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Category Archives: Chronic Diseases
Dr. Philip Lee Is Dead at 96; Engineered Introduction of Medicare
https://us.newschant.com/business/dr-philip-lee-is-dead-at-96-engineered-introduction-of-medicare/
Dr. Philip R. Lee, who as a number one federal well being official and fighter for social justice below President Lyndon B. Johnson wielded authorities Medicare money as a cudgel to desegregate the nation’s hospitals within the Sixties, died on Oct. 27 in a hospital in Manhattan. He was 96.
The trigger was coronary heart arrhythmia, his spouse, Dr. Roz Lasker, mentioned.
From his workplace at the Department of Health, Education and Welfare, because the assistant secretary for well being and scientific affairs from 1965 to 1969, Dr. Lee engineered the introduction of Medicare, which was established for older Americans in 1965, one 12 months after Johnson had bulldozed his landmark civil-rights invoice via Congress.
“To Phil, Medicare wasn’t just a ‘big law’ expanding coverage; it was a vehicle to address racial and economic injustice,” his nephew Peter Lee, the manager director of Covered California, which runs the state’s well being care market below the Affordable Care Act, was quoted as saying in a tribute by the University of California, San Francisco. Dr. Lee was the college’s chancellor from 1969 to 1972, after leaving the Johnson administration.
Dr. Lee’s use of Medicare funding to desegregate hospitals “changed the economic lives of millions of seniors,” Mr. Lee added.
Provisions within the Medicare laws subjected 7,000 hospitals nationwide to guidelines barring discrimination towards sufferers on the premise of race, creed or nationwide origin. The regulation required equal remedy throughout the board — from medical and nursing care to mattress assignments and cafeteria and restroom privileges — and barred discrimination in hiring, coaching or promotion.
Before the regulation took impact in 1966, fewer than half the hospitals within the nation met the desegregation commonplace and fewer than 25 p.c did within the South.
“I remember during one of my visits,” Dr. Lee instructed the journal of the American Society on Aging in 2015, “a cardiologist at Georgia Baptist Hospital told me, ‘Well, you know, Dr. Lee, if I put a nigger in with one of my white patients, it would kill the patient. My patient would die of a heart attack.’”
By February 1967, a 12 months or much less after many of the regulation’s provisions had taken impact, 95 p.c of hospitals have been compliant, Dr. Lee mentioned.
“He was largely responsible for that effort,” mentioned Professor David Barton Smith of Drexel University and writer of “The Power to Heal: Civil Rights, Medicare and the Struggle to Transform America’s Health System” (2016).
Dr. Lee hailed from a household of physicians — his father and 4 siblings have been medical doctors — and whereas working within the Palo Alto Medical Clinic (now the Palo Alto Medical Foundation), which his father based, he noticed firsthand the consequences on the poor and the aged of insufficient well being care and the shortage of insurance coverage protection.
As early as 1961, he was a guide on growing older to the Santa Clara Department of Welfare in California, and as a member of the American Medical Association and a Republican at the time, he defied each the A.M.A. and his celebration in testifying earlier than Congress on behalf of a precursor to Medicare that might have helped pay for hospital and nursing dwelling care via Social Security for sufferers over 65.
Dr. Lee was branded a socialist and a Communist (irrespective of that he had served as a physician within the Korean War).
In 1987, after main the University of California, San Francisco, and heading well being coverage and analysis packages there as a professor of social drugs, he additional riled fellow physicians when, as chairman of Congressional fee, he really helpful a standardized nationwide restrict on how a lot medical doctors enrolled within the Medicare program, with an enormous pool of sufferers obtainable to them, might cost above a set schedule.
He was referred to as again to Washington in 1993, once more to be an assistant secretary, this time of the renamed Department of Health and Human Services below the Clinton administration. Serving till 1997, he suggested the White House on its in the end failed effort on well being care reform.
In 2015 he endorsed the Obama administration’s Affordable Care Act and steered that the nation might go even additional in guaranteeing common well being care.
“In 1967, President Johnson said we would continue to work until equality of treatment is the rule,” Dr. Lee wrote in Generations: Journal of the American Society on Aging. “By making Medicare an option for all Americans, the kind of care I receive could be available to everyone.”
Philip Randolph Lee was born in San Francisco on April 17, 1924, to Dr. Russell Van Arsdale Lee, who had lobbied for nationwide medical insurance as a member of a fee appointed by President Harry S. Truman, and Dorothy (Womack) Lee, an newbie musician.
His curiosity in drugs, he instructed Stanford Medicine Magazine in 2004, “began with house calls with my dad from the age of 6 or 7.”
He earned his bachelor’s and medical levels at Stanford University in 1945 and 1948. As a member of the Naval Reserve, he was on lively responsibility as a physician at the top of World War II and once more from 1949 to 1951, through the Inchon invasion in Korea. He obtained a grasp of science diploma from the University of Minnesota in 1955 and had fellowships at the Rusk Institute of Rehabilitation Medicine in New York and the Mayo Clinic.
“Phil moved from clinical medicine to health policy and then devoted his life to addressing issues at the nexus of civil rights, social justice and health,” Dr. Lasker, his spouse, mentioned in an e-mail.
His distinguished function in shaping Medicare and different federal well being insurance policies was preceded by a stint, 1963-65, as director of well being for the Agency for International Development. As chancellor of the University of California, San Francisco, he was credited with rising racial variety amongst its workers, college and pupil physique.
In 2007, the college named its Institute for Health Policy Studies, which he based in 1972, in his honor.
He was additionally lauded for his aggressive function in confronting the AIDS epidemic because the president of the newly-formed Health Commission of the City and County of San Francisco from 1985 to 1989.
The writer of a half-dozen books, Dr. Lee was an early critic of the pharmaceutical trade in “Pills, Profits and Politics” (1974, with Milton Silverman).
More Than Politics On The Line For Voters With Preexisting Conditions
In swing states from Georgia to Arizona, the Affordable Care Act — and concerns over protecting preexisting conditions — loom over key races for Congress and the presidency.
“I can’t even believe it’s in jeopardy,” says Noshin Rafieei, a 36-year-old from Phoenix. “The people that are trying to eliminate the protection for individuals such as myself with preexisting conditions, they must not understand what it’s like.”
In 2016, Rafieei was diagnosed with colon cancer. A year later, her doctor discovered it had spread to her liver.
“I was taking oral chemo, morning and night — just imagine that’s your breakfast, essentially, and your dinner,” Rafieei says.
In February, she underwent a liver transplant.
Rafieei does have health insurance now through her employer, but she fears whether her medical history could disqualify her from getting care in the future.
“I had to pray that my insurance would approve of my transplant just in the nick of time,” she says. “I had that Stage 4 label attached to my name and that has dollar signs. Who wants to invest in someone with Stage 4?”
“That is no way to feel,” she adds.
After doing her research, Rafieei says she intends to vote for Joe Biden, who helped get the ACA passed in this first place.
“Health care for me is just the driving factor,” she says.
Even 10 years after the Affordable Care Act locked in a health care protection that Americans now overwhelmingly support — guarantees that insurers cannot deny coverage or charge more based on preexisting medical conditions — voters once again face contradicting campaign promises over which candidate will preserve the law’s legacy.
A majority of Democrats, independents and Republicans say they want their new president to preserve the ACA’s provision that protects as many as 135 million people from potentially being unable to get health care because of their medical history.
President Trump has pledged to keep this in place, even as his administration heads to the U.S Supreme Court the week after Election Day to argue the entire law should be struck down.
“We’ll always protect people with preexisting,” Trump said in the most recent debate. “I’d like to terminate Obamacare, come up with a brand new, beautiful health care.”
And yet the Trump administration has not unveiled a health care plan or identified any specific components it might include. In 2017, the administration joined with congressional Republicans to dismantle the Affordable Care Act, but none of the GOP-backed replacement plans could summon enough votes. The Republicans’ final attempt, a limited “skinny repeal” of parts of the ACA, failed in the Senate because of resistance within their own party.
In an attempt to reassure wary voters, Trump recently signed an executive order that asserts protections for preexisting conditions will stay in place, but legal experts say this has no teeth.
“It’s basically a pinky promise, but it doesn’t have teeth,” says Swapna Reddy, a clinical assistant professor at Arizona State University’s College of Health Solutions. “What is the enforceability? The order really doesn’t have any effect because it can’t regulate the insurance industry.”
Since the 2017 repeal and replace efforts, the health care law has continued to gain popularity.
Public approval is now at an all-time high, but polling shows many Republicans still don’t view the ACA as synonymous with its most popular provision — protections for preexisting conditions.
Democrats hope to change that.
“If you have a preexisting condition — heart disease, diabetes, breast cancer — they are coming for you,” said Biden’s running mate, California Sen. Kamala Harris, during her recent debate with Vice President Pence.
Voters support maintaining ACA’s legal protections
In key swing states, many voters say protecting preexisting conditions is their top health concern.
Rafieei, the Phoenix woman with colon cancer, still often has problems getting her treatments covered. Her insurance has denied medications that help quell the painful side effects of chemotherapy or complications related to her transplant.
“During those chemo days, I’d think, wow, I’m really sick, and I just got off the phone with my pharmacy and they’re denying me something that could possibly help me,” she says.
Because of her transplant, she will be on medication for the rest of her life, and sometimes she even has nightmares about being away and running out of it.
“I will have these panic attacks like, ‘Where’s my medicine? Oh my god, I have to get back to get my medicine?'”
Election season and talk of eliminating the ACA has not given Rafieei much reassurance, though.
“I cannot stomach politics. I am beyond terrified,” she says.
And yet she plans to head to the polls — in person — despite having a compromised immune system.
“It might be a long day. But you know what? I want to fix whatever I can,” she says.
A few days after she votes, she’ll get a coronavirus test and go in for another round of surgery.
A key health issue in political swing states
Rafieei’s home state of Arizona is emblematic of the political contradictions around the health care law.
The Republican-led state reaped the benefits of the ACA. Arizona’s uninsured rate dropped considerably since 2010, in part because it expanded Medicaid.
But the state’s governor also embraced the Republican effort to repeal and replace the law in 2017, and now Arizona’s attorney general is part of the lawsuit that will be heard by the Supreme Court on Nov. 10 that could topple the entire law.
Depending on how the Supreme Court rules, ASU’s Reddy says any meaningful replacement for preexisting conditions would involve Congress and the next president.
“At the moment, we have absolutely no national replacement plan,” she says.
Meanwhile, some states have passed their own laws to maintain protections for preexisting conditions, in the event the ACA is struck down. But Reddy says those vary considerably from state to state.
For example, Arizona’s law, passed just earlier this year, only prevents insurers from outright denying coverage — consumers with preexisting conditions can be charged more.
“We are in this season of chaos around the Affordable Care Act,” says Reddy. “From a consumer perspective, it’s really hard to decipher all these details.”
As in the congressional midterm election of 2018, Democrats are hammering away at Republican’s track record on preexisting conditions and the ACA.
In Arizona, Mark Kelly, the Democratic candidate running for Senate, has run ads and used every opportunity to remind voters of Republican Sen. Martha McSally’s votes to repeal the law.
In Georgia, Democratic challenger Jon Ossoff has taken a similar approach.
“Can you look down the camera and tell the people of this state why you voted four times to allow insurance companies to deny us health care coverage because we may suffer from diabetes or heart disease or have cancer in remission?” Ossoff said during a debate with his opponent, Republican Sen. David Purdue.
Republicans have often tried to skirt health care as a major issue this election cycle because there isn’t the same political advantage to pushing the repeal and replace argument, says Mark Peterson, a professor of public policy, political science and law at UCLA.
“It’s political suicide, there doesn’t seem to be any real political advantage anymore,” says Peterson.
But the timing of the Supreme Court case — exactly a week after election day — has somewhat obscured the issue for voters.
Republicans have chipped away at the health care law by reducing the individual mandate — the provision requiring consumers to purchase insurance — to zero dollars.
The premise of the Supreme Court case is that the ACA no longer qualifies as a tax because of this change in the penalty.
“It is an extraordinary stretch, even among many conservative legal scholars, to say that the entire law is predicated on the existence of an enforced individual mandate,” says Peterson.
The court could rule in a very limited way that does not disrupt the entire law or protections for preexisting conditions, he says.
Like many issues this election, Peterson says there is a big disconnect between what voters in the two parties believe is at stake with the ACA.
“Not everybody, particularly Republicans, associates the ACA with protecting preexisting conditions,” he says. “But it is pretty striking that overwhelmingly Democrats and Independents do — and a number of Republicans — that’s enough to give a significant national supermajority.”
Cartoon – Do you have Health Insurance?
Cartoon – Desperate for Healthcare Reform
What’s at stake in the ACA case
https://mailchi.mp/2480e0d1f164/the-weekly-gist-october-30-2020?e=d1e747d2d8
Since the Affordable Care Act (ACA) was signed into law a little more than a decade ago, it has fundamentally reshaped the American healthcare system. As the graphic below highlights, the far-reaching law expanded insurance coverage, increased consumer protections, led to new payment models, established minimum coverage standards, reformed the Indian Health Service—and even gave us calorie counts on menus, among myriad other things.
The fate of the ACA is once again in the Supreme Court’s hands—and the nine Justices, now including Amy Coney Barrett, are scheduled to hear arguments starting November 10th. Eighteen states with Republican leadership are asking the court to determine whether the individual mandate is constitutional without a financial penalty, and whether the mandate is severable from the rest of the law.
The process of unwinding a law that touches nearly every facet of the US healthcare system would mean a confusing and financially detrimental road ahead for many. Although we believe it’s unlikely that the entire law will be ruled unconstitutional, if it is—and no replacement legislation is passed—the effects could be devastating.
An estimated 21 million people would be at serious risk of losing their health insurance. This risk is magnified for Hispanic and Black Americans, who are also hardest hit by COVID-19. As many as 133M people with pre-existing conditions could face insurance disqualification or significantly higher premiums.
The lost coverage would result in a significant revenue hit for doctors and hospitals. While the impact would vary by state depending on Medicaid expansion terms, an Urban Institute report projects that total uncompensated care would grow an average of 78 percent for hospitals and 68 percent for physician services if the ACA is struck down. Although the Court is not expected to rule on the fate of the law until mid-2021, the direction and pace of future health reform legislation will be set by the ruling, under either a Trump or Biden administration.
Cartoon – State of the Union on Health Coverage
Cartoon – Doctors without borders, meet patient without insurance
COVID response leads voters’ healthcare concerns
https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8
The upcoming election has huge implications for healthcare, far beyond how COVID is managed, ranging from how care is covered to how it’s delivered. The graphic above shows a continuum of potential policy outcomes of the November 3rd vote.
If President Trump wins a second term and Republicans control at least one house of Congress, there will likely be more attempts to dismantle the ACA, as well as continued privatization of Medicare coverage.
If Democrats win the presidency and sweep Congress, actions to expand the Affordable Care Act (ACA), or even create a national public option, are on the table—although major healthcare reform seems unlikely to occur until the second half of a Biden term.
In the short term, we’d expect to see more policy activity in areas of bipartisan agreement, like improving price transparency, ending surprise billing and lowering the cost of prescription drugs, regardless of who lands in the White House.
While healthcare emerged as the most important issue for voters in the 2018 midterm elections, the COVID pandemic has overshadowed the broader healthcare reform platforms of both Presidential candidates heading into the election. As shown in the gray box, many Americans view the election as a referendum on the Trump administration’s COVID response. Managing the pandemic is one of the most important issues for voters, especially Democrats, who now rank the issue above reducing the cost of healthcare or lowering the cost of drugs.
In many aspects, the COVID policies of Biden and Trump are almost diametrically opposed, especially concerning the role of the federal government in organizing the nation’s pandemic response.
The next administration’s actions to prevent future COVID-19 surges, ensure safe a return to work and school, accelerate therapies, and coordinate vaccine delivery will remain the most important aspect of healthcare policy well into 2021.
Nebraska gets the nod for Medicaid work requirements
https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8
This week Nebraska became the latest state to receive waiver authority from the Trump administration to implement work requirements as part of its Medicaid expansion program.
The program, called “Heritage Health Adult”, will be a two-tiered system, with expansion-eligible adults choosing between “Basic” and “Prime” coverage levels. The lower tier will provide coverage for physical and behavioral health services, with a prescription drug benefit, and is open to adults not eligible for traditional Medicaid with incomes under 138 percent of the federal poverty line.
“Prime” enrollees will get additional dental, vision, and over-the-counter drug benefits, in exchange for agreeing to 80 hours per month of work, volunteering, or active job seeking, which must be reported to the state.
Nebraska voters approved the Medicaid expansion two years ago, although enrollment only began this August, and the work-linked demonstration project is slated to start next year. An estimated 90,000 additional Nebraskans are expected to enroll in Medicaid under the expanded program.
The approval of Nebraska’s Medicaid work requirement comes a week after the Trump administration approved a partial expansion of Medicaid in Georgia, called “Pathways to Coverage”, which is also tied to a requirement to seek or engage in employment or education activities.
The Georgia program also requires premium payments by eligible adults who make between 50 and 100 percent of the federal poverty line. Court challenges will inevitably ensue for both the Nebraska and Georgia programs—only Utah has successfully implemented Medicaid work requirements, with 16 other state programs either pending approval, held up in court, or awaiting implementation. We continue to be deeply skeptical of Medicaid work requirements, and believe they only serve to deter those who would otherwise qualify for coverage from enrolling, and that the expense of their implementation and ongoing operation often outweighs any savings to the state.
The argument that “work encourages health”, often advanced by proponents of work requirements, gets it exactly backwards—rather, health security encourages work, a reality that has become ever more urgent as the COVID pandemic has drawn on.
As the economy continues to falter, Medicaid’s importance as a safety net program grows ever greater, and work requirements create an unhelpful obstacle to basic healthcare access.
HENRY KOTULA 