“Starting in September, some of the worst abuses will be banned forever. No more discriminating against children with pre-existing conditions. No more retroactively dropping somebody’s policy when they get sick if they made an unintentional mistake on an application. No more lifetime limits or restrictive annual limits on coverage. Those days are over.” – PRESIDENT BARACK OBAMA

President Obama announced a Patient’s Bill of Rights made possible under health reform—a basic set of consumer protections that end some of the health [...]]]>

“Starting in September, some of the worst abuses will be banned forever. No more discriminating against children with pre-existing conditions. No more retroactively dropping somebody’s policy when they get sick if they made an unintentional mistake on an application. No more lifetime limits or restrictive annual limits on coverage. Those days are over.” – PRESIDENT BARACK OBAMA

President Obama announced a Patient’s Bill of Rights made possible under health reform—a basic set of consumer protections that end some of the health insurance companies’ worst abuses.

• 1. Prevents insurance companies from canceling your policy if you get sick. Right now, insurance companies can retroactively cancel your policy when you become sick if you or your employer made an unintentional mistake on your paperwork.
• 2. Stops insurance companies from denying coverage to children with pre-existing conditions. Beginning in September, discrimination against children with pre-existing conditions will be banned—a protection that will be extended to all Americans in 2014.
• 3. Prohibits setting lifetime limits on insurance policies issued or renewed after Sept. 23, 2010. No longer will insurance companies be able to take away coverage at the very moment when patients need it most. More than 100 million Americans have health coverage that imposes lifetime limits on care.
• 4. Phases out annual dollar limits on coverage over the next three years. Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for your health care. For the people with medical costs that hit these limits, the consequences can be devastating.
• 5. Allows you to designate any available participating primary care doctor as your provider. You’ll be able to keep the primary care doctor or pediatrician you choose, and see an OB-GYN without referral.
• 6. Removes insurance company barriers to receiving emergency care and prevents them from charging you more because you’re out of network. You’ll be able to get emergency care at a hospital outside of your plan’s network without facing higher co-pays or deductibles or having to fight to get approval first.

The Patient’s Bill of Rights starts to take effect this fall—but the benefits for individuals and families under health care reform don’t stop there. Over the course of the next several years, the historic health reform law will make care more affordable, hold insurers accountable, and finally give all Americans the coverage they deserve.

To learn more about what’s in the health care reform bill, please visit:
WHITEHOUSE.GOV

BY ANDREW GRANT-THOMAS at Race-Talk  (Kirwan Institute Project)

The recently passed health care reform bill, formally known as the Patient Protection and Affordable Care Act, will do much to support the health of people of color, not least through its expansion of Medicaid coverage to the near-poor and to childless adults mostly excluded from coverage previously.

Businesses with more than 50 employees will have to provide insurance to them all and private insurers will no longer be able to deny coverage to people [...]]]>

BY ANDREW GRANT-THOMAS at Race-Talk  (Kirwan Institute Project)

The recently passed health care reform bill, formally known as the Patient Protection and Affordable Care Act, will do much to support the health of people of color, not least through its expansion of Medicaid coverage to the near-poor and to childless adults mostly excluded from coverage previously.

Businesses with more than 50 employees will have to provide insurance to them all and private insurers will no longer be able to deny coverage to people with preexisting conditions. As psychiatrist Flavio Casoy notes in his excellent overview of the law, such measures “will be a lifeline for millions of people of color who are now blocked from getting health care services they desperately need.”
Bravo! But let’s not mistake the milestone for our destination.

The new health-reform law is but one cornerstone in the edifice we must build to support long, healthy lives for all our people. For one thing, according to the Congressional Budget Office, by 2019, years after all the law’s provisions will have gone into effect, an estimated 23 million people will remain uninsured. Undocumented immigrants, nine in ten of them people of color, will comprise roughly one-third of that number. Nonwhites will also be prominent among those who earn too much to qualify for Medicaid but too little to afford even a subsidized insurance plan. The Patient Protection and Affordable Care Act is a major step in the right direction, but it is not universal health care.

We also know that insurance coverage guarantees neither access to quality health care nor good health, and here, too, minorities suffer in comparison to whites. Broader coverage will not in itself increase the number, capacity, or cultural competence of health professionals in the underserved communities that are home to so many racial and ethnic minority group members. Indeed, extending coverage without increasing the number of primary care providers may well deepen racial inequities in health by further straining health care capacity in under-resourced areas.

Since the passage of near-universal healthcare in Massachusetts in 2006, emergency room visits in the state have spiked, fed largely by demand from newly insured patients with conditions best treated by primary care doctors. As Dr. Sandra Schneider of the American College of Emergency Physicians observes, “Just because you have insurance doesn’t mean there’s a physician who can see you.” Increasing the supply of primary care providers qualified to meet the needs of residents in all our nation’s communities is a critical arena in which much remains to be done.

Beyond the matter of access to care, people of color often receive lower quality of care than whites do. In Unequal Treatment, the landmark report issued by the Institutes of Medicine in 2003, the study committee concluded that the poorer health outcomes suffered by racial minorities relative to whites was due in part to their “unequal treatment” at the hands of health care providers and within health care systems.
Nonwhites are less likely to get lifesaving heart medications, bypass surgery, dialysis, or kidney transplants. They are more likely to have feet and legs amputated for late-stage diabetes treatment. Three in ten Latinos say they have had a problem communicating with health providers; two in ten say they have had difficulty getting care because of their race or ethnic background. In a 2005 survey conducted by the American Medical Association, 55 percent of physicians responding agreed that “minority patients generally receive lower quality care than white patients.” Two in three acknowledged having seen a patient receive poor care because or his or her race or ethnicity. The new healthcare law calls for enhanced data collection and reporting on race and ethnicity, as well as on sex, primary language, disability and for underserved rural and frontier populations. That call is to be applauded. Unfortunately, the law includes few measures aimed at the issues of racial inequities of health care raised in Unequal Treatment.

Looking ahead, we must insist that questions of coverage, provider numbers and capacity, and quality of care be asked and answered thoughtfully and forcefully. However, the most critical oversight in the national debate over health reform concerns the social determinants of health.

These are the social conditions, shaped by distributions of power, interests and resources, and given form by policy decisions, that most account for racial group disparities in health – food quality, poverty, working conditions, social exclusion, neighborhood environment, housing, social networks, exposure to chronic stress, discrimination, the diffusion of medical technology, and more. The Centers for Disease Control and Prevention has long suggested that suboptimal health care quality and access accounts for about 10 percent of premature deaths in the United States. Simply put, there is far more to health than health care.
Consider, for example, the racial geography of health. In 2000, black and Latino children were 32 percent of all children in the United States but were 84 percent of children living in severely distressed neighborhoods – defined as areas with high rates of poverty and high percentages of single-mother families, high school dropouts, and jobless adult males. One in 100 white children lived in such neighborhoods, as did one in four black children and one in eight Latino children. In 82 metropolitan areas, the typical poor black child lived in a neighborhood with a poverty rate of at least 20 percent. The same was true for poor white children in only five metropolitan areas.

Why dwell on these comparisons? Because we know that the physical and social conditions of neighborhoods shape their residents’ access to differing bundles of social, psychological, and economic resources and opportunities: access to healthy or unhealthy foods, more or less crime and safety, parks and jogging trails, playgrounds, pollution and toxins, social disorder, trust and cohesion, and the like.

In the words, of the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, variations along these dimensions of neighborhood life have been linked repeatedly to a range of health outcomes, including “mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other risk factors for chronic disease, as well as with mental health injuries, violence and other important health indicators.” Even when the causal pathways are unclear, this much we know: poor, racially isolated neighborhoods exact a terrible toll on the people who live there.

Creating “neighborhoods of opportunity” for all – and otherwise forging policy responses that account for what we know about the social determinants of health – is a formidable challenge, but one we can meet.

• We could consistently site new affordable housing developments in low-poverty, high-opportunity neighborhoods that improve rather than depress residents’ life chances.
• We could subsidize the movement of supermarkets, farmers markets, and other sources of fresh fruits and vegetables into communities that desperately need them.
• We could fashion school assignment plans that don’t condemn low-income children of color to substandard schools.
• We could implement zoning changes that reduce the concentration of pollution and hazardous wastes in already-disadvantaged neighborhoods.
• We could convert vacant land into community gardens and urban parks. We could provide more classes for parents on the critical importance of diet, exercise and immunizations for their children’s well-being.
• We could greatly reduce the spatial and social isolation of so many African Americans and Latinos through stricter monitoring of housing market practices, stronger enforcement of fair housing laws, expanded use of housing mobility programs, and more targeted homeownership assistance.
• We could do these things and more. And we must.

None of this is to suggest that the struggle for better health care is over. As Atul Gawande notes in The New Yorker (“Now What?”, April 5), even with passage of the Patient Protection and Affordable Care Act a number of hurdles must be overcome before its limited-but-important promise is realized.

These challenges include the anti-reform lawsuits planned by at least a dozen state Attorneys General, public ambivalence, and an energized opposition. Moreover, the slow phase-in of key provisions of the law will make it vulnerable to attack well beyond the immediate legal and political battles. And even then, Gawande observes, will the communities charged with making the provisions of the law work actually muster the creativity and thoughtfulness to do so? There are no chickens to be counted here.

The point is that even if all these challenges are met, we have much more – and even more critical – work to do.

BY NATUREIS2BLOOM

“If we want our study samples to be broadly representative, then we should make every effort to make our institutions equally representative by increasing the presence of minority clinicians, scientists and members of research teams and institutional review boards. If we want minority communities to participate in our work, we must first fix the racial and ethnic imbalance that continues to tilt our ivory towers.” — Somnath Saha, M.D., M.P.H., of the Portland VA Medical Center, Oregon

Springtime has [...]]]>

BY NATUREIS2BLOOM

“If we want our study samples to be broadly representative, then we should make every effort to make our institutions equally representative by increasing the presence of minority clinicians, scientists and members of research teams and institutional review boards. If we want minority communities to participate in our work, we must first fix the racial and ethnic imbalance that continues to tilt our ivory towers.” — Somnath Saha, M.D., M.P.H., of the Portland VA Medical Center, Oregon

Springtime has many rites of passage attributed to it alone: garden parties, weddings and graduations, to name a few. As I reflected on these ideas.

I began to consider the spring season of 2009, and far less romantic notions. During last year’s spring, many American’s stood aghast as an unseasonable breakout of influenza ripped through the country. Health professionals and the general public scrambled to keep up with the recommends and precautions being issued via health-related government agencies like the Centers for Disease Control (CDC) and NIH (National Institute of Health).
Many of us living in large metro areas saw the health crisis began to hit home as both children and adults in these urban communities lost the struggle with a newly identified influenza, given the unusual moniker H1N1. We began to decline hugs and handshakes from one another and keep our children home, while witnessing school closures, dozens of surgically-masked people walking the streets, and hospital ER lines that wound around city blocks.
The predictions for the fall flu season were exceptionally grim, and the race to develop a vaccine against the H1N1 strain began in fervor. By October 2009, a vaccine was available, and the Centers for Disease Control (CDC) identified high risk populations who should receive the vaccine. Urban populations, specifically African Americans, were encouraged to get the vaccine. To the bewilderment of the medical establishment, the Black community viewed the invitation with suspicion and doubt. Why, people wondered, after seeing the frenzied outbreak of this illness the previous spring, were Blacks now balking at receiving the vaccine designed to prevent it? One possible suggestion is the lack of confidence held by many in the African American community for the health care system.

Black distrust of the health care system is shrouded in the history that bears witness to a system built on the bodies of our ancestors. Attorney and author Vernellia R. Randall’s book, Dying While Black, charts this phenomenon, beginning in the nineteenth century and continuing through the modern period, including the allegations that AIDS was created by a government sanctioned health care system. Her research illustrates to us how Blacks have been exploited by the medical sciences for the purpose of research, often without knowledge or consent. Here we find stories shared by Black residents of northern and southern cities about the “night doctors” – medical personnel that would grab Black citizens for use in experiments after the sun went down. Although this has never been substantially documented, there is evidence that during this period the bodies of the Black deceased were systematically being removed from their graves for the purpose of medical research.

During the 1890s, the American health care system experienced an unprecedented boom in research and scientific growth that was internationally noted as bold and brilliant, and not being performed anywhere else on earth.

Tragically, these advances were at the expense of the health and welfare of the Blacks and other poor populations in the country. Enslaved Blacks in particular served as instructional material for teaching medical students both here and abroad.

There are several well researched and documented instances of medical abuse and misconduct where Blacks have been subjects of ill-advised, if not patently criminal research studies. The Tuskegee Syphilis Experiment is one such case. The Tuskegee Experiment involved four hundred African American men in a government-sponsored study to research the effects of untreated syphilis. This “study” began a few years prior to the development and use of penicillin as an effective treatment for syphilis. Yet it continued for nearly thirty years after the known availability of effective treatment. The men involved with the study were never offered the antibiotic. In fact, the intended end point of the research experiment was the post-mortem exam of each participant to study the ravages of the disease on the Black male vis-à-vis that of the white population.

Unfortunately, the Tuskegee debacle is not an isolated event; many more instances of bioethical misconduct occurred in the mid- and late twentieth century period. During the 1960s and ‘70s, cases became exposed all over the country. Black prisoners were used for skin-testing experimental drugs; blood samples were obtained from thousands of Black boys to test for “anemia” (the blood was actually being collected for a study on the genetic predisposition to criminal activity); young and poor Black women were used to test a device for terminating pregnancy that resulted in severe bleeding and total hysterectomy; a Sickle Cell Anemia testing program breached medical confidentiality, leading to poorly managed “genetic counseling” services which seemed to serve as Black population control and genocide. The list goes on.

There is a long and un-storied history of medical science and its abuses toward what it has considered the dregs of humanity: the poor, uneducated, and the “feeble-minded.” In the Jim Crow south, “Negro” was parlance for all of the above. The Immortal Life of Henrietta Lacks, a book on Blacks and bioethics by author Rebecca Skloot, tells the story of Henrietta Lacks, a Black woman who was thrust into the void when she developed cervical cancer. Born on a 1950s tobacco farm in the Jim Crow South meant that health care was relegated to the so-called public wards of Johns Hopkins University Hospital. The hospital was, at that time, one of the few that would see black clients. Without her consent, tissue samples were collected from Mrs. Lacks and developed in the cytology laboratories at Johns Hopkins. The cells thrived (unlike others collected samples) and were so prolific, they were sold throughout the United States and internationally to research labs. The HeLa cells, as they are known globally, have been used extensively in biomedical and pharmaceutical research, including the development of the polio vaccine, breast cancer treatment drugs, and human-origin insulin, and many, many others. Breakthroughs that have made lives better the world over. Sadly, these medical triumphs came at too high a price for the Lacks family, and specifically her children who were never aware of their mother’s contributions to science until an article was published and medical science came knocking at their doors (again) seeking additional genetic and biological tissue from them.
The Lacks’ family story is merely the most contemporary exposé of an unhealthy relationship between African Americans and the medical community at large, in matters related to trust and confidence. It begs the question, “How is the medical community responding to this lack of confidence?” A health care survey conducted in 2009 found that Blacks (as opposed to whites) were more likely to not trust their doctors when it came to addressing their health concerns, or explain treatment for medical conditions to their satisfaction.

There continues to be an underlying element of mistrust between minority populations at any socioeconomic level and the American health care system at large. Clearly, the perception of mistrust from the African American community in particular is in largely caused by previous experiences with the health care system, and the history that has deepened that distrust.

The realities of the Tuskegee and HeLa experiments have the effect of maintaining and strengthening the distrust in the health care system by Blacks in ways that may be inestimable. It leaves many African Americans, as well as other underrepresented populations, wondering how they may fare better when assessing the health systems in existence. Fortunately, gains may be made via the newly adopted health reform bill, which includes provisions for improvements in the delivery of health services and information. The reform bill is not without flaws, however, and research study protocols continue to be a prickly area everywhere in health delivery.

The very structure of modern healthcare delivery systems depends upon these constructs to assure the safety and respect of its main consumer – the patient. Science and medicine have at their disposal disciplines to assist in the management and delivery of ethical health services. Every stakeholder in the health care industry must be implored to comply with the ethical principles of nonmaleficence (“first, do no harm”) and beneficence (“actively doing good”). Bioethics review boards and panels are standing committees at most pharmaceutical research and hospital centers. Ethicists operating within the medical and pharmaceutical disciplines have designed reasoning frameworks that may be applied to the prickly topics that arise at the intersection of medicine and race. Increased representation on these bioethical review boards by minorities and lay persons would assist in quality assurance for all health care consumers. The involvement of independent “watch-dog” organizations, such as Amnesty International, may also help. Amnesty is currently completing an open study on the high mortality rate of young, pregnant, and poor women in the United States, with a focus on Black populations.

The truth is that many of the health consumer/patient protections in place continue to function at the expense of human beings like the men in the Tuskegee program and Henrietta Lacks. Government agencies entrusted with the public‘s health, organized medicine, and the pharmaceutical industry have much work to do to create a progressive, inclusive health care system that fosters trust and confidence. Our health care system needs a check-up in the ethical ward, so to speak, to revitalize that trust. Our health care system and all of its principals must indeed be committed to both doing good and avoiding evil.

Photo: Brandon Marty, 13, gets his H1N1 vaccination in the form of a nasal spray at Montefiore Medical Center, Bronx, NY. Giancarli/News

ERICA WERNER,Associated Press JULIE PACE,Associated Press

WHEATON, Md. (AP) — Barack Obama on Tuesday sought acceptance of the new health overhaul law from skeptical seniors, a crucial constituency the White House wants to win over, even as the Gulf oil spill dominates public debate and the president’s time.

The questions Obama got from a large crowd at the Holiday Park Multipurpose Senior Center in suburban Maryland, and from others listening on the phone, suggested that even if [...]]]>

ERICA WERNER,Associated Press
JULIE PACE,Associated Press

WHEATON, Md. (AP) — Barack Obama on Tuesday sought acceptance of the new health overhaul law from skeptical seniors, a crucial constituency the White House wants to win over, even as the Gulf oil spill dominates public debate and the president’s time.

The questions Obama got from a large crowd at the Holiday Park Multipurpose Senior Center in suburban Maryland, and from others listening on the phone, suggested that even if rancorous debate has faded, plenty of doubts remain. And there’s only so much Obama can do to ease them. That may be a sobering prospect for the White House with crucial midterm elections looming.

Tuesday’s event was timed to coincide with the release later this week of the first batch of $250 checks to seniors who fall into Medicare’s prescription drug coverage gap, known as the “doughnut hole.” Some 4 million elderly and disabled people will get checks this year, a down payment on the law’s approach of closing the doughnut hole entirely over the next decade.

The first question Obama got, from a woman in the audience: Why can’t he close the doughnut hole faster?

Answer: “It’s very expensive.”

The next question was from a listener in Illinois who wanted to know whether participants in the private insurance plans in Medicare, called Medicare Advantage, would lose benefits.

The answer is yes, according to the Congressional Budget Office, but Obama didn’t come out and say it, explaining instead that Medicare Advantage plans are overpaid and subsidized by the majority of seniors who are on regular Medicare — something that’s also true.

Obama’s overall message: “What you need to know is the guaranteed Medicare benefits you’ve earned will not change … your guaranteed benefits will not change.”

He took shots at Republicans who want to repeal the law and said, “We’re going to fight any effort to go back to a system that doesn’t work for the American people and doesn’t work for our seniors.”

It might not be enough to reassure them.

Another question was from a laid-off worker in Nevada, too young for Medicare, who asked about losing COBRA subsidies that help him keep insurance.

Obama noted that the health law will help people like that join purchasing pools to gain competitive power to buy insurance. It won’t happen until 2014, so it won’t provide the immediate relief the Nevada worker is seeking.

But, Obama said optimistically, 2014 “is right around the corner.”

Copyright 2010 The Associated Press.

Even though most African Americans are extremely pleased with the passage of the New Healthcare Reform Bill, their is still widespread concern and confusion as to how this bill will affect  Small Business. Stephanie Cutter, writing for the White House Blog, lays this concern to rest.

Posted by Stehpanie Cutter

Today, an opinion piece in the Wall Street Journal misstates many provisions of the Affordable Care Act and fails to mention the many ways the new law will improve our health [...]]]>

Even though most African Americans are extremely pleased with the passage of the New Healthcare Reform Bill, their is still widespread concern and confusion as to how this bill will affect  Small Business. Stephanie Cutter, writing for the White House Blog, lays this concern to rest.

Posted by Stehpanie Cutter

Today, an opinion piece in the Wall Street Journal misstates many provisions of the Affordable Care Act and fails to mention the many ways the new law will improve our health care system for small business owners and their employees. Here are the facts:

Bringing Down Costs, Reducing the Deficit
Without reform, health care costs will continue to crush business and government budgets. The Affordable Care Act reverses this trend. Americans buying comparable coverage to what they have today in the individual market would see premiums fall by 14 to 20 percent.  The total cost of care provided to Americans who get their insurance through the workplace could fall by as much as $3,000 a person and lower costs will make it easier for businesses to provide quality benefits to their employees. And the Congressional Budget Office has also confirmed that the Affordable Care Act will reduce the deficit by more than $100 billion by the end of the decade and lead to even greater deficit reduction in the next decade.

Cost Reduction and Tax Credits for Small Business
An estimated 4 million small businesses nationwide could qualify for a small business tax credit this year, which will provide a total of $40 billion in relief for small firms over the next 10 years. These tax credits are specifically targeted to the small firms that find it hardest to provide insurance to their workers. Qualifying for the credits isn’t difficult, nor does it require small business owners to fill out a long series of new forms. You can learn more about the tax credits here.

But tax credits aren’t the only way small businesses will benefit from the Affordable Care Act. A number of reforms in the new law will bring down premiums and health care costs for all Americans. Those reforms include rewarding providers for providing high-quality care and fighting waste, fraud and abuse. The new law also gives small businesses access to Small Business Health Options Program (SHOP) Exchanges. Currently, small businesses pay 18 percent more in premiums and higher administrative costs than large businesses. SHOP exchanges will expand the purchasing power of small businesses and the Congressional Budget Office has confirmed that they will help drive premiums down.

Requiring Insurance Companies to Pay Their Fair Share
Under the Affordable Care Act, insurance companies will have access to millions of new customers, many of whom will receive support from the federal government to purchase private insurance. With insurance companies reaping such a substantial benefit, it’s only right for them to pay their fair share and do their part to reform and improve our health care system.  An analysis of the impact of reform legislation on insurance premiums by the Congressional Budget Office found that the impact of insurance industry fees on small firms would be “modest,” and that even after accounting for these fees, small group plans will face lower premiums to purchase health insurance coverage.

Reporting Requirements
Beginning in 2013, the new law includes provisions requiring new information reporting on the purchase of certain goods. Some in the business community have expressed concerns with this provision and the IRS is looking for every way to minimize any burden on businesses and avoid duplicative reporting. For example, the IRS has already indicated that transactions done with a credit or debit card will be exempt from this provision, so whenever a business uses a credit card for a purchase, there will be no reporting requirement under the new law. The IRS is working diligently to answer questions on this provision and will consider alternate approaches and continue to seek out input and comments from small businesses in the weeks and months ahead.

The Bottom Line
The Affordable Care Act will bring down costs and improve health care for all Americans – including small business owners and their employees. You can learn more about the benefits of the new law for small businesses by clicking here.

Stephanie Cutter is Assistant to the President for Special Projects

Scott P