Health Care at the High Court: 5 Ways This Time Is …

The never-ending political fight over health care hit the Supreme Court Wednesday, and insurance coverage for millions of Americans is on the line.

Didn't we do this already?

Yes, but foes of President Barack Obama's signature law hope this time the justices will gut "Obamacare." The law's defenders say it's a trumped-up attack.

Still sound familiar? Actually, a lot has changed since the Supreme Court's big health care decision of 2012.

Five ways this time is different:

PEOPLE ALREADY ARE USING THE HEALTH CARE PLANS

The first case came as major parts of the law were being phased in. The promised subsidies to help low- and middle-income families afford insurance were not available.

Now the law is in its second year of providing coverage to people who are not insured through their jobs. More than 11 million people are enrolled; nearly 9 out of 10 receive tax subsidies to help cover the cost.

If the Supreme Court rules against the government, many would be unable to afford their premiums.

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Health Care at the High Court: 5 Ways This Time Is ...

Health care maze: Retired teacher tells how dispute has affected her medical care

Published: Thursday, March 5, 2015 at 05:19 PM.

Ann Lancaster of Boiling Springs doesnt understand the disagreement between United HealthCare and Carolinas HealthCare System.

But 83-year-old Lancaster, a retired schoolteacher, does know that since she switched to United HealthCare she has paid more up front costs, and if she gets sick and has to go to Carolinas HealthCare System Cleveland, her insurance wouldnt be accepted.

That would bother me if I couldnt get care at Cleveland, Lancaster said.

Helping her navigate the insurance and health care maze is her cousin and power of attorney, Kitty Hoyle.

Cant find a doctor

Since Lancaster fell last fall and spent time in the hospital and a nursing home, Hoyle has tried to find her a primary care doctor who has hospital privileges.

I cant find a doctor, Hoyle said. No doctor will call back, and when they find out what kind of insurance she has, they dont want to take it.

Lancaster is back home now under the care of the nursing home doctor, but Hoyle also worries what would happen if she had to go back to the hospital.

She needs a doctor who has privileges at the hospital who has continuity of care they know me and know her, Hoyle said. It is shameful that this retired teacher cant find a primary care doctor in the county she served for 42 years.

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Health care maze: Retired teacher tells how dispute has affected her medical care

Chemical Exposure Linked to Billions in Health Care Costs

Exposure to hormone-disrupting chemicals is likely leading to an increased risk of serious health problems costing at least $175 billion (U.S.) per year in Europe alone, according to a study published Thursday.

Chemicals that can mimic or block estrogen or other hormones are commonly found in thousands of products around the world, including plastics, pesticides, furniture, and cosmetics.

The new research estimated health care costs in Europe, where policymakers are debating whether to enact the world's first regulations targeting endocrine disruptors. The European Union's controversial strategy, if approved, would have a profound effect on industries and consumer products worldwide.

Linda Birnbaum, the leading environmental health official in the U.S. government, called the new findings, which include four published papers, "a wake-up call" for policymakers and health experts.

"If you applied these [health care] numbers to the U.S., they would be applicable, and in some cases higher," says Birnbaum, director of the U.S. National Institute of Environmental Health Sciences.

The researchers detailed the costs related to three types of conditions: neurological effects, such as attention deficit disorders; obesity and diabetes; and male reproductive disorders, including infertility.

Some hormone-altering chemicals in consumer products have been linked to increased risk of diabetes.

Photograph by Mario Anzuoni, Reuters/Corbis

The biggest estimated costs, by far, were associated with chemicals' reported effects on children's developing brains. Numerous studies have linked widely used pesticides and flame retardants to neurological disorders and altered thyroid hormones, which are essential for proper prenatal brain development.

The researchers concluded that there is a greater than 99 percent chance that endocrine-disrupting chemicals are contributing to the diseases, according to the studies published in the Journal of Clinical Endocrinology and Metabolism.

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Chemical Exposure Linked to Billions in Health Care Costs

News In Two Minutes – Public Health Danger – Poison – Unrest – Radiation Danger – Exclusion Zone – Video


News In Two Minutes - Public Health Danger - Poison - Unrest - Radiation Danger - Exclusion Zone
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Dementia in Maine: Overview & Introduction to Available Resources – Video


Dementia in Maine: Overview Introduction to Available Resources
As practitioners in the state with the oldest median age, Maine health care providers hold a special responsibility for caring for the health and well-being of our seniors. Mental health -...

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Ebolas Not Over For Health Cares Volunteers

You might have missed it, because were barely talking about it in the United States, but the African Ebola epidemic has still not died down: the World Health Organization identified 99 new cases in its most recent status report. And as long as the disease persists, the possibility exists that it could spread back out of that confined area to other countries. Which makes it a good time to consider several new reports of what happened to US health care workers involved in responding to Ebola, and how that experience still affects their lives.

Short version: Of two who contracted Ebola and survived, one remains ill and fears she was manipulated, and the other, though well, feels he was misrepresented and stigmatized. Both worry their experience will dissuade others from volunteering in turn. And a major new government report backs them up.

The Dallas Morning News reported Saturday on Nina Pham, one of two nurses infected by Thomas Eric Duncan, a Liberian who flew into the United States not knowing he had Ebola. After developing the disease and being treated by her own hospital, Pham was flown to the Clinical Center at the National Institutes of Health, where she was treated with experimental drugs and the blood serum of US physician Kent Brantly, who had already recovered. (Her colleague Amber Vinson got similar treatment at Emory University.) Pham survived and returned home, but months later, she struggles with liver disorders, insomnia, hair loss, what sounds like post-traumatic shock, and an uncertain medical future.

Pham is suing the hospital where she worked and was treated, Texas Health Presbyterian, for putting its staff at risk. From the story by Jennifer Emily:

Pham says she will file a lawsuit Monday in Dallas County against Texas Health Resources alleging that while she became the American face of the fight against the disease, the hospitals lack of training and proper equipment and violations of her privacy made her a symbol of corporate neglect a casualty of a hospital systems failure to prepare for a known and impending medical crisis.

Pham wants unspecified damages for physical pain and mental anguish, medical expenses and loss of future earnings. But she said that she wants to make hospitals and big corporations realize that nurses and health care workers, especially frontline people, are important. And we dont want nurses to start turning into patients.

A few days before that story, another US health care workers who treated victims of the diseases and then developed Ebola published his own account. Dr. Craig Spencer was healthy when he flew home to Manhattan; as requested by the Centers for Disease Control and Prevention, he took his temperature twice a day, looking for any spike that would indicate he was developing symptoms and becoming infectious. On the day his temperature rose, he checked himself into Bellevue Hospital. He writes in the New England Journal of Medicine:

People fear the unknown, and fear in measured doses can be therapeutic and inform rational responses, but in excess, it fosters poor decision making that can be harmful. After my diagnosis, the media and politicians could have educated the public about Ebola. Instead, they spent hours retracing my steps through New York and debating whether Ebola can be transmitted through a bowling ball. Little attention was devoted to the fact that the science of disease transmission and the experience in previous Ebola outbreaks suggested that it was nearly impossible for me to have transmitted the virus before I had a fever. The media sold hype with flashy headlines Ebola: `The ISIS of Biological Agents?; Nurses in safety gear got Ebola, why wouldnt you?; Ebola in the air? A nightmare that could happen and fabricated stories about my personal life and the threat I posed to public health, abdicating their responsibility for informing public opinion and influencing public policy.

Spencer was hospitalized for two weeks; his recovery rendered the US Ebola-free. (Kaci Hickox, who shortly afterward was forcibly quarantined in a tent by New Jersey Governor Chris Christie, never had Ebola.) He worries though that his experience will deter other health care workers from volunteering where they are needed:

My U.S. colleagues who have returned home from battling Ebola have been treated as pariahs. I believe we send the wrong message by imposing a 21-day waiting period before they can transition from public health hazard to hero. As a society, we recognize the need for some of our best-trained physicians and public health professionals to participate in a potentially fatal mission because failing to stop the epidemic at its source threatens everyone. We should also have faith that these professionals will follow proven, science-based protocols and protect their loved ones by monitoring themselves. It worked for me, and it has worked for hundreds of my colleagues who have returned from this and past Ebola outbreaks without infecting anyone.

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Ebolas Not Over For Health Cares Volunteers

Justices sharply divided over health care law subsidies

WASHINGTON (AP) - The Supreme Court was sharply divided Wednesday in the latest challenge to President Barack Obama's health overhaul, this time over the tax subsidies that make insurance affordable for millions of Americans.

The justices aggressively questioned lawyers on both sides of what Justice Elena Kagan called "this never-ending saga," the latest politically charged fight over the Affordable Care Act.

Chief Justice John Roberts said almost nothing in nearly 90 minutes of back-and-forth, and Justice Anthony Kennedy's questions did not make clear how he will come out. Roberts was the decisive vote to uphold the law in 2012.

Otherwise, the same liberal-conservative divide that characterized the earlier case was evident.

Opponents of the law say that only residents of states that set up their own insurance markets can get federal subsidies to help pay their premiums. The administration says the law provides for subsidies in all 50 states.

The liberal justices peppered lawyer Michael Carvin almost from the outset of his argument to limit the subsidies.

Justice Ruth Bader Ginsburg said the law set up flexibility for states to either set up their own markets or rely on the federal healthcare.gov. Giving subsidies only to people in some states would be "disastrous," Ginsburg said.

When Solicitor General Donald Verrilli Jr. stepped to the lectern, the liberal justices fell silent, and Justices Samuel Alito and Antonin Scalia took over.

"It may not be the statute Congress intended, but it may be the statute Congress wrote," Scalia said of the provision in question. The case focuses on four words in the law, "established by the state." The challengers say those words are clear and conclusive evidence that Congress wanted to limit subsidies to those consumers who get their insurance through a marketplace, or exchange, that was established by a state.

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Justices sharply divided over health care law subsidies

Editorial: If Texans' health care subsidies disappear, we need a plan

Regardless of your politics, the possibility that fellow Texans and millions more Americans nationwide who bought insurance under the Affordable Care Act could return to the ranks of the uninsured is a serious matter.

Yet this is what is at stake when the U.S. Supreme Court hears oral arguments Wednesday in King vs. Burwell. More than 1 million Texans who now have health insurance through federally run exchanges may not be allowed to keep their coverage.

Imagine the devastating effect if the cost of your health care premiums tripled, which could happen if the federal subsidies many count on suddenly disappear. Most people eligible for subsidies have modest incomes; many would be unable to afford any coverage without financial help, adding to the ranks of the uninsured.

Texas already leads the nation in the number of uninsured residents; the state doesnt need to toss more people into health care limbo.

However, if the Supreme Court hands down a problematic Burwell ruling, Texas lawmakers can ease the shock. State Rep. Chris Turner, D-Grand Prairie, recently introduced HB 817 as a safety net. If the court says Texans cant receive subsidies through federally run exchanges, the bill would automatically trigger the creation of a state-run health care exchange that would allow Texans to continue to receive federal subsidies and keep their existing coverage.

The legal issue before the court is whether people who live in states like Texas that did not establish a state-run health care exchange are eligible to receive federal tax subsidies. Last spring, two federal appeals courts reached opposite conclusions. One court said the subsidies applied to Americans in all states; the other said they applied only to consumers in states that operated their own health care exchanges.

This newspaper understands some of the opposition to the Affordable Care Act and, in fact, questioned the programs cost as the bill originally moved through Congress. However, it is now law. Millions have based their insurance decisions on the program; a ruling would affect people of all political stripes in every House and Senate district. The well-being of those who enrolled should be protected.

Turners bill addresses only part of Texas broader health care challenge under the Affordable Care Act. Texas lawmakers also need to reform Medicaid eligibility so the state can draw extra federal dollars to cover the large percentage of uninsured low-income residents as a number of Texas business groups have urged. Unfortunately, in a letter to President Barack Obama, Lt. Gov. Dan Patrick and state Senate Republicans on Monday reiterated their opposition to expanding Medicaid while demanding that the federal government allow Texas to make sweeping changes in the Medicaid program. This appears to be a nonstarter.

Texas must begin to solve its myriad health care challenges. Turners bill is a pragmatic way to keep a looming problem from becoming a nightmare. It deserves bipartisan support.

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Editorial: If Texans' health care subsidies disappear, we need a plan

Twenty-eight countries have worse health care systems than Liberias

I've been to Liberia twice and seen that impoverished nation's health-care system as it was overwhelmed by Ebola, which all but eliminated regular services for a time. (Here's the story I wrote about that.) So it was somewhat alarming to come across the notion that, under normal circustances, the quality of the health care in Liberia isn't even close to the worst in Africa, Asia and elsewhere in the developing world.

That's the main message in a new report from the nonprofit organization Save the Children, which ranked 72 countries on six measures of health-care provision for children, including the newborn mortality rate, the number of health-care workers per 10,000 population, immunizations and skilled birth attendance.

The result, Save the Children found, is that 28 nations fared more poorly than Liberia (which ranked 44th), including Nigeria (70th), Haiti (68th), Pakistan (57th), India (55th) and Kenya (47th). The two other Ebola-ravaged countries, Sierra Leone (46th) and Guinea (65th), also fell below Liberia. Somalia is last at 72nd.

In part, this illustrates the fact that Liberia had made some strides in maternal and child health in the 11 years after its civil war ended and before the Ebola outbreak began. But mostly it reflects the pitiful amount of money spent on health care in developing nations. The World Health organization estimates that $86 per person per year is the minimum spending required to provide essential health-care services. In 2012, Guinea spent $9, Sierra Leone spent $16 and Liberia spent $20, according to the report. All three figures were increases from 2006.

Germany, in contrast, spent $3,592, the United Kingdom $3,009, the United States $4,126 and Norway $7,704.

The report contends that for $1.58 billion -- about a third of the $4.3 billion cost of the Ebola response so far -- the health-care systems of Liberia, Sierra Leone and Guinea could be brought up to minimum standards.

Ebola ravaged the three West African countries for a number of reasons, including unfamiliarity with a virus that previously had been confined to the rain forest; unsafe burial practices and denial among the populations of Liberia, Guinea and Sierra Leone. The World Health Organization and nations such as the United States that have the capacity to intervene were way too slow to recognize the danger and help.

To date, nearly 24,000 people have been infected and more than 9,600 of them have died. In recent months, however, the number of cases has fallen sharply in Liberia and the situation has improved in Sierra Leone.

But there is also little doubt that a more robust health-care system in the three countries could have helped. Nigeria (which, as noted above, fared poorly on Save the Children's list) mounted such a response when the epidemic threatened to spread there, and stamped it out. Despite initial stumbles, so did the United States.

"The current Ebola virus disease outbreak in western Africa highlights how an epidemic can proliferate rapidly and pose huge problems in the absence of a strong health system capable of a rapid and integrated response," the report quotes the World Health Organization as saying in one bulletin.

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Twenty-eight countries have worse health care systems than Liberias

City Roundup: Health Care Zones, Land Trusts

Not a whole lot has happened in Jackson in the two years since the Legislature passed Gov. Phil Bryant's health-care zone law in 2012.

That legislation,formally called Mississippi Health Care Industry Zone Act, gives the Mississippi Development Authority the ability to dedicate "health-care zones." Inside those zones, businesses will be eligible for tax breaks and incentives. That includes clinics, medical-supply manufacturers and retailers and telecommunication companies.

So far, state officials have approved 12 zones around the statebut, oddly, none in Jackson or Hinds County despite the presence of University of Mississippi Medical Center, Baptist Health Systems and St. Dominic Hospital, all within a stone's throw from one another.

Recently introduced legislation, called the Mississippi Healthcare Industry Zone Master Plan Act, aims to provide additional incentives to Jackson and other cities to help get their health-care master plans off the ground. House Bill 1634, which the House passed unanimously and the Senate Finance Committee will consider, would create several grant and loan funds that could pay for job training, health-care facility payrolls, municipal bond payments and state new-market tax credit allocation to MDA-certified master plans.

"The city can be a unifying force," given all Jackson's health-care organizations, including the hospitals, clinics and the Jackson Medical Mall, said Jackson Ward 2 Councilman Melvin Priester Jr.

The master planning process would begin with stakeholder meetings, market analyses and mapping of existing community assets in the health-care businesses, including medical facilities, educational assets and industrial parks. Master planners would also consider how existing plans, including city comprehensive plans, might mesh with a health-care master plan.

For example, backers of HB 1634 hope that it would help plans that are under way for a Jackson Medical Corridor, for which Andrew Jenkins of AJA Management developed a plan for a proposed project that would stretch the length of Woodrow Wilson Avenue between Interstates 55 and 220.

The legislation also has the backing of the Mississippi Chapter of the American Planning Association. In a letter to stakeholders, urging them to support the master-plan act, Mississippi APA President Donovan Scruggs said:

"As Mississippi attempts to grow a statewide health care cluster, our state has a tremendous opportunity to transform its competitive landscape and at the same time promote a primary objective of the Mississippi Chapter of the American Planning Association to nurture and grow communities of lasting value and diversity with choices for living, working and enjoying life."

Bank Shot

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City Roundup: Health Care Zones, Land Trusts

Quality of Health Care Focus of NYC Jail Oversight Hearing

New York City lawmakers are taking a hard look at the quality of health care inmates receive at the Rikers Island jail complex and whether the city should renew a $126.6 million contract with a private health provider.

Tuesday's City Council oversight hearing follows a report by The Associated Press last year that raised serious questions about the medical care inmates received in at least 15 deaths. Those cases included inmates who were denied medication, improperly assessed or not treated in a timely manner.

Some lawmakers are questioning whether the Brentwood, Tennessee-based Corizon Health Inc., has performed well enough to have its three-year contract renewed when it expires Dec. 31.

"The most recent history surrounding Corizon in the past few years at Rikers is beyond troubling," said City Councilman Corey Johnson, chair of the council's health committee. "And if you look at Corizon's record around the country it raises more red flags."

Contract evaluations obtained by the AP show that officials downgraded Corizon's performance from "good" in 2012 to "fair" in 2013 citing inconsistent leadership in mental observation units. The downgrade followed the September 2013 death of Bradley Ballard, a mentally ill, diabetic inmate locked alone in his cell for six days without medication. A state oversight panel called his care "so incompetent and inadequate as to shock the conscience."

A spokesman for Corizon, the nation's largest private provider of correctional health care which is responsible for 345,000 inmates in 27 states, said providing quality health care to a difficult population was a company priority.

"As an organization committed to continuous improvement, we look forward to speaking to the New York City Council," said Andrew Moyer.

The treatment of inmates at Rikers has come under increased scrutiny in the past year since the AP first revealed the deaths of Ballard and Jerome Murdough, another mentally ill inmate who died after he was locked alone in a jail cell that sweltered to more than 100 degrees because of a malfunctioning heating system.

An October report by the AP, based on hundreds of investigative documents, found that treatment, or lack of it, was cited as a factor in at least 15 deaths filed away as "medical" since 2009, including that of a 32-year-old man who died of a bacterial infection in his stomach and intestines after days of bloody stools. He received treatment only after fellow inmates staged a protest.

Officials have said Mayor Bill de Blasio is conducting a comprehensive review of the Corizon contract but hasn't yet made a decision about its future.

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Quality of Health Care Focus of NYC Jail Oversight Hearing

Powell: Taming retiree health care

Robert Powell, Special for USA TODAY 11:47 a.m. EST March 2, 2015

Robert Powell(Photo: Josh T. Reynolds, for USA WEEKEND)

Good news: Recurring, predictable out-of-pocket health care expenses remain somewhat stable over the course of retirement.

The bad news: Non-recurring unpredictable expenses such as surgery, hospitalizations, and nursing home care increase with age, tend to be more expensive, and, in the absence of a plan to manage those costs, can wreak havoc on a household's finances, according to research just published by the Employee Benefit Research Institute (EBRI), a nonpartisan research institute based in Washington, D.C.

"Health care is one of the key components of retirement expenses, and is the only part of household expenditures that increases with age," Sudipto Banerjee, a research associate at EBRI and author of the report, said in a release. "While some of these costs are more predictable, others are uncertain, and for many people these expenses spike toward the end of life when resources are slim. To successfully manage your resources in retirement, a good plan may include separate preparations for each."

In its research, EBRI found that average, annual out-of-pocket health care costs for a household between 65-74 years old was $4,383 in 2011, which accounted for 11% of total household expenses. But out-of-pocket health care expenses rise for households ages 85 and above to $6,603 a year, or 19% of total household expenses.

On the go? Listen to Robert Powell's interview with Sudipto Banerjee in the audio player below:

The average annual expenditure for recurring health care expenses doctor visits, dentist visits and usage of prescription drugs among the Medicare eligible population was $1,885. According to EBRI, assuming a 2% rate of inflation and 3% rate of return, a person with a life expectancy of 90 would need $40,798 at age 65 to fund his or her recurring health care expenses. This does not include expenses for any insurance premiums or over-the-counter medications, EBRI noted.

But it's the non-recurring and unexpected health-care costs overnight hospital stays, overnight nursing-home stays, outpatient surgery, home health care and usage of special facilities that must be managed.

Nursing-home stays, for instance, can be very expensive, according to EBRI. For people ages 85 and above, the average and the 90th percentile of nursing-home expenses were $24,185 and $66,600 during a two-year period, respectively.

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Powell: Taming retiree health care

Study: Health care 'super-utilizers,' cost ratio uneven

Pennsylvanians who are more frequently admitted to the hospital claim a disproportionate amount of public health money, according to a recent study by a state health cost-tracking agency.

Research published in February by the Pennsylvania Health Care Cost Containment Council, or PHC4, shows patients admitted into a hospital five times or more between July 2013 and June 2014 comprised only 3 percent of total inpatient admissions.

But those 3 percent ate up 14 percent or $545 million of all inpatient Medicare claims payments and 17 percent or $216 million of all inpatient Medicaid claims payments.

It comes down to access.

Patients who lack health insurance or a primary care physician, especially those with chronic illnesses like diabetes, heart disease or chronic obstructive pulmonary disease, often dont get regular care to effectively manage their symptoms.

Richard Martin, M.D., department director for Geisigners community practices in Lackawanna and Monroe counties, said its a lack of regular maintenance that leads to catastrophe in the form of emergency room visits, followed by longer stays in the hospital.

Many of these people just dont have insurance, he said. So they wait until an illness becomes more significant that they end up in the emergency department.

Experts blame a flawed health care system, saying the burden, at least in part, falls on doctors to offer preventive and follow-up care patients need to stay out of the hospital bed and a few steps ahead of their illnesses.

While it may seem these so-called super-utilizers are taking more than their fair share of public health resources, many health care professionals in the region are quick to caution against throwing accusations.

I dont think it would be fair to say, well, these people are abusing the system; these people are feeding at the trough inappropriately, said Justin Matus, Ph.D., associate dean at Wilkes Universitys Sidhu School of Business.

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Study: Health care 'super-utilizers,' cost ratio uneven