Forum on overweight and obesity

May 5th the Universal Health Care Foundation of CT and the CT Public Health Policy Institute will hold a forum to present a new analysis of the overweight and obesity problem in CT, including background, costs and consequences, and possible future interventions. The forum will be in May at the University of Hartford. For more information contact Kathy Kranz Lewis PhD, MPH, RNExecutive Director, Connecticut Public Health Policy Institute and Assistant Professor, Department of Nursing, University of Hartford at kalewis@hartford.edu or (860) 768-5464.

Hear a brain scientist describe her stroke

Jill Bolte Taylor, a Harvard-trained brain scientist, wrote a book describing her experience of surviving a stroke. For a very entertaining video of the author relating the morning she woke up to find that a blood vessel had burst in her brain click here and scroll down. She describes, with great humor, how she processed the pain, the euphoria, her struggle to summon help through the fog, and her remarkable opportunity as a scientist to observe a stroke from the inside.
For the long version of her talk, including a real human brain, click here.
Ellen Andrews

Half of foreclosures due to sickness and medical bills

In a legislative meeting Friday I heard an amazing statistic from a realtor – that half of foreclosures are due to medical bills. This doesn’t surprise me, many of our clients have health problems that threaten their ability to pay the mortgage. Previous studies have found that half of bankruptcies are due to high medical bills. But still many people in the meeting were surprised to hear the connection. It is not well-reported. This blog featured a March 15th Courant article about a family’s bankruptcy to avoid foreclosure and noted that the precipitating factor, an illness that led to a lost job that led to the financial problems, was buried in the 8th paragraph.
Searching the internet to find the realtor’s source, I found “Get Sick, Get Out: The Medical Causes of Home Foreclosures”, a study by Christopher Robertson, Richard Egelhof, and Michael Hoke at Harvard Law School. In a study of foreclosures in four states, they found that medical illness and high bills caused half (49%) of the cases of families losing their homes and were involved in seen out of ten. Thirty two percent were due to illness or injury, 23% due to unmanageable medical bills, 27% due to lost work resulting from a medical problem, and 14% due to caring for a sick family member. Thirty seven percent of respondents paid more than $2,000 out of pocket for health costs, 30% missed two or more weeks of work due to illness or injury, 8% were disabled and unable to work, and 13% used home equity to pay medical bills. The authors recommend legally suspending foreclosures during a verifiable medical crisis as a policy option to address the housing crisis.
Ellen Andrews

Approps budget health impact analysis

Our summary of health coverage related items in the Appropriations budget is posted. The legislature restored the large majority of Governor Rell’s proposed cuts including rejecting premiums and copays for Medicaid, cuts in services to SAGA, restored coverage for immigrants and medical interpretation.

Lousy student health insurance – An update

Aetna Student Health finally returned my call about the $500 in medical bills they haven’t paid. Now I’m getting a completely different answer (I think I’ve been given about four different explanations so far). The most recent customer service representative said that I met the maximum benefit level for this medical service. I explained that the last person I talked to said these doctor visits were counted differently, under the three doctor visits per accident or sickness. She said that the case notes were not showing that he said that and if he did, he was wrong. She was a bit curt and not at all sympathetic. Seeing as I’ve been given so many different answers by customer service reps, I’m going to give myself a few days to calm down, review my notes and the policy’s brochure, and call back to see if I get a different answer from the next person I talk to. I might decide to submit a written appeal. Maybe if Aetna has to reject my bills with a written explanation, I’ll get a definitive answer.

As an aside, I was re-reading my Aetna Student Health policy and I read a few things that struck me as odd. The policy lists 50 exclusions that the plan will not cover, including medical bills from committing a felony and medical bills from participating in a riot. But you are allowed to defend yourself in a riot and have your resulting medical bills paid, as long as you’re not defending yourself against “persons who are trying to restore law and order.” I don’t know why they would single out those two types of activities as ones that they won’t cover. What about all of those college students committing misdemeanors or getting hurt at political demonstrations? I guess they’re covered.
Jen Ramirez

Appropriations passes a budget

The budget approved by the Appropriations Committee restores many of Governor Rell’s proposed cuts to health care programs. The committee did not agree to the Governor’s proposed co-pays and premiums on HUSKY families; imposition of premiums would jeopardize significant federal stimulus funding. Also to ensure CT gets new federal funding, the committee rejected the Governor’s proposal to eliminate self-determination of income for HUSKY applicants. The legislature restored HUSKY eligibility for legal immigrants that the Governor proposed to eliminate; the federal SCHIP reauthorization bill grants the state a 65% match on those costs. The committee did not agree to the Governor’s proposal to eliminate prenatal care for undocumented immigrants, eliminate funding for medical interpreters, or to eliminate vision and transportation services for SAGA clients. The committee provided funding for smoking cessation treatment under Medicaid that was not in the Governor’s budget. The committee provided funds to implement the family planning waiver; those funds would be 90% matched by the federal government. The committee did not agree to the Governor’s proposal to eliminate all but emergency dental care for adults in Medicaid and SAGA, however they did implement utilization review for those services. The committee did agree to weaken the Medicaid and SAGA medical necessity definition. The committee agreed to some of the Governor’s proposed pharmacy cuts, but not others. The legislature took money out of the Governor’s proposal for her Charter Oak Plan to reflect lower than expected enrollment. The budget restores funding for the Office of Health Care Advocate. A more detailed analysis will be coming.
Ellen Andrews

HUSKY waiver hearing – good and bad news on PCCM

As expected, yesterday’s Medicaid waiver hearing before the Human Services and Appropriations Committees was contentious and long. DSS brought out the troops – I counted nineteen staff in the room and they flew in two actuaries from Mercer. CMS also came in from Boston. DSS began with a rosy, but incomplete, description of the program and of PCCM. We did learn that the program is up to 200 members now. They left out the part about the working group of advocates, providers and DSS staff which developed a state plan last summer, submitted to and approved by the legislative committees in September without revision. That plan called for statewide, expansive implementation open to any willing provider and any HUSKY families within 20 miles of a PCCM provider. They left out the part about DSS, in November, suddenly deciding to limit the program to two small communities, only providers who applied during a very short time frame, and only to some of their current patients. DSS stated, in error, that those two communities were the only ones with sufficient provider capacity to support PCCM. Advocates pointed out that the Commissioner admitted in a November letter to legislators that New Haven and Hartford also had sufficient capacity. They also left out that they are arbitrarily subjecting PCCM providers to Freedom of Information laws and refused to approve marketing and educational materials developed by the working group for consumers to explain the program. Sensing the likelihood of criticism from legislators, consumer advocates and others who care about health care for HUSKY families, DSS offered a symbolic amendment saying they would expand PCCM statewide sometime in the next two years and it was their “intention” to be statewide by the end of 2009.

In their testimony, advocates and providers universally expressed strong support for PCCM and state wide implementation. Click here for our testimony. Speakers also argued for opening the program to any providers willing to care for HUSKY families, eliminating irrelevant and intimidating Freedom of Information burdens on doctors’ offices, PCCM marketing efforts equivalent to the HUSKY HMOs (funded by taxpayers), and opening the program to all HUSKY families. The advocates described recruiting 350+ providers this summer from across the state to apply to the program, providers who are sick of the HMOs, the hassles, and the lousy rates, and getting ready to leave the program but who were willing to stay and give PCCM a chance. Unfortunately, DSS said no thanks to all but 25 of them who practice in Waterbury and Willimantic. The advocates emphasized that since November, DSS has systematically hobbled the program to the point where it is no longer viable for providers, ensuring it will fail. HUSKY needs PCCM as an alternative to the troubled HMOs. Advocates noted that if the committees allowed DSS to destroy PCCM, they need to get used to 24% HMO rate increases.

Legislators expressed deep frustration with the department for the delays and policy changes to weaken the program. They drafted a different amendment (and then amended that), negotiating the terms in a back room with only DSS and OPM staff. Advocates were told to leave the room. The amendment requires DSS to market the program and open it to any willing providers and families in the pilot areas. That’s the good part. However, the amendment also requires DSS to implement PCCM in Hartford and New Haven only by the end of 2009 and to commission an evaluation (DSS directed) six months later to assess quality, access to care, and cost containment. If that evaluation finds that PCCM is “successful” they may expand it farther. That’s the bad part. Staywell Health Center, Waterbury’s community health center, testified that they have only twenty PCCM patients enrolled because of DSS’ limitations. Staywell will get the massive sum of $1,800 per year to manage the care of those patients. What are the chances that DSS’ evaluator will find improved access, higher quality AND reduced costs with those resources?
Ellen Andrews