Anyone ElseTerrified about Repeal of ACA Bill
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Yes and yes!!
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Appeals Court Rebukes Administration's Attempt to Force Work Requirements, Other Barriers on Medicaid Program
14 Feb 2020
Washington, DC - Earlier today a three-judge panel of the U.S. Court of Appeals for the District of Columbia ruled in favor of the plaintiffs in Gresham v. Azar, concerning the Trump administration's approval of a restrictive Medicaid waiver project, which among other things, conditioned Medicaid coverage on compliance with work requirements. Judge David Sentelle issued the unanimous opinion. The panel found that in approving the project without considering its effect on Medicaid coverage, the U.S. Department of Health and Human Services violated the Administrative Procedure Act.
Perkins also noted the sound legal justification behind the ruling, "Section 1115 of the Social Security Act only allows the Secretary to approve experimental projects that further the Medicaid Act's purpose As Judge Sentelle's opinion repeatedly notes, the text of the Medicaid Act is clear as to this purpose – to provide health care coverage. The agency was bound by the purpose Congress selected and could not change it as it attempted to do. Only Congress can do that."
Source: National Health Law Program www.healthlaw.org
Read the court's opinion here: https://healthlaw.org/wp-content/uploads/2020/02/G...
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Bloomberg gives death panels a try
Mike Bloomberg says health care will bankrupt us unless we deny it to the elderly. He means the elderly who aren't rich.
He's talking about a National Health Service. That's been tried — is still being tried — in Canada and England and Australia. All are notorious for patients dying from neglect, or while waiting to use life-saving treatment readily available in America without waiting, such as dialysis. It's well known that Canadians near the border often come down to America for such treatment. They would die waiting in line at home.
That's what nationalized health care does, and it's what Mike has in mind for us.
Twelve years ago, Sarah Palin warned us about death panels deciding who got to live or die while waiting for treatment. Liberals raised a hue and cry about her terminology, but that's what Mike Bloomberg's talking about — only Mike would make the decision ahead of time by drawing a line under all those 95 and older. Until it became necessary to draw it under those 85 and older. Then 75. There would be no lower limit, so this could go on until — what age?
But it really wouldn't be about age. It would be about who can bribe his way to the front of the line, or who is related to whom. We already know that's where the scam ends up once begun.
We were better off before Hillary Clinton began yammering about a "health care crisis" nearly 30 years ago. There was no such crisis then, and there is none now, but there certainly will be if we go where Mike Bloomberg wants to take us.
If Mike seriously wants to help, he could donate some of his billions toward the purchase and maintenance of the expensive machines that help save lives — X-ray, CAT scans, dialysis, etc. — for hospitals and health clinics and consortia that can't afford them. He could help new doctors coming into the marketplace set up practices with low-interest loans and low-rate malpractice insurance. These would make a direct difference in medical costs and save lives without some bureaucrat picking and choosing who lives and who dies.
Get busy, Mike. Ideas like these would actually help people. What you're thinking right now would not.
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Trump's support for bipartisan Senate drug pricing bill may not be enough to push it into law
Senate leaders have yet to embrace the legislation despite widespread public angst about health-care costs.
A Senate bill to control prescription drug prices seemed to have everything it needed: bipartisan backing, President Trump's endorsement and broad public support.But
its status on legislative life support reveals the perils of tackling
one of the nation's most hot-button topics just months before a presidential election. And even though Trump has said he
supports the measure, he has stopped far short of trying to ensure its
passage.Grassley said that he asked White House advisers to get Trump involved
in winning support for the legislation and speaking publicly about it,
but that they were reluctant to involve Trump to that degree. Grassley
said he "never got a good reason" as to why advisers did not want to
involve the president.McConnell...has since then shown little interest in revisiting health-care legislation, a divisive issue within the Republican Party.
The pharmaceutical lobby... has spent millions lobbying against the bill.
Those close to McConnell say he is personally opposed to the bill
because of price caps it imposes on drug companies and because he does
not like to take up legislation that splits his party.Sen. Joni Ernst (R-Iowa): "...what's the point of having life-saving drugs if you can't afford them."
https://www.washingtonpost.com/health/2020/02/18/t...
Find info on the legislation here:
Senate releases bipartisan proposal to lower seniors' drug prices
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It's Time To Explore The Unique And Conflicting Narratives Of Disability Issues
In at least one way, disability issues are the same as any other issue. Facts and details are important, but they don't explain the full range of debated approaches and priorities. Powerful narratives are also involved … some truthful and drawn from genuine, lived experience of disability, others dishonest or based on fear and prejudice.
The increased prominence of disability issues in the 2020 Election campaign makes understanding these narratives more important than ever.
Here are four disability issues that are getting some attention right now, along with suggestions about the competing disability narratives that lie underneath the facts, assertions, and arguments of each one.
https://www.forbes.com/sites/andrewpulrang/2020/01...
{Includes links to presidential campaign info on positions on disability.}
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Lumpie, Washington Posts wants us to purchase a subscription. Could you just post the whole story on lowering drug prices for Seniors? Thanks.
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Marijen,
Yes, that subscription thing is a pain for avid readers. Can't post entire article on a public site due to copyright issues.
The Post does run some really good "deals" on subscriptions. For those interested in reading on an ongoing basis, I recommend watching for those deals. Libraries may also offer electronic access.
Thanks.
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They are offering a $1 fee but the thing is I'm not interested in signing up for all these websites that want money. I bought a deal subscription for Wall Street Journal and cancelling after the special offer period was nearly impossible.
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Here is another link on the Senior Drug Pricing Bill.
https://www.cnbc.com/2019/07/23/key-senate-panel-u...
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marj...I watched the video of Bloomberg saying that a 95 year old who shows up at a hospital with prostate cancer should be denied treatment and should go home and move on with their life...I wish to elaborate on that statement. Having read Otis Brawley, MD’s book, How We Do Harm, Bloomberg might have been referring to the philosophy that too often we over treat without any evidence. AND, we might be, by over treating, potentially, limiting the quality of one’s life and/or shortening their lives.
When Dr. Brawley titled his book How WE Do Harm, he meant exactly that, we! All of us., Doctors,patients, Pharma,researchers and lastly, loved ones. All of us, he believed needed to be part of discussion about how to deliver healthcare. He believes the discussion is an intimate one that begins and ends with the patient and family. Having recently lost my beloved 93 year old mother who was a retired director of nursing at a public hospital, my mother would have gone further than Bloomberg. She would have said not to even take the 95 year old to the hospital. She would have said that the 95 year old would have probably died from something else...like old age! That’s not saying you should deny a 95 year old treatment. If a 95 year old shows up at a hospital and is suffering from pneumonia and it can be treated and the patient could be quickly cured, then of course treat the patient. That said, I get it and so does Dr. Brawley that some people want to have the kitchen sink thrown at them and the heck with side effects and evidence. I recall when my mother was 91 she no longer wanted to take a statin because for years she had muscle cramps. The doctor was adamant that she should take it. My sister, a nurse and I supported our mother’s decision to discontinue therapy. The doctor was disappointed. Finishing the conversation with the doctor, I asked, “Could you show us the evidence that taking a statin at this point in our mother’s life is going to make her live longe?” He had no answer. There was no evidence.
and all of that imaging? Imaging is a good tool. But for many illnesses, much of the money spent on it is a waste. A good example? Population based mammograms save lives, but diagnostic mammograms save, many, many more lives. Much of the money spent in the US on population based mammograms could be spent on research...finding BETTER ways of screening as well as on finding cures. Much of Europe and Canada base imaging on risk and age and invite patients at average riskto have screening mammograms every 2 years. Breast cancer mortalityrates are the same as in the United States. Imagine all of the money in the US that could be earmarked for research if we followed the other industrialized countries’ breast cancer screening models?Sadly, as long as have threads like this one that predominately spreads rhetoric, I am left doubting whether we might ever begin the true conversation that needs to occur...the one Dr. Brawley believes needs to occur so that one day we will have a healthcare system that is fair to all and ultimately saves more lives.
Please do not interpret that I encourage the Canadian and European healthcare models. I do not. Nor am I endorsing Bloomberg. I just think we need to step back, take a deep breath and begin the discussion from a place of understanding....
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90 something friend of mine’s dad had valve replacement surgery (and of course died shortly after the surgery.) I kept thinking, why did anyone agree to do this to him?
My dad is on hospice for CHF. He and my mom have decided to go talk to their GP (who tends to blow sunshine up their butts) again about my 84 year old gravely ill Dad getting a pacemaker. Just because we can doesn’t mean we should, leaving out that it is a vast waste of money and does not improve anything.
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These discussions about American/Canadian/European health care differences need to take into account the number of American families who end up in bankruptcy court secondary to health care costs. It hardly matters how good your health care is if you are broke and can’t afford to get it. Try standing in line for healthcare when you have no money for deductibles/co-shares/medications. You’ll always be at the end of the line. Health care is a multifaceted issue. A friend is a hospital CEO and says Americans would be appalled at the money spent on the last 30 days of a persons life.....and they usually know the person is going to die regardless. Performing surgery on a 95 yo is questionable at best....but it’s done. Americans see their healthcare through rose colored glasses, except those who can’t afford it.....they have 20/20 vision.
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melissa...sorry to hear the news about your dad...one blessing is your parents have one another to lean on during this most stressful time in their lives. Please accept my thoughts and prayers ...and thank you for sharing their plight...
Yoga...Dr. Brawley begins his book describing how a woman came into the emergency room at a public hospital with her ulcerated breast in a paper bag. He was ANGRY that that would occur in the US. Yes. The delivery of healthcare is a multifaceted conundrum. Dr. Brawley argues that the answer begins with the patient and family. And that physician who said people would be outraged at the expense of caring for a person during the last month of life..Most people don’t know the cost. And I would go a step further by saying most people would probably not want to pass in a hospital and yet the knee jerk response is to go to the hospital.
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voracious, Indeed!
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Don't think that people in the US are not denied treatment b/c of age. My 91 yo FIL was denied a cochlear implant b/c of age and transplant teams deny organs to older people all the time. They have a 40 yo and a 70 yo both needing an organ, most often the 40 yo will get it b/c of longevity expectations for the organ.
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Statistics can be brutal. I have read the statistics about over diagnosis and over treatment of very early stage breast cancer. It's difficult to get one's head around. We've been told early diagnosis = cure for so long. Different verse, same song: I also fought a lengthy battle to get my MBC diagnosed. It's an over simplification but the docs essentially kept saying "chances are" it's benign. Well, that's true. Chances were that those lesions would be benign. But they weren't. And as one of my friends so succinctly put it "if they're wrong, you're the one who's dead." I'm not sure how you apply that experience to clinical practice except to say that it sucks to come out on the bad end of the statistics. At a societal level, we certainly have not thought through how many patients it is acceptable to lose, for what economic (cost) savings - and whom. I think it would be beneficial to think through those issues more...to have more public dialog around those issues. I wish I were more optimistic about finding consistency of community values around these issues. Too often our values seem to be "more for me. Less for you." And I don't think that's a very sound value system.
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Neal and Brady Release Legislative Text of Surprise Medical Billing Proposal
Feb 7, 2020Ways and Means Committee Chairman Richard E. Neal (D-MA) and Ranking Member Kevin Brady (R-TX) released legislative text of the Consumer Protections Against Surprise Medical Bills Act of 2020, the Committee's proposal to better shield patients from bankrupting surprise medical bills. The members' plan puts patients first by protecting the patient from balance bills, enhancing consumer protections, requiring greater transparency, and empowering patients with information about their health care costs. The Ways and Means approach recognizes the importance of the private market dynamics between insurance plans and providers, and it includes an independent mediated negotiation process to resolve billing disagreements.
https://waysandmeans.house.gov/media-center/press-...
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"Health Issues and the Election Quiz"
Kaiser Family Foundation
Test your knowledge about health facts, policy issues, and proposals emerging among presidential candidates in a top voter issue: health care!https://www.kff.org/quiz/health-issues-and-the-ele...
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Clinicopathological Characteristics and Disease-Specific Survival of Single Hormone Receptor–Positive Breast Cancer
- The authors of this cohort study of 823,399 patients with breast cancer evaluated the outcomes associated with single hormone receptor–positive disease. Breast cancer–specific survival was worse in patients with single hormone receptor–positive subtypes compared with double hormone receptor–positive subtypes, yet still better than double hormone receptor–negative subtypes. Patients with single estrogen receptor–positive subtypes had superior breast cancer–specific survival compared with patients with single progesterone receptor–positive subtypes.
- Patients with single hormone receptor–positive breast tumors may require a tailored treatment regimen to ensure maximum therapeutic benefit.
doi:10.1001/jamanetworkopen.2019.181600 -
Voraciousreader- exactly! I say that as a geriatric social worker working in a skilled facility.
We overtreat those who can afford and may not need the procedure. Think elective procedure on a 80+ individual. But cannot provide basic and preventive healthcare for young adults and children. Many older adults have multiple health conditions that will kill them before a prostate cancer would. It's not death panels but pragmatic healthcare management.
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Medicaid Expansion Tied to Earlier Cancer Detection
Lower rate of advanced-stage disease, but no improvement in timely cancer care
Medicaid expansion under the Affordable Care Act (ACA) was associated not only with increased insurance rates for newly diagnosed cancer patients, but also reduced likelihood of advanced-stage disease at diagnosis, a large retrospective analysis found.
https://www.medpagetoday.com/hematologyoncology/br...
Primary Source
JAMA Network Open
Source Reference: Takvorian SU, et al "Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer" JAMA Netw Open 2020; DOI: 10.1001/jamanetworkopen.2019.21653.
Secondary Source
JAMA Network Open
Source Reference: Fu S, et al "The Affordable Care Act and insurance status, stage, and timely treatment among patients with cancer. What are the possible effects?" JAMA Netw Open 2020; DOI: 10.1001/jamanetworkopen.2019.21690.
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Study: Screening Eliminates Survival Disparities in TNBC
But higher triple-negative breast cancer incidence remains in African-American women
Survival differences between black and white women with triple-negative breast cancer (TNBC) appear to vanish when these tumors are detected by screening mammography, a single-center analysis suggested.
"This work clearly shows that TNBC can be detected by screening mammography and that screening does save lives," said Laurie Margolies, MD, a professor of radiology at Icahn School of Medicine at Mount Sinai in New York City. This study "argues for increased screening for all women and highlights the need for increased efforts to screen traditionally underserved populations."
...patients with screen-detected disease had a 79% reduced likelihood of death from any cause compared with patients for whom screening was not used to detect disease...
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ASCO Backs Recycled Meds
The American Society of Clinical Oncology (ASCO) announced its support for drug repository programs as a way to reduce costs and waste, with the stipulation that they be for oral medications only, "are maintained within a closed system," and have "sufficient patient protections in place."
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Broad Coalition Urges Congress to Include CLINICAL TREATMENT Act in Healthcare Extenders Package
Bipartisan CLINICAL TREATMENT ACT would ensure clinical trial coverage for Medicaid patientsVarious medical, research, and patient organizations, including ASCO, are urging congress to pass the bipartisan Clinical Treatment Act, which would guarantee coverage for Medicaid patients participating in clinical trials.
CLINICAL TREATMENT Act (H.R. 913)
https://www.asco.org/practice-policy/policy-issues...
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Lumpie - thank you for your posts and for starting this forum. Health Care, Health Care reform, how to make sure there is access, and how to pay for it. It is so complicated. It scares me that the Republican leadership seems to want to burn what we have to the ground and start over. We will never get it back it we do that. But the Democratic Leadership and hopefuls seem to over simplify the problem. I kept my health insurance after I retired. I am seeing a therapist for lymphadema who advised me that Medicare does not pay for lymphadema treatment. So I plan on keeping my insurance even when I become elligible for Medicare. I'm tempted to send my elected representatives my used sleeve/gloves and ask them to wear it every day.
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Lumpie didn’t start this forum. It started out as a discussion thread. Lumpie has decided to post lots of links in the thread
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True. Not sure if it was in 2017 when Congress was voting on whether or not to do away with the ACA or shortly thereafter...I was searching for BCO.org forums on the issue and this one seemed to fit so I have continued to post press links and occasional commentary on this and related issues. Access to coverage is certainly a giant concern for many of us. There are lots of variations on plans and proposals out there...I just hope we can keep something reliable and reasonable!
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BlueGirlRedState: I had not heard that Medicare does not cover lymphedema therapy. That is crazy! Even if you don't send them your sleeve (but if you did, that would be great!), please do contact your representatives at both the state and federal level and make sure that they understand how this issue impacts you. I think that most representatives listen to their constituency and, while they may not do an immediate "180" on their position, some will modify their positions over time. If they hear from enough constituents, they may adapt more quickly. And that is progress.
I hope you get to keep access to quality care that meets your needs. (And I hope we all get to have access to quality care that meets our needs.)
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Medicare paid for my thirty LE PT treatments over two years. They don't pay for sleeves and compression bras.
There is an organization working to get Medicare to cover the compression items. You might find it at Step Up
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BlueGirl, I can certainly understand your concern about Medicare not covering lymphedema garments and wanting to keep your insurance once you are eligible for Medicare. If you (or your spouse) are still employed and covered under your employer’s plan, you can stay on your current insurance plan. However, if you are planning to use COBRA or pay out of pocket, you may find the premium to be hefty. Medicare part B premiums are very reasonable and you could pay for garments out of pocket and still be money ahead. I’ve been on Medicare for 3 yrs and have not had any denials for any treatment for any condition. It’s too bad we have these worries on top of all the worry about bc.
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