Missouri will head to the polls on Tuesday for Primary elections.
For the Democrats, Robin Carnahan is a clear favorite with no serious challengers to win the US Senate nomination. Likewise, current State Auditor Susan Montee should be nominated for a second term. With no serious contest in either state-wide race, that means that turnout for the Democratic Primary will be driven by local races. Of course, there are primaries for local offices (and the General Assembly) in the areas with a strong Democratic presence, so Democratic turnout may not be that much different from 2006 (which was similar in not having any major state-wide contest). There is one interesting Democratic Congressional Primary (in the 7th District to replace Roy "I'm part of the Washington Establishment except when I am not" Blunt). It is unlikely that either Democrat can win the General Election as the 7th is a significant part of the base of the Missouri Republican Party, but Scott Eckersley might be able to make it closer. Additionally, as someone who was fired from the legal counsel office of former Governor Matt Blunt (Roy's son) for raising ethical question, Scott would be a thorn in the side of the Republican ticket.
The real interest in Missouri will be on the Republican Primary. For the U.S., Senate, there are nine candidates running. Most polls have Roy Blunt winning. Roy Blunt has also gotten the support of the national party, including leaders of the Tea Party movement like Michelle Bachman. The only national figure of note supporting the main alternative, State Senator Chuck Purgason is Joe the Plumber (which has drawn an ethical complaint). Howerver, leaders of the Tea Party movement in Missouri have been critical of Representative Bachman for endorsing Roy Blunt. And, while signs do not vote, I have seen many Purgason signs in Republican (Theocrat version) areas. The expectation is that Representative Blunt will win, but this race may be closer than the experts project.
For State Auditor, you have a potentially very close two-way contest between former Ambassador Tom Schweich and State House Budget Chair Alan Icet. Ambassador Schweich had been touted as a potential moderate candidate for U.S. Senate but made a deal with the state party to drop down to the State Auditor's race. State Representative Icet was not willing to back down. Ambassador Schweich has gotten the support from the official leadership of the Missouri Republican Party, but State Representative Icet has gotten the most support from the Republican caucus in the General Assembly. This race is a real battle for control of the Republican Party between Washington and Missouri.
There are also two significant Congressional Primaries. In the Seventh, eight Republicans filed for the open seat. It is hard to tell which of the candidates is the most insane and which candidate is leading. Thirty percent could very well win the nomination. Given the nature of the Seventh, the Republicans could nominate someone to the right of Michelle Bachman, Rand Paul, and Jim Demint and still win the general election. But, a close race might make a difference in how the lines are drawn for 2012.
In the Fourth, nine Republicans have filed for the opportunity to challenge very conservative Democratic Representative Ike Skelton. The Fourth District, when it becomes an open seat, will be tough for the Democrats to hold (there are currently three Democratic State Representatives and 0 Democratic State Senators from the Fourth). For readers of this site, Representative Skelton's votes are probably too conservative. However, his voting record is probably about as progressive as a Representative from the Fourth could be. There are two major Republican candiates -- former State Representative Vicki Hartzler, and State Senator Bill Stouffer. The question is whether they have managed to get enough name recognition to stand out from the other seven candidates. Again, 30% might just win this race.
Finally, there is Proposition C. Prop C is a meaningless proposition that will be interpreted by the Missouri Courts as holding that there is no state law requirement that individuals participate in health care insurance and also provides for dissolving inactive insurance companies. There are no express references in the proposition to federal health care laws. However, it is being touted by conservatives as a referendum on federal health care reform. Given the likely turnout in the respective party primaries, it will likely pass.
Owing to the lack of a public option in the non-single payer health care legislation enacted by Congress, the insurance industry is doing all sorts of interesting things to keep profit high, and health care provision low. Today, it has to do with choosing doctors and hospitals in-network.
A little history: ALL health care used to be fee-for-service. That is, the doctor or the hospital had a fee, you knew what it was, and you either paid it, or arranged a payment plan. Originally, in the US, insurance covered 80% of the bill, and the patient covered 20% after a minimal deduction. In an effort to save money, the insurance industry developed managed care in the late 1980's and rolled it out nationwide in the early 1990's. This is different from the original/true HMOs, which were more like co-operatives. In managed care, there was a gatekeeper doctor who was paid to keep costs down. Certain things, like lab tests, were capitated, so that the lab made more money the fewer tests they ran. The biggest problem was that people never saw actual bills, nor understood actual charges, and all transparency was lost.
In the new system, it won't change whether there are co-pays and deductibles in terms of amounts, but rather, as the Times is reporting, an individual's choice of doctors. This can save employers, especially small employers with healthy workforces, up to 15% on annual premiums.
Here's what they're not talking about: which doctors and hospitals will the approved list be limited TO? When managed care was beginning in the 1980's, docs and hospitals received packets from the various insurance companies asking if they would like to participate in the network. The contracts related to what you'd be able to do in terms of billing, and the charges you'd be able to charge. Initially, the insurance companies wanted as many doctors as possible, about 6 months in, they would say that "you're too late, we already have enough doctors in your geographic area." Doctors were not chosen based on ability, number of malpractice cases, outcomes: only on when they returned the forms. Hospitals were less of a choice in most places because there were not "too many" of them except in certain cities, and because hospitals specialized, most ended up on the lists because the insurers couldn't deny classes of care. That is, 25 years ago not everyone treated, say, cancer, and an insurer could not have a preferred provider list with no oncologists nor treatment centers.
The reason I bring this up is because YOU may well have a choice as to whether to select this lower cost plan, or pay more for a greater choice of doctors and facilities. While this will be sold and packaged as a way to cut costs without cutting services, it's not true. Some doctors are better than others. "Better" being an objective matter. I'd like to believe that 100% of all doctors wash their hands between each and every patient, but this is not true. Some don't even glove. Which means, for example, if you're in a doc's office with cut skin, you can get an infection (effectual community MRSA) that you wouldn't have acquired with a better doc. Diagnoses can be missed, treatment can be incorrect.
So, when you are looking at choosing employer health care choices this fall, if you have a choice, THINK. Consider if your docs and hospitals are on the list, or if you have the money to go out-of-network if necessary. It might be a good time to evaluate who is providing care for you and your family.
"Health care" is financial and political: it is also a personal thing, the difference between life and death if something goes wrong in your body or in the body of someone you love.
I received the following email written by my friend Jerry Policoff. He's not only a true progressive and a great researcher, but he's also currently running for the Pennsylvania Assembly. Web link here, Facebook link here. Shameless plug: Jerry is a great guy, and would make a terrific Assemblyman. If you live in the 41st, please help with phone banking and canvassing - if you live outside the district and can help with $5, $10 or whatever, please do! Thanks....and now, a great article:
Just yesterday I found myself wondering whatever became of Elizabeth Fowler. I made a mental note to myself to do a Google search because I suspected she had, or soon would be moving on from her last job, now that her work was done. I wondered if she would become a lobbyist or perhaps a health insurance company executive.
You don’t know who Elizabeth Fowler is? Well, until 2006 she worked for Senator Max Baucus as his top health advisor before she left to become Vice President in charge of Policy at the giant health insurance company, WellPoint.
In 2008, just as it was becoming clear that the Senate Finance Committee, chaired by Baucus, would be playing the main roll in drafting healthcare reform legislation, Elizabeth Fowler returned to the public sector, accepting the job of Chief Health Counsel to the Senate Finance Committee where she supervised a staff of about 20 in overseeing the drafting of the actual bill (Baucus’s press release touting her return to government service somehow failed to mention her recent employment as a WellPoint executive). She was called the "chief operating officer" of the healthcare reform process by Politico. When the bill first appeared on line blogger Marcy Wheeler discovered that Liz Fowler was listed as the author of the document in the pdf "properties." You may recall that the Baucus bill was widely seen as a one that was overly friendly to the interests and concerns of the health insurance industry, and perhaps most important, excluded any public option, much to the pleasure of that industry.
Being the cynic that I am, I found myself assuming that Ms. Fowler would be moving on now that it was Mission Accomplished but David Sirota spared me the trouble of having to do a Google search. He reported in the Huffington Post yesterday on a largely unnoticed story from the previous day’s (Billings) Montana Gazette announcing that Elizabeth Fowler was indeed moving on. Her new job? Deputy director of the Office of Consumer Information and Oversight at the U.S. Department of Health and Human Services where she will help the Obama Administration implement the new law.
If you're a long-term reader, you know how I feel about patient-centric care. It is the way medicine should ALWAYS be practiced. For those of you who are new to the term, "patient-centric" care means that the medical team does the right thing for each patient, in every situation, each and every time.
It does NOT mean running unnecessary tests: that's defensive medicine, done for the malpractice attorneys more than anyone else. It does not mean using the latest and greatest drugs just because they are available: that's accomplished for big Pharma.
Some of patient-centric care is theoretically simple:
Make a correct diagnosis based on asking the right questions, listening to the answers, treating the whole patient and not "the broken leg" or "the irregular heartbeat"
Coordinate care so that, for example, you don't send an elderly patient home when he cannot feed himself without help. Ensure that medications from different physicians don't interact badly.
Follow best practices: strict checklists, bar-coded medications, and of course, fingers, nails, fingers, fingers, fingers. (Yup, it's a problem in hospitals, too.)
The listening, coordination, and best practices run in diametric opposition to the structures of all insurance plans. The Fed law will not change that. It is not a patient-centric plan.
However, there is something new growing, and it's starting with a number of regional companies, and nationally with Lowe's. Yes, the home improvement chain.
These companies are implementing programs, currently limited to surgeries, where workers are sent to the best facilities, at negotiated rates, with better outcomes, and for less money than local care often costs. New name: Domestic Medical Travel.
The decisions are somewhat economic, but they are more long-range economic. That is, Lowe's and the regional companies are undertaking these programs to save on hospital expenses, which comprise about a third of the total health care costs annually. BUT they are also looking at outcomes, understanding that replacing a knee may be necessary, but you want that employee to be able to have a successful surgical outcome and come back to work, as opposed to needing a year of rehab or a second surgery.
In general, if an employee is willing to travel to the selected medical facility, deductibles are waived, and the company picks up the cost of travel for the employee or partner, along with a stay in a hotel if the patient cannot travel immediately after being released from the hospital.
One of the greatest benefits of this program is that the facilities chosen tend to provide world-class care. Lowe's is using the Cleveland Clinic, for example, for cardiac procedures. Remember that hospitals do not excel at everything: some, like MD Anderson and Sloan Kettering, are known for their cancer care, Wills is known for its ophthalmology care, etc. Choosing hospitals that are good at specific things leads to better outcomes. For example, if you need a heart stent, going to a hospital that does several thousand a year is better than going to a facility that does 10 a year.
One of the things promised by this spring's health care legislation was a website, run by HHS, with information on health care options for all Americans. And the Feds did launch a site: unfortunately, not all states are up and running on their end. Here it is (you can click on it to visit and explore the site):
It's interesting. The site is well-organized and easy to navigate. Right up to the point where you're looking for actual information. I checked on my state (Pennsylvania) and tried to look at the options for buying insurance as an individual, as a family, and as someone with a pre-existing medical condition.
Turns out that none of the prices for policies will be available until October, and some of the links were designated as "correct link not provided". As for the pre-existing conditions, there is a plan, it's reasonably priced, and has a $1,000 deductible. To apply, there is a phone number to call, which is missing. However, refreshing the page several times will make it magically appear.
I checked another half-dozen states, and none of them had prices for non-high risk pool policies prior to October. Further, as stated on the website, the existence of a policy from a given company is no guarantee that they will accept an individual as a policy-holder prior to 2014. There are links to the state health insurance web sites (where they exist) and the caliber of those sites vary.
Nowhere on the site could I find information on how low income folks can apply for subsidies. If you are good at navigating sites, you can get to Medicaid information. However, if you were not good at site navigation, you would likely need help.
This site is in stark contrast to the Medicare site launched a few years ago to help seniors pick their pharma coverage. There, all of the information was displayed in great detail. At the time, I reviewed the sites (all state-based, but under one umbrella) for my parents, aunts and uncles, and parents of friends, because they all found the site hard to understand. I am concerned that this site, while "cleaner" will not be any easier to navigate for people that are not tech savvy. Still, once the data is in, it looks like a good place to compare coverage if yours is not provided by your employer, or if you are an employer looking to set up an insurance plan for your employees.
Yesterday, the White House and HHS issued rules relative to implementation of the health care legislation that passed earlier this year. In case you're wondering why there are rules in addition to legislation, it's the rules that add specificity to most legislation. So, if a piece of legislation said that I would cook you dinner every night for the next year, the rule would stipulate what I would cook.
I haven't read the rule yet. Not for lack of trying, but because I've been unable to find a legitimate copy of it. I have found the fact sheet, the press release, and a ton of data on the leaked draft from last week, but not the actual rule, and I'm hesitant to work off the draft version, in case it changed. So I'm going off what I know to be accurate, and will have more once I find a copy of the actual rule.
The main thrust of this set of rules relates to grandfathering in existing health insurance plans at companies. The rule is nicknamed the "Barack Obama you-can-keep-your-health-care-if-you-like-it rule." More about the politics of the "Barack Obama you-can-keep-your-health-care-if-you-like-it rule" after the jump.
The law, per the President, said that health insurance plans existing on 23 March 2010 at some companies could remain in effect, but it is the rules that define what the companies have to do to keep that "grandfathering". Companies cannot change co-payments more than the rate of medical inflation plus 15%, for example. That is 19% for 2011. However, there is nothing in the rules which precludes the increase of premiums. So, your company can keep its health insurance plan, but your premium could double, or whatever, provided your employer does not raise the percentage of the total premium you pay more than 5%. The rules say that a company will lose its grandfather status if the employer changes insurance companies.
Law of unintended consequences: Some employers share risk with their insurance companies, and when claims are held down, the profit is split by both companies. Say a company currently pays $6,000/year for a single person to have insurance, and the split is 80/20. You would then pay $1,200/year for premiums. To stay grandfathered, the premium you pay cannot rise more than 5% over the 20%. BUT if the total premium assessed the employer rises to $10,000, you could be charged $2,100/year, which would be 21% of the $10,000. Your costs go up, but conceivably the aggregate cost to the employer goes down in the background because of the risk-sharing.
Losing your plan might not be a bad thing: the grandfathered plans do not have to meet the minimum standards for provided care mandated by the legislation. Many companies now offer "junk" insurance. You pay a low premium, but the policy caps out at, say $15,000/year in total payouts, with a $2,500 deductible. If that employer has to get a new plan, it will not be able to keep the payout cap.
Per the chart on the HHS fact sheet, it is predicted by the government that by 2014, between 39% and 69% of all employees will lose grandfather status. For small companies, that will be up to 80%. When the status goes, the costs to the employee can increase greatly, potentially becoming unaffordable. And if the employer offers ANYTHING, workers will be precluded from joining the exchanges.
For large businesses with junk plans, it will pay to be grandfathered, as they will not be subject to certain aspects of the law, like covering preventive medicine.
Most people can be doctors: you get through college, med school, residency, pass the boards, and you can call yourself a doctor. It doesn't make you a GOOD doctor. Face it, someone has to graduate last in the class and you do NOT want that person diagnosing or treating you.
Once you become a doctor, you probably want to become board certified. Why? Well, in addition to the fellowship and the extra training, you "re-up" on a regular basis (differing based on which specialty you've chosen.) To maintain board certification, you need to keep up with continuing education, which matters in medicine. Not that every advance is perfect, but you really want your doctor to be up to date with new things that are available.
Rand Paul is an actual ophthamologist. He was graduated from Duke, an excellent institution. But he didn't like the idea of being board certified SO HE CREATED HIS OWN BOARD and claimed certification. Hard to imagine, but true.
Here's the political thought: if he gets elected to the Senate and doesn't like that, will he start his own? If he doesn't win election, will he buy a building, stick a dome on it, and call himself "Senator" anyway? Rand Paul may well be the best thing that could possibly have happened to Jack Conway.
When President Obama made speeches about health care reform, he claimed many times that "...and if you like your current health care, you'll be able to keep it." Turns out he should have asked the people who pay the lion's share of that coverage before he spoke.
What Obama meant was that if an employer has a health insurance program, workers could stay on that program, and would not be forced by the government into any other program. Like, say, a Public Option, or Single Payer. This was at the behest of the insurance companies in the person of Karen Ignagni. The idea was to protect those companies' bottom lines, most of which is employer-based. Again, someone should have spoken to the companies. If corporations drop coverage, it's a boon to their bottom line, as the numbers later in this post will show. In addition, the drop doesn't affect insurance companies, as they will still sell policies on the open market. The only person adversely affected in all this is the individual worker. Go figure.
AT&T, Verizon, Deere, Caterpillar and other large corporations are currently considering their options. You may remember that within days of the health care bill being signed into law, some companies announced that they would opt out and pay the fine. Henry Waxman's Committee requested documentation and scheduled hearings. Once they read the documents, they canceled the hearings. Without forcing you to read all 1,100 pages submitted to the Energy Committee, here are some highlight from AT&T, Deere, and Verizon. Bottom line? It will cost much less to shed coverage and pay the fine. Example:
The fine for AT&T would have amounted to $2,000 per employee, costing the company a grand total of $600 million a year. Maintaining benefits, meanwhile, will cost the firm some $4.6 billion.
I know what you're thinking: having a good benefits package helps companies attract the best talent, and makes them an attractive choice to prospective employees. Also, you're probably thinking that the companies would pay extra money to their employees if they ditched their insurance coverage.
Here's where those trains come off their respective rails: if unemployment is at 3%, and there's a huge manufacturing base with strong unions and the non-union companies want to prevent unionization of their industries and stockholders are happy with moderate growth, then yes, they'd keep the benefits. None of the preconditions are currently met. $4 billion is a lot for AT&T to pull in one year from cost cutting. And there would be similar amounts for other large corporations.
Further, there is the cascade effect: once many large companies don't offer health insurance it will ripple, and eventually very few, if any, companies will offer it. The funny thing is, the unintended consequence may well be that the government ends up with Single Payer because of this situation.
Remember the CBO score indicating that the health care bill would decrease the deficit? One of their assumptions was that fewer than 25 million Americans would be collecting government subsidies for health insurance by 2020. But:
By Fortune's reckoning, each person who's dropped would cost the government an average of around $2,100 after deducting the extra taxes collected on their additional pay. So if 50% of people covered by company plans get dumped, federal health care costs will rise by $160 billion a year in 2016, in addition to the $93 billion in subsidies already forecast by the CBO.
It could easily end up costing less to the government to go into the Single Payer business, and therefore act as the insurance provider (although not the service provider). Remember, though, that government only doesn't do things if it lacks money or political will. In this case, the money may be there, but the political will may not.
In the intervening years, however, it will be ugly.
One of the early enacted provisions of the new health care legislation is that by 1 July of this year, each state must enact a high-risk pool, if they don't have one already, or allow the Feds to step in. These pools are supposed to provide insurance coverage to those people who don't have health insurance, have not had coverage for at least the six prior months, and have a pre-existing condition which precludes them from procuring coverage on the open market.
Under the legislation, states have four options:
Participate in a new high-risk health-insurance pool
Build on an existing state program
Establish a new state-based high risk pool with federal funding
Do nothing at all, in which case, the federal government would step in
The parameters of the high risk pools are as follow:
High-risk insurance pools will not be able to impose preexisting condition exclusions, will have to keep their premiums at “standard rates” (or no higher than the average person of that age would pay for insurance in the private market), limit on out-of-pocket medical costs to $5,950 a year for an individual, and insurers will have to maintain an actuarial value of at least 65%. Issuers will also be prohibited from varying premiums on the basis of age by a factor greater than 4 to 1.
Last month, HHS Secretary Kathleen Sebelius sent a letter to all the states asking which option each would select. Here's what we know so far:
Why are the states opting out? First, if you look at those states, marked in red, you'll notice that most either ARE red states, or are purple with a red governor. Second, there is a monetary concern:
Several of the states that declined to run the pools said they were concerned they would be forced to pay for the program if it exhausted its federal funding. Last week, an actuarial report from HHS found the program would burn through the $5 billion set aside for it as soon as next year, though the money is supposed to last until 2014.
There are several things to think about: first, these decisions did really come down along party lines, with most, albeit not all, Republican states ignoring their usual states rights cries to cede control to the Feds. This will certainly have repercussions down the road.
Second, there really are some serious financial considerations. It's not just the $5 billion, it's the insurance companies in certain states that are refusing to participate because they fear they won't get paid. It's also the fact that these programs may well not be affordable to people without insurance.
Next, there is the personal decision of whether or not to participate in the pools. There are a lot of unemployed people on COBRA whose benefits will expire over the next year unless they get a new job. To qualify for the pool, these folks have to wait six months. If one has a chronic condition, or a very serious illness, a decision to wait and forgo medical care in the interim could be a fatal decision. It's very possible that these individual decisions could easily stress both the medical profession and monies currently allocated for the uninsured. As an example, if you have someone with high blood pressure, high cholesterol, high triglycerides, a stent, and a prior heart attack, that person would not qualify for health insurance for six months post-COBRA. If he could not afford his meds, the chances of a second heart attack are very high. When he's taken to the ER, the law requires that he be treated if denying care would lead to imminent death. Cost? $38,000 - $50,000. And either someone pays or the hospital eats a cost they are wont to absorb.
Finally, there is the logistic issue of the Feds providing some things to some states, and other things to other states. It might end up like Medicaid where there are vast state-to-state differences in access, cost, and service levels. It's also a great strain on the Feds to have to work around existing state regulations in their implementation. As always, it's one of the major reasons that Single Payer is the best option, and a strong Public Option would be the second choice.
In 2007, the Army created 35 warrior transition units (WTUs) at Army installations to fill a gap in support personnel for wounded Soldiers. The WTUs provide critical support to wounded Soldiers— who are expected to require six months of rehabilitative care and the need for complex medical management—and their Families. The units have physicians, nurses, squad leaders, platoon sergeants, and mental health professionals. These leaders are responsible for making sure wounded Soldiers’ needs are met, their care is coordinated, and their Families are taken care of.
At the heart of the WTU system’s success is its “triad of care.” The triad is comprised of a squad leader, nurse case manager, and a primary care physician. The squad leader leads the Soldiers, and the nurse case manager coordinates their care. The primary care physician oversees care, which can be complex, given the multiple issues experienced by some Soldiers. The triad of care creates the familiar environment of a military unit and surrounds the Soldier and Family with comprehensive care and support, all focused on the wounded warrior’s sole mission—to heal. These professionals put the Soldier first, cut through red tape, and mind the details.
Created in the wake of the scandal in 2007 over serious shortcomings at Walter Reed Army Medical Center, Warrior Transition Units were intended to be sheltering way stations where injured soldiers could recuperate and return to duty or gently process out of the Army. There are currently about 7,200 soldiers at 32 transition units across the Army, with about 465 soldiers at Fort Carson’s unit.
But interviews with more than a dozen soldiers and health care professionals from Fort Carson’s transition unit, along with reports from other posts, suggest that the units are far from being restful sanctuaries. For many soldiers, they have become warehouses of despair, where damaged men and women are kept out of sight, fed a diet of powerful prescription pills and treated harshly by noncommissioned officers. Because of their wounds, soldiers in Warrior Transition Units are particularly vulnerable to depression and addiction, but many soldiers from Fort Carson’s unit say their treatment there has made their suffering worse. [...]
At least four soldiers in the Fort Carson unit have committed suicide since 2007, the most of any transition unit as of February, according to the Army.
Sadly, the units are run not by medical personnel, but by NCOs using drill sargent tactics to keep order, even when the patients are drugged into stupors. Again from the Times:
In many cases, the noncommissioned officers have made it clear that they do not believe the psychological symptoms reported by the unit’s soldiers are real or particularly serious. At Fort Hood, Tex., a study conducted just before the shooting rampage there last November — which found that many soldiers in the Warrior Transition Unit thought their treatment relied too heavily on medication — also concluded that a majority of the cadre believed that soldiers were faking post-traumatic stress or exaggerating their symptoms.
Are the wars in Iraq and Afghanistan wrong? Certainly. Should the soldiers never have been sent over? Absolutely to Iraq, less clean in Afghanistan. But we owe these men and women. We owe them thanks for putting their lives at risk: they followed orders, they completed their individual missions. This situation is disgraceful.
Yesterday I received an email from a lifelong Republican friend in California. It was a request to sign a petition. Vikki knows better than to send anything pro-Republican, so I figured I'd take a look: the petition, which you can sign here, is to get Congress to pass legislation mandating that health insurance companies allow women who have mastectomies to stay in the hospital for a minimum of 48 hours post-surgery.
In January 1997, Congresswoman Rosa DeLauro of Connecticut sponsored H.R. 135, the Breast Cancer Patient Protection Act of 1997, in the 105th Congress. The bill sought to "amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for a minimum hospital stay for mastectomies and lymph node dissections performed for the treatment of breast cancer." Among other provisions, the proposed law mandated that the benefits of patients covered under group insurance plans not be restricted "for any hospital length of stay in connection with a mastectomy for the treatment of breast cancer to less than 48 This bill was never brought to the floor for a vote after its introduction to Congress. It was referred to various congressional committees, where it languished without action until it expired with the end of the 105th Congress. Rep. DeLauro sponsored the same bill five more times:
In March of 2009 Rep. DeLauro introduced the bill for the sixth time as H.R. 1691 (the Breast Cancer Patient Protection Act of 2009), while Senator Olympia Snowe of Maine introduced the same bill to the Senate as S. 688. House and Senate versions are both currently in committee.
This email came to me the day after the story broke that Wellpoint is throwing women off their insurance when they are diagnosed with breast cancer. One of the uglier rescission policies, since it is so far-reaching.
And so you know the drill: call, baby, call, your reps in the House and Senate. On BOTH counts. Women who have paid their premiums deserve the care for which they've paid, and then, deserve to be allowed hospital care post-surgery. As always, if you don't know the phone number, or (heaven forbid) the name of your reps, drop us a line and we'll send back the information.
Secretary Sebelius was outraged publicly, and called on Wellpoint to stop this heinous process now. But there are still 4 years until 2014 when the anti-rescission parts of the legislation launch. Action is needed now.
The big winners today are insurance policy holders in the Commonwealth of Massachusetts. Under the radar, the six largest insurance companies in the state had applied for rate hikes, predominantly in the individual and small business markets, of up to 34%. State Insurance Commissioner Joseph Murphy said no. The insurers sued, and yesterday, Suffolk Superior Court Judge Stephen E. Neel denied their request for an injunction, so the state's rejection of 235 separate proposed rate hikes stands. It should be noted this is approximately 93% of the requested rate hikes, the rest were accepted.
Judge Neel said that the insurers had not gone through the appeals process within the insurance division, and therefore they lacked legal standing. Commissioner Murphy and Governor Patrick, applauded the decision. The insurance companies said they'd lose MILLIONS...I pretty much doubt that, but it will be fun to watch them be proved wrong.
Bigger winner? Joe Arpaio. Yesterday, the Arizona House passed a measure making it illegal to be an undocumented alien in Arizona. This had already passed the state Senate, and Governor Brewer is expected to sign it. It means that if the police "reasonably suspect" that someone lacks the proper papers, they must arrest the person and make him/her prove that he/she is in Arizona legally. Look for the kind of neighborhood sweeps Joe Arpaio has been undertaking. Despite Arpaio's Federal indictments for civil rights violations, this state law might protect him.
The losers? The citizens of Arizona. Hatred and bigotry are always a problem...In addition, if you remember Hazelton, PA, the town where Lou Dobbs and Lou Barletta endeavored to basically ban brown people: the whole town suffered. And likely that will occur in Arizona also. We know that immigrants, especially those without proper documents, take a lot of low-paying jobs. If suddenly all the restaurants, delivery services, landscapers, farmers and ranchers, construction companies, etc., have to pay 10% or 50% more to get help, what does that do to prices? Or the ability of these companies to stay in business? The state sales, income and property taxes will all decrease when a large chunk of population moves on to a better place to live, thus further depressing state coffers. What of people who see a crime? They won't testify or even give information because of the threat of racial intimidation, even if they are native born Americans -- this opens a great opportunity for criminals, especially the violent ones. What of the schools? There could be large drops in student populations, and thus the need for fewer schools, fewer teachers, and more people out of work.
But remember -- it NEVER stops with one group. The haters will finish with the Hispanics, and then move on to the other groups they wish to destroy....remember the old quote "...and when they came for me..."
Tonight, Frontline on PBS will be starting a series. Here's the ad:
And a preview of part one on insurance, and the insurance lobby:
Bottom line: what really went on in getting "reform" passed. It's a good information set if you have an opinion about the legislation, want to learn about the process, or can never get enough Wendell Potter, this is the show for you.
Now that Health Care Reform (or at least the version of Health Care Reform that was able to pass) has become laws, there has been rumbling from the nattering nabobs of negativism that they are going to go to court to have it declared unconstitutional. While this fight will take several years, now is a good time to lay out some of the issues.
1) Standing -- Standing is the legal right to bring a lawsuit. Typically, it requires proof of some specific individual harm. While there has been a lot of state Attorneys General and other officials either filing law suits or threatening to file law suits, I have trouble seeing any of these individuals as having standing to challenge many of the provisions. There are about three or four theories of standing being suggested by various people, but none of them matches with the view of standing that the US Supreme Court has.
Theory #1-- The State Government (or a state official) inherently represents the people of the State (or can be given that authority by state statute). It is almost amazing hearing this theory coming from conservatives. While a government has many powers, it is not the people of the State or a region. If this theory is true, governments have automatic standing to file any lawsuit that they want without any direct tie or impact on the state government. If that is the case, then California can file a lawsuit against Toyota for product liability on behalf of anybody in California who might get injured due to a sticky accelerator.
Theory #2 -- To defend a state law. The problem with this theory is a complete lack of understanding of the Supremacy Clause and the relationship between state law and federal law. A state law can be valid even if it is trumped by a federal law on the same issue. (For example, the federal government might require prescriptions for certain drugs while the state government does not or vice versa. Both statutes are valid, and a pharmacy has to comply with the more restrictive statute.) On the other hand, a state statute that purports to declare a federal law to be invalid is simply unconstitutional on its face regardless of whether or not the federal law is valid. Again, if this theory created standing, it would be easy for a state to challenge any legislation that it disagreed with. If you don't like federal labelling laws that pre-empt state product liability laws, simply pass a statute saying that your state is exempt from that provision and then you can challenge it in court. I can't see too many conservatives supporting that theory.
As will be discussed further below, there are some limited circumstances in which a state might have standing to challenge part of Health Care reform, but I can't see any of them working.
Owing to the lack of a public option in the non-single payer health care legislation enacted by Congress, the insurance industry is doing all sorts of interesting things to keep profit high, and health care provision low. Today, it has to do with choosing doctors and hospitals in-network. 
If you're a long-term reader, you know how I feel about patient-centric care. It is the way medicine should ALWAYS be practiced. For those of you who are new to the term, "patient-centric" care means that the medical team does the right thing for each patient, in every situation, each and every time. 
When President Obama made speeches about health care reform, he claimed many times that "...and if you like your current health care, you'll be able to keep it." Turns out he should have asked the people who pay the lion's share of that coverage before he spoke.
Why are the states opting out? First, if you look at those states, marked in red, you'll notice that most either ARE red states, or are purple with a red governor. Second, there is a monetary 
Yesterday I received an email from a lifelong Republican friend in California. It was a request to sign a petition. Vikki knows better than to send anything pro-Republican, so I figured I'd take a look: the petition, which you can sign 
