Category Archives: Medicare

Despite expanded coverage, hospitals may see more bad debt – Nashville Business Journal

I definitely don’t want to harsh on anyone’s mellow about Obamacare, but this is the part that worries me:  the bad debt that hospitals are going to take on.  This issue is going to have to be reconciled somehow.

Despite expanded coverage, hospitals may see more bad debt – Nashville Business Journal.

ODI: Health insurance premiums to increase 41 percent |

Then again, maybe not.

ODI: Health insurance premiums to increase 41 percent |

More people covered, costs lower for Washington Health Plan – – Aug. 2, 2013

Obamacare — it’s working!

More people covered, costs lower for Washington Health Plan – – Aug. 2, 2013.

Mississippi GOP Leaders Say They Will Resist Expanding Health Care

In case you wonder what Obamacare will look like in some states, here is an example of a state, Mississippi, that is already saying “Whoa, horsie!” when it comes to implementation.

Miss. Medicaid expansion unlikely, GOP leaders say – The Dispatch.

I wonder about the implementation here in Rhode Island and whether we will be able to extend health care coverage to all, given our sagging economy. As I said in an earlier post, I see health care as a potential economic driver, and I hope Rhode Island will find ways to make this happen.

As a health care practitioner, I am particularly interested in changes specific to children and families. For more on how the law specifically impacts children and families, the Children’s Mental Health Network has a page that gives a helpful breakdown of all the changes.

[Ninjanurse butts in to Kiersten's post]
Lt. Governor Elizabeth Roberts sent an email with this–

Rhode Island has been implementing the federal health reform law for over two years, beginning with Lt. Governor Roberts’ early efforts in 2010 to ensure Rhode Island had a clear path ahead toward achieving universal coverage for Rhode Islanders. With the Supreme Court’s ruling, that path has been cleared for the state to move forward in partnership with the federal government and continue to benefit from its support and funding.

The Supreme Court decision means up to 120,000 uninsured Rhode Islanders will be able to enroll in healthcare coverage starting October 1, 2013 and will have access to the coverage by January 1, 2014. Rhode Island families and small businesses soon will have an online marketplace known as the RI Health Benefits Exchange where they can easily buy and compare health insurance options. Some residents will even qualify for free or low-cost insurance depending on their income. Rhode Islanders will begin to hear more about this marketplace in the coming months.

These are not empty words, but a work in progress. As much as I wish we could speed it up, I know that good people are working overtime to meet these goals.

One of those good people is a Republican, Christine Ferguson, who has been appointed by Governor Chafee as head of the new Rhode Island health insurance exchange. Ms. Ferguson has a long resume of health management experience in Rhode Island and Massachusetts and is a passionate and effective advocate for people in need of access to basic healthcare. We’re lucky to have her on our team at this point in time.

My Conscience Clause

I’m thinking about how my tax dollars are going to buy proton pump inhibitors for people who not only don’t have ulcers, don’t have raging gastric reflux– but people who tell me their stomachs are just fine!

I’m outraged. My religion, which I re-name weekly, forbids over-prescription of drugs of dubious benefit to people who don’t actually have a disease. My philosophy is called ‘evidence based’. It’s a minority religion, I’ll admit, but reality does have a way of sticking around whether it fits our narrative or not.

I demand that insurance companies stop funding proton-pump inhibitors for people who would do just fine with an occasional Tums. I demand that the secular authorities bow down to my authority as High Priestess (self-ordained) and re-arrange everyone’s insurance immediately.

Don’t whine to me that your stomach hurts. I have conscience, and I’m exercising it on you.

Toxic Debt Ceiling Collapses on US Elderly

AARP released a statement about the newly passed legislation on the debt ceiling. While in the first two paragraphs, it’s clear they are trying to be nice, by the third paragraph, they are getting down to business about what is wrong with this legislation. From the statement:

“We are relieved that Congress has acted on a bipartisan agreement to address the debt ceiling and prevent default to ensure that seniors will continue to receive their Social Security checks and have access to health care. We are also gratified that after hearing from millions of AARP members, the President and Congress did not cut Social Security, Medicare and long-term care in the first round of deficit reduction.

“Going forward, we are pleased that Social Security, Medicaid and Medicare benefits are protected if the so-called “super committee” fails to reach an agreement later this fall, but we will remain vigilant in our efforts to protect the health and retirement security of seniors and future retirees. We are concerned that a fast-track committee process will deny Americans a voice in the discussion about critical tax, health and retirement issues. We also are concerned about the potential use of a trigger that would arbitrarily cut provider payments under Medicare, which could unfairly shift costs to seniors.

“Seniors have worked their entire lives to achieve a level of health and economic security in retirement. As the deficit debate continues, AARP will continue to impress upon Congress the need to protect Medicare and Social Security from harmful cuts. With the compounded effect of loss of retirement savings and home equity, high unemployment and rising health care costs, cuts to the benefits seniors have earned could undermine the standard of living of not just those with limited incomes, but middle class seniors who have median incomes of only $18,500.

“AARP will continue to raise the voices of millions of Americans who rely on their Social Security and Medicare benefits and oppose benefit cuts for deficit reduction. Americans want a broader conversation around health and economic security, not one focused solely on deficit reduction.

“AARP believes that the American public deserves a seat at the table in any forum, including the newly created super committee, that discusses potential changes to these critical programs. We believe that our nation’s leaders should work together to strengthen health and retirement security for current and future generations.”

Who is going to be on this “Super Committee”? Is this “Super Committee” going to supplant Congress? How many seats on the Super Committee are going to be reserved for the already-super-influential corporations?

What are we fighting for?

As the public debate over health care reform rages on, the private battles with health insurers for essential coverage continue on, as well. While some fight for political advantage, others fight for their lives. The triviality of the former should be obvious to even the most insensate, particularly when contrasted with the high stakes of the latter. Individually, each tale of medical hardship rends the heart and evokes sorrow and sympathy. Collectively, the tales make a compelling case for the desperate necessity of reform. Consider the following two stories:

Family Learns Pre-Existing Conditions Apply at Birth

Houston Tracy, a 12-day-old boy, has already survived a rare birth defect, a feeding tube and open heart surgery. Now his family is waiting to see how the battle with an insurance company will fare.

Last week, Houston’s parents found out that the term “pre-existing condition” can apply the moment someone is born.

“When he came out, he made one little cry and he didn’t really cry much,” said Houston’s father, Doug Tracy, 39, of Crowley, Texas.

Tracy cut the umbilical cord and watched the hospital staff clean his son. But before his wife Kim Tracy, 36, could touch their son doctors got worried. “We could tell there was something wrong by the way they [the doctors] were acting,” Doug Tracy said.

Houston’s skin wasn’t turning a shade of pink like most newborns because, somehow, his blood wasn’t getting enough oxygen. Doctors rushed Houston, with Tracy riding by his side, in an ambulance to Cook Children’s Medical Center in Fort Worth, Texas.

Within hours the Tracy family would learn their son was born with a heart condition called d-transposition of the great arteries, meaning the aorta and pulmonary artery are transposed where they should meet the heart. Doctors wanted to operate within days to save his life….

Houston was born on Monday, March 15. By Friday that week, doctors operated successfully….But by March 24, the Tracy family formally heard their son was denied health insurance.

“We don’t have health coverage on ourselves because it’s too expensive these days and because of the economy,” Doug Tracy said. The couple are small business owners and would have to buy individual policies, which they have for their other children Cooper, 4, and Jewel, 11.

Doug Tracy said the family had no idea there was something wrong with Houston before he was born.

“Prenatal, every doctor visit was perfect, his heart beat was fine,” he said. But Tracy said he called Blue Cross and Blue Shield of Texas twice in preparation of Houston’s birth, and he asked if they could get a policy on his son before he was born.

“They said we can’t do that because he wasn’t born yet, but as soon as the baby’s born go online and fill an application out,” he said. Doug Tracy applied for Houston’s insurance March 18, and the first month’s premium of $267 was charged to his credit card, he said.

“Wednesday, the 24, is when I got a letter of decline — they declined it the day after the [health insurance] bill was signed,” Doug Tracy said. [full article]

And about 1,000 miles away in Wisconsin:

Woman’s move triggers loss of coverage for cancer treatment

For nearly a decade, Paula Oertel’s brain tumor was kept at bay by a drug that was not approved to treat her condition.

Then Oertel did something she never imagined would jeopardize her good health. She moved. Less than 30 miles – from one county in Wisconsin to another.

The move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including the drug. And the tumor returned within four months.

What happened to Oertel stunned her doctor, Mark Malkin. Nothing he learned in medical school prepared him for what now is too often a sad and frustrating part of his job as a cancer specialist: fighting Medicare and private insurance companies over life-or-death decisions.

Doctors aren’t supposed to get emotionally involved in the cases of their patients, but tears well up in Malkin’s eyes when he talks about Oertel, the 40-year-old Oshkosh woman he has been treating for several years.

“I wish Paula would have a second chance,” he said, choking up.

Oertel and Malkin are facing an ailment no drug can cure: a complex health insurance system that can overwhelm a seriously ill patient unequipped to deal with its complicated rules.

As America debates health care reform, cases such as Oertel’s illustrate how important decisions made between doctors and patients can be overruled, leaving patients with no options and the likelihood of dying in a matter of months. [full article]

Meanwhile, those who profit from a system that denies or restricts coverage are digging in their heels. The New York Times reports that, “just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.” Their stance is clear. They will resist change, to the detriment of us all. It’s sickening.

The Truth About Healthcare: More is Not Always Better

For those who are concerned about health care, health care costs, and health care reform, I highly recommend Atul Gawande’s report from McAllen, Texas, where Medicare spending is twice the national average.  From The New Yorker: 

It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.

McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”  [full text]

Breaking Out of the Nursing Home

One of my most memorable patients is a woman I’ll call Victoria, who is almost completely paralyzed. She can use her hands a little, but can’t turn in bed. She needs complete care by a nurse’s aid several times a day, every day. Her body is failing, but her mind is intact, and she knows her rights.

“They won’t get me back in a nursing home.�

I don’t know if I agree with her decision to get care at home, but I think she demonstrates what is possible. If she can manage with her extreme disability, what reason is there to force her to live in a nursing home when she doesn’t want to? What excuse is there for this?

PLANT CITY, Fla. – Charles Todd Lee spent a lifetime going backstage at concerts, following politicians on the campaign trail and capturing iconic shots of everyone from Martin Luther King Jr. to Mick Jagger to Mickey Mantle. Today, he enjoys such freedom only in his dreams.

The 67-year-old photographer has been confined to a nursing home for five years, the victim of a stroke that paralyzed his left side. And he’s angry…

Lee is among the Medicaid recipients across Florida challenging the nightmare of the old and disabled: to be forced from comfort and familiarity into a nursing home.

They say the state is illegally forcing them to live in nursing homes when they should be able to live where they choose. Advocates charge that nursing homes, afraid of losing money, have successfully pressured politicians to make qualifying for community care more difficult. They have filed a federal lawsuit seeking class-action status on behalf of nearly 8,500 institutionalized Floridians…

Americans who qualify for Medicaid and get sick or disabled enough to require substantial care typically have little problem gaining admission to a nursing home. But obtaining Medicaid-supported services at home, such as visits from an aide, is substantially harder and often involves a long waiting list, even though it may cost the government less.

Did you read that last line? ‘Even though it may cost the government less’.

I’m not intending to criticize nursing homes. I’ve worked in several, and they’ve improved a great deal in the last twenty years. For some people a nursing home is the best option, and many use nursing homes for short-term rehabilitation or respite.

But Charles Todd Lee, paralyzed on the left side, able to give an interview, sounds far less disabled than Victoria. What the heck is he doing in a nursing home? Against his will?

When decisions are made about Medicaid spending, a share goes to nursing homes and a share to home care. Neither is cheap, but home care is usually less expensive. Home care is underfunded in Rhode Island, making it difficult to recruit and retain good workers who are the foundation of the whole system.

I think we are doing better than Florida, but maintaining home care as a real option will require support from the state and advocacy from consumers.

Special Needs

I love my job. I ride around and see the insides of people’s houses and hear their stories. For a writer it doesn’t get any better.

I’m thinking today about a mother and daughter I visited in Providence. I was there to supervise a nurse’s aid who was giving care to the daughter.

The daughter was in her thirties, a petite, quiet, severely mentally disabled woman. It wasn’t Down syndrome. I never found out what caused the disability, but the young woman would never be able to live without help. She needed to be fed, dressed, played with and constantly watched. She was like a two year old child, although stronger and more mobile. She occasionally had seizures, fortunately not often. She would have fits of temper, but with gentleness she could be calmed.

The house fascinated me. It seemed that nothing had been changed since President Kennedy. Maybe nothing had been changed since the mother began her life of devotion to a baby who would need her every day for as long as she could give.

If this little family had any money, it was not apparent. There was nothing new in the house anywhere. The mother was cheerful and uncomplaining, focusing on what was going well. No emergency room visits for months, no seizures or colds. She had nothing but praise for the kind nurse’s aid who cared for her daughter.

What does it take to support a special needs child in barest poverty? My agency sent a nurse’s aid to give the mother a few hours of respite. The daughter was enrolled in a day program from morning till afternoon on weekdays. Given her condition she would have been on Medicaid and SSI Disability to cover her medical expenses and prescription drugs.

Hillary Clinton was attacked for saying that it takes a village to raise a child, but it’s a fact that no one can give this level of care without help. In a run-down apartment in a poor section of town a mother depends on social programs just to survive.

I have visited other families where a mother, or both parents, devote their lives to the care of a disabled child. It doesn’t get easier as parents age and children’s needs increase.

I was listening to WRNI today, a conservative economist was talking about cutting government spending, specifically Medicaid and Medicare. Our governor has cut children’s health care. The Republican candidate promises not to raise taxes.

At the same time, the religious right are exuberant about the ‘culture of life’. They say that Sarah Palin ‘walks the walk’. Will she, or any of her party stand up and defend the programs that make life possible for children with special needs? Will they defend those programs against demagogues and short-sighted tax-cutters? Will they even give domestic needs the same respect they give the military?

If the Republican vice-presidential candidate is truly a maverick she has her chance to speak up now.


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