Health Insurance Within Reach
By RONI CARYN RABIN
Ever since Marci Lieber, a part-time social worker in Brooklyn, learned she was pregnant, she and her husband have been scrambling to find health insurance. But insurers consider pregnancy a pre-existing condition, and won’t sell anyone a new policy that covers it.
That changes on Jan. 1, 2014, when insurers will no longer be permitted to deny coverage of pre-existing conditions — and all Americans will be required to have health insurance under the Affordable Care Act. Ms. Lieber, 37, hopes to purchase a policy through New York State’s new health exchange as early as this October.
Just in time: the baby is due Jan. 25.
“I hadn’t paid super close attention to the A.C.A. I didn’t realize it would apply to my life,” Ms. Lieber said. She learned she could purchase a policy through the new exchange from a counselor at Community Health Advocates, a consumer assistance program that helps New Yorkers find health coverage.
Ms. Lieber isn’t alone. Many Americans still don’t realize the A.C.A. is coming into effect, including 6 out of 10 low-income workers who especially stand to benefit, according to a study by the Kaiser Family Foundation. Many mistakenly believe the law has been overturned and few have any idea how they are to go about purchasing health insurance from the online exchanges being set up in each state — or that the federal government intends to help many of them pay for it.
But many efforts are being made to simplify the process of buying insurance and to make the exchanges as user-friendly as possible.
For starters, the state exchanges are Web sites designed to make it possible to purchase health insurance if you don’t get it from your employer. If they work as promised, the exchanges will let consumers compare different options as easily as they would booking a trip on Travelocity or researching a car onEdmunds.com. You can find a link to your state’s exchange at www.healthcare.gov.
All health plans offered on a state exchange must provide comprehensive coverage that includes doctors’ visits, lab work, hospital stays, emergency room services, maternity care, prescriptions, mental health services and children’s dental and vision care. Presumably, this means fewer consumers will be stung by minimal coverage and unexpected denials — the fine print of health policies that everyone dreads.
Don’t let expansion debate be last word on Medicaid
Posted July 15, 2013, at 1:58 p.m.
The attention-grabbing debate over whether Maine should expand eligibility for Medicaid is over for now. But that doesn’t change the fact that Maine’s existing Medicaid program still serves more than 300,000 of the state’s low-income, disabled and elderly residents. And it doesn’t change the reality that Medicaid continues to account for about a quarter of the state budget.
What also remains unchanged is that Health and Human Services Commissioner Mary Mayhew asked federal officials in March for more flexibility so Maine could manage its Medicaid program, known here as MaineCare, the way it saw fit.
Mayhew’s other request in the March letter garnered more attention at the time, and it appeared that request was part of a political move by the LePage administration: Ask the federal government to fully cover 10 years of Maine’s Medicaid expansion costs while federal law specifically provides for only three, force the feds to reject the request because it ran counter to federal law, then use the rejection as political cover to veto an expansion bill.
But the request for flexibility can’t be dismissed as easily. And federal officials didn’t.
In a reply to Mayhew’s March letter, Cindy Mann, director of the Centers for Medicare and Medicaid Services, invited Mayhew to follow up and start a discussion with Medicaid administrators over what flexibility the state needs to manage a sustainable Medicaid program.
Mayhew told the Bangor Daily News in a March interview that flexibility has largely to do with the paperwork-intensive process state officials must follow to make even slight changes to Medicaid policies.
“Frankly, even where it is permissible, it is incredibly bureaucratic and administratively burdensome,” she said. “We know that health care delivery is changing rapidly, and Medicaid’s policies need to keep pace.”
Mayhew also cited the state’s inability to make better use of services provided in clients’ homes and communities — rather than in more expensive institutions and nursing homes — especially for elderly residents and Mainers with severe cognitive and physical disabilities.
Health Plan Cost for New Yorkers Set to Fall 50%
By RONI CARYN RABIN and REED ABELSON
Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under the federal health care lawtake effect, state officials are to announce on Wednesday.
State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.
Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.
“Health insurance has suddenly become affordable in New York,” said Elisabeth Benjamin, vice president for health initiatives with the Community Service Society of New York. “It’s not bargain-basement prices, but we’re going from Bergdorf’s to Filene’s here.”
“The extraordinary decline in New York’s insurance rates for individual consumers demonstrates the profound promise of the Affordable Care Act,” she added.
Administration officials, long confronted by Republicans and other critics of President Obama’s signature law, were quick to add New York to the list of states that appear to be successfully carrying out the law and setting up exchanges.
“We’re seeing in New York what we’ve seen in other states like California and Oregon — that competition and transparency in the marketplaces are leading to affordable and new choices for families,” said Joanne Peters, a spokeswoman for the Department of Health and Human Services
Cholesterol Levels Are Leveling Off
By LAURIE TARKAN
Pharmaceutical companies are racing to develop a new class of drugs that may lower blood levels of LDL cholesterol to a point few scientists had believed attainable, The New York Times reported last week. For many people with high cholesterol, the breakthrough can’t come soon enough.
Statins, the miracle drugs responsible for keeping cholesterol in check in wide swaths of the population, may be reaching the limits of their effectiveness. Average cholesterol levels in Americans have stopped falling since 2008, according to a large analysis of patient records published recently in PLoS One.
Researchers at Quest Diagnostics, a national laboratory chain, reviewed blood levels of LDL, the so-called bad cholesterol, in 105 million adults tested by the company between 2001 and 2011. Average LDL levels declined from 120 milligrams per deciliter of blood in 2001 to 104.7 in 2008, about a 13 percent drop.
But in the next three years, average LDL levels flattened out.
An LDL of 100 mg/dL is considered healthy, but experts say people at very high risk of heart disease should bring their levels down even further, to about 70 mg/dL or lower. The percentage of patients with an LDL under 100 mg/dL rose from 26 percent in 2001 to 45.6 percent in 2008, then leveled off. Those with a high LDL of 160 mg/dL or more dropped from 13.7 percent in 2001 to 6 percent in 2011.
The study was not a random sampling; it comprised individuals whose physicians had requested cholesterol tests. Still, the findings have worried experts.
“The study suggests that the progress has slowed in systematically lowering cholesterol levels,” said Dr. Steven Nissen, the chairman of cardiovascular medicine at the Cleveland Clinic, who was not involved in the study.
The authors suggested that these results may affect cardiovascular mortality rates as well. “There has been approximately a 70 percent decrease in cardiovascular disease mortality from 1970 through 2009,” said Dr. Harvey W. Kaufman, senior medical director at Quest Diagnostics and an author of the study. “A large portion of this was driven by the reduction in cholesterol, and this progress is now threatened.”
A combination of factors have brought down LDL levels, including improved diet and exercise. But statins have been a significant driver over the past 25 years.
Ask Well: Trying to Avoid Statins
By GINA KOLATA
QStatins are widely prescribed for lowering cholesterol, but cardiologists often don’t discuss (or sometimes even dismiss) one of the significant side-effects: muscle pain. What causes it, and can it be alleviated without having to give up the important protection of the statin?
If you routinely hear voices, hallucinate, sink into suicidal depression or suffer inescapable torment, Los Angeles has a place for you.
The county jail.
On Monday, the jail held 3,200 inmates diagnosed with a mental illness and accused of a crime. Most have not been to trial, many have waited months for their day in court, and the majority have cycled through at least once before. There's no longer enough room to house them all in segregated areas, so 1,000 mentally ill men and 300 women are housed with the general population.
Sheriff Lee Baca has said for decades that he runs the nation's largest mental hospital, but we've heard it so often that the shock has worn off. We know there's something inexcusably wrong with the system — something backward and inhumane. But we shrug and move on, and the failure of public policy persists, at great public expense, while Los Angeles County officials order up another round of studies.
On the seventh floor of the Twin Towers, some of the most severely ill men stood in the locked single cells of a dorm-style bloc Monday, staring into space, banging on walls or howling. On the fifth floor, cells were filled to capacity and bunks were squeezed into the common dining area to handle the overflow. Some of the bunks are two beds high, some three. Privacy and quiet do not exist for inmates or their jailhouse therapists.
If you're trying to figure out what makes for a desirable therapeutic environment, said Sara Hough, who runs the jail clinical program for the county Mental Health Department and takes pride in trying to deliver desperately needed care, "this ain't it."
County sheriff's Sgt. Julie Geary pointed out an inmate who thinks that he's Abraham Lincoln and that he's possessed by a spirit. Nearby was a man who's been in and out of jail so many times, Geary is on a first-name basis with him. "You're back," she recalled telling Herman. And she knows which inmates can be expected to complain that poisonous gas is being piped into their cells.
On the fifth floor, a 49-year-old inmate squatted and spoke to me through a small opening in a locked door. He was diagnosed with paranoid schizophrenia as a young man, he said. I asked how many different times he's been in jail since then.
"About 15," he guessed.
And the total amount of time he's been locked up?
"Sir, to be honest with you, about 27 years."
While I spoke to him, another middle-aged man kept gesturing through a window that he wanted to talk, too.
"Sir," he said, "I'm just trying to get into a drug program."
He rattled off a list of diagnoses he's received, including bipolar disorder and schizoaffective disorder. Like the 15-timer, he's been in jail so many times he could only guess at the number.
"About 10," he said.
Clearly, locking these men up over and over again isn't working, and it isn't cheap. But it's what the system has been doing for years in Los Angeles County and in jails and prisons across the country.
http://www.latimes.com/news/local/la-me-0717-lopez-twintowers-20130717,0,690008,print.column
Brian Smith oversees the part of the campus that he and many others at Cerner commonly refer to as "The Bunker."
It’s one of the data centers that Cerner has constructed in recent years, with concrete walls built to withstand a strong tornado, armed guards and multiple security levels. It’s designed to protect what’s inside: a temperature-controlled room full of thousands of servers. There are back-up generators for back-up generators, Smith says, to be sure that this health information isn’t compromised or made inaccessible by a power outage.
This data center and Cerner's others are responsible for health information generated by hundreds of hospital systems and doctors’ offices throughout the U.S.
This could be your data, that prescription your doctor just entered into his or her computer, that lab result that just got processed. The transactions go through here in real time.
Data storage is a big selling point for Cerner, but it's one part of what the company does. It has software for all sorts of medical settings, and it offers other IT services, such as sending Cerner technicians into hospitals to run the systems.
http://www.kaiserhealthnews.org/Stories/2013/July/16/electronic-health-records-data-bunker.aspx
Reader Question • 4 votes
A
Most muscle pain is unexplained but there is a general consensus among heart researchers that it is a real side effect occurring in a few percent of statin users.
Because as a reporter I cannot give medical advice, I asked Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation to reply to your question. He wrote:
Muscle pain can be a troubling adverse effect of statins. There is uncertainty about the actual incidence, but many experienced cardiologists believe that muscle pain occurs in 2 to 5 percent of patients.
The usual approach to ease muscle pain is lowering the dosage of the statin or trying another statin, which is sometimes successful. Because of the life-saving benefits of statins, we are often persistent in trying all of the available statins (there are six of them. In a few patients, we use alternative dosing schedules, such as rosuvastatin given once or twice a week.
There are anecdotal reports of improvement in muscle symptoms with administration of an over-the-counter supplement, coenzyme Q10, but benefits are not well documented via good quality studies.
One of the fascinating aspects of PCSK9 inhibitors, the drugs discussed in Ms. Kolata’s story “Rare Mutation Ignites Race for Cholesterol Drugs,” is the apparent freedom of these drugs from muscle adverse effects. The makers of these investigational drugs are studying their usage in patients with statin intolerance.
Another reference that I have found useful is the clinical guidelines for statin use, issued by an expert committee put together by the National Heart, Lung, and Blood Institute, the American College of Cardiology, and the American Heart Association. Q
How much of high cholesterol is genetics and how much is purely a diet and exercise issue? Could someone with a high reading manage it with proper diet and exercise and no statins?
Reader Question • 61 votes
A
Heart researchers say diet and exercise are the first line of defense against heart disease but many people cannot get their LDL cholesterol levels to target levels with these lifestyle measures alone. If their risk of heart disease is high enough, these people should take statins, researchers say.
It's a crime to house the mentally ill this way
The crowded Los Angeles County jail holds thousands who are mentally ill and accused of a crime. Most have been there before.
Steve Lopez
5:00 AM PDT, July 17, 2013
The county jail.
On Monday, the jail held 3,200 inmates diagnosed with a mental illness and accused of a crime. Most have not been to trial, many have waited months for their day in court, and the majority have cycled through at least once before. There's no longer enough room to house them all in segregated areas, so 1,000 mentally ill men and 300 women are housed with the general population.
Sheriff Lee Baca has said for decades that he runs the nation's largest mental hospital, but we've heard it so often that the shock has worn off. We know there's something inexcusably wrong with the system — something backward and inhumane. But we shrug and move on, and the failure of public policy persists, at great public expense, while Los Angeles County officials order up another round of studies.
On the seventh floor of the Twin Towers, some of the most severely ill men stood in the locked single cells of a dorm-style bloc Monday, staring into space, banging on walls or howling. On the fifth floor, cells were filled to capacity and bunks were squeezed into the common dining area to handle the overflow. Some of the bunks are two beds high, some three. Privacy and quiet do not exist for inmates or their jailhouse therapists.
If you're trying to figure out what makes for a desirable therapeutic environment, said Sara Hough, who runs the jail clinical program for the county Mental Health Department and takes pride in trying to deliver desperately needed care, "this ain't it."
County sheriff's Sgt. Julie Geary pointed out an inmate who thinks that he's Abraham Lincoln and that he's possessed by a spirit. Nearby was a man who's been in and out of jail so many times, Geary is on a first-name basis with him. "You're back," she recalled telling Herman. And she knows which inmates can be expected to complain that poisonous gas is being piped into their cells.
On the fifth floor, a 49-year-old inmate squatted and spoke to me through a small opening in a locked door. He was diagnosed with paranoid schizophrenia as a young man, he said. I asked how many different times he's been in jail since then.
"About 15," he guessed.
And the total amount of time he's been locked up?
"Sir, to be honest with you, about 27 years."
While I spoke to him, another middle-aged man kept gesturing through a window that he wanted to talk, too.
"Sir," he said, "I'm just trying to get into a drug program."
He rattled off a list of diagnoses he's received, including bipolar disorder and schizoaffective disorder. Like the 15-timer, he's been in jail so many times he could only guess at the number.
"About 10," he said.
Clearly, locking these men up over and over again isn't working, and it isn't cheap. But it's what the system has been doing for years in Los Angeles County and in jails and prisons across the country.
http://www.latimes.com/news/local/la-me-0717-lopez-twintowers-20130717,0,690008,print.column
Cerner Builds Recession-Proof 'Bunker' For Health Data
This is a story about data. Lots and lots of data.
And not just any data. Extremely sensitive data.
The U.S. health system is undergoing a major technological shift right now. Some equate it to finally catching up to where the banking and airline industries have been for years: Doctors and hospitals are moving to electronic health records systems, and it’s not easy. Cerner, based in Kansas City, Mo., has grown into one of the nation's biggest players in the field of health information technology.
Cerner's main headquarters seems like a college campus, peppered with trees and walking paths, along with some Star Trek-like architecture.
It’s one of the data centers that Cerner has constructed in recent years, with concrete walls built to withstand a strong tornado, armed guards and multiple security levels. It’s designed to protect what’s inside: a temperature-controlled room full of thousands of servers. There are back-up generators for back-up generators, Smith says, to be sure that this health information isn’t compromised or made inaccessible by a power outage.
This data center and Cerner's others are responsible for health information generated by hundreds of hospital systems and doctors’ offices throughout the U.S.
This could be your data, that prescription your doctor just entered into his or her computer, that lab result that just got processed. The transactions go through here in real time.
Data storage is a big selling point for Cerner, but it's one part of what the company does. It has software for all sorts of medical settings, and it offers other IT services, such as sending Cerner technicians into hospitals to run the systems.
http://www.kaiserhealthnews.org/Stories/2013/July/16/electronic-health-records-data-bunker.aspx
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