poverty level. The federal government will pay the cost for newly eligible beneficiaries from 2014 to 2016, with its share gradually decreasing to 90 percent in 2020. In upholding the law in June, the Supreme Court ruled that the expansion of Medicaid was an option for states, not a requirement. The ruling touched off ferocious debates in statehouses around the country.

Arkansas Republicans, who control both houses of the Legislature, opposed a straight expansion of Medicaid, but have warmed to the idea of subsidizing private insurance for the same people.

�The feds have agreed to do what my legislators in various conversations have asked me to go ask them to do,� Mr. Beebe said. �Basically they�ve agreed to give us about everything we�ve asked for. What that really amounts to is to take the Medicaid population and expand it all the way to 138 percent of the poverty level and use federal Medicaid dollars to purchase insurance through the exchange.�

�It will probably cost the feds a little more money to do this,� Mr. Beebe said. Arkansas officials said the increase would be less than 15 percent.

Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, said he saw nothing inherently wrong in expanding Medicaid by paying the premiums of private health plans in a state insurance exchange.

With that approach, he said, low-income people can stay in one health plan even if their income fluctuates, so they lose Medicaid and become eligible for subsidies in the exchange, or vice versa. �How better to assure continuous coverage and continuous access to the same doctors?� Mr. Weil asked.

However, Leonardo D. Cuello, who represents poor people as a lawyer at the National Health Law Program, said the use of private plans could lessen protections for beneficiaries and increase costs to the government.

�Congress authorized premium assistance more than 20 years ago as a way to save money, by allowing Medicaid to pay premiums for people who had access to private coverage through an employer�s group health plan,� Mr. Cuello said. �It will now be used to provide individual coverage that is more expensive than Medicaid.�

Thursday, March 21, 2013

Affordable Care Act at 3: Paying for Quality Saves Health Care Dollars

This blog originally appeared on the Health Affairs Blog.

For decades before the passage of the Affordable Care Act, health care costs outstripped inflation, without corresponding improvements in health care quality.� Our system didn�t incentivize quality or efficiency.� We paid providers for the quantity of care, not the quality of care.� And we were not using technology to deliver smarter care.

The Affordable Care Act includes steps to improve the quality of health care and lower costs for you and for our nation as a whole.� This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and creating the health information technology infrastructure that enables new payment and delivery models to work.

Here are just a few ways that the health care law builds a smarter health care system and incentivizes quality of care � not quantity of care - to drive down costs and save you money.

We�re Shifting the Focus to Quality, Not Quantity

The health care law creates new Accountable Care Organizations (ACO) that incentivize doctors and other providers to work together to provide more coordinated care to their patients. �ACOs agree to take responsibility for the cost and quality of their patients� care, to improve care coordination and safety, and to promote appropriate use of preventive health services.� And when this new care model saves the Medicare program money, that savings is shared with the ACO. Over 250 organizations are participating in Medicare ACOs, giving more than 4 million Medicare beneficiaries access to high-quality coordinated care throughout the nation.� ACOs are estimated to save the Medicare program up to $940 million in the first four years.

The Affordable Care Act also ties Medicare Advantage bonus payments to the quality of coverage these private plans offer.� This gives seniors a broader range of higher-quality Medicare Advantage plans from which to choose.� As a result, in 2013, the 14 million Medicare beneficiaries currently enrolled in Medicare Advantage have access to 127 four- and five-star plans, which is 21 more high-quality plans than were available in the previous year.

Keeping You Out of The Hospital

Every year, about 2.6 million seniors � or nearly one in five hospitalized Medicare enrollees � are readmitted within 30 days of discharge, at a cost of more than $26 billion to the Medicare program.� Many of these readmissions stem from preventable problems. These rates can be drastically reduced if we do a better job coordinating care and support.� The health care law�s Hospital Readmissions Reduction Program reduces Medicare payments to hospitals with relatively high rates of potentially preventable readmissions to encourage them to focus on this key indicator of patient safety and care quality.

We�re starting to see results.� Medicare readmissions rates have remained stuck near 19 percent over the five years that the data has been collected (and likely for decades prior to that), but in 2012 the nationwide rate of hospital readmissions of Medicare patients declined to about 17.8 percent.� This translates to over 70,000 fewer preventable hospital readmissions.

Lowering Costs

Taken together, these improvements are providing more value for your health care dollar and helping to fuel historically low cost growth rates in Medicare and Medicaid.� Last year, per-beneficiary Medicare costs increased by only 0.4 percent, continuing the historically low Medicare growth we saw in 2011 and 2010. Per-beneficiary spending in Medicaid actually decreased 1.9 percent from 2011 to 2012.�

And a recent report found that health care price inflation in January dropped to 1.5 percent, one of the smallest increases on record.

As the nation�s largest insurer, Medicare can lead the way in effective practices like this that deliver better care and drive down costs.� Our goal is that these reforms and investments build a health care system that will ensure quality care for generations to come.

Learn more about the key features of the Affordable Care Act.

Follow Secretary Sebelius on Twitter at @Sebelius.

Tuesday, March 19, 2013

The Doctor Will See You And A Dozen Strangers Now

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Friday, March 15, 2013

Cardiac Arrest Survivors Have Better Outlook Than Doctors Think

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Why Workers Should Be Wary About Corporate Wellness

A growing number of US companies are now urging their employees to slim down, exercise more, reduce their cholesterol and blood pressure levels, or quit smoking�all socially desirable goals. But if these workers fail to cooperate with the new corporate �wellness� regime and adopt a healthier lifestyle (under the tutelage of their employer), the penalty, for many, will be higher out-of-pocket payments.

Corporate America has long been shifting the burden of medical costs onto workers. Cost-sharing negotiated with unions or, more commonly, imposed unilaterally by non-union firms has raised labor�s share of health insurance premiums to an average of 18 percent for individual coverage and nearly 30 percent for families. Workers or their dependents also face escalating deductibles, co-pays and co-insurance, which can add hundreds or thousands of dollars to their annual healthcare spending.

Now, under the banner of health promotion, management is making some workers pay more for their insurance based on individual differences in their medical condition or lack of adherence to �wellness� standards. This new, more individualized form of cost-shifting threatens to stigmatize and penalize the chronic health conditions of millions of workers, expose some to job discrimination and undermine labor solidarity in the process. In addition, workplace privacy advocates are warning about the invasiveness of so-called �health risk assessments��now commonly required in corporate wellness programs�because these surveys probe off-duty behavior related to sex, drugs and alcohol.

Under the federal Health Insurance Portability and Accountability Act (HIPAA), management can already compel some workers to pay up to 20 percent more than others covered by the same medical plan. According to Lewis Maltby of the National Workrights Institute, �all that is required is that the penalty be �designed to promote good health.� The employer is not required to demonstrate that the amount approximates the increase in cost due to an employee who engages in any unhealthy behavior.� Under President Obama�s Affordable Care Act, �this abuse will continue to grow,� Maltby predicts, �when the penalty employers can charge without justification increases to 30 percent� next year.

Among the other groups sounding the alarm about this trend are Families USA, Georgetown University�s Health Policy Institute, the American Cancer Society and the American Heart and Diabetes Associations. A report by the HPI at Georgetown called in February 2012 for new federal and state standards that will protect consumers from �programs that inappropriately punish workers in poor health, are overly coercive, or create perverse financial incentives that result in poorer health outcomes.”

As Cancer Society lobbyist Dick Woodruff told National Public Radio, “The whole point of healthcare reform is to make sure that everyone gets insurance. And if people have to pay more because they�re unhealthy, that�s a barrier. It defeats the whole purpose.”

California Nurses Association co-president DeAnn McEwan, a nurse for nearly forty years, sees great risk of �discrimination through backdoor redlining for individuals with pre-existing conditions and disabilities.� She points out that the workers �more likely to have the health conditions that wellness programs target are low-income individuals and racial/ethnic minorities.� By no coincidence, she says, they also �face barriers to health such as unsafe neighborhoods; poor air quality; substandard, decaying housing; and lack of access to affordable, healthy food.�

Despite these warnings, many other unions are buying into wellness schemes under management pressure for more costly contract concessions. Employers and their consultants pitch these programs, initially, as a way to provide �discounts� for workers who sign up for annual health evaluations, subsidized gym membership, smoking cessation classes or other forms of health counseling. In Chicago, for example, the Chicago Teachers Union returned from its inspiring strike last September with a freeze on insurance rates but a new wellness plan similar to the one covering 38,000 other city employees. According to one top CTU official, it �was definitely one of the least popular parts of the contract settlement� because of �concerns that what we�re seeing is just the thin edge of the wedge.�

The teachers� program begins early this year with biometric testing for cholesterol, blood pressure and sugar levels, weight and body mass index. Teachers with an identified problem may be assigned a health coach who works for a third-party vendor. All must log into a wellness website, every month, earning points for reading articles or watching videos; the penalty for failing to do so will be $50 monthly fine. A family with two adult members that opts out of the program entirely will pay $1,200 more annually for their insurance. In the union�s next round of bargaining, this CTU leader worries that management �may try to attach penalties for being overweight or a smoker� in a profession where �many negative health outcomes have a lot to do with job stress.�

Efforts to promote better eating, more walking, bike-riding or working out at the gym would be quite positive�and far more effective�if they were part of a broader campaign that addressed the societal roots of bad nutrition, obesity, diabetes, high blood pressure or heart and lung problems. As CNA�s McEwan points out, many chronic, costly conditions have socioeconomic causes, including exposure to hazardous workplace environments. They�re not just the product of bad individual choices by workers or their family members�some of whom are just showing the side-effects of consuming their own employer�s heavily marketed food products.

Consider, for example, the chutzpah of PepsiCo�s insistence that its Teamster-represented drivers and warehouse workers in upstate New York pay a �sin tax� of $50 a month if they smoke or have weight-related medical issues like hypertension, high-blood pressure, and diabetes. As PepsiCo spokesperson Dave DeCecco told Bloomberg News in February 2012, �These programs enable our associates and their families to have a healthier lifestyle.� DeCecco didn�t say whether that lifestyle shift should also include not eating the salty, sugary, high-fat junk food that generates billions in profits for PepsiCo, while playing a major role in our national epidemic of obesity.

In California, such corporate hypocrisy takes a different form in healthcare. Some of the same hospital chains that have pushed hardest for �wellness� penalties don�t want to make changes in working conditions that would reduce job stress, fatigue, unsafe workloads and other causes of occupational illness and injury. Better nurse/patient staffing ratios, limits on forced overtime, guaranteed lunch and break time, and more lift equipment to reduce back injuries would all contribute to employee wellness (and lower healthcare costs, by increasing patient safety). But Kaiser Permanente, Sutter Health, Dignity Healthcare and Daughters of Charity Health Systems all want to shift the focus, in bargaining, from their own unhealthy practices to the off-duty behavior of individual employees, reports John Borsos, a contract negotiator for the National Union of Healthcare Workers (NUHW), which recently affiliated with the CNA

Borsos is particularly critical of the �Total Health Program� created at Kaiser Permanente (KP), with the backing of unions involved in Kaiser�s Labor-Management Partnership (LMP), led by the Service Employees International Union (SEIU). �Total Health� is being touted by SEIU as �a long-term business strategy for KP� that will give it a �competitive advantage� over other health maintenance organizations. If cost savings are achieved, Kaiser promises a monetary bonus for work groups that complete an annual health assessment, update their �biometric risk screenings,� and �maintain or make steady improvements on key biometric risks (weight, smoking, blood pressure and cholesterol).�

Individual compliance will be �encouraged� by a network of �Wellness Ambassadors��derided as �wellness cops� by the NUHW– who will get paid time off from Kaiser for their activities. Borsos predicts that Kaiser personnel who decline to participate �will be subject to enormous pressure from co-workers when a portion of their future pay is tied to everyone�s participation.� For more on the NUHW-CNA critique of �Total Health� at Kaiser, see �Which Way to Wellness: A Workers Guide to Labor and Workplace Strategies for Better Healthcare.� (http://www.stopseiucuts.com/wp-content/files_mf/whichwaytowellnesswinslow.pdf). Labor Notes has also published an excellent guide for unions engaged in bargaining about wellness issues. (See http://labornotes.org/2013/01/what-do-when-boss-catches-wellness-fever.)

The danger of a membership backlash to the wrong kind of wellness plan is very real. In 2011, labor organizations represented on Oregon�s Public Employee Benefits Board (PEBB), agreed to a new �Health Engagement Model� (HEM), that required mandatory �risk assessments� (including waist measuring), plus penalties for non-compliance. According to one labor educator in the state, the HEM �riled up many workers, who turned their fury and frustration on the unions.� The Service Employees International Union was among those soon apologizing for �a poorly communicated change to our health plans that included a punitive surcharge� and �got us started on the wrong foot.� Labor officials later persuaded the PEBB that non-participants in “health engagement� should no longer be subject to the surcharge; instead, participants are now rewarded with an additional $17.50 per pay period. However, the health plan forces non-participating workers and their families to pay $100 to $300 more in deductibles, a �punitive aspect� still opposed by their unions.

A survey of 355 private companies by Towers Watson, a leading HR consultant, showed a 50 percent increase in their use of such financial incentives and penalties between 2009 and 2011 Thirty-eight percent of these firms reported further plans to penalize workers who fail to meet health improvement goals tied to their cholesterol levels or body mass index. Clearly, if unions don�t get their act together on �wellness,� their members are going to get rolled, one way or another.

The best labor response to these schemes would be to shift the terms of the wellness debate, at the bargaining table and in public policy arenas. Unions need to take a more holistic approach to their members� health problems, one that doesn�t let Corporate America off the hook for its role in producing the social determinants of poor health, including poverty, inequality and unhealthy jobs.

Labor should also make wellness controversies a teachable moment for workers upset by punitive medical plan changes but not previously supportive of or well-informed about single payer healthcare. �Medicare for all� would eliminate job-based benefit coverage and the new forms of cost-shifting and differential treatment now being introduced under the guise of �getting healthy.� In nations with social insurance systems, health outcomes are better, in part, because achieving public health goals, like reduced obesity, isn�t left to companies more concerned about their bottom line than workers� waistlines. American workers who don�t want their boss playing �wellness cop� need both short-term legal protection and a longer-term political solution.

Steve Early spent many years helping members of the Communications Workers of America bargain about health insurance issues. He is the author, most recently, of The Civil Wars in U.S. Labor from Haymarket Books. He can be reached at Lsupport@aol.com.

Thursday, March 14, 2013

Collecting the Data We Need to Reduce Health Disparities

The Obama Administration is committed to promoting the health and well-being of all Americans, yet when we don�t have accurate information about who we serve, it is difficult to meet the unique needs of diverse communities. Many racial and ethnic minorities, people with disabilities, lesbian, gay, bisexual, and transgender (LGBT) communities, and other underserved populations face unique health challenges, have reduced access to health care and insurance, and often pay the price with poorer health throughout their lives.� Over the past decade, little progress has been made in reducing these disparities. According to the Institute of Medicine, inadequate data on race, ethnicity, and language lowers the likelihood of effective actions to address health disparities.

But, thanks to the Affordable Care Act, section 4302 invests in the implementation of a new health data collection and analysis strategy. It requires all national federal data collection efforts to collect data on:

RaceEthnicityPrimary languageDisability statusGender

HHS also announced a new plan to collect data related to health of LGBT populations.� We will integrate questions on sexual orientation into national data collection efforts by 2013 and begin the process to collect information on gender identity.� This is a critical step toward development of a government-wide standard for LGBT data collection. By establishing consistent methods for collecting and reporting health data, we will be able to better understand the causes of health problems in underserved populations.

HHS continues to make significant progress toward improving the health of underserved populations. By collecting relevant data in a standardized format, we will be able to continue reducing the health disparities in many underserved communities.

The public may submit comments for the draft minority data collection standards at www.regulations.gov under docket number HHS-OMH-2011-0013.� Public comments will be accepted until July 30.�

Information is also available here.

Wednesday, March 13, 2013

Blacking Out Single-Payer–And Killing The Auto Industry

By Jonathan Tasini–

When the history of our current economic crisis is written, there will need to be a full chapter devoted to the willful ignorance or stupidity of the traditional media. Right before our eyes stands the solution to a huge chunk of our fiscal nightmare and a lifeline for the auto industry: single-payer health care. And, yet, there is a virtual traditional media blackout on single-payer, witness another example in yesterday’s New York Times.

In The Week In Review, reporter Kevin Sack stumbles through an entirely conventional wisdom article, with this brilliant observation:

Mr. Obama seems to recognize that the recession, with its devastating job losses, affords him the potential to accelerate public opinion. To broaden support for his plan — whatever it ends up being — he insisted last week that systematic improvements in health care would be essential to any lasting economic recovery.

Sacks goes on to chronicle some of the desperation faced by millions of uninsured and under-insured people. And, then, he arrives at the framing of the solutions:

There is a rough consensus, certainly among the Democrats who control both houses, around many key components of the Obama plan — to expand government subsidization of insurance for the poor, to stimulate competition through a new government plan, to require insurers to accept those with pre-existing medical problems and to invest in computerization, prevention and payment incentives for better care.

And…

Less certain, of course, is how to pay for it. During the campaign, Mr. Obama said he would get about half of the necessary total, estimated at more than $100 billion a year, by raising taxes on those making more than $250,000. The rest was to come from savings generated by various efficiencies (their value is a matter of considerable dispute).

Mr. Obama reaffirmed on Thursday that his proposal to roll back the Bush tax cuts might be deferred because of the recession. “We’re probably going to have to, then, find additional dollars to pay for some investments in the short term,” he said, adding that he wants his health plan to pay for itself over a decade.

Some of those dollars may be found by packaging health care initiatives as stimulus measures, a recessionary opportunity presented by the public’s acceptance of deficit spending to spur the economy. What, after all, is $100 billion for health coverage if the government can print $700 billion to bail out the banks?

What is startling–though, perhaps, it should not be by now–is that Sack cannot write the phrase “single-payer” in the entire article, even though it is the only health care plan that would SAVE money and relieve the auto industry–and the rest of the business world–of billions of dollars in health care costs.

Even The Financial Times is starting to get it, though indirectly. In an article today on the auto industry, it acknowledges that wages are pretty much the same between U.S. auto workers and non-union Japanese companies. The big difference is health care, particularly for retirees:

GM and Toyota workers earn similar wages of about $29 an hour.

The big difference is in fringe benefits, such as healthcare insurance and pensions.

The overall labour-cost figures also include retiree benefits. Thousands of GM, Ford and Chrysler workers were on pensions with generous healthcare benefits – foreign carmakers have a fraction of the number of retirees.

I wrote as far back as 2005 that single-payer was the solution to the cost issues of the auto industry. But, The New York Times, along with the rest of the traditional media, repeatedly refuses to include single-payer as a legitimate option.

This commentary is from the Huffington Post.

Ryan Budget Proposal Echoes Obamacare While Rejecting It

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Monday, March 11, 2013

These Health Law Bets Are No Figure Of Speech

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Isbah-Care: Getting Health Coverage as a Young Adult

Isbah Raja, a 23-year-old student at the University of Texas, suffered from lupus, an autoimmune disease that attacks her organs, causing pains in her joints and clumps of hair to fall out. Like too many other young adults prior to passage of the health care law, she had to worry about getting and staying well while also trying to get health insurance.

She�s now covered by her father�s health plan and will be until she�s 26, because of the health care reform law. More than 3 million young adults now have health coverage because the Affordable Care Act requires insurers to allow young adults up to 26 to be covered by their parents� health plans.

YouTube embedded video: http://www.youtube-nocookie.com/embed/k9XFBOLxs2E��

The Affordable Care Act �directly had an impact on my life,� Isbah says. �I don�t have to worry about not being able to see a specialist, not being able to get the medications I need.�

And, Isbah notes, that when she ages off the plan and has to secure health insurance on her own, the health care law will bar insurers from denying her coverage because of her pre-existing condition.

�That�s a comforting feeling,� Isbah says. �There�s no more anxiety anymore.�

Medicare. For All. For Life. Everywhere.

When the Medicare for All bus gets stuck, a neighborhood shows its true spirit

After spending the past month on the California Nurses Association ‘Medicare for All’ bus tour in California, I am more confident than ever about the prospects of winning guaranteed healthcare for all under an improved Medicare model. Cradle to grave. For life. In California. Everywhere.

Our wonderful videographer, Erin Fitzgerald, has been traveling with us and capturing the stories Californians have shared along the way. In advance of our two stops in Santa Monica Wednesday, July 11, at the Unitarian Universalist Community Church at 1260 18th Street (3-6 p.m. health screenings and 6:30-8 p.m. town hall) and tomorrow at the West Covina City Hall (same times and events), Erin captured images from our stops so far and shared them in this video piece:

At West Covina City Hall, 1444 W Garvey Ave South, Thursday evening at 6:30 p.m., July 12, Reggie Cervantes, 9/11 responder, and Dawnelle Keys, mom whose beautiful toddler Mychelle died because an out-of-network hospital wouldn�t treat her, will join me for a mini-SiCKO reunion. Join us as we talk about why Medicare for all for life would have been the only thing that might have saved us from been fodder for Michael Moore�s 2007 film.

There is no question that Californians want guaranteed healthcare for all. Only a small percentage of those we have reached out to have rejected the call. And those few seem fixed on their own isolated �I-have-mine-and-I-don�t �care-about-you� mindset. Those few folks are often turned around when medical crisis strikes, and though I never wish that on anyone else, I know that in an instant life as you know it can change and leave you utterly dependent on others for our lives.

So it was perhaps fitting that last night in South L.A. when we were just getting ready to pull out of our stop at the S.C.O.P.E. offices after the screenings and town hall, our bus got stuck. One wheel perched high in the air, we were straddling the whole of Florence Avenue and going nowhere. Within seconds, traffic started to back up and people in the neighborhood jumped to try to help us. One man tried to shove wood planks under the airborne wheel to give traction but the driver feared that with any additional pressure, that wood might fly out from under the wheel and hurt or kill someone. It didn�t work. So many good people tried to help, but it just didn�t work at all.

Finally, after quite some time, a police officer stuck his head in our bus and said, �What are you all doing in the ghetto?� That seemed an odd question to ask on many levels, but perhaps speaks to where we are in terms of our shared humanity and perceptions of that humanity. The police officer facilitated getting a huge wrecker to the site to pull the bus forward and, after significant effort, return our bus to the road.

It was interesting to me to see first the pulling together of community and then the intervention of publicly paid law enforcement personal and others to fix the problem. There was no consideration given to just letting us sit forever in that precarious spot. Seems like the right way to handle it when any one of us faces crisis outside our control. Could the bus driver have taken that turn and curb one degree or two differently and avoided the problem? Maybe. We�ll never know that, and that didn�t really matter. What mattered was that when confronted with a stuck bus and its stranded occupants, the local community came together to help.

I�ve been on a bus for Medicare for All that caught fire on the side of a highway in rural West Virginia. I have been on the SiCKO buses that traveled around the country with nurses educating people about the broken healthcare system and their demand for one single standard of high quality care for all. And now I�ve been on a bus that was stuck in South Los Angeles in a neighborhood where many people choose to avoid, but where the people who live there are both generous and equal in their shared need for healthcare.

Bus tours are grueling and we sometimes wonder about the costs and the challenges that come along with them. But always there are the amazing moments of clarity that come from being present with one another in ways that are so personal and direct. I have spent six months of the past five years on a bus fighting for Medicare for All for life. And I am so very lucky to have done so. But now, if you don�t mind, I�d like us to pull this together and win. And as the young father says at the end of Erin�s video, �Why not healthcare for the world?� Why not, California? We can do it.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Sunday, March 10, 2013

Court Gives States Ammunition In Health Care Battle

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Susan Clark (left) argues with another protester about the Affordable Care Act outside the U.S. Supreme Court. Chief Justice John Roberts likened the law's Medicaid expansion provision to "a gun to the head" of states.

Kris Connor/Getty Images

Nothing breeds lawsuits like uncertainty. That being the case, the Supreme Court's landmark health care ruling is almost certain to open the door to lawsuits challenging the federal government's authority.

The court ruled the federal government can't force states to participate in a major expansion of Medicaid or else risk losing existing Medicaid funds from Washington. That threat amounted to unconstitutional coercion.

"In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement' � it is a gun to the head," Chief Justice John Roberts wrote in his majority opinion.

Congress and federal agencies frequently put strings on the money they give to states. But the high court's health ruling didn't draw a clear line between the types of financial conditions that are OK and those that are unfair to states.

"The way Roberts wrote the opinion, it's a deliberate invitation to litigation," says Brian Galle, a law professor at Boston College.

Testing The Limits

“ This could become a very significant ruling if they're willing to be aggressive about elaborating on this.- Tim Conlan, public policy professor at George Mason University It's possible that this ruling will have broad implications, because Congress uses the threat of financial penalties to get states to do all kinds of things, such as meeting clean air requirements and making elementary school children take annual standardized tests. It's also possible that it won't mean much, because Medicaid is such an exceptionally large program. "This could be a sui generis situation," says Tim Conlan, a public policy professor at George Mason University. "No other federal-state program comes close to the size of Medicaid." But Conlan says there appear to be a majority of justices willing to ask larger questions about the limits on congressional spending power than has been the case for decades. "This could become a very significant ruling if they're willing to be aggressive about elaborating on this," he says. The justices probably will get a chance to do so. States are likely to be emboldened to challenge other federal strictures. If courts find financial penalties that are much smaller than Medicaid to be unconstitutionally harmful to states, this could lead to a massive shift in relations between the states and the federal government � Congress would become much more limited in its ability to impose national standards over a vast amount of domestic policy. New Ammunition For States A spokeswoman for the National Association of Attorneys General says the group's members are still sorting out what the health care ruling means for other federal-state program. The offices of individual state attorneys general, including some who challenged the health care law, similarly say they haven't yet thought through all the implications. “ We've had very little guidance about the point at which a condition becomes coercive. I'm not sure we really have any more guidance now.- Richard Garnett, associate dean of Notre Dame Law School State attorneys general and governors often challenge new rules out of Washington. Typically, they don't win. "I don't know that states have won anything since the New Deal," says Ray Scheppach, a former executive director of the National Governors Association. But the Medicaid ruling gives them new impetus to try. "States are not going to stand passively by and allow the federal government to pass detrimental legislation," says Susan Frederick, federal affairs counsel for the National Conference of State Legislatures. She added: "What we can take away from the Affordable Care Act litigation is that states are no longer afraid to challenge federal legislation." Conlan agrees. "If there's ever been an open invitation for attorneys general to pursue cases, this was it," he notes. "The court did not do what it did in Bush v. Gore, which was to say there will never be another case with these characteristics, which they could have done easily." Congress has been imposing requirements on states in exchange for money for at least a century, Conlan says. During the 19th century, Congress handed out land grant and college funds without any real provisos. Since then, however, Congress has used its spending authority to force states to change the way they do business in lots of areas, from highway administration to welfare policy. "In a sense, Congress learned its lessons about just providing the funds and leaving it up to states' good judgment," Conlan says. No Clear Guidance But the Medicare decision upends that dynamic. If governors in states such as Louisiana, Florida and Texas make good on recent announcements that they won't participate in the Medicaid expansion, the federal government lacks leverage to do much about it. "It is true that this is the first time that the court has invalidated an expansion based upon restraint on federal power," says James Blumstein, a law professor at Vanderbilt University who wrote an amicus brief in the Medicaid case that anticipated Roberts' ruling. "But they've always said for years, decades, that this [limit] existed," Blumstein says. "If this [Medicaid rule] had not crossed the line, the line wouldn't have existed." So where exactly is the line now? No one is certain. In his health care opinion, Roberts cited a 1987 decision, South Dakota v. Dole, in which the court found that it wasn't "impermissively coercive," as the chief justice put it, to require states to raise the minimum drinking age to 21 or lose 5 percent of their federal highway funds. The sum at stake amounted to less than one-half of 1 percent of South Dakota's budget at the time � a lot less than the share of federal Medicaid money that makes up every state's budget, which is about 15 percent, according to the National Association of State Budget Officers. But because there's such a big gap between the amount of money the court has said is permissible and the amount it has ruled is unconstitutional, no one has a clear sense of how much leverage Congress can wield over the states. "We've had very little guidance about the point at which a condition becomes coercive," says Richard Garnett, associate dean of Notre Dame Law School. "I'm not sure we really have any more guidance now." Redefining The Lines It's possible that the Medicaid ruling will remain an outlier. Medicaid is far and away the largest federal-state program, and it was an unusual move for Congress to put the entirety of existing Medicaid dollars at risk, as opposed to a small percentage of program funding. Supreme Court decisions in the 1970s and 1980s suggested that justices were open to exploring limits on what Washington could force states to do, based on congressional spending power, but nothing much came of those cases. And the court said as far back as the 1930s that it didn't want to wade into the murky waters of defining what might constitute coercion because that would result in "endless difficulties." On the other hand, nothing in the court's opinion suggested that it views Medicaid as unique because of its size. Other federal rules also put lots of money at risk. The government places numerous strings on education dollars, for instance. Those may not make up a huge percentage of any state's spending, but federal grant money dominates the budgets of some school districts, which might be encouraged to sue when presented with strictures they don't like. The Civil Rights Act, meanwhile, threatens to cut off all federal dollars from any entity that discriminates on the basis of race or gender.

It's also unclear whether the court's decision opens the door for states and localities to challenge existing rules, or only new ones.

"The Supreme Court knows that this decision is going to result in some federal rules being ruled unconstitutional by some judges and maybe even upheld by some circuit courts," says Galle, the Boston College law professor. "They know that."

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New Gains Seen in Health Insurance Coverage and Access to Care for Young Adults

The Affordable Care Act, the health care law signed by President Obama in 2010, has resulted in substantial increases in health insurance coverage for young adults, according to a new report published by Health Affairs.

The report posted online and scheduled for Health Affairs� January issue, also shows that the law has led to significant reductions in the number of young adults who delayed or did not get needed care because of cost. The report provides proof that the health care law resulted in increased access to health care for young adults.

These gains have come due to the law�s provision that allows young adults to remain on their parents� family plan until their 26th birthday, even if they move away from home or graduate from school. This policy took effect September 23, 2010, helping more than 3 million young adults gain health coverage.

For young adults like Justin Metcalf, who has a rare genetic lung disease, getting coverage means more security and the freedom to take the time to graduate school or choose the job that�s best for him without worrying whether it comes with health insurance.

Among the report�s findings:

Coverage for young adults was up 6.7 percentage points from September 2010 to September 2011.Coverage gains have been significant across all racial and ethnic groups, married and unmarried young adults, and working and non-working individuals.Coverage increases were significant for both men and women, although much larger for men, who had much lower coverage rates before the Affordable Care Act.There were significant reductions in the number of young adults who delayed receiving care and in those who did not receive care because of cost.

This report is the latest to document how the health care law is helping millions of Americans gain access to affordable health care coverage and security they need and deserve.

And beginning in 2014, Americans will have even better coverage options with the creation of new health insurance marketplaces or Exchanges, in which individuals and small-business owners will have the opportunity to choose from a range of quality, affordable health plans to find one that fits their needs and budget.

The report can be found at http://content.healthaffairs.org/content/early/2012/12/13/hlthaff.2012.0552

For more information about the Affordable Care Act and young adults, please see http://www.healthcare.gov/news/factsheets/2011/08/young-adults.html and http://www.aspe.hhs.gov/aspe/gaininginsurance/rb.shtml

Friday, March 8, 2013

To Save A Life, Odds Favor Defibrillators In Casinos

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Thursday, March 7, 2013

The Health Care Law Is Saving Americans Money

The Affordable Care Act holds insurance companies accountable and puts more money back into the pockets of Americans across the country. According to a new report, consumers saved over $2 billion because of new rules that protect people from insurance industry abuses.

As a former Insurance Commissioner, I�m familiar with how alone consumers can feel when dealing with their insurance companies.� �Under the health care law, insurers are finally being held accountable to their policyholders.� For the first time ever, new rate review rules in the health care law prevent insurance companies in all states from raising rates with no accountability or transparency.� Forty-five states and the District of Columbia have received $160 million in grants to increase their oversight of premium hikes.�

Some states, like Nevada, are using the funds to better educate consumers about the resources available to them.� Others � like Mississippi and South Dakota � have used the money to add new consumer protections. �In these states, officials can not only review rate hikes, but can also reject those hikes that are not justified.�

And more improvements in states around the country are on the way.

Last September, we also put in place new rules that ensure that every single rate increase of 10 percent or more is �reviewed on either the state or federal level.� For the first time, we have been able to guarantee Americans that no matter what state they live in, insurers will no longer be able to raise their rates by double digits without justification.

These rules make the insurance marketplace more transparent and more competitive. And today�s report shows that these rules are beginning to work.� Of the double digit rate hikes that have been reviewed, half of them have been reduced or withdrawn altogether.� That�s saved nearly 800,000 Americans an estimated $148 million.

When you look at all reductions to proposed rate hikes, including those below 10 percent, consumers have saved an estimated $1 billion.

And that only begins to capture the effect of the law�s new protections.� For example, these numbers don�t count the countless additional rate hikes that insurance companies decided not to try, knowing they could no longer do so �without increased scrutiny.

These rules work hand in hand with other provisions of the law that save money for consumers. Thanks to the law�s 80/20 rule, 13 million Americans will benefit from an additional $1.1 billion in rebates.� That rule sets a maximum amount of Americans� premiums insurers may spend on overhead like marketing and bonuses and requires them to pay their customers the difference if they exceed that limit.�

Added together, these reforms have saved consumers an estimated $2.1 billion in the last year.

What today�s report documents is a health insurance market that�s finally starting to work for consumers the way markets are supposed to.� Instead of being able to raise rates without any consequences, insurers are being forced to offer more competitive prices.� And consumers are getting more information to help them shop around for the best deal.

For today�s report, visit here.

Wednesday, March 6, 2013

Old Triumph Over Young In Federal Spending, And Sequester Makes It Worse

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Federal spending on seniors already far outpaces that devoted to children. Last year, overall spending on children dropped for the first time in 30 years. The sequester, which expressly protects programs for the elderly, will exacerbate that difference.

Anne de Haas/iStockphoto.com

For years, federal programs for seniors and those that help kids have been on a collision course.

Now, given the automatic spending cuts taking place under sequestration, the moment for real competition may have arrived.

While Medicare and Social Security will come through the sequester mostly unscathed, a broad swath of programs targeted toward children � Head Start, education, nutrition assistance, child welfare � stand to lose hundreds of millions or even billions of dollars.

"There's a conflict between parts of the budget that go to younger people and that part that goes to older people," says Neil Howe, a demographer and consultant. "Up to this point, young people are on the losing side."

Groups that advocate for seniors say that this sort of "generational equity" argument is a misleading attempt to divide and conquer.

The Urban Institute

"It reinforces this notion that to take care of children, you have to undermine their grandparents in some way," says Eric Kingson, a social work professor at Syracuse University and founding co-chairman of Social Security Works. "It serves to drive wedges between groups that are very naturally joined at the hip."

But while it's true that cutting a dollar in Social Security won't send that dollar straight to the Head Start account, such programs are inevitably competing at a time of limited federal resources.

"The sequester again shows that as a country we're not willing to make an investment in our kids," says Mark Shriver, vice president of Save the Children.

Federal spending on seniors already far outpaces that devoted to children. Last year, overall spending on children dropped for the first time in 30 years.

Given automatic increases baked into the entitlement programs, as well as increasing demands from an aging population, simple math dictates that spending for the elderly will grow only more generous under current law � and that threatens to crowd out spending on children, among other priorities.

"New revenue will be eaten up by entitlements," says Bruce Lesley, president of First Focus, a children's advocacy group. "In the long run, unless things change, kids will get almost nothing."

Not All Bad For Kids

It's a little misleading, though, to look only at federal dollars. Washington may spend more on seniors, but that's partly because many programs that aid the young are primarily funded at the state and local level.

"The federal government is in charge of the old people," says Dowell Myers, a demographer at the University of Southern California. "States do 90 percent of school funding."

Even at the federal level, while many programs that benefit children directly or indirectly are under the ax, others have been sheltered from the sequester � notably, food stamps, the earned-income tax credit and Medicaid.

"It could be much worse," says Julia Isaacs, a senior fellow at the Urban Institute. "The people who wrote the law exempted so many low-income programs, and children are, unfortunately, disproportionately low-income."

Speaking With Many Voices

Looking beyond the sequester, though, funding for kids' programs appears much more vulnerable than Social Security and Medicare.

Increased funding for entitlements is essentially on autopilot, while those that benefit children depend on members of Congress digging into the federal wallet on an annual basis.

Often, the kids lose out. While the very nature of entitlements means that they are universally available for seniors, millions of eligible kids are not able to take advantage of programs such as Head Start. Other programs, such as special education, are chronically underfunded.

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The nonprofit group Next Generation took out this full-page ad in The Washington Post on Sunday, arguing that "America made a choice to help lift seniors out of poverty. We need to do the same for our kids."

Courtesy: Next Generation

Spending on children is also more diffuse. While seniors are highly vocal about Social Security and Medicare, advocates for children have to try to protect a long list of different spending categories � education, foster care, health and much more.

"The kid community is very segmented," says Lesley, the First Focus president. "There's no AARP, which says it has 50 million members, for kids."

Boomers And 'Parasites'

The idea that disparate funding on old and young could trigger generational warfare has sometimes seeped into the popular culture. Christopher Buckley's 2007 satirical novel, Boomsday, opens with a mob of young people rioting outside a Florida gated community "known to harbor early retiring boomers" to protest a Social Security payroll tax hike.

Economics reporter Jim Tankersley, now with The Washington Post, argued in an essay last fall at National Journal that the baby boomer generation has sucked a disproportionate share of resources out of the country, calling his own father "a parasite."

Such open resentment is comparatively rare, however.

"Most of us live in families and communities; we don't live in isolation," says Donna Butts, executive director of Generations United, which promotes intergenerational initiatives. "Young people don't want Social Security to be eliminated for the older people in their lives, and the old people don't want to see schools cut for the younger members of their family."

Picking Between Priorities

Kingson, the Social Security advocate, notes that even programs that appear designed strictly to help the elderly, such as Alzheimer's research, will end up paying greater dividends for those who are currently young.

"Old people have a stake in children's policies," he says. "You don't have to rob Peter Sr. to pay Peter Jr."

But while it's true that today's young people will eventually grow old themselves, government budgets are about the present. And those who are now old are better protected than children and youth.

Shriver, the Save the Children executive, says it's "fantastic" that federal entitlements have helped bring poverty rates down among seniors in recent decades. But he wishes similar action were taken to help kids.

"Kids don't have any political juice � they don't have PACs, they don't have AARP, and poor kids, in particular, their families don't make campaign contributions," Shriver says. "That's why we as a country have invested [more] in seniors."

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Monday, March 4, 2013

Got A Health Care Puzzle? There Should Be An App!

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Why The Hospital Wants The Pharmacist To Be Your Coach

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Sunday, March 3, 2013

Stressed Out Americans Want Help, But Many Don't Get It

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Helping People Live Well with Chronic Diseases

Coordinated health care for all Americans is incredibly important. But it is especially critical for people with multiple chronic conditions.

One in four Americans has more than one chronic condition such as heart disease, cancer or diabetes. And a person with multiple chronic conditions may have not just a primary care doctor, but a cardiologist, a kidney specialist, and a mental health counselor, for example, all of whom provide care. Ensuring that care is coordinated�making sure each provider knows what tests that person has taken, what medications she is on, and what her medical history is� is not always an easy thing to do.

In fact, people who are dealing with several illnesses together are at greater risk of disability, hospitalizations, readmissions, adverse drug events, and even death than those who are not.� Caring for people with multiple conditions is also costly.� In fact, two-thirds of health dollars in the U.S. are for patients with two or more chronic conditions, and 93 percent of Medicare spending goes to care for this population.

But thanks to the Affordable Care Act, we are beginning to see more coordinated care by encouraging providers to work together. �In the last few weeks, the Department of Health and Human Services (HHS) has launched a number of initiatives to achieve coordinated care for beneficiaries with Medicare.�

The release of final regulations governing Accountable Care Organizations (ACOs) which facilitate coordination among �your many providers along with another project to help community health clinics become �medical homes� for those with Medicare demonstrate this commitment.

We have also compiled a Strategic Framework on Multiple Chronic Conditions, which identified 111 programs, activities and initiatives across the HHS that focus on improving the quality of life and health status of people with multiple chronic conditions.�

Many of the programs include efforts to prevent chronic diseases, develop comprehensive health homes (a single provider or practice to coordinate care), and integrate primary care and behavioral health for people with multiple chronic conditions.�� Other initiatives support the use of self-care through expansion of the Chronic Disease Self-Management Program. ��Others fund comparative effectiveness research to optimize prevention and care for those with multiple chronic conditions.

Implementing strategies of the framework � whether developing new care models, empowering individuals, equipping providers with tools, or enhancing research � should result in better care, better health and lower costs.

Ultimately, we need to help people take preventive measures and we need to ensure our health care system is prepared to meet the needs of those who must deal with multiple chronic conditions. Using the tools we have, including those provided by the Affordable Care Act, we can improve the health of those who live with multiple chronic conditions and lives of Americans.

Healthcare-NOW! Activist, Alison Landes, on the air

Yesterday, Alison Landes, a single-payer activist with Healthcare-NOW! and Floridians for Health Care was interviewed on WMNF 88.5 by Rob Lorei. Listen to the full show.

The show’s topic was “Does the Nation Need Health Care Reform?”

Excerpt from the show: Today we�ll talk about health care reform. It�s near the top of the agenda of the incoming president. Obama supporters will soon be holding house parties to discuss what people at the grassroots level would like to see done about health care. Also, Pinellas Democrats will soon hold a series of meetings to talk about health care reform.

Our first guests today are nearing a financial crisis because they don�t have health insurance. They are Joycelyn and Jim Elliott. He is a chiropractor by profession. She has been unable to work due to stress. In 2004, they moved from Tampa to Nebraska to restart their lives. I spoke with them yesterday.

Allison Landes lives in Boca Raton and she�s a volunteer with Floridian�s for Health Care, a group that advocates a single payer style health care system.

Read the full article here.

Saturday, March 2, 2013

Medicaid expansion a tough sell to governors of both parties

While the resistance of Republican governors has dominated the debate over the health-care law in the wake of last month�s Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage.

At least seven Democratic governors have been noncommittal about their willingness to go along with expanding their Medicaid programs, the chief means by which the law would extend coverage to millions of Americans with incomes below or near the poverty line.

�Unlike the federal government, Montana can�t just print money,� Gov. Brian Schweitzer (D) said in a statement Wednesday. �We have a budget surplus, and we�re going to keep it that way.�

The law would add an estimated 84,000 people to Montana�s Medicaid program, doubling its size, the governor said. Although the federal government would pay the vast majority of the additional costs, Montana�s health and human services department estimates the state�s share would reach $71 million in 2019. Outside groups say the costs would be far lower than that.

The range of state leaders expressing unease suggests that implementing the law could be rough going, with divisions not always breaking along party lines. The topic is likely to factor prominently in this week�s meeting of the National Governors Association in Williamsburg, Va. And it has been fueled by a long list of unanswered questions about the choice now before states.

In particular, it is unclear how the court�s pronouncement that states cannot be penalized for refusing to adopt the law�s more generous eligibility standards for Medicaid in 2014 changes the rules governing the expansion.

Will states that opt in have the option of scaling back in future years? If a state that opts out decides it wants to participate at some later point, will the federal government still pay nearly the full cost of covering those who become newly eligible for Medicaid? And can a state participate only partially � for instance, by raising the income cutoff for its program to a level lower than the ceiling envisioned in the law, which is set at 133 percent of the federal poverty line?

Asked at a forum Wednesday to describe state reactions to the Supreme Court ruling, Dan Crippen, executive director of the National Governors Association, offered a one word reply: �confusion.�

The association was one of several � along with the Republican Governors Association and the National Association of Medicaid Directors (NAMD) � to send a letter to Secretary of Health and Human Services Kathleen Sebelius this week with a voluminous list of queries.

�The answers to these questions are key,� said NAMD Director Matt Salo. �States need to be making these decisions now, and it�s hard to make them if you don�t have clarity.�

Friday, March 1, 2013

Robyn-Care: Providing Extensive Care for a Sick Baby

Robyn Martin is a remarkable woman from Maryland who shared her story of how the Affordable Care Act, the new health care law, is affecting her family�s life. In a discussion with Health and Human Services Secretary Kathleen Sebelius and other women in Maryland, Robyn spoke of her son Jax, who has serious genetic disorders, including a heart defect. After he was born, he immediately was placed in the neonatal intensive care unit (NCIU), where he spent three weeks.� Jax has undergone surgery since then.� The Affordable Care Act�s prohibition on lifetime dollar limits for coverage is so important to Robyn�s family.

�I don�t know how much all of his health care has cost to this point, but in five months, I know it�s got to be a lot. The first day in the NICU was $150,000,� Robyn says. �If he in five months used up the lifetime limit for him, my family would be in really dire straits.�

Read more about the impact of the health care law on Robyn�s family.

Visit www.healthcare.gov/mycare to learn more about the benefits and rights under the Affordable Care Act.

Praying for Health Care Sanity

I admit it. I pray. I know there are intellectuals who are above such frivolity and for whom the showing of any belief in a power greater than one�s self and one�s intellect is the ultimate sign of weakness and inferiority. I don�t care. I am not weak, and just because I am not in the economic or intellectual class as some have identified that class does not mean my brain is inferior to anyone else�s.

I think a lot about cruelty and the power that the profit-making gods have over people in America today. And I work every day to support efforts to make the healthcare system less profit-driven and more humane. To do the work I do, I educated myself and have worked at least as hard intellectually and professionally as any of the elite class who hold so much power over the rest of us � not because they have earned that power, but because they have purchased it with cash, with cruelty and with blind ambition to control the lives of others.

Today, I pray. And for many American patients, prayer is one of the ways we try to steal ourselves against the traumas of an inhumane healthcare system run by the same profit-driven forces that control nearly every aspect of our lives every day. My insurance company has made my most recent cancer journey hell for me. For the past two months, the diagnostic efforts and now my treatment options have been second-guessed and delayed. But nothing else in life is delayed. So I pray. I pray my doctors have the wisdom and skill to work around Aetna�s demands (I am sure you could easily substitute your own insurance company�s name here), and I pray I can dance fast enough around all the other issues in life to keep everything steady through this process.

A few weeks ago I wrote that if this cancer ends up requiring some long, expensive fight for care and I will likely not be OK anyway, I will not spend the rest of my life fighting with an insurance company and begging for mercy. That has not changed. But I am not even yet to the point where I can make that decision � the insurance company has questioned every single test and every procedure though I have faithfully used their �preferred providers.�

I pray today, as many Americans patients do, that I wake up this afternoon and hear a good result, but that I won�t be left with hundreds or thousands in bills somehow. I pray, as many American patients do, that I won�t be seen in the wider world as damaged goods and unable to fulfill my other responsibilities. I pray, as many American patients do, not that I won�t hurt or die but that I won�t make others suffer because I couldn�t navigate the cruel system well enough even as I felt ill and needed help but didn�t dare ask for it.

Would this all be different if we had an improved, expanded, Medicare for all, for life, system? Of course it would. I would still pray. But I could stop praying for everything external to my healing and begin focusing all of my emotional, spiritual, and physical energy on fighting for health and well-being. And what a gift that would be.

So, you bet I pray today. I pray Aetna, cancer and those who think I am weak just get the hell out of the way. I pray for my doctors to help me heal, and I pray to just get on with my work. Oh, and I pray for small bills and that I�ll keep having the income I need to pay them. If we had Medicare for all for life, I�d be praying for strength and health. Simple prayers. Not too intellectual. Just me and my god, without interference from Aetna. Amen.