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Sunday, March 9, 2014

Health Care Reform Articles - March 9, 2014

When Health Costs Harm Your Credit

By 
LIKE most people, I am generally vigilant about paying my bills — credit cards, mortgage, cellphone and so on. But medical bills have a different trajectory. I (usually) open the envelopes and peruse the amalgam of codes and charges. I sigh or swear. And set them aside for when I have time to clarify the confusion: An out-of-network charge from a doctor I know is in-network? An un-itemized laboratory bill from a doctor I’ve never heard of? A bill for a huge charge before my insurer has paid its yet unknown portion of a hospital’s unknowable fee?
I would never countenance the phrase “60 days past due” on my Visa card statement. But medical bills? Well... with the complex negotiations that determine my ultimate payment, it often takes months to understand what I actually owe.
Unfortunately, I may be playing a dangerous game. Mounting evidence shows that chaos in medical billing is not just affecting our health care but dinging the financial reputation of many Americans: While the bills themselves frequently take months to sort out, medical debts can be reported rapidly to credit agencies, and often without notification. And even small unpaid bills can severely damage credit ratings.
A mortgage initiator in Texas, Rodney Anderson of Supreme Lending, recently looked at the credit records of 5,000 applicants and found that 40 percent had medical debt in collection, with the average around $400; even worse, most applicants were unaware of their debt. Richard Cordray, director of the federal Consumer Financial Protection Bureau, has noted that half of all accounts reported by collection agencies now come from medical bills, and the credit record of one in five Americans is affected.
A single medical bill reported to a credit agency can easily become a “millstone around your neck” said Mark Rukavina, principal at Community Health Advisors, a health care advisory service. He added: “It will take a long time to make that right, even once the bill is paid. I’ve had mortgage brokers call me and say ‘I have these people with great credit. They’ve refinanced before, but now they’ve got this medical bill and even though they’ve paid it off, I can’t get them a good rate.’ ”


The Soaring Cost of a Simple Breath


By 
OCTOBER 12, 2013
OAKLAND, Calif. — The kitchen counter in the home of the Hayes family is scattered with the inhalers, sprays and bottles of pills that have allowed Hannah, 13, and her sister, Abby, 10, to excel at dance and gymnastics despite a horrific pollen season that has set off asthma attacks, leaving the girls struggling to breathe.

Asthma — the most common chronic disease that affects Americans of all ages, about 40 million people — can usually be well controlled with drugs. But being able to afford prescription medications in the United States often requires top-notch insurance or plenty of disposable income, and time to hunt for deals and bargains.
The arsenal of medicines in the Hayeses’ kitchen helps explain why. Pulmicort, a steroid inhaler, generally retails for over $175 in the United States, while pharmacists in Britain buy the identical product for about $20 and dispense it free of charge to asthma patients. Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented.
“The one that really blew my mind was the nasal spray,” said Robin Levi, Hannah and Abby’s mother, referring to her $80 co-payment for Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs under $7 in Europe, where it is available over the counter.
The Centers for Disease Control and Prevention puts the annual cost of asthma in the United States at more than $56 billion, including millions of potentially avoidable hospital visits and more than 3,300 deaths, many involving patients who skimped on medicines or did without.
“The thing is that asthma is so fixable,” said Dr. Elaine Davenport, who works in Oakland’s Breathmobile, a mobile asthma clinic whose patients often cannot afford high prescription costs. “All people need is medicine and education.”
Republicans press Medicare attack in congressional elections 
By David Morgan7 hours ago
By David MorganWASHINGTON (Reuters) - Republicans, looking for ways to turn November's congressional elections into a referendum on President Barack Obama's signature healthcare law, are trying to portray Obamacare as a danger to Medicare.
The aim is to court one of the biggest and most reliable voting blocs in midterm elections, senior citizens and people near retirement, by depicting Republicans as defenders of the federal healthcare program for 42 million seniors.
It's an attempt to turn the tables on Democrats, who in the 2012 presidential election attacked Republican Mitt Romney over Republican proposals to overhaul Medicare.
"You'd have to be a blind man in a dark room not to see the political implications of Obamacare in general and now specifically with respect to Medicare," said Brock McCleary, former polling director for the Republican National Committee.
The strategy faces an early test in Tuesday's special U.S. House election in Florida, where analysts say Republican David Jolly and his allies are using Medicare in an 11th-hour effort to create an Obamacare liability for Democrat Alex Sink among older residents who make up 45 percent of the local population.
Republicans and Democrats will sift through the election results in search for effective political messages that can be replayed in races including statewide contests in Arkansas, Louisiana and North Carolina that could determine whether Republicans gain control of the Senate.

Is There a Doctor in the House? Yes, 17. And 3 in the Senate.

By 
LAKE OSWEGO, Ore. — First thing on a recent Monday, Monica Wehby could be found in the operating room performing brain surgery on a child. But the Saturday before, she was shooting guns, because sometimes that’s what you do when you’re running for office.
“I’m pretty steady-handed, don’t have much of a tremor,” Dr. Wehby, a Republican Senate candidate and pediatric neurosurgeon, joked to a small group of people here in this Portland suburb. She grinned as she described hitting the bull’s-eye despite having no experience with firearms. Her left hand bore a blister from where the Glock had pinched her.
The politicking is all new for Dr. Wehby, 51, who wants to unseat Senator Jeff Merkley, a first-term Democrat. And when people find out that she wants to leave one of the most highly specialized and well-compensated fields in medicine for Washington, they often react with disbelief.



Yet she is hardly alone among her physician peers. A heightened political awareness, and a healthy self-regard that they could do a better job, are drawing a surprisingly large number to the power of elective office.
A few of the more incredulous questions she has fielded: “Why would you ruin a perfectly good life by running for Senate?” “Are you off your medication?” “I know you’re used to dealing with small brains, but what about no brains?”
http://www.nytimes.com/2014/03/08/us/politics/doctors-confident-in-their-healing-powers-rush-for-congress.html?hp
Maine Dems and GOP Continue to Disagree About Medicaid Expansion
03/07/2014   Reported By: Patty B. Wight

Republican lawmakers in Augusta this week announced what they said is an alternative to an idea they don't like, the expansion of Maine's Medicaid program under the Affordable Care Act. Their plan would be to have the uninsured buy coverage on the online marketplace. About half of Mainers who would be covered under the expansion currently qualify for subsidies to purchase insurance on the marketplace for just a few bucks a month. But expansion proponents said that solution isn't as simple as it seems.
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MaineCare Marketplace Proposed By GOPListen
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Expanding Medicaid, known as MaineCare in Maine, would add about 70,000 people to a program that many Republican lawmakers said is already unwieldy. Senator Mike Thibodeau said the state has two options.

 "Is asking able-bodied individuals to take part in their own economic future the best course?" asked Thibodeau. "Or is growing state government and expanding the very program that is consuming huge portions of our budget and creating tremendous cost overruns the best course?"

 Thibodeau's choice would be the former and Republican Minority Leader Ken Fredette said this would be a viable alternative to Medicaid expansion.

 "Most of the people who will be eligible for Medicaid if we expand are already eligible for plans on the exchange for about ten dollars a month," said Fredette.

 This alternative plan, said Fredette, offers a pathway to economic prosperity.

 "By rejecting Medicaid expansion, many will actually have an incentive to take a raise or a promotion for a few extra hours so they can qualify for private plans," he said.

 Senator Mike Thibodeau said even if a consumer doesn't currently qualify for subsidies, he or she can still access them, he said it's all about personal choice.

 "They are asking you, what is your economic status, and what is your intention as far as your economic status in the future? All you have to do is commit to making $12,000 a year."

 "That is very dangerous advice," said Sara Gagne Holmes is Executive Director of Maine Equal Justice Partners

 "Given that when you apply for subsidies on the exchange, you do so under penalty of perjury, and there are significant civil and criminal fines if you knowingly provide false information," she said.

 Gagne Holmes said those lower premium prices don't take into account other health out of pocket costs such as co-pays and deductibles. The marketplace plans with the lowest premiums, bronze plans, actually don't offer subsidies to cover those other expenses for people making between 100 and 250 percent of the poverty level.

Facing death – and hope

By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, March 7, 2014
A man in his 90s became very ill and was brought to the hospital by ambulance. The emergency room physician called and asked me to admit the patient to the intensive care unit. I was upstairs in the hospital.
I briefly studied the electronic record before heading downstairs. I learned that the man suffered from dementia, advanced to the point that his primary care physician was unable to have any meaningful dialogue with him for several years. I also saw data to convince me that this man was critically ill.
In the emergency room the physician reviewed with me the things that he and the nurses had initiated but added that in the bigger picture that he thought the patient was dying. He mentioned that he had asked about “do not resuscitate status” but that the patient’s wife didn’t have an answer. She "wanted everything done.” He had explained the need for intensive care and called me.
As I evaluated the patient I found a man poorly responsive and generally very ill. He had cachexia, which means wasted muscles and body mass, in other words he was beginning to look like a skeleton. His mental status and vital signs suggested that critical care measures already initiated were appropriate. Given the patients advanced age and profound frailty, the emergency room physician was probably right, I thought, this patient appeared to be dying.
“I am so sorry to say this,” I told the patient’s wife. "When he couldn’t eat over the last few days, it was a sign that he was starting the very last chapter of his life.” As gently as I could, that death might be imminent, no matter what treatment we offered.
There was a pause.
“I like that other doctor better.”
The patient’s wife was referring to the emergency room doctor who had assured her that we would do “everything.” She was not ready to face her husband’s end, nor to hear the event spoken about.
I sat with her for a quiet moment. After years of supporting him in their own home, she would now be relegated to his bedside, watching the hospital staff perform his care. I listened to her recount the details of their usual day and wondered how I could best help her. Compared with their usual routine, the strangeness and stress of the experience seemed enormous.
As a hospital medicine physician and also a hospice and palliative medicine physician, I have experienced many moments like these. These silences illuminate our social acquaintance with – or perhaps our everyday distance from – the experience of illness and death and how our system fails its patients.
Three weeks ago we had a death in our own family. My father-in-law had suffered three cancers, the last one incurable, and he was fading away over his last months. In the end, when he collapsed, the ambulance was called and he too went to the intensive care unit for the last day of his life. My colleagues asked if his death was expected. It was, I suppose, but when it came, the social dislocation and stress were profound.
When it comes to serious illness, the infirmities that come with age, and the process of dying, our health system is unnecessarily inhumane. Over the recent decade, of those who die in the United States, the percentage who receive care in the ICU during the last year of life has risen from about 1 of every 5 to nearly 1 of every 3.
Facing a loved one’s death is overwhelming. Since the chances are very good that all of us will face death, it seems obvious we should be devoting our resources to building a system based upon caring for patients with the kind of dignity they deserve.
But to do so would take a profound change in direction for the whole nation. Instead we have health policy dominated by the financial interests of so many corporations, insurance companies, the pharmaceutical industry, profits from devices and all kinds of schemes to extract resources from caregiving.
The contradiction remains that with so many capable caregivers, such advanced medical science and technology and so much of our national budget at the ready, we could do so much better. And in that contradiction lies the hope.
Dr. Andrew Coates practices internal medicine in Upstate New York. He is president of Physicians for a National Health Program.

The Fat Drug

By PAGAN KENNEDY
IF you walk into a farm-supply store today, you’re likely to find a bag of antibiotic powder that claims to boost the growth of poultry and livestock. That’s because decades of agricultural research has shown that antibiotics seem to flip a switch in young animals’ bodies, helping them pack on pounds. Manufacturers brag about the miraculous effects of feeding antibiotics to chicks and nursing calves. Dusty agricultural journals attest to the ways in which the drugs can act like a kind of superfood to produce cheap meat.
But what if that meat is us? Recently, a group of medical investigators have begun to wonder whether antibiotics might cause the same growth promotion in humans. New evidence shows that America’s obesity epidemic may be connected to our high consumption of these drugs. But before we get to those findings, it’s helpful to start at the beginning, in 1948, when the wonder drugs were new — and big was beautiful.
That year, a biochemist named Thomas H. Jukes marveled at a pinch of golden powder in a vial. It was a new antibiotic named Aureomycin, and Mr. Jukes and his colleagues at Lederle Laboratories suspected that it would become a blockbuster, lifesaving drug. But they hoped to find other ways to profit from the powder as well. At the time, Lederle scientists had been searching for a food additive for farm animals, and Mr. Jukes believed that Aureomycin could be it. After raising chicks on Aureomycin-laced food and on ordinary mash, he found that the antibiotics did boost the chicks’ growth; some of them grew to weigh twice as much as the ones in the control group.
Mr. Jukes wanted more Aureomycin, but his bosses cut him off because the drug was in such high demand to treat human illnesses. So he hit on a novel solution. He picked through the laboratory’s dump to recover the slurry left over after the manufacture of the drug. He and his colleagues used those leftovers to carry on their experiments, now on pigs, sheep and cows. All of the animals gained weight. Trash, it turned out, could be transformed into meat.
http://www.nytimes.com/2014/03/09/opinion/sunday/the-fat-drug.html?hp&rref=opinion

With more poverty and less health care, rural Maine would benefit most from Medicaid expansion

By Christy Daggett, Special to the BDN
Posted March 09, 2014, at 11:12 a.m.
Maine is the most rural state in the nation. This isn’t because Maine is bigger and wilder than Wyoming or Montana, but because Maine has a higher percentage of its residents choosing to reside outside of urban areas. Maine is a beautiful state, and its many rural and remote communities offer a vital and meaningful lifestyle. But Maine’s rustic character also makes assuring quality, affordable health care for rural residents a formidable challenge.
Both nationally and in Maine, data show that rural residents are less healthy and face greater obstacles to health care compared with their urban counterparts. They are more likely to die prematurely, suffer from chronic disease and lack insurance.
Maine’s rural rim counties have the highest percentages of uninsured residents ( 17 percent of Washington County residents are uninsured) due to a combination of factors, including lower annual incomes and higher rates of self-employment. In the meantime, Washington County was one of the few counties in the northeastern U.S. where the life expectancy of women decreased between 1983 and 1999. For the first time since the 1918 Spanish influenza epidemic, Washington County women cannot expect to live as long as their mothers did.
Because a significant percentage of working Americans earns too little to afford private coverage, the Affordable Care Act provides federal dollars for states to expand their Medicaid programs to cover low-income, working people. Expanding Medicaid offers a way to cover low-income Mainers at a minimal cost to the state budget. The state contributes nothing for the first three years, and minimal percentages until 2020, when the state will pay for 10 percent of the costs associated with expansion.
Regrettably, Gov. Paul LePage has twice vetoed the Legislature’s approval of Medicaid expansion and likely will do the same in 2014, unless the Legislature can muster a veto-proof majority.
Given the high uninsurance rate in rural areas, is the governor’s veto in the best interest of his constituents?
ACA politics are worsening the health care inequity between urban and rural Americans. Urban states, such as New Jersey and Massachusetts, leapt at the chance to accept ACA funds and inject federal dollars into their economies. More urban Americans will have health care coverage.
In contrast, most of the states with the highest rates of rural and small city residents have rejected Medicaid expansion. An estimated 1.7 million uninsured rural Americans in these states will fall into the “coverage gap” due to this choice. The media has given scant attention to the rural Americans who have been denied health care coverage by their state leaders.
Population has declined steadily in rural Maine for decades. Rural counties have higher rates of poverty and fewer people in their prime working years to fuel the economy. Given this backdrop, the politicization of Medicaid expansion further deprives rural residents and ensures the well-known disparities in health and life expectancy will persist. Beyond this, refusing to expand Medicaid also penalizes already-threatened rural hospitals.
Of Maine’s 36 hospitals, 16 are federally designated critical access hospitals. These facilities have fewer than 25 beds and are at least 35 miles from the next hospital. Critical access hospitals serve a poorer population that is more likely to be uninsured or older and eligible for Medicare. They also usually are not able to offer the more lucrative specialty services that drive revenue at large city hospitals. Critical access hospitals cannot turn away the uninsured, but treating these individuals strains already-fragile budgets.
Faced with recent cuts in Medicare reimbursements, and no corresponding expansion of Medicaid to cover their uninsured population, critical access hospitals are already undergoing layoffs, or facing closure, in some states with large rural populations refusing federal funds, including Texas and Mississippi. Leaders in these communities have tied their hospitals’ troubles directly to their state legislatures’ refusal to expand Medicaid.
Rural regions of Maine stand to benefit the most from Medicaid expansion and will be penalized most harshly if the state’s leaders continue to refuse federal funds. Maine’s rural counties already have the lowest incomes and highest rates of uninsured. In an ideological public battle over the funds, who is representing rural Maine’s interests?


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