Sebelius Rejects Bipartisan Calls for Delay in Health Law
By ROBERT PEAR
WASHINGTON — Kathleen Sebelius, the secretary of health and human services, said Wednesday that the government needed to fix hundreds of problems with the website for the federal health insurance marketplace, but she categorically rejected bipartisan calls to delay parts of the new health care law.
Her comments, at a hearing of the Senate Finance Committee, came just hours after the Obama administration said that the chief information officer at the Centers for Medicare and Medicaid Services, whose office supervised the creation of the troubled website, was retiring.
The official, Tony Trenkle, will step down on Nov. 15 “to take a position in the private sector,” said an email message circulated among agency employees.
Mr. Trenkle, reached by telephone on Wednesday, refused to discuss his plans. “I can’t speak with you,” he said.
Mr. Trenkle’s retirement is part of a management shake-up announced by Michelle Snyder, the chief operating officer of the Medicare agency, who was herself deeply involved in major decisions about the insurance marketplace, or exchange.
The health insurance marketplace has been plagued with problems since it opened on Oct. 1.
With many people unable to obtain coverage through the website, lawmakers of both parties have suggested extending the open enrollment period or delaying the financial penalties for people who go without insurance.
Ms. Sebelius said that she and her colleagues had identified “a couple of hundred functional fixes” that must be made to the website, HealthCare.gov. But she turned aside calls for a delay in major provisions of the law.
“Delaying the Affordable Care Act would not delay people’s cancer or diabetes or Parkinson’s disease,” Ms. Sebelius said. “It would not delay the need for mental health services or cholesterol screenings or prenatal care. Delaying the Affordable Care Act doesn’t delay the foreclosure notices for families forced into bankruptcy by unpayable medical bills.”
Obama to Promote Health Act in Texas, Its Biggest Doubter
By JACKIE CALMES
WASHINGTON — President Obama on Wednesday travels to Texas, the largest of the Republican-led states that refuse to participate in his Affordable Care Act, to highlight the efforts of local groups and volunteers who are trying to make the law work for an estimated 2.5 million uninsured state residents.
In remarks planned for this afternoon in Dallas, at Temple Emanu-El, Mr. Obama will be “calling on folks in Texas to join conservative governors in other states like Ohio and in Michigan, in Arizona, to put politics aside and not deny people health care out of ideology or politics,” said David M. Simas, a White House adviser.
About half the states have left it to the federal government to set up insurance exchanges, or marketplaces, where people can shop for coverage plans, and have also refused federal funds to expand Medicaid to more citizens. Among the most adamant in rejecting the law has been Gov. Rick Perry of Texas, a Republican who is considering a second campaign for president.
Mr. Perry and Republican state legislators, who call the law an unworkable, big-government intrusion, have defied pressure from chambers of commerce, hospital and doctor groups, and nonprofit and community organizations in the state. Texas has several cities and rural areas that have among the highest concentrations of uninsured people in the nation, according to the nonpartisan Kaiser Family Foundation.
Kaiser and the Urban Institute, a Washington policy research organization, estimate that nearly 2.5 million more Texans could be insured through the marketplaces by 2016, or just over one-third of a projected uninsured population that will exceed 7 million. And if Texas were to expand Medicaid as the Affordable Care Act provides, and accept the federal funds, another 1.2 million people would qualify for coverage, reducing the state’s uninsured population by more than half, the groups say.
That increased coverage would reduce the costs to Texas communities for uncompensated medical care – from uninsured residents leaving hospitals, emergency rooms and clinics with their bills – by $1.7 billion over a decade, and generate other economic benefits for the health care industry and local communities, according to Kaiser.
Despite Fumbles, Obama Defends Health Care Law
By JACKIE CALMES and JONATHAN WEISMAN
DALLAS — President Obama strongly defended his signature health care law on Wednesday in the largest state that has refused to participate, as rattled Senate Democrats called for changing or delaying key parts of the new health coverage.
Against a backdrop of closer-than-expected election results in Virginia that some attributed to opposition to the health law, Mr. Obama again expressed regret for the troubles at the federal website that have prevented many people from enrolling for insurance. But he said the Texas government — by refusing to take federal funds and expand Medicaid eligibility — had left more than a million people uninsured. He promised to get problems with the health program fixed.
“As challenging as this may seem sometimes, as frustrating as HealthCare.gov may be sometimes, we are going to get this done,” Mr. Obama told about 150 volunteers and paid navigators helping in enrollment who had gathered to meet him at Temple Emanu-El here. “We’re on the right side of history.”
The president made his remarks as leaders of both parties carefully examined the results of Tuesday’s elections, searching for indications of what went wrong and how they could perform better next year.
In trying to rebuild confidence in the new health care law, Mr. Obama must also appeal to Democratic officials worried about the poor rollout one year before members of Congress must face voters.
The increasing concern of Democrats, combined with steady criticism from Republicans over the law’s rollout, has the White House caught in political crossfire. The administration has tried to reassure allies that the flaws will be corrected and that it is reaching out to consumers whose plans are being canceled because they do not meet the new law’s requirements.
Before flying to Texas, Mr. Obama and Vice President Joseph R. Biden Jr. met privately with 16 Democratic senators, many in tough re-election bids next year, to hear their frustrations. Senator Mark Begich, Democrat of Alaska and one of next year’s most embattled incumbents, emerged from the meeting to blast the administration’s “mismanagement.”
Child Mortality in India
India has shown real progress in reducing child mortality over the past decade. According to the United Nations, in 2001, 2.5 million Indian children under the age of 5 died. In 2012, 1.5 million died. This is good news, but India alone still accounts for 20 percent of child mortality worldwide — and a shocking 48 percent of Indian children under the age of 5 are chronically malnourished.
According to the World Bank, India’s under-5 child mortality rate in 2012 was 56 deaths per 1,000, far short of the country’s goal of reducing child mortality to 39 per 1,000 by 2015. By comparison, the child mortality rate in 2012 in Bangladesh was 41; in Brazil, 14; and in the United States, 7.
The overall statistics tell only part of the story. A baby’s chances in India of living past age 5 depends on its gender, where it is born, the mother’s age and education level, whether she is well nourished and on the family’s access to clean water and sanitation. While babies from higher-income families in India have a better chance over all, in some districts, the lot of poor babies has improved dramatically while in others it has not. According to a report published by The Lancet in September, half of India’s child mortality occurs in just 81 of its 597 districts. Several are in India’s richest states, including Gujarat, hailed as a high-growth economic model, and Karnataka, whose capital, Bangalore, is India’s Silicon Valley. Unfortunately, causes of death are not tracked at the district level.
Connections That Work: Mercy Killers Makes California Run For Single Payer
Isn’t it nice when a plan comes together? It’s even better when that plan includes working to implement a single payer health care system in the United States.
Earlier this year, I connected with Julliard-trained actor Michael Milligan and with Cindy Young, the incredible dynamo from Campaign For A Healthy California. It had been my privilege to have met and interviewed each of these fabulous individuals separately. I instantly knew: You two need to talk.
And the result of that connection has led to this magnificent November California run of the powerful play Mercy Killers. As one reviewer wrote:
“Raw, emotional, and devastatingly honest. Broadway actor Michael Milligan’s solo show gives an insight into the destructive personal impact of the American healthcare system. It makes public the private stories of thousands of Americans and shows an urgent need for change in a system failing so many. His performance is incredibly powerful and passionate, sweeping the audience up in Joe’s story; making them laugh sometimes and bringing them to the edge of tears at others. Milligan has written a beautifully moving and thought-provoking piece . . . ”
What Our Patients Can Teach Us
By MIKKAEL A. SEKERES, M.D.What Our Patients Can Teach Us
By MIKKAEL A. SEKERES, M.D.
When the man who was about to become my patient couldn’t tolerate the fatigue any longer, he asked his son, one of 10 children, to take him in their buggy from his woodworking shop to the local doctor who tended to this Amish community, located 90 miles south of Cleveland. Labs showed a white blood cell count that was 12 times normal and profound anemia, and he was driven by ambulance to our hospital.
His white beard made him look much older than his 50 years. His overalls, and the plain dress and bonnet worn by his wife sitting by his side, were incongruous with the starched white of his bedsheets and the crisp, official-sounding blips coming from the machine monitoring his vital signs. He lay comfortably, hands clasped in his lap.
“It’s nice to meet you, though I’m sorry it’s under these circumstances,” I said as I shook his hand, his grip much stronger than mine.
We already had confirmation of his leukemia from a test, flow cytometry, that we had performed on his blood. I told him this and started a discussion about treatment options.
“Given your young age and good health, I recommend we treat your leukemia with intensive chemotherapy, which we give here in the hospital. You would need to remain here, though, for four to six weeks.” He absorbed this information, and I could see him consider the effect this would have on his business and his ability to provide for his family.
“Well, let me ask you a question,” he said, his voice both serious and philosophical. “What if I chose to leave the hospital without treatment and go back home.”
His leukemia was particularly aggressive and had already started to affect his organs. He also had a fever. I told him there was a good chance he would die in the next few days if he left.
“What is your reticence in being treated?” I asked.
He set his jaw. “I’ve seen too many folks spend their remaining time getting chemotherapy only to die anyway. I’ll not go through this if it means just a few more months to live.” He looked squarely at me. “This world is not my final destiny, anyway.”
I explained that sometimes the leukemia was curable, and the number of chemotherapy courses finite, but acknowledged that he was right, with bad leukemias like his, treatment could be futile. Something else seemed to be troubling him.
“Are you worried at all about the cost to your community of a hospital stay?” I asked. Many Amish do not carry private insurance, but pay for a member’s catastrophic illness by pooling their resources.
For the first time, his wife spoke. “I think that’s part of it.”
Living With Cancer: Tumbling Blocks
By SUSAN GUBAR
On a night several months ago, the digital clock blinked 11:53. My husband was asleep so I crept down the hall, only turning on a light when I got into my study. On a sheet on the floor were fabrics laid out for a new quilt in the tumbling block pattern. Pictures of my friends kept me company, but there was no photo of the woman over whom I was grieving.
One of my former graduate students was dying of lung cancer, and no, she did not smoke. Her name was Susan, too. In my email to her, I closed with “Susan2,” which quickly became “S2.” She signed “Susan Also,” which quickly became “SA.” Students are supposed to outlive their teachers.
SA had heard the sentence from an oncologist that I expect eventually to hear: “I have nothing else to offer you.” Weakened by metastases, she had asked her partner to call hospice for help at home.
SA is the third of my former graduate students to receive a cancer diagnosis. When many of them convened on the occasion of my retirement, one had already died in her 30s from breast cancer. A speaker invited to that event, a younger colleague from another university, could not attend because she was sick with what turned out to be endometrial cancer. Another who did attend has subsequently had to undergo surgery for ovarian cancer.
We Americans are assured by experts that cancer accounts for one of every four deaths because of our aging population. But these women, who led health-conscious lives, were all under the age of 65, as I was when I received my diagnosis. I gazed at a photograph on my desk of Ilinca, who died at 52. Could this epidemic, I wondered, be caused by hazardous additives in our food, pesticides in the air, soil, water or pollutants in our houses, parks, office buildings?
Loyal Obama Supporters, Canceled by Obamacare
By Charles Ornstein
San Francisco architect Lee Hammack says he and his wife, JoEllen Brothers, are “cradle Democrats.” They have donated to the liberal group Organizing for America and worked the phone banks a year ago for President Obama’s re-election.
Since 1995, Hammack and Brothers have received their health coverage from Kaiser Permanente, where Brothers worked until 2009 as a dietitian and diabetes educator. “We’ve both been in very good health all of our lives – exercise, don’t smoke, drink lightly, healthy weight, no health issues, and so on,” Hammack told me.
The couple — Lee, 60, and JoEllen, 59 — have been paying $550 a month for their health coverage — a plan that offers solid coverage, not one of the skimpy plans Obama has criticized. But recently, Kaiser informed them the plan would be canceled at the end of the year because it did not meet the requirements of the Affordable Care Act. The couple would need to find another one. The cost would be around double what they pay now, but the benefits would be worse.
“From all of the sob stories I’ve heard and read, ours is the most extreme,” Lee told me in an email last week.
I’ve been skeptical about media stories featuring those who claimed they would be worse off because their insurance policies were being canceled on account of the ACA. In many cases, it turns out, the consumers could have found cheaper coverage through the new health insurance marketplaces, or their plans weren’t very good to begin with. Some didn’t know they could qualify for subsidies that would lower their insurance premiums.
So I tried to find flaws in what Hammack told me. I couldn’t find any.
Rip-Off: How Private-Sector Health Costs Are Killing the American Dream
November 2, 2013 |
Part one of this series, “The High Cost of Low Taxes [3],” noted that while Americans enjoy a tax burden lower than that of other wealthy countries, we also pay four times as much as they do, on average, for out-of-pocket “social costs” in the private sector – on health care, retirement security, disability and unemployment insurance, and the rest of the safety net. When you add up what we pay in taxes and what we pay out of pocket, the US spends about the same amount on social costs overall as some of the most generous, heavily taxed social democracies, but we get a far less secure safety net in return.
The federal government doesn’t have a deficit problem. Its fiscal issues are entirely related to the bloated cost of American health care. If we paid the same amount for health care per person as people do in other wealthy countries with longer average life expectancies, we’d have a balanced budget now and surpluses projected for the future [4].
But those are just numbers on a spreadsheet. Fran and Randy Malott understand those costs more viscerally. The Whittier, Calif., couple aren’t living the American dream right now. They haven’t for a while. They were slammed when Wall Street’s house of cards came tumbling down, and now they’re feeling the squeeze of the Great American Rip-off.
Fran lost her job as a customer service representative in 2009, at the height of the Great Recession. “A lot of companies are getting rid of customer service these days,” explains Randy. He lost his job managing a temp agency a year or so later. The Malotts are two of what Paul Krugman called [5] “the forgotten millions” – the long-term unemployed who face unique barriers to reentering the workforce [6], including discrimination by potential employers just because they’ve been out of work for an extended period. “And our age doesn’t help either,” says Randy. He’s 59 and she’s 60. “There was unemployment for a while,” Randy says, “and now we’re getting by on savings.”
He tells Moyers & Company, “we live pretty frugally,” but the $1,600 a month they’re forking over for health insurance represents about half their total spending. The Malotts are a healthy couple, yet they’re watching their life savings drain away, in large part due to their health insurance company. The $140,000 the Malotts had socked away for retirement is now down to around $45,000. “We’ve got quite a ways to go before Social Security and Medicare kick in,” says Randy.
The Malotts are in a tough spot, like a lot of people who find themselves in similar circumstances. Studies have shown that long-term unemployment causes stress and illness [7]. In the rest of the world’s highly developed countries, the Malotts’ health care would be covered by their government – the risk of long-term unemployment would be spread across an entire society – which means they’d have one less serious stressor, and around $45,000 more in the bank than they do today.
http://www.alternet.org/print/economy/rip-how-private-sector-health-costs-are-killing-american-dream
While Media Focuses on Obamacare Glitches, Hundreds in MD Call for Universal Healthcare
October 30, 2013 |
Protesters organized by Health Care is a Human Right - Maryland took to the streets in Baltimore demanding healthcare as a basic human right.
“We didn't start a movement to be anti-Obamacare or to be anti-CareFirst or anti-Kaiser,” says Sergio Espana of Health Care Is a Human Right - Maryland. “We started a movement for something. And it was to remind ourselves that there are fundamental public goods. And we understand that we need to fight to make sure that they're actually protected. And chief among them, in terms of our organization, our campaign, is that health care itself is a public good.”
The march route included the headquarters of CareFirst, one of Maryland’s largest health insurance providers. CareFirst says they plan to increase rates on January 1 because President Obama's healthcare reforms will increase their costs. They will increase the cost of their individual policies by an average of 25 percent.
“We didn't have a debate during the health-reform process,” said Dr. Margaret Flowers of Physicians for a National Health Program. “It was completely scripted to pass this piece of legislation that props up the health industries. And so now that the exchanges are opening and people are going to see that the market-based system doesn't work, more and more people are going to have problems affording the health care they need.”
JAISAL NOOR, TRNN PRODUCER: Obamacare was the target of the Tea Party-led government shutdown, and the media's spotlight remains on the numerous glitches facing the Affordable Care Act's insurance exchanges.
But on October 26 in Baltimore, protesters took to the streets in an attempt to change the conversation. Their message: access to quality health care is a basic human right.
ERNEST “BEAR” LINDSAY, UNITED WORKERS: My name is Ernest. Everybody in United Workers calls me Bear.
It was important for me to come out here today because Maryland does not have universal health care, our country does not have universal health care. I myself had to fight and go without health care for about four, five years, which I now have because I'm on SSI and I'm also a vet.
But this country can be the world police. Why can't we have universal health care? Other countries, like Italy, Germany, France, have universal health care.
We need to take care of our own here first. You know. And you've got people running around that don't have health care that have to pay--decide whether they're going to pay for medicine or rent or phone bill. And that doesn't need to be so.
Rules to Require Equal Coverage for Mental Ills
By JACKIE CALMES and ROBERT PEAR
WASHINGTON — The Obama administration on Friday will complete a generation-long effort to require insurers to cover care for mental health and addiction just like physical illnesses when it issues long-awaited regulations defining parity in benefits and treatment.
The rules, which will apply to almost all forms of insurance, will have far-reaching consequences for many Americans. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders.
In issuing the regulations, senior officials said, the administration will have acted on all 23 executive actions that the president and Vice President Joseph R. Biden Jr. announced early this year to reduce gun crimes after the Newtown, Conn., school massacre. In planning those actions, the administration anticipated that gun control legislation would fail in Congress as pressure from the gun lobby proved longer-lasting than the national trauma over the killings of first graders and their caretakers last Dec. 14.
“We feel actually like we’ve made a lot of progress on mental health as a result in this year, and this is kind of the big one,” said a senior administration official, one of several who described the outlines of the regulations that Kathleen Sebelius, the secretary of health and human services, will announce at a mental health conference on Friday in Atlanta with the former first lady Rosalynn Carter.
While laws and regulations dating to 1996 took initial steps in requiring insurance parity for medical and mental health, “here we’re doing full parity, and we’ve also taken steps to extend it to the people covered in the Affordable Care Act,” the senior official said. “This is kind of the final word on parity.”
With the announcement, the administration will make some news that is certain to be popular with many Americans at a time when Mr. Obama and Ms. Sebelius have been on the defensive for the bungled introduction of the insurance marketplaces created under the Affordable Care Act.
According to administration officials, the rule would ensure that health plans’ co-payments, deductibles and limits on visits to health care providers are not more restrictive or less generous for mental health benefits than for medical and surgical benefits. Significantly, the regulations would clarify how parity applies to residential treatments and outpatient services, where much of the care for people with addictions or mental illnesses occurs
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