dinner conversation

Last night I was at dinner in someone’s home and the following is the abridged version of a portion of dinner conversation. I say abridged because I was so mad that one, the guest had the audacity to discuss politics in a room of people this person had never met, save one, and two I didn’t want to go ballistic and embarrass the host so I left.

Guest: I was at the VA hospital today for (some random event) and was able to see the blueprint of the new hospital.

Me: Oh really, tell me about it…

Guest: Well on Banks street, the old oak trees were saved, and some of the buildings will be built around the oaks, so there will be a corridor down the middle – a shaded promenade with benches and such.

Me: That sounds nice!

Guest: While I was there today, some of the (nameless) dignitaries were discussing how the Charity Hospitals were being dismantled and they were looking at private corporations to take over the care of the patients.

Me: Oh really? Well after Katrina, when Charity hospital was closed down, all the patients had to go somewhere so they were seen at Ochsner, East Jefferson – it didn’t work well and those hospitals lost a lot of money…

Guest: Yeah, one of the doctors at (nameless hospital) was telling me how after the storm, a gun shot wound patient broke into some pharmacy storage area to take medicine, so that didn’t work out too well with “those” (emphasis guest) patients at the private hospitals. So its going to be difficult for “those” (emphasis guest) patients to find somewhere to go.

Me: I honestly don’t see how the state could possibly shut down the Charity Hospitals? What are they going to do with the new hospital? Sell it?

Guest: Well there will be no more Charity system, they are doing everything right now to close all the hospitals. It won’t be an issue especially if Obamacare is defeated in November when Romney wins.

Me: Its called the Patient Protection and Affordable Care Act. Plus there is no guarantee Romney will win.

Guest: Well if Obama is re-elected, there are ways to defeat the health care bill.

Me: Oh Really? You know, we really shouldn’t be going there (having political discussion with strangers) at dinner…

Guest: Well how do you think Obamacare is going to be funded? The federal government will need to put up $50 billion dollars they don’t have to pay for it…

At this point I excused myself and helped clear the table and began washing dishes. The guest continued carrying on political discussion with the others remaining at the table which I could hear from the kitchen. I did as much as I could to assist the host –  but very soon after when another guest excused themselves it was my cue to leave too.

I find it extraordinarily disturbing that there is a subversive political process going on which is hell bent on obliterating health care for the poor and uninsured in Louisiana. There has already been a loss of thousands of state jobs, and this current round will result in 1500 more people out of work. How does this contribute to the tax base, the spend and growth economy, putting people out of work, regardless of the fact that these are hard working and dedicated state employees?  Where are all the students of health care, physicians, nurses, allied health, going to go for training? Not to mention all of the sick, sick patients and not just the victims of and perpetrators of violent trauma: there is no plan in the foreseeable future for the state to pony up through Bayou Health or any other fee schedule to reimburse the private hospitals that will wind up caring for the uninsured poor. And once these private hospitals begin to see red, what will happen to the patients? Will they just start dying in the streets? Where is the social justice in that?

There is a call to action out there, let your voice be heard. Representative Jerome Richard from Thibodaux has called to convene a special session to address the recent bulldozing of healthcare, among other things. Contact your state legislators and senators, and demand they go to special session in November to reverse the evisceration of health care in this state. You the citizens elected the legislators and they answer to you, compel them to do their job and do what’s right by their constituents and not the special interests.

*****UPDATE***** This link will take you to an online petition through Change dot org requesting the legislature to convene a special session to find out what in God’s name is going on with the railroading of health care in Louisiana – please consider signing it – thanks

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How The Affordable Care Act Will Affect You

The Supreme Court is gearing up to hear challenges to The Affordable Care Act soon. Access to affordable healthcare is an issue that impacts virtually every person in this country and one we should all be concerned about, whether you’re already covered under a plan or are uninsured. There are so many people in dire straits in our current economic climate and thousands are losing their healthcare benefits along with their jobs. Many are bankrupted after using their life savings to pay for medical costs over the lifetime max allowed by their insurance plans. (Under the plan, annual limits on benefits are phased out by 2014.)

This morning I read a piece in Women’s Voices for Change that has a lot of good information and links about The Affordable Care Act and I’ve decided to publish it here in it’s entirety. I hope you find it as valuable as I have.

The Affordable Care Act: An Online Primer

November 28, 2011 by

Though the Supreme Court is preparing to hear arguments about its constitutionality, the Patient Protection and Affordable Care Act is law, and more provisions are set to go into effect this coming year and in 2013. With that in mind—and to brush up on the basics before the Court digs in—we asked healthcare scholar Janet Golden to give us a quick roundup of information that’s easily available online.  —Ed. 

On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act. (If you’ve got hours and hours of time to kill you can read the whole thing online.  Before, during, and after the debate over this legislation, it’s been deemed everything from a sell-out to big business as usual to a socialist plot. But with more of its provisions going into effect in 2012, it’s worth taking a closer look at what’s in it for over-40 women and their families.

A key provision is the mandate requiring individuals to be covered by health insurance. It provides subsidies for low- and moderate-income individuals to purchase coverage, mandates a basic set of benefits, and prohibits exclusions based on pre-existing conditions. The logic of the mandate is simple: for the Affordable Care Act to effectively lower health care costs while covering those with expensive chronic conditions, we all need to participate. It simply isn’t fair for someone to avoid insurance premiums for decades and then, when needing millions in care, to jump into the coverage pool.  Moreover, if only those needing care get coverage, insurance rates will be unaffordable.  In a 2009 commentary on CBS News Moneywatch, one economist offered a simple explanation of the need for the individual mandate.

So what exactly is in this law—which I’ll call the Affordable Care Act—and how do you get accurate information about the phase-in of benefits? And which provisions directly affect women over 40? The answers can be found at a number of easily understood websites.

The federal government website Healthcare.gov offers a timeline explaining the implementation of the numerous provisions in the law. For example, women who run small businesses or who lead small nonprofit groups became eligible for tax credits for their contributions to their employees’ health insurance retroactive to January 1, 2010. Women over 65 on Medicare who hit the “donut hole” in their prescription-drug coverage received a one-time rebate check for $250, with additional coverage and discounts being phased-in. The website also has a list of the preventive services for women, mandated under the law, that are covered. Notably, mammography, cervical cancer screenings, and well-woman visits are covered. Funds for prevention—including those aimed at smoking and obesity—are increased under the law. It’s worth scrolling through the timeline and looking at the phase-in of various reforms. (Perhaps you’ve gone to the doctor this year and been pleased to find that you don’t have a co-pay for these services!) You’ll find additional information in Healthcare.gov factsheets.

Of the many sites offering information, my personal favorite is the one supported by the Commonwealth Fund, a private foundation that funds research on healthcare issues and grant programs aimed at improving healthcare practice and policy.  Their timeline and “health reform provisions” tool are the most clearly written and easiest to navigate of any that I’ve found.

Another rich source of information is the Kaiser Family Foundation website. The foundation, which is not affiliated with Kaiser Permanente or Kaiser Industries, aims to provide independent, factual information on health issues. They have a dedicated discussion of health reform, and if you’d rather watch than read, they produced a short video on the topic narrated by Cokie Roberts. If you think you know all you need to about the Affordable Care Act, you can take their ten-question online quiz and determine your knowledge of the new law.  (For the record, I scored 9 out of 10—better than 97 percent of all Americans!)

The Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to determine the minimum set of benefits to be provided by all insurers. The Department asked the Institute of Medicine—an arm of the National Academy of Sciences that provides “unbiased and authoritative advice to decision makers and the public”—to propose criteria and methods for deciding what benefits should be covered. You guessed it—the IOM report is available online, too.

The Trust for America’s Health, a non-profit, non-partisan organization focused on public health and disease prevention, also has a website on the implementation of the Affordable Care Act.  The TFAH does an excellent job of pointing to the health-promotion and disease-prevention funding that comes out of the legislation, including better nutrition in schools, injury-prevention programs, smoking-cessation efforts and nutrition labeling in chain restaurants.

As I’ve tried to suggest, the Patient Protection and Affordable Care Act has numerous provisions and a phase-in period of several years. It is aimed at not only providing access to care through insurance, but promoting health through other initiatives. It is complex, but good sources of information are available.

Now, the Supreme Court is getting ready to hear arguments about the law in the wake of conflicting federal court rulings about various provisions. If you’d like to keep up with the news about this and other key health care debates, visit, or sign up for email delivery of Kaiser Health News.  Your access to health services and public health efforts in your community, now and in the years to come, may depend upon the Supreme Court’s ruling, so it’s a good idea to stay informed.

Janet Golden is a professor of history at Rutgers-Camden and the author of numerous books and articles. She is a specialist in women’s history, medical history, and the history of childhood.

~~~
Testimonial photos via We Are the 99 Percent.

How Repeal of the Affordable Care Act Will Hurt Louisiana Women

Via The National Women’s Law Center

Repealing the Affordable Care Act will Hurt Women in Louisiana
January 2011

The Affordable Care Act makes important advances for women’s health. The new law protects women in Louisiana from discriminatory health insurance practices, makes health coverage more affordable and easier for them to obtain, and improves access to many of the health services they need. Repealing this important law will hurt women in Louisiana by returning to the days of a health care system that did not work for women.

Insurance Industry Practices that are Harmful to Women Would Continue
In addition to the prohibition on sex discrimination in health care, the new health care law explicitly prohibits discriminatory insurance practices. These important protections will prohibit insurers from treating women like a pre-existing condition. Here are a few of the important insurance protections women will lose if the law is repealed:

􀀑 A ban on gender rating for individuals and small businesses. Under the new law, by 2014 (at the latest) insurers in Louisiana would no longer be allowed to charge individual women and small employers with a predominately-female workforce more for coverage.
􀀑 Prohibitions on coverage denials and exclusions for women with “pre-existing conditions” such as pregnancy; having had a C-section, breast, or cervical cancer; or having received medical treatment for domestic or sexual violence. By 2014 (at the latest) insurers in Louisiana will be required to accept all applicants for coverage regardless of their medical history, and will no longer be able to issue coverage with pre-existing condition exclusions. For children, the prohibition on pre-existing condition exclusions began in September 2010.
􀂃 Uninsured women in Louisiana who were uninsured due to a pre-existing condition will lose access to coverage through the pre-existing condition insurance plan – or “high-risk pool” – that is available on a temporary basis, until the new insurance rules are in effect in 2014.
􀀑 A ban on lifetime and annual limits, which prohibits health plans from placing dollar limits on covered services, giving women the security of knowing that their plan benefits won’t run out when they need them the most. Lifetime limits were banned for all health plans starting in September 2010. Annual limits are also strictly regulated and will be banned entirely for all new health plans and existing group plans in 2014.

Obtaining Insurance will be Harder and More Expensive if the Affordable Care Act is Repealed.
Women in Louisiana are poorer (on average) than men and have more trouble affording health care. For instance, nearly a quarter of all women in the state report not visiting a doctor due to high costs.1 The new health care law would expand access to affordable coverage in several ways by 2014, but if the law is repealed women will lose opportunities to obtain the affordable coverage they need. For example:
Up to 97,500 uninsured, low-income women in Louisiana would not become eligible for  Medicaid, which by 2014 would be expanded to those up to 133% of the federal poverty level (FPL), or roughly $29,000 a year for a family of four. 2
􀀑 Women would not see the benefits of a new Health Insurance Exchange that would be established in Louisiana to serve as an easy-to-use “insurance shopping center” where women can compare and choose the high-quality health plan that best fits their needs.
􀀑 Approximately 176,000 women in Louisiana would not receive health insurance subsidies to help towards premiums and out-of-pocket costs of Exchange-based health plans; subsidies would be available to those with family incomes up to 400% of the FPL, or roughly $88,000 a year for a family of four. 3
Women Would Lose Coverage of Many of the Important Health Care Services They Need.
􀀑 All new health plans issued on or after September 23, 2010 are required to cover recommended preventive care at no cost. Repealing the new law would mean women would lose no-cost access to important preventive screenings such as mammograms and pap smears.
􀀑 Starting in 2014, health plans sold to individuals and small businesses must cover a broad range of health services. If the law is repealed, plans will not be federally required to cover many services important to women including maternity care, prescription drugs and mental health care.

There Are Many Additional Provisions of the New Law That Will Improve the Health and Well-Being of Louisiana Women and Their Families- Which Women Will Lose with Repeal.
Additional benefits of the new health care law that women will lose with repeal include (but are certainly not limited to):

􀀑 Tax Credits for Small Business: Women are more likely than men to work for small businesses that don’t offer health insurance, and will benefit from the new tax credits to help small businesses provide coverage to their employees (available for the 2010 tax year), as well as unprecedented access to affordable small group health coverage through the Exchanges.
􀀑 Coverage for Young Women Up to Age 26: Young women—who are more likely to be uninsured than women in any other age group—will benefit from a new rule that took effect September 2010 which allows young adults to remain on their parents’ health insurance policy as a dependent until age 26. 4
􀀑 Closing the Medicare Drug Coverage Gap: Older women will benefit from a provision which closes the Medicare Part D “donut hole,” or the coverage gap that currently requires seniors to spend a considerable amount out-of-pocket for prescription drugs. In 2007, 64% of the Medicare beneficiaries that were affected by the “donut hole” were women.5
􀀑 New Long Term Care Insurance Options: A new national, voluntary insurance program known as CLASS will be established as early as 2011 to provide long-term services and supports to individuals with functional limitations. This program will alleviate burdens on family caregivers, who are most often women.6
􀀑 Time for Nursing Moms to Express Breast Milk at Work: Nursing mothers and their infants will gain from a requirement that employers provide a reasonable break time and location to express breast milk (effective immediately).7,8
􀀑 “Direct Access” to Obstetrical and Gynecological Care: As of September 2010, all new health plans are prohibited from requiring authorization or prior approval when women seek this type of health care.9

For more detailed information on how women will benefit from Affordable Care Act, visit the National Women’s Law Center website: www.nwlc.org/reformmatters

________________________________________________
1 Kaiser Family Foundation, Putting Women’s Health Disparities on the Map (2009), http://www.statehealthfacts.org/comparemapreport.jsp?rep=31&cat=15
2 National Women’s Law Center calculations based on health insurance data for women ages 18-64 from the Current Population Survey’s 2008 Annual Social and Economic Supplement, using CPS Table Creator, http://www.census.gov/hhes/www/cpstc/cps_table_creator.html
3 Ibid. Includes an estimated 102,000 uninsured women and 51,000 women who currently purchase coverage from the individual health insurance market.
4 At least thirty states already have laws that extend dependent coverage to young adult children, regardless of enrollment in school. Many of these state laws are more restrictive than the new federal law, and none apply to self-insured or ERISA plans (as the federal law does). The National Conference of State Legislatures (NCSL) provides a list of states’ dependent coverage laws at: http://www.ncsl.org/default.aspx?tabid=14497
5 U.S. Department of Health and Human Services, Strengthening the Health Insurance System: How Health Insurance Reform Will Help America’s Older and Senior Women, http://www.healthreform.gov/reports/seniorwomen/index.html, Last Accessed on April 26, 2010.
6 Kaiser Family Foundation, Women and Health Care: A National Profile (July 2005), http://www.kff.org/womenshealth/upload/Women-and-Health-Care-A-National-Profile-Key-Findings-from-the-Kaiser-Women-s-Health-Survey.pdf
7 This provision applies to all employers, though employers with fewer than 50 employees may be exempt if they demonstrate that the requirements impose an “undue hardship” on their business.
8 At least twenty-four states already have laws related to expressing breast milk in the workplace. The National Conference of State Legislatures (NCSL) provides a list of these states and summaries of their laws at: http://www.ncsl.org/IssuesResearch/Health/BreastfeedingLaws/tabid/14389/Default.aspx
9 Thirty-six states and DC already have direct access laws that managed care companies and group health plans must comply with. However, the new health reform law is broader in scope, since it requires all new health plans (i.e. for individuals and groups of all sizes, including self-insured health plans) to comply. The Kaiser Family Foundation provides a list of existing direct access laws at: http://www.statehealthfacts.org/comparemaptable.jsp?ind=493&cat=10

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Now It’s The Woman’s Turn

This image is on the RNC’s brand-spanking new website, firenancypelosi.com. I’m surprised it doesn’t say “Jezebel” or some such inflammatory slogan underneath considering the hell-fire and brimstone background.

“It’s personal for women. After we pass this bill, being a woman will no longer be a pre-existing medical condition.” — Speaker Nancy Pelosi, March 21, 2010

Nancy has my hearty congratulations for her perseverance in getting the National Healthcare Reform bill passed last night.
Here is what we can expect to happen this year as a result:

*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

*Insurers will be barred from excluding children for coverage because of pre-existing conditions.

*Young adults will be able to stay on their parents’ health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

*Medicare drug beneficiaries who fall into the “doughnut hole” coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

*A tax credit becomes available for some small businesses to help provide coverage for workers.

*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

Read this article on Factbox for more factual info about what we can expect. No fire and brimstone required.

Over 1000 Uninsured Treated at Morial Convention Center

Huge thanks to National Association of Free Clinics. You Rock!

From Earth Tiimes:

NEW ORLEANS, Nov. 14 /PRNewswire/ — Organizers of a free health clinic for uninsured residents of Louisiana are pleased with its success today. Not only did the clinic see 1,000 patients, it may have saved the lives of some sick individuals. Many of the patients had not seen a physician since Hurricane Katrina struck the Gulf Coast in 2005.

Volunteer physicians and other medical providers tended to the health care needs of over 1,000 patients who attended the C.A.R.E. (Communities Are Responding Everyday) Clinic at the Ernest N. Morial Convention Center in New Orleans. The clinic was organized by the National Association of Free Clinics and Louisiana Free Clinic Association (NAFC).

“We saw a number of very sick patients today who have not had medical care for many years,” Doctor Corey Hebert, a New Orleans physician and one of the clinic’s medical directors said. “This clinic was a life saver for many people who have no way to pay for their healthcare needs.”

Corey went on to say, “It is important that this is the same facility where people were dying four years ago and today we are giving them life.” His remarks were in reference to the aftermath of Katrina and the human crisis that occurred at convention center.

“It was wonderful to provide free care to so many people in one day,” Nicole Lamoureux, executive director of the NAFC, said. “But it also was important that we were able to connect a large number of these patients with free clinics and other health care providers who can provide them with care on a day-to-day basis.”

The NAFC and the Louisiana Free Clinic Association sponsored the event. The 727 volunteers who participated included physicians, nurses, other medical providers and non-medical individuals.

“I am very moved by all the physicians and other medical providers who volunteered to make this C.A.R.E. Clinic such a success,” Dr. Rani Whitfield, M.D., said. Whitfield, a Baton Rouge physician, served as co-medical director for the clinic. “The dedication to helping those need help was moving.”

The clinic operated from 8:00 a.m. to 5:00 p.m. today at no cost to patients or taxpayers. Most of the patients registered before the event, but walk-ins were seen on a first-come-first-served basis.

“We did good work today,” Whitfield added. “It was good to connect many people in need of medical care with doctors, nurses and others who can help them on an ongoing basis.”

This was the second massive free clinic the NAFC has sponsored. Over 1,700 patients received treatment at the first one, which was held in Houston in September. Two more C.A.R.E. Clinics are planned in Little Rock on Nov. 21 and Kansas City on Dec. 9-10.

“I’m looking forward to building on the successes in Houston and New Orleans to help even more people,” NAFC President Sheri Wood, who is based in Kansas City, said.

More information about the NAFC and the Little Rock and Kansas City events is available online at: http://freeclinics.us.

New Orleans CARE Clinic Preliminary Numbers

* 68% of patients seen seek medical care in the emergency room or do not seek care when ill

* 53% of those seen have not seen a doctor in more than one year with many not seeing a doctor since Katrina

* 90% of patients seen have more than one diagnosis
o Hypertension and diabetes being the most prevalent

* 55% of those seen were women and 45% were men

SOURCE National Association of Free Clinics