Affordable Care Act: A new lease on life

A distressed mom’s story:
     Our son was born with a serious congenital heart defect but is healthy and living a productive life, thanks to two open-heart surgeries, one at age six and the second at age 42. He suffered a heart attack at age 20 and a stroke at age 30, both requiring hospitalization, tests, and medication, but has recovered.

     Currently, he is a successful free-lance videographer in Massachusetts, working for a number of production companies, but has no organization through which he can buy medical insurance.  The MA Affordable Care Act made possible for him to purchase medical insurance as an individual with a pre-existing condition.  This insurance covered his second surgery which gave him a new lease on life.  His insurance cost before the Affordable Care Act in Massachusetts was well over $1,000 a month, after RomneyCare fell to $800 a month and after ObamaCare fell to $700 a month – still a significant expense.  But it has been a huge relief to know that the insurance is there in the event of another medical emergency.  The Affordable Care Act works!

     Repealing the parts of ObamaCare that cover costs of this program will totally destroy it, leaving people like my son at the mercy of greedy insurance companies.  His insurance costs are certainly going to go higher than $1,000 per month as soon as the Affordable Care Act is repealed by the Republicans.  

     What will replace ObamaCare for the 20,000,000 who, like my son, are trying to survive?
Are the Republicans so power hungry that they cannot see what they are doing?

The storyteller is a member of the Greater Boston Interfaith Organization, a group of the congregations of 42 churches, synagogues and mosques.  GBIO was a leader in the coalition that brought universal health insurance to Massachusetts, as the model for ObamaCare.

Read about the effects of universal health insurance in Massachusetts.

Happy Anniversary!: Affordable Care Act at the five-year mark

March 23 marked five years since Pres. Obama signed the Affordable Care Act into law.  Ten million more people now have insurance coverage.  As the ACA has only been in effect for a little more than a year, though, to ascertain its other likely effects, it is more useful to consider the first five years of the universal health coverage law in Massachusetts, the model for the ACA.

In Massachusetts, universal coverage became law in April 2006 as Chapter 58.  The most widely cited study of its effects over the first five years describes an improvement in the self-assessed health status of non-elderly Massachusetts adults.  That's the gold standard for whether the whole law was worth it:  do people feel healthier?  Before the law, 60% rated their health as very good or excellent; afterward, 65% rated it that way. Far more people were insured, and got medical care, according to the article by Sharon K. Long, Karen Stockley and Heather Dahlen in Health Affairs in January 2012, "Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares To Tackle Costs."

Read a story about the likely effects of universal health insurance on women's health.

May yield substantial benefits: The fifth birthday of the Massachusetts universal health insurance law

In 1993, John Ayanian and a team of researchers studied the detection and treatment of breast cancer among women in New Jersey with and without health insurance. In their widely cited article in the New England Journal of Medicine about the harm to women's health of the lack of insurance, they concluded, "Comprehensive programs to improve access to early detection and optimal treatment may yield substantial benefits." Little did they know.

Fast forward to 2011, and the recent fifth birthday of the passage in Massachusetts of a state law requiring near-universal health insurance, Chapter 58 of the Acts of 2006. By my calculations, the new coverage for many thousands of women has likely led to the earlier detection and treatment of breast cancer, saving the lives of dozens of women each year, and more than 200 since the law went into effect. It would be interesting to see more precise calculations. Perhaps this could be an exercise for public health students.

Happy Birthday, and many more!

Read about the first birthday of the Massachusetts health reform law.

Be brave anyway: Marcelas and Tiffany Owens and the Patient Protection and Affordable Care Act

Here's what I imagine the late Tiffany Owens would say today to her 11-year-old son Marcelas, who was beside Pres. Obama at the signing of the healthcare reform bill:

To my beautiful young man Marcelas,

I'm so proud of you! Thank you so much for being brave in speaking for me to all those important men and women. I wish I could be with you.

A lot of people have been yelling at you on TV and blogs. Try not to let that bother you. When you stand up for something you believe in like you've been doing, people on the other side can get mad, especially if you're effective. Maybe, like they say, I could have done things that might have prevented my health from getting so bad, but maybe not. I don't know enough about pulmonary hypertension to know. I'm not sure anyone does. And that misses the point, anyway. The point is that sick people should still be able to be taken care of by doctors and nurses, even if they lost their job, and don't have health insurance anymore. That's what you told all those people, and that's exactly what I wanted you to tell them.

People won't always listen to you as much as they did about this. But you should still speak your mind, with respect. And, of course, you may well never get to the White House again! Don't expect that you'll always be rewarded for being brave – but be brave anyway.

There are lots of people here with stories like mine – 45,000 every year, who died because they didn't have health insurance. You helped to speak for them, too. And you helped to save the lives of lots of people like them, from now on, because of the new law.

I miss you so much, Marcelas! Give a big hug to your Grandma, and do what she tells you.

Much love,

Your mother

Advice: Remember Tiffany Owens.

Read another story.

Meghan Morris, Rep. Stephen Lynch, Healthcare Reform, and History

Legislative assistants in Congress dream of the chance to make history. That moment arrives today for Meghan Morris in Rep. Stephen Lynch's office.

Congressman Lynch is one of the few Democrats to oppose national health reform. His vote could be the decisive one, given the closeness of the vote. Will he be known as the person who tipped the balance, giving health insurance coverage to 39 million people, and banishing the "pre-existing condition" exclusion from insurance policies? Or as the one who extinguished the financial security and hope for millions of working-class people for health insurance coverage, for many more years?

Meghan, you'll soon report the count of the letters the office received, and will advise Rep. Lynch on the optics as of next week, on November 2, and in ten years. Next week, the optics of a No vote could make him the butt of late-night talk show jokes, and make him look like a disloyal black sheep, a Democrat in name only, another Democrat who snatched defeat from the jaws of victory. On Nov. 2, it won't look like much of anything, either way, for Massachusetts voters will make their decisions on other grounds. In ten years, and from then on, he'll look foolish.

The optics of a Yes vote? Next week, he'll look like one of a crowd who helped make history. On Nov. 2, it won't matter either way. In ten years, we'll all think, "He and those other Dems actually accomplished something big. We're not going back. How could we have excluded so many working class and suffering people for so long?"

Your call, Meghan. Please rise to the moment.

Advice to voters: Tell your friends in the suburban Boston towns of Brockton, Braintree, Needham, and points between to contact Meghan at Meghan.Morris@mail.house.gov or by calling Rep. Lynch's office at 617-428-2000 or 202-225-8273.

Read a story about the one-year anniversary of universal health insurance in Massachusetts.

A strong step in the right direction: What Massachusetts Voters Did Not Say

Here's my letter to the editor after the election of Scott Brown to the U.S. Senate:

Massachusetts citizens have consistently supported the state's universal health insurance law. The most recent survey, in September, found that 79% want the law continued. The law has the support of Republicans and Democrats, including some prominent ones. The Republican front-runner in the gubernatorial race, Charles Baker, calls the law "a strong step in the right direction" and indeed, calls for expanding services, according to his campaign's website. Sen. Scott Brown voted for the law as a state senator, and in his recent campaign for the U.S. Senate, did not ask for its repeal. Republican Governor Mitt Romney signed the bill into law. Massachusetts' Republicans and Democrats generally support the law.

The meaning of Massachusetts voters' election of Scott Brown to the U.S. Senate is unclear – but it clearly does not show general dissatisfaction with universal health insurance as it is in effect here. It would be a tragic mistake, harming the health of tens of millions of Americans, to conclude that Massachusetts residents have spoken against expanded health insurance coverage.

Read Dr. Atul Gawande's opinion on the effects of Massachusetts’ near-universal health insurance coverage.

Advice: Forward this to your U.S. congressman.

David, Goliath, Max Baucus, and Nikki White: The Senate Finance Committee's plan for national health insurance

Nikki White was a slim, young and athletic college graduate. She had a job, and health insurance. At 21, she had been diagnosed with systematic lupus erythematosus, a chronic inflammatory disease that gradually weakened her to the point where she could not work. When she lost her job, she lost her health insurance. She tried everything to get medical care, writing letters for months, but no insurance company would accept her because of her costly pre-existing condition.

Finally, she collapsed when at her home in Tennessee, and was rushed to the Emergency Department. She received plenty of free care, including six months in an intensive care unit (costing taxpayers hundreds of thousands of dollars). It was far too late, and she died in 2006 at age 32.

Every 12 minutes, an American like Nikki dies. You read it right, and I’ve checked the math. That's the key finding of a study that determined that 45,000 Americans die each year from the lack of health insurance.

The same day the study was released, the value of insurance company stocks rose on the news that Sen. Max Baucus submitted the Finance Committee's health insurance plan. Investors believe that Baucus' scheme would be highly profitable for insurers, who will gain millions of paying customers. Insurers would not have to compete against a public program. Instead, these highly experienced, financially stable Goliaths would compete against nonprofit co-ops, i.e., young start-ups. Insurers are adept at cherry-picking the healthiest, least expensive people to insure, likely leaving the sicker, more costly uninsured people for the nonprofit co-ops. It's easy to guess who'll profit in that marketplace. That's why insurance stocks rose.

Here in Massachusetts, we don't have this problem. Here, Nikki would be alive. We have some excellent insurers – and near-universal health insurance.

Advice to non-Massachusetts residents: Move here. If you don't want to do that, call your senator or congressman and insist they support a public option for health insurance.

Read how universal health insurance saved someone’s life. Thanks to Nicholas Kristof for the source story in the New York Times of Sept. 13, and Dr. Andrew Wilper et al in the December 2009 [sic] issue of the American Journal of Public Health.

She was finally able to visit a specialist: Hip dysplasia treatment through Health Care for All

Barbara was born with a health condition called hip dysplasia, causing severe pain which affects her life in many ways. She works as a secretary at a landscape company and is a 22-year-old single mother. She can't walk well unless she takes a high number of very expensive medications.

She had been uninsured for two years and suffering without the medications that allow her to function normally when she was helped by a counselor at the Helpline of Health Care for All in Massachusetts. A few weeks after she filled out an application over the phone, she started her Commonwealth Care health insurance coverage and was finally able visit a specialist to take care of her health issues.

Barbara has been in treatment ever since. Pain medication is keeping her comfortable until her surgery scheduled for next month. She will have a hip replacement and the chance of success of her surgery is 98%. She is so excited about her new hip and stresses the important role that Health Care For All played in helping her through the whole process. Here is what Barbara has to say:

"We are so lucky to be Massachusetts residents. My daughter is 1 year-old and she was born with the same problem I have. But thanks to all the health care we receive, her health condition was diagnosed as soon as she was born and she had all the care necessary to fix her hips before she started having severe problems. She used a harness for a period of 4 months which helped to cure her problem. And through MassHealth she has the opportunity to go to the doctor for regular checkups. So I couldn't be happier about the health reform in Massachusetts and all the assistance and care I receive every time I call the helpline."

Advice to Massachusetts residents without health insurance: Call the HelpLine at 800- 272-4232.

Read a story of a young mother in another state who lacked insurance.

Thanks to Monika Lira Malhoit for the source blog post at A Healthy Blog.

Beginner's Luck & the Darlin' Spector of Universal Health Care: Obama's First Hundred Days

Today was Barack Obama's 100th day as president, giving us wags an irresistible chance to bloviate.

Are you healthier than you were on January 19? Probably not. Will you be healthier in the future, based on the last 100 days? Probably so, though not for the reasons you think.

Pres. Obama chose a guy from Scranton, Pennsylvania as his vice president. Joe Biden had been commuting home from Washington DC on the train, sharing seats with passengers he came to know well – like Sen. Arlen Spector of Pennsylvania. Biden influenced Spector's decision to change his party affiliation, giving the Democrats a nearly filibuster-proof majority in the US Senate. And it significantly strengthens the chance of passage of legislation favored by Pres. Obama like the coming universal health care bill.

Today the Senate voted by 53-43 to accept the president's budget, which includes funding for universal insurance. Sen. Spector, along with all the other Republicans, voted No. Presumably the newly Democratic Sen. Spector will vote Yes in the future, adding a critically important vote to the slim majority for the very controversial universal health insurance bill, forthcoming by October.

The conservative Democrats who voted against the budget because of what they saw as its excessive funding will likely insist on cost controls in the future universal health insurance bill, according to today's NY Times. Electronic medical records are being touted for this purpose for their role in limiting costs. For example, an EMR might reveal to a doctor that an expensive test like an X-ray or CT scan has already been performed, saving costs and time in the hospital. Or the legibility of the EMR's typed doctors' orders and progress notes might prevent costly errors. Or the automatic reminders generated by the EMR might lead to the earlier detection and cheaper treatment of cancer. Of course, in addition to these financial benefits of the EMR are their savings of lives and suffering: fewer days in the hospital, invasive tests that need not be performed, less chemotherapy, etc.

Obama was lucky to have Sen. Spector become a Democrat. Arguably, he created his own luck by choosing the guy from Scranton as a vice president. Either way, the result is a higher chance of passage of universal health insurance, and of substantial financial support for the widespread use of electronic medical records.

The result, ultimately, in your life: you're more likely to get an automatic reminder from your doctor about your next appointment. When you call your doctor's medical practice at night and get a covering doctor on call, that doctor is more likely to have electronic access to your medical record, and to give you better advice. When you're in the hospital, the computer will be more likely to intercept would-be overdoses and wrong drugs.

And, if you’re one of the 50 million Americans who don't have health insurance now, you'll be more likely to get coverage, and health care, based on Obama's decisions, and luck, during the last 100 days.

These likely future improvements of broader health insurance and broadened use of EMRs add to those in Obama's first month.

All in all, not a bad start in improving public health.

Without the routine cruelty: A path to health insurance for all

From Dr. Atul Gawande's essay in the New Yorker:
I once took care of a 19-year-old college student who had maxed out her insurance coverage. She had a treatable but metastatic cancer. But neither she nor her parents could afford the radiation therapy that she required. I made calls to find state programs, charities – anything that could help her – to no avail. She put off the treatment for almost a year because she didn't want to force her parents to take out a second mortgage on their home. But eventually they had to choose between their daughter and their life's savings.

For the past year, since universal health coverage in Massachusetts, I haven't had a single Massachusetts patient who has had to ask how much the necessary tests will cost; not one who has told me he needed to put off his cancer operation until he found a job that provided insurance coverage. And that's a remarkable change: a glimpse of American health care without the routine cruelty.

Dr. Gawande mentions this patient, and the Massachusetts model of health care for all, in the context of describing how governments have generally brought about universal coverage by expanding existing programs rather than starting completely afresh. He raises the possibility of achieving universal coverage by expanding Medicare, or the Veterans Health Administration's system, or Federal employees' insurance plan, etc.

The veterans' health system offers the best starting place, for it provides what is demonstrably the highest quality of care in our country. We should expand the VHA to offer universal care for four key reasons. First, its care for patients’ chronic illnesses is exceptional. Second, it offers care across the country, in a network of 170 hospitals. Third, it uses an integrated electronic medical record, so when patients move across the country, or have medical needs while on vacation, their medical records can easily remain accessible by nearby doctors. Fourth, it is primarily a provider network, rather than a virtual insurance network, which gives it more intrinsic capability to further improve the quality of care.

We should allow the VHA to recruit more physicians so we can offer uninsured people who live near VHA hospitals the option of getting their care through the VHA.

Read a very different story from Dr. Gawande.

Thanks to Dr. Atul Gawande for the source article in the Jan. 26 issue of the New Yorker.

Mustard and relish sandwiches: Broadening health insurance coverage

From Barack Obama's More Perfect Union speech, March 18, 2008, Philadelphia, Pennsylvania:

There is a young, twenty-three year old white woman named Ashley Baia who organized for our campaign in Florence, South Carolina. She had been working to organize a mostly African-American community since the beginning of this campaign, and one day she was at a round-table discussion where everyone went around telling their story and why they were there.

And Ashley said that when she was nine years old, her mother got cancer. And because she had to miss days of work, she was let go and lost her health care. They had to file for bankruptcy, and that's when Ashley decided that she had to do something to help her mom.

She knew that food was one of their most expensive costs, and so Ashley convinced her mother that what she really liked and really wanted to eat more than anything else was mustard and relish sandwiches. Because that was the cheapest way to eat.

She did this for a year until her mom got better, and she told everyone at the round table that the reason she joined our campaign was so that she could help the millions of other children in the country who want and need to help their parents too.

Now Ashley might have made a different choice. Perhaps somebody told her along the way that the source of her mother's problems were blacks who were on welfare and too lazy to work, or Hispanics who were coming into the country illegally. But she didn't. She sought out allies in her fight against injustice.

Anyway, Ashley finishes her story and then goes around the room and asks everyone else why they're supporting the campaign. They all have different stories and reasons. Many bring up a specific issue. And finally they come to this elderly black man who's been sitting there quietly the entire time. And Ashley asks him why he's there. And he does not bring up a specific issue. He does not say health care or the economy. He does not say education or the war. He does not say that he was there because of Barack Obama. He simply says to everyone in the room, "I am here because of Ashley."

I'm here because of Ashley." By itself, that single moment of recognition between that young white girl and that old black man is not enough. It is not enough to give health care to the sick, or jobs to the jobless, or education to our children.

But it is where we start. It is where our union grows stronger. And as so many generations have come to realize over the course of the 221 years since a band of patriots signed that document in Philadelphia, that is where the perfection begins.

Advice: Vote for, and work for, a presidential candidate who will broaden health insurance coverage.

Read another story of poor access to care.

Her first one since childhood: Counselors for the uninsured

Francine Fitz, a 57-year-old Worcester widow who relied on the E.R. for routine health problems until she was diagnosed with breast cancer last year, is one of the patients helped by counselors at the UMass Memorial Medical Center. The counselor, Heather Reddick, helped her enroll in subsidized health insurance. A telemarketer paid $10 an hour, Francine could not afford her employer's health plan, she said.

The counselor also helped her find a primary care doctor, her first one since childhood. The doctor works at a UMass health center and had just opened his practice to new patients, so Francine was able to get an appointment the next day.

Now, when she feels sick, she calls her doctor first, instead of heading to the E.R.

"I have never seen a doctor who calls me at home to make sure I'm OK," she says. "He even gives my children his private cell phone number, if they have a question."

A number of medical centers have added telephone help lines, counselors and social workers in their E.R.s to answer insurance questions, enroll uninsured people, and find them a primary care doctor. UMass Memorial Medical Center has gone further, sending counselors to laundromats, barber shops, farmers' markets, and churches. Armed with BlackBerries, portable scanners and laptops, they sign people up for insurance as well as food stamps, Social Security disability coverage, and other programs.

Advice to uninsured people in the E.R.: Ask the hospital what help they can give you in addition to treating your immediate medical problem.

Read another story about the new Massachusetts health coverage law.

Thanks to Kay Lazar for the source story in today's Boston Globe.

Only in America: Pre-existing conditions and their consequences

The grotesque reality of my life has been constant constraint by the need for health insurance. With a congenital heart condition and a degenerative eye condition, I married my wife while in graduate school because I was no longer eligible for my parents' group pan, and at the time few graduate programs offered group health.

My career choices were dictated by the knowledge that I needed group health: the tenuous life of an academic in a tough job market seemed too risky, so I switched to law school.

I avoided private-sector legal jobs upon discovering that many firms do not provide group insurance but expect individual lawyers to find individual health plans, so I ended up working for the state.

Fortunately, things have worked out for me so far. It was not desperate need, such as you described [in "Health Benefits Inspire a Rush to the Altar, or Divorce Court"] but a sense of obligation and responsibility that drove me to make major life decisions based on health insurance needs (I do not have family who could foot the bill for open-heart surgery).

But only in America are people with pre-existing medical conditions forced to plan every aspect of their lives around the need for group health insurance. I have often toyed with the thought of emigrating to Canada or Britain simply to escape the constant, gnawing, lifelong fear of what might happen should my group health for any reason ever lapse.

-David Tallman, Atlanta

Advice: Insurance may be available through trade and professional associations.

Read a story about a person who has become uninsurable.

Thanks to David for his source letter to the editor of the New York Times, published on August 18.

I became poor trying to save her: Unaffordable cancer care

After Dave Williams learned in April that the mass in his neck was malignant, his doctor referred him to a local cancer center. At his appointment, he was stunned at what he heard. "They said, 'We're looking at $30,000 of treatment, and we need $20,000 upfront,'" says Dave, 62, of Beesville, Texas. I don't have that kind of money."

For the retired landscape designer, the hospital's demand was an especially heavy blow, since he had recently paid off $273,000 in out-of-pocket costs for his ex-wife's care for ovarian cancer (his employer-sponsored health plan refused to cover her because she had cancer when he enrolled). "I became poor trying to save her, but she died," he says. He now lives in a trailer on a friend's property.

He applied for "charity care" at other hospitals but was rejected because he has saved about $10,000 in a 401(k) retirement savings account. "They all asked for a lot of money upfront before they would do anything to help me," he says. Dave is still exploring his options.

Advice to people with ruinously high healthcare expenses: Almost no one pays the full retail amount of a hospital's charges. The typical insurance plan gets a discount of about 60%, according to Sid Kirchheimer, so negotiate aggressively, or get someone who can.

Read a story of how universal health insurance has helped people who have found it hard to pay for their care.

Thanks to Sid Kirchheimer for the source article in the July-August issue of AARP Bulletin.

Happy First Birthday, Universal Health Insurance: CHICA Bonita!

On April 12 last year, Massachusetts enacted an ambitious law to expand health coverage to most of the state’s 500,000 uninsured residents. Now, a year later, more than 110,000 formerly uninsured residents have coverage. MassHealth, the Medicaid provider, expanded to cover 50,000 of them, and 63,000 get coverage through the Commonwealth Health Insurance Connector Authority (CHICA). Another 100,000 eligible people have not yet enrolled.

Read today’s Boston Globe column by John McDonough--a proud father, who may be sleepless over his baby’s normal growing pains about affordability. And give him a cigar—a chocolate one…

P.S. Its dental coverage for newly insured people under the federal poverty line is quietly saving the lives of homeless kids like Deamonte Driver, may he rest in peace.

Advice to Americans outside of Massachusetts: Read how Massachusetts is handling this - and start watering your grassroots organizations—it’s Spring.