UPE, a recently created Pennsylvania nonprofit corporation,  has filed with Insurance Commissioner Karen Weldin Stewart, a proposed plan to affiliate with West Penn Allegheny Health System and Highmark Insurance Company.    This will be a merger between a health insurance company, Highmark, and a hospital system.  West Penn is a five-hospital system in the Pittsburgh area.  It raises questions here in Delaware about how it may impact management of Highmark Blue Cross of Delaware.  It has raised antitrust questions in the Justice Department.   There is a pattern across the country of insurance companies merging with health care providers, hospitals and doctors.  But I don't believe it has ever happened in Delaware.  Is this a sign of things to come here in Delaware.  Will we see insurance companies opening medical practices and merging with clinics and hospitals?   How will that impact patient care?  

This is the question asked by Senator Max Baucus (D-MT) at an April 17^th Senate Finance Committee hearing with Secretary Kathleen Sebelius.  His concern is that Health and Human Services is not doing enough to get out information about how to sign up for the new Health Insurance Marketplace or about tax credits for small businesses or about what the benefits will be. Open enrollment in the Marketplace starts October 1^st.  The Navigator is someone who will do community outreach to individuals and to small businesses to help them know what their options are and how to sign up.  Secretary Sebelius was fuzzy about who exactly will be the Navigators, how many Navigators will there be, and when will they start.  Senator Baucus asks for benchmarks in order to track progress.  He said,  "I'm  going to keep on this til I feel better about it."  I agree.  So am I.

Critics are saying that Obamacare will be extremely costly.  I say our current health care system is already extremely costly and we are already paying for it.  Obamacare will hold down cost increases for us all, especially the catastrophic costs that bankrupt many Americans each year and leave many small local businesses and working, middle class Americans uninsured and underinsured.

A woman told me recently that her daughter and son-in-law, who run a small air conditioning business in Florida, have never been able to afford health insurance.  He recently had a heart attack.  Now they have an $80,000 hospital bill to pay.  If the critics tell this couple that Obamacare will be extremely costly, I believe they would say "We're already paying".  At least Obamacare will help them buy decent health insurance.  Under Obamacare he cannot be denied coverage because of his heart attack, which under our current system would be denied as a pre-existing condition.  And Obamacare gives them a subsidy to afford health insurance based on their income.   

Critics are also repeating the old scare tactic that "More doctors are planning to retire due to this health care law." I can't speak for the specialists, but I know of no primary care doctor in Delaware who is planning to retire because of Obamacare.  If there is, I'd like to hear from him or her.

This summer we will start to hear more about how to sign up for Obamacare's health insurance marketplace.  Open enrollment begins October 1, 2013.  Insurance coverage starts January 1, 2014.

Comments are welcomed

I still have this twenty inch ceramic Christmas tree.  It's green. There is a light bulb inside. When you turn on the light bulb, the colorful ornaments shine against the green ceramic.  My grandmom Hill made it in crafts at the Senior Center and gave it to me when I was away at college.  I unpack it every year out of the same cardboard box.  Then it comes out of the old brown paper A&P grocery bag.  Then I wipe away the old shredded newspaper that grandmom originally packed around it.  Before I had a house of my own, the ceramic tree usually was the only Christmas tree I put up.  It has followed me from Delaware, to Michigan, to Washington DC, to Virginia, to South Carolina, to North Carolina, and back to Delaware.  No matter what has happened in my life that year, the tree is a sign that God, and grandmom, remain faithful.  It's like my "star in the East".  Every year about this time I seek out the cardboard box.  I open the treasured gift.  I turn on the light bulb and I see the ornaments and the star on top glow.  I have come to worship our newborn savior, our hope for peace and healing.      

Mitt Romney says if he becomes President he will repeal Obamacare or at the very least repeal large portions of Obamacare.   A recent experience with a patient makes it clear to me what is at stake if President Obama loses re-election and if Obamacare is repealed or defunded.

A 47 year old man with a history of bladder cancer had a good job here in Kent County through the worst of the recession. Through no fault of his own he lost the job and the work place health insurance four months ago.  He found a new job one month ago.  There is a three month waiting period before the health insurance on the new job goes into effect.  In the meantime his bladder cancer has reoccurred.  He will not go to his urologist because he has no insurance.  But he did have to go to the emergency room in the middle of the night last week because he was bleeding and in pain. 

This lapse in insurance coverage between jobs is dangerous, costly and frightening.  Most likely it has happened to somebody you know or to you personally.  It is one of the biggest problems in our health care system.  And Obamacare does a lot to solve it.  

The new Health Benefits Exchange, which is an online market for selecting a qualified health plan, will offer this patient real time enrollment in a "bridge" plan while he looks for another job.   The patient reports his new income status to the Exchange where he then selects a qualified health plan.  His premium subsidy is calculated based on his new, lower income.  The subsidy is paid directly to the new insurance plan.  He pays the difference.  Coverage begins right away with no denials for his pre-existing condition of bladder cancer.   This is how Obamacare will at least minimize if not eliminate the lapse in insurance between jobs. 

Governor Romney says that he has a plan to replace Obamacare.  But what is that plan and how long will it take to implement?  He says free market competition will solve the problem.  But from what I have seen, the only competition that health insurance companies know is 'who can deny care to the most sick people'.

Obamacare starts in January 2014.  That's only a year from now.  Why throw that away?

So much is at stake in this election.  America is a great nation.  We are resilient and we will prosper again.  For health reform and for so much else, please vote to re-elect President Obama.   

People who are taking care of a spouse or a parent with Alzheimer's dementia know what I mean when I say most days you just want to cry.  Your heart breaks to see your mother slowly but surely decline.     She falls asleep while the stove is on. She is incontinent and won't wear a Depends.  She cannot manage her pills or her finances.    Unless you put food in front of her she forgets to eat. She resists help, becomes argumentative and at times even combative.   How do you get a demented person to take a bath when she refuses and starts to kick and cuss?  One lady told me she has to put on her bathing suit and get in the shower with her mother and it's a fight all the way.   At the doctor's office she takes off her shoes and the doctor says she has athlete's foot, why haven't her toe nails been cut, and how did she get such bad calluses.   You feel like you are being accused of neglecting your mother. Most of the time she doesn't know who you are.  The worst is when you know that she knows she is getting worse. 

You can't quit your job to stay at home with her.   That reduces your income and also your pension and your social security.   You want to keep her out of the nursing home as long as possible.  But few people can afford an Assisted Living facility which is mostly private pay at two to four thousand dollars a month.   And the cost of an aide in the home at sixteen to twenty-two dollars an hour adds up to thousands of dollars very quickly. 

At the national level researchers are trying to figure out what can prevent dementia.  Pharmaceutical companies are trying to find a pill that will effectively slow down or reverse dementia.  Medical device companies are trying to develop machines and scans that detect early dementia.

Meanwhile, an estimated 5.2 million Americans age 65 and older have Alzheimer's dementia.   Two hundred thousand Americans under age 65 have younger-onset Alzheimer's.  As of 2010, fourteen thousand Delawareans have Alzheimer's.  Fifteen million Americans provide unpaid care for a person with dementia.  In 2011, family members and friends provided an estimated 17.4 billion hours of unpaid care, a contribution to the nation valued at over $210 billion.   These people need help now.   We need affordable, community services to help both the caregiver and the patient. 

Adult Day Care programs can be a big help.  Adult Day Care is more than just going to the senior center.  Adult Day Care is a supervised program for functionally impaired adults.  Functionally impaired includes dementia but also includes physical impairments.  Adult Day Care offers structured activities, some nursing care, a healthy meal, transportation services, and coordination with the caregiver.   

I have done some research into the Adult Day Care programs we have in Delaware.  I wanted to know how much they cost, how many people they serve, and do they offer transportation.  I got my information from the Alzheimer's Association and from the day care program directors.  I sincerely thank all the program directors who took the time to speak to me and send me information.    

Here is what I learned.  The following is a list by county of the Adult Day Care programs and a brief summary of their programs. 

Sussex County

1. Laurel, located within the Laurel Senior Center    Phone  875-2536

Fees are based on sliding scale income.  Someone with a moderate income may pay about $7 a day.  Fee is waived if client cannot pay.  The Center's bus provides transportation.  They get Title III funding from the State Division of Aging and Adults with Physical Disabilities. They serve Medicaid patients under the Home and Community Based Medicaid waiver.  Medicaid patients pay nothing for the day care program and they also are provided with home aides to get them ready to get on the bus in the morning and assist them when they come home in the afternoon.  Staff can help with medications. 

2. Gull House in Rehoboth Beach        Phone  226-2160

Bills the state for Medicaid patients.   Non-Medicaid patients pay a copay which is calculated based on sliding scale income.  Minimum charge is $17 a day, waived if necessary. They get Title III grants from the state.  Affiliated with Beebe Hospital.    Offers a “2 day a week” and a “5 day a week” program.  Serves about 42 people.  Program lasts from 7:30 am to 2 pm.  Does not provide transportation.   Staff assists with arranging Paratransit bus service.

3. Easter Seals in Georgetown       Phone 856-7364

For all range of ages and clients with dementia or physical disabilities.  Funding is block grants from the state.  They also bill the state Medicaid Home and Community Based waiver program.  Also, accept private Long Term Care Insurance.  No Title III funding.  Offers incontinence care, licensed nutritionist, and Federal Child and Adult Care Food Program.   Transportation is by Prime Care stretcher van or wheelchair van if needed, otherwise use Paratransit bus. 

4. CHEER Center in Georgetown is planning for a possible new Adult Day Care program.  Phone 856-5187

Kent County

1.  Day Break Mature Adult Care within Modern Maturity Center in Dover      Phone 734-1200

Fees are $15 per day minimum ($50 per day maximum), sliding scale based on income.  Receives funding from Title III and Caregiver Respite grants.  Also accepts Medicaid under Home & Community based waiver.  Serves 60-68 patients, some with dementia and some with other physical disabilities.  Have their own bus to pick up clients and take them home.   

2. New Horizons Adult Care, Smyrna     Phone 223-1033

Maximum fee is $74.26 a day, but it's adjusted based on sliding scale income.  They serve the Medicaid patients under the Community and Home Based Medicaid waiver.  They get some Veterans Administration funding for a 2 day a week respite program.  Serves 17 to 24 people, licensed for 46.  Transportation is by Paratransit bus. 

New Castle County

1. Gilpin in Wilmington       Phone 654-4486

Stand-alone center, not inside a senior center.  Cost is $88.40 a day.  They bill the state for Medicaid clients.  Non-Medicaid patients are private pay and there is no sliding scale income adjustment.  Can serve up to 50 people. Transportation is by Paratransit which Medicaid also pays for.

2. Elwyn in Wilmington        Phone 658-8860

Freestanding center.  Senior Reflections program.  Gets state Title IIIB funding for people over 60 years old for up to 5 days a week if they have a diagnosis that requires them to have supervision, such as dementia, multiple sclerosis or stroke.  Gets state Title IIIE funding for a 2 day a week program for people over 50 years old and with a cognitive disability.  State pays 85% of the program cost.  Bills the state for Medicaid clients.  Medicaid clients get free transportation on Paratransit.  Non-Medicaid clients are charged a copay calculated based on sliding scale income and pay as little as $50 a month.  Non-Medicaid clients pay $4 a day to be picked up and taken home by Paratransit.  Staff arranges the Paratransit rides.   

3. Christiana Care Adult Day (formerly called Riverside Transitional Care)       Phone 765-4175

Serves Medicaid waiver patients at no cost to the patient.  For non-Medicaid clients, it's private pay at $78 a day with no adjustment for sliding scale income.  Five days a week.  Serves 20 to 24 people a day.  Transportation by Paratransit.

4. Active Day Senior Care of Newark         Phone 533-3543

Privately owned, nationwide chain.  Serves Medicaid patients at no cost to the patient.   Cost is $78 a day.  But 50% of clients are funded under Title III, which means people pay based on sliding scale income.  A very small program in the Veterans Administration pays for a few veterans for a 2 day a week program.  Serves 38 clients.  Transportation is by Paratransit.

5. Evergreen in Wilmington/Hockessin area.     Phone  995-8448

Serves dementia patients exclusively.  This is under a special state grant.  Also, gets state funding from Title III which allows them to charge a copay based on sliding scale income.  Staff to client ratio is 1 to 4.  They have case workers.  They ensure hydration, toileting every two hours, hygiene, nutrition.  Nurse helps with medications.  Serves 28 clients.  Transportation is by Hart to Hart van and by Paratransit.

6. Weston Adult Day Care, New Castle     Phone 328-6425

Nonprofit.  Serves dementia patients exclusively.  Accepts Medicaid clients at no cost.  Otherwise it's private pay.  Cost is $35 for four hours and $55 for over four hours.

7. Easter Seals Adult Day in New Castle     Phone 324-4444

Takes Medicaid patients at no cost.  Otherwise it's private pay at $75.92 per day. Serves 40 clients.

In summary, here is what I have learned:

1)  There are twelve Adult Day Care programs throughout the state and a new one possibly being planned for Georgetown. 

2) Two centers in New Castle County are exclusively for dementia patients.  The others serve a mix of dementia and physical disabilities. 

3) Funding is from several sources.  Medicaid patients get the most financial help and social services.  The program and the transportation are free to Medicaid clients.  Medicaid clients have access to additional services such as home aids and case workers.  Most but not all the programs accept Medicaid.

4) If you're not on Medicaid, Title III state funds pay most of the program cost.  You are charged a copay based on sliding scale income.  You do not get a home aide or a case worker.  You pay for Paratransit if you use it.  Not all the programs have Title III funding which means not all the programs adjust your charges based on sliding scale income.   

5) The Veterans Administration has a small funding source for a 2 day a week program. 

6) They all accept private long term care insurance for those few people who have it. 

7) Some programs are associated with their local hospital system such as Christiana and Beebe. 

8)  The services offered are similar among the programs and include some level of skilled care for managing medicines, incontinence care, personal hygiene, behaviors, and nutrition.  Do they help with taking a bath, cutting toe nails, washing hair? I didn't ask but that would be my next question.

9)  As for transportation to and from the program, some have their own bus.  Those that don't have their own bus will help the client arrange for pick up by Paratransit.  I'd be a little afraid to put a dementia patient on a Paratransit bus but they assure me it works. 

In general, Adult Day Care provides a structured program that can contribute to the mental and physical well-being of this vulnerable population of our frail elderly loved ones.  Adult Day Care provides respite for the caregiver.  It can prevent unnecessary hospitalizations and forestall institutional placement.  Staff can help the family plan for possible future nursing home placement. 

Does Delaware need more of these services?   I would say yes.  I think that small, community based programs would be ideal so that the frail elderly person does not have to travel on the bus for a long time.  I encourage everyone to know about the Adult Day Care services in your area and be an advocate for their continued funding and their expansion.  

Right now Medicaid, which is a major funding source for Adult Day Care, is coming under attack.  Republican Congressman and current Republican Vice-Presidential candidate Paul Ryan has proposed cutting Medicaid by one-third by 2022, according to the CBO.  He wants to convert Medicaid to a block grant where states would receive a fixed federal amount to spend.  An underfunded block grant would mean that states would have to either limit enrollment in programs like Adult Day Care during a recession or cover all costs associated with additional enrollees without help from the federal government. 

Fifteen million unpaid caregivers make for a big voting bloc.  Be sure to talk to your elected officials and tell them that funding for Adult Day Care is important to you and your family.   

Senior citizens, Medicare beneficiaries,  be on guard against aggressive marketing and advertising from Medicare Advantage Plans like Bravo.   One thing that private companies can do much better than government is marketing and advertising.  We all are influenced by advertising much more than we like to admit. Beware of the sales pitches you will hear from insurance agents asking you to cancel traditional Medicare and buy a Medicare Advantage Plan during the upcoming Medicare open enrollment period October 15^th through December 7^th.   

In our community the Medicare Advantage Plans are Bravo, which is a CIGNA product, and Evercare, which is a UnitedHealthcare product.     

A Medicare Advantage Plan is a market-oriented, private insurance policy which takes the place of traditional Medicare.  It combines hospital and outpatient services.  It may or may not include prescription coverage.  The private insurer, such as Bravo, is paid a monthly fee by the government in exchange for providing managed-care medical services.  As of 2011 the per capita payment was a little over $900 per member per month.    

The power of aggressive marketing and advertising by private insurance companies and incentive payments to agents to sell Medicare Advantage Plans cannot be overestimated.  In contrast, the public insurance option, which in this situation is the traditional Medicare that you get automatically on the first day of the month of your 65^th birthday, is like the wallflower sitting off in the corner, while the flashy cheerleader is the center of attention.  The flashy cheerleader is the Medicare Advantage Plan because it gets all the marketing support.  Another simile - Traditional Medicare is like a home cooked dinner of chicken, vegetables and a roll – 465 calories, 6 gm fat, 55 gm carbs, costs about $3 and you cook it the way you want.  The Medicare Advantage Plan is like a Big Mac – 540 calories, 29 gm fat, 45 gm carbs for $4.20 and all the marketing and advertising that McDonalds can buy. 

I have seen in our community a disturbing pattern of Medicare patients being sold Bravo Medicare Advantage for no apparent good reason.  People who are satisfied with their traditional Medicare appear at my office with a Bravo card.  Why?  One man told me a sales woman called him and asked to come to his house.  “She made it sound like she was from the government and I had to switch.”  This patient was afraid that if he did not switch to Bravo he would lose his insurance.    A salesman “came to my house and said this would take care of everything”, another man told me.   “He told me Medicare would not pay for my cataract surgery but Bravo would”, another patient said. Another patient who was sold a Bravo policy needed to be transferred to the University of Pennsylvania for heart surgery but the University of Pennsylvania was not in Bravo’s network so Bravo denied the transfer.  That was the first time that her daughter and son heard of their mother being sold a Bravo policy.  The patient herself did not remember and could offer no explanation.

The private health insurance companies promise in online marketing, called Health Insurance Online, in a Medicare Advantage Plan “if the services provided by the company cost less than the payments collected (That’s the $900 from the government as described above.)  the company keeps some profit and rebates the rest to the consumer in the form of a credit that the consumer can apply to buying additional coverage”.  It’s a rebate but you have to use it to buy more coverage.  Sounds like “Madison Avenue” slick marketing talk to me.  Or it sounds like the “company store”.  You get paid but you have to use your pay to buy at the company store.

Some senior citizens are sharp enough to see through sales talk but, let’s be honest, many are not.  The elderly population includes many vulnerable people who are insecure and struggling.  They don’t want to complain.  They don’t want to bother their children.  They want to remain independent, so they struggle to make these decisions on their own.  And then there are many fragile seniors with some level of dementia who get taken advantage of by aggressive salespeople. 

I know a senior with mild dementia who was sold hundreds of dollars worth of magazine subscriptions over the phone before her daughter started seeing the bills come in for Handguns magazine.   We hear reports of home improvement companies taking money from seniors for work that never gets done. The sale of Medicare Advantage Plans, such as Bravo, is the same thing except the State Department of Insurance and the U.S. Center for Medicare Services (CMS) have rules about what insurance agents can and cannot do to market their product.  These rules are meant to protect the elderly.  

From what I have heard, many people have complained about aggressive sales tactics by Bravo – salespeople going into senior apartment complexes and approaching unsuspecting seniors in common areas or knocking on doors.   Salespeople presenting themselves as government representatives, which to seniors who have previously been on Medicaid or the Prescription Assistance program, is probably easy to do.  Salespeople going to a senior’s home because another senior may have unwittingly given out their name. 

Since Medicare Advantage started in 2007, state and federal regulators have been aware of deceptive marketing.   The U.S. Department of Health and Human Services Office of Inspector General reported in March 2010 that Medicare beneficiaries remain vulnerable to sales agents’ marketing of Medicare Advantage Plans. This investigation resulted from Congressional hearings in 2007 and 2008 examining complaints about sales agents’ marketing plans.  In response, Congress passed new rules to protect seniors. Still in 2010 the Inspector General found abuses.  The private insurance plans continued to offer inappropriate financial incentives to market Medicare Advantage plans.   And there was no decrease in the number of complaints reported to CMS.  Complaints included “1) providing misleading information about plan benefits, 2) enrolling Medicare beneficiaries without their consent, and 3) engaging in aggressive sales tactics”.  

The Inspector General’s report can be viewed at    http://oig.hhs.gov/oei/reports/oei-05-09-00070.pdf  

I mailed a complaint to the Delaware Department of Insurance hoping to learn what they are doing to protect our senior citizens.  I know that the Department of Insurance through its ElderInfo office does a lot to help seniors understand their Medicare options and pick the best policy for their circumstances.  ElderInfo does community education and outreach.   Also, Department of Insurance will sit down with a senior and give one on one counseling about their Medicare options.  The senior can call ElderInfo at 302-674-7364 to make an appointment.   

What is the Department of Insurance doing about complaints?   In their response to my complaint I learned that the State regulates and can take action against an insurance agent who has engaged in inappropriate sales behavior, but they have no authority over the insurance company because Medicare Advantage is a federal plan.  So unless I could give them the name of a specific agent, which I could not, it was outside of their jurisdiction.  If the complaint is against the Medicare Advantage insurance plan, then the Department of Insurance refers that complaint to federal agents at CMS on the senior’s behalf. 

My complaint was referred to CMS.  In their prompt reply, CMS asked me to give them the names and policy numbers of specific patients.  I would not do that.  They said they could do nothing unless I gave them specific names.  I asked - What would you do with the names?   Answer - They would give the names to Bravo and then Bravo is supposed to contact the patient and work out a solution to the problem.  That doesn’t sound very reassuring. 

CMS also is keeping a tally of the number of complaints they get against each Medicare Advantage Plan and that number is a factor in the performance score- also called the Star rating - the Plan gets.  The Plan’s Star rating may have implications for future payments and participation in Medicare Advantage. So a formal complaint from a beneficiary can make a difference.

Be careful out there.  The time to be particularly on guard is the upcoming annual open enrollment period (October 15-December 7) which is the only time of the year when you can change from traditional Medicare to Medicare Advantage or back to traditional Medicare.   Also beware that if you leave traditional Medicare with a Medi-Gap policy and then a year later you want to go back to traditional Medicare, you may be subject to new health underwriting and you may have trouble switching back to a Medi-Gap plan.    

Our elderly family members don’t like to complain and they don’t like to bother us, so let’s take the first step on this one.  Tell your parents and grandparents not to change their Medicare without discussing it with a trusted family member first.  And if the sales agent is not providing truthful, comprehensive information, make a complaint to the Department of Insurance Elder Info at 302-674-7364. Let our senior citizens know that we are paying attention and we care.

Avoid the subject.  Smile and walk away when somebody starts to talk about it. This is the only way I have found to maintain peace among friends when some of us are pro-choice and others are pro-life.  When some of us are Catholic and the others are not.  Arguments about abortion become ugly and mean.  I am pro-choice and non-Catholic.  Out of respect I avoid the topic, smile, walk away, and agree to disagree. 

For ten years I have driven down Governors Avenue in Dover past the anti-abortion people picketing out in front of Planned Parenthood.  In that time I have only once stopped to hurl verbal insults at picketers.  The time I did, a priest in the group got down on his knees on the sidewalk, raised his arms up toward heaven, and began praying out loud.     

When a Holy Cross High School student told me the school was giving her and her friends the day off from school and was transporting them to Washington, D.C. to participate in an anti-abortion demonstration at the Capitol, I just smiled.  “Hope you have a nice trip.” 

I make contributions to Planned Parenthood and Emily’s list.  I know we have Roe v. Wade as strong legal precedent protecting a woman’s right to choose abortion.  We have the 1965 Supreme Court decision in Griswold v. Connecticut, permitting the use of contraceptives.  We have the 1970 law in Title X protecting a woman’s right to access family planning services.   We have some Equal Employment Opportunity court rulings that say it is gender discrimination if an employer refuses to provide insurance coverage for birth control.  I am pro-choice but at the same time I think we should work to reduce the number of abortions by making birth control, family planning and adoption services readily accessible to all American women.

And so I have maintained peace with my friends for years and avoided arguments about abortion.  It was like we had a covenant in this community to respect each other’s beliefs and differences. 

The covenant was broken on Wednesday June 20, 2012 when I saw a 5” by 10” announcement in The News Journal inviting the public “to join Bishop Francis Malooly at a special Fortnight for Freedom Mass on June 21^st at 7 pm at Holy Cross Catholic Church in Dover”.  Most people reading the News Journal that day had no idea what that meant.  But I knew exactly what it meant. 

Probably more than most people I read a lot about the battles going on over the Affordable Care Act and health reform.  Just the day before I read about this Fortnight for Freedom campaign by the Catholic bishops.  The Catholic bishops attack the Affordable Care Act because it requires all employers who offer their employees private health insurance to provide insurance coverage for birth control and family planning.  The Catholic church is exempt from this requirement under their first amendment right to religious freedom and conscientious objection.  I agree with that.  But Catholic schools, charities and hospitals are not exempt because these entities receive public tax money.  The Catholic bishops object.  They want their schools and hospitals to be exempt also.  The Catholic bishops are not willing to compromise and maintain that peaceful balance between church interests and public interests.   The Fortnight for Freedom campaign is designed to whip up support for their objection to the Affordable Care Act.

Catholic schools receive public tax money through vouchers and tax credits in some states, not Delaware.  Catholic universities accept public tax money through student loans.  Catholic hospitals receive public tax money through Medicare and Medicaid.  Saint Francis, Delaware’s only Catholic hospital, has received loans from the Delaware Economic Development Office and operating funds from the Delaware Health Fund Advisory Committee.  As recently as 6/25/12 Saint Francis Hospital was asking the state for favorable term modification on a $4 million loan from the Delaware Strategic Fund.    Catholic Charities receives public tax money to run programs such as a homeless shelter in Seattle, Washington.  Catholic Charities in Delaware receives grants from Blue Cross Blue Shield through their Blue Prints for Community Program.  (Hey, that’s my insurance premium money!)   Larry Snyder, President of Catholic Charities USA, spoke to Republican Congressman Paul Ryan’s House Committee on the Budget in May 2012 and asked for more public tax money under the Social Service Block Grant program.  Yet the Catholic bishops want these entities to be exempt from complying with the public law that protects women’s rights.  That’s just wrong.  If you receive public tax money, you must comply with public law.

I ask – Is this conscientious objection or just refusal to compromise?  The Catholic bishops are on the war path against the Affordable Care Act, against birth control, against getting your tubes tied, against the morning after pill, against family planning services, against counseling to prevent unintended pregnancies, and against a woman’s constitutional right to privacy.  The Catholic bishops are camouflaging their war campaign under the lie that the Affordable Care Act is a threat to religious liberty and freedom of conscience.  The Catholic bishops started this campaign at their Catholic Bishops Conference in Atlanta, Georgia.   Never did I imagine they would come to Dover, Delaware.  But there they were in my local newspaper, throwing their lies in my face.   And Bishop Francis Malooly himself was leading the assault on my peaceful community of Dover the next day June 21^st at 7 pm.

I had to protest.  They were attacking the Affordable Care Act which I support.  And they were attacking women’s rights which every woman in this country must protect for the next generation just like our ancestors fought for us.   I stood in front of Holy Cross Catholic Church from 6:30 to 8:30 Thursday evening as people arrived and left this “special” mass.  I held a sign saying “Stop the War on Women”.

The Catholic bishops are simply going too far.  They are deliberately confusing abortion and birth control.  It’s like they’re trying to whip up their anti-abortion people to also be anti-birth control. I detect a sleight of hand trick.  They are saying that birth control really is abortion so if you’re against abortion then you should also be against birth control and family planning and if the Affordable Care Act guarantees every American woman access to birth control and family planning then you should be against the Affordable Care Act.

I know this because of the crazy comments I got from two people who came up to me on the sidewalk after mass.  One woman asked me “Have you ever had an abortion?”  “When does life begin?”  When I told her I don’t know, she questioned my medical credentials and asked me if I was on drugs.  Bishop Malooly did a good flimflam job on her.  He’s talking about restricting birth control and she’s thinking about abortion.  The next step is to get her to equate birth control and abortion.  The Catholic bishops whip up talk about abortion and confuse it with birth control in order to rally their troops.  This woman is an example.    

A man said to me “Pregnancy is not a disease”.  The Catholic bishops say pregnancy is not a disease therefore it should not be either aborted or prevented.  They believe that birth control and abortion are equally wrong.  I really don’t think most people agree with that.  Many of us oppose aborting a pregnancy.  But most of us believe a woman has a right to take birth control pills to prevent an unintended pregnancy. It’s the unintended pregnancy that carries increased health problems for mother and baby.  Don’t let the Catholic bishops confuse this important difference and then in the midst of the confusion they take away some women’s right to contraceptives and family planning. It’s like the old shell game – Now you see your rights, now you don’t.

And then there is the suspicious association between the Catholic bishops and the Republican party.  The Wall Street Journal reported on 2/8/12 that Republican Congressman John Boehner (R-OH) vows that the U.S.  House of Representatives  will act to reverse the Obama administration attack on religious freedom.   The Los Angeles times reported on 2/13/12 Republican Senator Mitch McConnell (R-KY) said on CBS “Face the Nation” that he would press legislation to exempt all employers from providing insurance coverage for contraceptives if they have religious or moral objections.  The Republican senator said, “This is what happens when the government tries to take over healthcare and tries to interfere with your religious beliefs.”

I respect my friends who are devout Catholics.  But after years of trying, I can no longer avoid this argument.  In my humble opinion the Catholic bishops have nothing but contempt for women’s rights.  They have no intention of maintaining a peaceful coexistence between their religious beliefs and a woman’s constitutional rights.  They won’t even let a woman be a priest.  They have no misgivings about coming after us with the full “shock and awe” power of the Catholic church.  They have no misgivings about getting mixed up in partisan politics if they think it will advance their campaign against women’s rights.  

I disagree with the Letter to the Editor 4/6/12 “Socialized health care is not American!”

Health reform is very much happening at the state and local levels, not just the federal level, and not just by governmental agencies.  The letter writer is wrong to say that it’s “socialized health care rammed down our throats” and “where the federal government will be our health care providers”.   Health reform is coming from the local communities, from the medical community, local hospitals, private insurance companies, private services companies, private information technology companies, private pharmaceutical companies.  This is not socialized health care run by the federal government.  Funding and guidelines are coming in part from the federal government but not entirely.  The ideas, the planning, the control in many examples are at the local level.  

Examples of local health reform are the Patient Centered Medical Home projects in our state.  The Patient Centered Medical Home is a well established team approach to achieve lower health care costs, better quality health care and better health outcomes. The current projects include:

1. Primary care centered pilot project developed by Blue Cross Blue Shield of Delaware and the Medical Society of Delaware - expected to launch in May 2012.

2. University Health Sciences Alliance nurse practitioner led medical home in Newark - already in operation.

3. The Delaware Cancer Consortium, composed of Delaware doctors and concerned citizens - made Delaware the first state to eliminate the disparity between African-Americans and whites in the incidence rate of colorectal cancer.

4. Project Engage – Alliance between Brandywine Counseling and Christiana Care Health System to identify and better serve patients with substance abuse and addiction problems who are frequent, high expense admissions to the hospital.

5.  AI DuPont Hospital for Children – Working with three pediatric practices in New Castle County to identify frequent users of the Emergency Room and help them make better use of lower cost primary care.

From such projects we learn that if you go to the patients who are the highest expense and highest frequency users and direct them to more efficient, cost effective care, then the money you save more than pays for the programs.  We have to leverage those cost savings in order to make these projects self-sustaining.

It’s not socialized health care and the federal government is not the only provider or even the primary provider.  People who keep on calling it socialized health care serve only to divide us.  Health reform is happening at all levels of government and by private companies and non-profit companies.          

Three days in the U.S. Supreme Court.  Momentous. Supreme Court hearings on the Affordable Care Act, although now I hear it is ok to call it Obamacare.  Obamacare is no longer a pejorative term since President Obama started using it himself.

While I have many thoughts about what I heard on the audio tapes, I am focusing today on the Court’s interest in the economic impact the uninsured have on commerce.  I am certainly not a constitutional lawyer but I am told that the justices likely are interested in what will be the impact on the health of the American workforce and the economic impact on commerce if the Affordable Care Act is struck down.

From what I heard, I am not sure that the justices got a complete picture of the impact that the uninsured have on commerce across this country. The justices heard about the uninsured but they did not hear about the underinsured.  They heard about the almost 50 million Americans who are uninsured.   18.5% of the non-elderly were uninsured in 2010 across the country.  In Delaware 14% were uninsured and that rate ranged by county from 10% in New Castle County, 13.5% in Kent County and 17.6% in Sussex County.  (Statistics from Kaiser Family Foundation www.kff.org and The News Journal 7/28/10 and are based on 2010 Census.)   

The justices did not hear about the underinsured.  While the uninsured are most at risk, researchers estimate that about a fifth of insured individuals are underinsured, meaning that their health insurance limits coverage.  For example, their policy may not pay for prescription medicines or mental health services, so they face substantial financial costs if they get sick.     

The uninsured paid out-of-pocket for their health care $30 billion in 2008 and left $57 billion in unpaid bills.  This is called uncompensated care.  It is a significant financial burden on hospitals as well as the federal, state and local governments. 

The economic impact on families is significant.  In 2010, 27% of uninsured adults used up all or most of their savings paying medical bills.  Medical bills are the second most frequently cited reason for bankruptcy in the nation.

The American Journal of Public Health in December 2009 reported that lack of insurance can be linked to about 45,000 deaths a year in the U.S.

I spoke to a woman from Clayton who was diagnosed with multiple myeloma and found out her insurance would not pay for the chemotherapy that her oncologist at Christiana prescribed.  She was self-employed and had an individual insurance policy.  Her policy did not cover specialty drugs such as chemotherapy.   She was underinsured.  This is the kind of bad insurance policy that Paul Ryan, Mitch McConnell and Mitt Romney want you to be able to buy across state lines from some shyster a thousand miles away operating in an unregulated insurance market.  So this woman had to quit work, go on disability, beg the pharmaceutical company to give her the medicine for free until she could get Medicare.  That is an expense to taxpayers for the disability payments and it is an additional expense to the pharmaceutical company during a time when pharmaceutical companies, even in Delaware, are laying off workers.

The Supreme Court  justices heard that the uninsured are young people who never go to the doctor and who have willingly made the decision not to buy health insurance because they need to spend their money on other things but they will buy insurance when they need it.  The lawyers made it sound like this is liberty!  This is freedom! Don’t tread on me!

But the uninsured are not all young.  They are not all healthy. And many of them feel shackled, not free.  They feel shackled by the worries of being sick and disabled by disease which has become a pre-existing condition for which they are denied health insurance.

I met a father whose son has hemophilia.  The out of pocket cost of the medicine his 14 year old son needs to stay alive is $15,000 a year.  When the boy becomes a young adult, he is not going to have the freedom to choose not to buy health insurance.  The only way he will be able to get health insurance is if he works for the government or a large corporation that offers good group health insurance.  He will never have the freedom to start his own business or be self-employed because his illness will be a denied, pre-existing condition on the individual and small group markets.  Our economy will never benefit from his potential to be an entrepreneur and to create jobs.

Early retirees, defined as retirees aged 50 to 64, are often uninsured.  They retire before age 65, maybe voluntarily, maybe not so voluntarily.  They may be victims of age discrimination in the workplace.  They may be victims of downsizing in corporations that want to be rid of retiree pension and health care costs.  They may be sick and disabled after years of hard, physical labor.  They are too young for Medicare and they cannot afford COBRA coverage from a former employer.  They just pray that they do not get too sick before they get Medicare at age 65.  But sometimes they do get sick and then they use the emergency room and get admitted to the hospital and the cost becomes uncompensated care which the hospitals and the taxpayers have to pay. 

The uninsured and underinsured bring uncertainty and disorder to commerce and to the labor market.  They significantly impact the health and productivity of the labor force.  This is happening in the health care industry which is 18% of the U.S. GDP.  They represent at least 18% of the non-elderly population, more if you count the underinsured.  They shift costs unto the rest of us.  They account for many personal bankruptcies. The Affordable Care Act can help to solve the problems of uninsurance, underinsurance, and uncompensated care.  So striking down the Act would have a significant impact on commerce and on the labor force.   

So the Supreme Court justices will weigh and balance the relevant issues – impact on commerce, individual mandate, and probably others.  The problem is the strength of the law is dependent on the individual mandate.  If the individual mandate falls, the law will be crippled. 

The individual mandate raises concerns about government intrusion into our lives.  I share those concerns. We live in a society where government puts up cameras on public streets to watch who goes where.  Where the GPS on your cell phone can be used to track you down.  Where the internet is keeping track of every website you go to and every thought you email or tweet.  Where there is a mandate to buy car insurance.  Where you have to get a permit 15 days ahead of time to hold a demonstration on The Green in downtown Dover to exercise your right to assemble and to express your free speech.  Where cameras look at your belongings and your body parts at airports.  Where important IV medicines are not available due to shortages.  Where counterfeit medicines are coming into our country.  Where cardiac stents and orthopedic devices are approved for use before they have been thoroughly tested.  Where young women’s access to family planning services is being threatened.  And you are worried about a mandate – with many exceptions – to buy health insurance? I think we have bigger things to worry about. 

I have learned something from opponents of Obamacare.  I do understand their concern about government intrusion into our lives.  I never thought the case against the individual mandate would go this far or come so close to overturning the law.  Conservatives have arrested Obamacare, taken it to the United States Supreme Court and left it stranded on a cliff. The Supreme Court will either kill it, cripple it or let it live.   Liberals and progressives – I am one – be on guard.  This is what conservatives are capable of doing to the country we love so dearly.      

Two years ago the new Affordable Care Act (the ACA) was passed and meaningful health care reform began.  I would like to summarize what I see happening with the Affordable Care Act here in Delaware.   

If we can all agree we want universal health insurance coverage and we want to bend down the cost curve on rising health care costs, I propose the Affordable Care Act is a good way forward toward our shared goals and it needs our active support.  I don’t claim to know everything about the ACA.  But I try to keep up with the part that helps working people under age 65 who have to buy their health insurance on the individual and small group markets.  These are the people who have always gotten the short end of the stick on health insurance and any attempt at reform over the past decades.  These are people who pay the highest rates and these are the people who get denied for a pre-existing condition.  

This is the part of the Affordable Care Act that really needs our support.  I hope more people will speak up and insist that our elected officials make complete implementation of the ACA with strong consumer advocacy a priority this year.

I believe the passage of the Affordable Care Act in 2010 was a political miracle. If I am handed a miracle I will be determined to protect it and promote it.   Miracles don’t happen every day.  The past 100 years is full of times when America tried to do health reform but countervailing forces fought against each other until the whole thing fell apart. 

Ever since the Affordable Care Act was passed in March 2010 it has been under assault.  First, in February 2011 there was repeal of the 1099 requirement that businesses report all income over $600. That provision would have collected $17 billion over 10 years in previously underpaid income tax and it was to be applied toward the Affordable Care Act.   Senator Carper and Congressman Carney voted to repeal.   So we honest taxpayers have to keep making up for this lost income and the ACA has lost some of its funding.  Remember Speaker of the House John Boehner  told the Cincinnati Enquirer back in September 2010 that federal officials who administer the new health care law will “get not one dime from us. Not a dime”.  

Then Delaware Insurance Commissioner Karen Weldon Stewart tried to get Delaware exempted from the new Medical Loss Ratio MLR rules for small group and individual plans. Thank goodness she lost that one.  Her request was denied.  The new MLR requirements have led to lower premiums because insurers can no longer count taxes or broker commissions as medical expenses.   In Delaware, Aetna has cut premiums on individual policies.    

The Affordable Care Act is being planned and implemented in our state by the Department of Health and Social Services and the Delaware Health Care Commission.  I support their work but I fear a crucial piece is missing.  I fear the implementation of the ACA to its full extent is in jeopardy unless we have a strong advocate that insists on an active, consumer- oriented Health Benefits Exchange with strong consumer advocacy.  The Exchange will be a one-stop consumer resource that simplifies shopping for health insurance.  It has the potential to guide market reforms and identify needed legal and regulatory changes.  

So who is at the table at the Health Care Commission?  Who has a vote to make decisions about implementing health reform in our state? There is representative from the State Chamber of Commerce.  It was recently reported that the U.S. Chamber of Commerce is taking out TV ads supporting Republican congressional candidates who vow to repeal the ACA. Who else is at the table and has a vote?   There is the State Finance Director Tom Cook.  There is a representative from Christiana Hospital and one from the University of Delaware Health Sciences.  Secretary Rita Landgraf very ably represents the Medicaid population.  There is Ted Becker, a small business owner from the beach area, whose main focus is healthcare workforce development.   But there is nobody at the table with a vote whose focus is the interests of the consumers in Delaware who have to buy their health insurance on the individual and small group market.    

The Insurance Commissioner is supposed to represent consumer interests and she does have a seat on the Health Care Commission and a vote. But she has been absent for almost all those meetings over the past year.    

You and I, the citizens who want health reform, have to speak up.  Ask your elected officials, “What is the state doing to get the ACA up and running?”  “Are you familiar with what the Insurance Commissioner is doing to modernize the insurance rate review process?”  “Why did Delaware decide to join a federal Exchange instead of set up our own Exchange?”  “Governor Markel, we want you to appoint a strong consumer advocate to the governing board of the Health Benefits Exchange.” 

Call the insurance companies out on what they do that is wrong.  The ACA says that the governing board of the Exchange shall not include any representative from an insurance company.  But there is an effort in Washington DC to get that rule repealed.  And now they say they will let each state decide for itself.   I believe that would be a mistake.  We need to be sure that the private insurance companies are not on the Exchange governing board. 

So my goal is to get the Affordable Care Act implemented to the fullest extent possible, including strong consumer protections in the individual and small group markets.  And I am not confident that is being done.

 In the meantime the Affordable Care Act is gradually taking shape.  Concrete initiatives are underway.  In Delaware the framework is being laid.   Delaware got a Federal establishment grant of $3,400,096 from the U.S. Department of Health and Human Services to work on the Exchange and the computer portal which will be the point of entry for the consumer to come into the Exchange and see what their choices are.   The portal will be like Travelocity.  Delaware received a $700,000 grant for consultants who worked all last summer and continue to work on public outreach to all stakeholder groups to get their input.  They held public forums throughout the state last summer.  The Delaware Department of Insurance received a $1 million grant to modernize health insurance rate review and open up the process to more public participation. 

This is all part of the Affordable Care Act.   The framework has to be approved by the US Department of Health and Human Services by January 2013,  although now they are saying they may push back that due date.  These delays are dangerous because it gives the opponents of reform more time to chip away at the reform act.  Tell your elected representatives we want no delays and we expect them to stay on top of what is going on. 

Parts of the Affordable Care Act are already in place and helping people.  For example:

1) The new Medical Loss Ratio rules, which are already lowering rates 8-10% in individual and small group markets. 

2) 2.5 million young adults have access to quality health insurance on their parents’ insurance policy.

3) $604 national average yearly savings on prescription medicines for senior citizens who go into the donut hole on their Medicare part D prescription drugs.   The average savings for Delawareans is higher at $757 per year.

4) Delaware’s Department of Insurance has enhanced their oversight of premium rate hikes.  They have a rate review page on their website where they now disclose rate filings before the rates are reviewed and approved, not just after the fact.

5) Public participation in review of unreasonable rate hikes for non-grandfathered insurance plans in the individual and small group markets.

6) Small businesses with fewer than 25 employees may qualify for a tax credit of up to 35% (up to 25% for nonprofits) to offset the cost of employee health insurance.  This credit will increase in 2014 to 50% (35% for non-profits). 

 7) The Affordable Care Act beginning in 2014 puts caps on out-of-pocket expenses.  This will greatly help patients with hemophilia, multiple sclerosis, rheumatoid arthritis, HIV, who have to buy some of the most expensive drugs on the Tier 4 of their drug formulary.  For some Tier 4 drugs, they have to pay 25 to 30% of the total cost.  The Affordable Care Act beginning in 2014 caps the amount these patients spend annually.   The caps are $5,950 for individuals and $11,900 for families.  The spending caps will be adjusted downward for people whose incomes are less than 400% of poverty. 

8) Pre-Existing Condition Insurance Plan.  This offers a comprehensive benefits package to people who cannot get private insurance due to a pre-existing medical condition.  It offers a bridge to 2014, when the new health insurance exchange begins, which also will accept everyone regardless of pre-existing condition.      

The Affordable Care Act is helping to lay down the technical infrastructure for a modern health care system.  Stimulus funding for electronic medical records is coming from the HITECH Act of 2009.  The ACA sets a high standard for the use of electronic medical records in a meaningful way that promotes patient centered medical homes, preventative services and coordination of care among different providers.  One product of that here in Delaware is an organization called Quality Insights.  They are working with over 1,000 medical practices in DE to set up electronic medical systems that meet meaningful use quality standards.  They are giving bonus incentives to the doctors to buy and set up these electronic medical records. This effort has created many good paying, skilled jobs and has laid the infrastructure for a modern health care system   

Another organization that has grown out of the Affordable Care Act is Enroll America –a coalition of businesses, hospitals, doctors, insurers, pharmaceuticals, and representatives from all the states.  They are promoting the use of the latest technology to do online Medicaid application that provides real-time eligibility determinations for Medicaid. They hope to extend this technology in 2014 to take online applications for the Exchange and offer real-time eligibility determinations for subsidies.  Participants will log onto a portal to see what their options are.  They’re working on having live application sites at non-traditional places like kiosks at the mall or the drug store.  In Oklahoma they’re using mobile websites and social media strategies to reach out to consumers to give them application instructions, reminders and important deadlines.  

The Affordable Care Act calls for comparative effectiveness studies using large claims databases.  Progress has been made on that. The very large Medicare claims database up until last year included only traditional Medicare claims data because the private insurers refused to share claims data, stating that their data are confidential and proprietary.  Last year Aetna and some others broke the ice and said they would share some of their claims data for university and government researchers to use.  This data will be used for clinical effectiveness research which will be a source of valuable information for the Independent Payment Advisory Board, another important part of the ACA. 

Governor Markel called for using a claims database here in Delaware to better analyze costs and clinical outcomes in Medicaid.  I would propose that all insurers who want to sell on Delaware’s Health Benefits Exchange should be required to share their data on a total statewide claims data base. 

Many good paying jobs in research and statistics are being created by all this.  I told a group of Wesley College  students three years ago that if they have an interest in math, look into statistics and computer science as a career path because there will be many good jobs, both private and public, in this type of research. 

We are seeing the creation of companies like ActiveHealth which uses computer software to sift through patient data on claims and prescriptions to determine and identify trends.  Astra Zeneca just last month  started a collaboration with IMS Health, another group that goes through existing anonymous electronic health records to identify clinical outcome and economic and treatment pattern data.  Astra Zeneca already has a research partnership with HealthCare, a subsidiary of WellPoint.  This makes possible real-world analyses of hospital length of stay, readmissions, and overall health status and cost of care. This is being driven in part by the new health reform law.

Opponents of reform are using the Supreme Court as an excuse to halt work on the ACA’s implementation.  That was their intention all along.  To stall.   I say “No, Do not stall progress.” 

The Affordable Care Act is thousands of people working to implement it, millions of people already benefiting from it, and millions of dollars already invested in the infrastructure for a modern health care system.   All of this after the political miracle of getting it passed in the first place.   I submit to you that if our common goal is universal health care and bending down the cost curve on rising health care costs, that the ACA is the better way forward.  Finally after decades we see significant health reform as it applies to the working people under age 65.  Let’s work together to fully implement the Affordable Care Act.  Everybody call or email Governor Markel and your elected officials and ask “When will Delaware’s Health Benefits Exchange be set up and how will you insure that strong consumer advocates will be on its governing board?”

In conclusion, the Affordable Care Act is a work in progress and citizens who support health reform have a role to play in getting it implemented to the maximum benefit possible.  We are still in a fight.  

The new health reform law, the Affordable Care Act (ACA), establishes an Independent Payment Advisory Board (IPAB) with authority to issue recommendations to reduce growth in Medicare spending. One of the reasons for establishing IPAB was to separate Medicare policymaking from Congressional politics.  IPAB can make expert recommendations about Medicare, within spending constraints established by Congress.   Congress then must decide on the Board’s recommendations by a simple up or down vote on a fast-track basis, meaning they have to vote it up or down within a required timeframe.   The Board is prohibited from recommending changes in premiums, benefits, eligibility or other changes that would result in rationing health care services.   

The IPAB will be composed of 15 full-time members appointed by the President and confirmed by the Senate.   Board members must have an expertise in health care, economics, research and technology assessment, experience with employers and third-party payers, and consumers.  It requires a balance between urban and rural representation.  A majority of members must be non-providers. 

Some in Congress, mostly Republicans but some Democrats too, want to repeal the Independent Payment Advisory Board.  Representative Phil Roe (R-TN) introduced HR 452 “The Medicare Decisions Accountability Act of 2011” which would repeal the IPAB and will likely be voted on this week.  Senator John Cornyn (R-TX) introduced S. 668 “Health Care Bureaucrats Elimination Act” which would repeal the IPAB.  They claim that the IPAB will lead to bureaucrats rationing health care for seniors.

Also opposing the IPAB are the pharmaceutical industry, the hospital industry, and physician groups – which makes me wonder – What are opponents afraid will be rationed?  Are they worried about health care for seniors or are they worried about income for providers and power for Congressmen?

In support of the IPAB, the Bowles-Simpson National Commission on Fiscal Responsibility and Reform proposes to strengthen the role and authority of IPAB and give it greater flexibility to reduce the growth in Medicare spending.

Congressmen Paul Ryan (R-WI) and Eric Cantor (R-VA) say that the free market should make these decisions, not IPAB.  Congressman Barnie Frank (D-MA) says that Congress should make these decisions, not the free market or IPAB.

So do you believe that the new health reform law will ration your health care?  Is this a good thing or a bad thing?

 I believe that health care has been rationed in the past, is being rationed now and, yes, will be rationed in the future.  Under the current system, you get health care services if you work for a large employer who offers you a good group health insurance policy or if you are dirt poor and qualify for Medicaid or if you are old and get Medicare. Most everybody else is rationed out of our health care system.

Who do you think should make decisions about what medical care you get and how much care you get?  Should it be the free market, the elected officials in Congress, your doctor, a Board of medical experts, yourself, or some combination of these?  I think it should be medical experts who have objectively studied the issue, your doctor, you, and to some extent the free market, but not the politicians in Congress. 

I support the IPAB because I believe it will help our country to build a higher quality, more cost effective way of delivering essential health benefits and it will be independent of the political influence of Congress. I think the current effort in Congress to repeal the Independent Payment Advisory Board is wrong.  Powerful, entrenched interest groups are resisting change.  Our challenge is to stay focused on reforming our health care system, and reform includes the Independent Payment Advisory Board.

I am disappointed in Jim Flood Sr.’s opinion piece in the Dover Post 3/7/12 where he talks about a “contraception mandate” in the new health reform law as if insurance coverage for birth control pills is a new idea forced on us by President Obama and the new health reform law.  He also suggests that because there is “strong opinion” about this, then “it must be resolved by the Supreme Court”.

Family planning services, including contraceptives, is a woman’s right firmly fixed in law by Title X [“Population Research and Voluntary Family Planning programs” (Public Law 91-572)] which was enacted in 1970 under President Nixon. President Obama and the new health reform law comply with Title X law.  There is no legitimate legal dispute to take to the Supreme Court.

The Catholic Bishops, Rick Santorum, Mitt Romney, and Rush Limbaugh may have a “strong opinion” against your insurance paying for your birth control pills, but they cannot rob us of our legal rights and send us back in time over forty years.  Women have fought for these rights for decades.  I hope that women across this country work together to resist this attack on our rights to family planning and related preventative health services.  This is an essential health benefit that should be covered by insurance.

Secretary Rita Langraf announced on 3/1/12 that Delaware will not pursue our own State Health Benefits Exchange and will instead pursue a federal partnership model. Delaware will proceed with a spirit of collaboration with other states with small populations. Other "low population" states that are looking at a federal model are Arkansas, Montana, New Hampshire, South Carolina, and Wyoming. The reasons given for this decision are the cost, low numbers, the uncertain future of the exchanges, and time constraints. We can expect further announcements in April.
My first thoughts are how will a federal exchange deal with different state insurance regulations?  Will this be the beginning of a regional health insurance market?  How will that work when the states are not contiguous? 
To my friends in the Republican Party who always say that health reform should be left up to the states, I say here is your answer.  Many states simply are not able to change their health insurance market on their own.

More to come.  Comments are welcomed.