Archive for the 'health' Category

Why Organized Labor Is Organizing Against Obamacare

This significant article shows a potential new source of support for winning Single-Payer healthcare: organized labor. Unions which had held back from embracing Single-Payer because they had their own health plans are now realizing that Obamacare does not just encourage employers to cut back full-time jobs to un-benefited part-time jobs. Obamacare also damages hard-won union-based health plans.

2013-09-17-GP_meeting-detail

Click to enlarge image.

The Fiscal Times, August 30, 2013

Why Organized Labor Is Organizing Against Obamacare
(Read this article on-line at http://tinyurl.com/pchnggr )

By ERIC PIANIN, The Fiscal Times

Now look who’s making a fuss about Obamacare.

President Obama has had his hands full fending off Republican assaults against Obamacare. Sen. Ted Cruz of Texas and a handful of other GOP lawmakers even favor shutting down the government, if necessary, to prevent the new law from fully taking effect.

But Obama is also getting blasted these days from an unexpected quarter: Major labor groups instrumental in helping the president win a critical second term are charging that Obamacare is undercutting existing union-sponsored health insurance programs and even encouraging employers to cut workers’ hours.

This is the latest bizarre wrinkle in the unfolding political drama over Obama’s signature program for extending health insurance coverage to millions of uninsured Americans.

Last month, leaders of three of the largest labor unions sent a scathing letter to Senate Majority Leader Harry Reid (D-NV) and House Minority Leader Nancy Pelosi (D-CA), warning that if the problems with the insurance program are not addressed, the new health care law will “shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour work week that is the backbone of the American middle class.”

The letter was written by James Hoffa, president of the International Brotherhood of Teamsters, Joseph Hansen, president of the United Food and Commercial Workers International Union, and Donald Taylor, president of UNITE-HERE, a union that represents hotel, airport and food service workers. It stressed the unions’ displeasure with a law they all had previously supported and helped to pass.

“When you and the president sought our support for the Affordable Care Act, you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat,” said the letter. “We have been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision. Now this vision has come back to haunt us.”

AFL-CIO president Richard Trumka echoed those concerns Thursday, telling reporters during a breakfast event that the administration and Congress made some serious blunders in drafting the legislation that must be fixed to quiet the growing union discontent.

“We’ve been working with the administration to find solutions to what I think are inad-vertent holes in the act,” said Trumka. “When the act was put together, it wasn’t thought completely through. So we work on a daily basis. I’m hopeful we get something done in the very near future.”

PERVERSE INCENTIVE?

From labor’s perspective, arguably the biggest problem is that the law – when fully implemented – will create an incentive for employers to keep their workers’ hours below 30 hours a week.

The Affordable Care Act will eventually penalize firms employing 50 or more people that don’t offer health insurance – or that offer coverage below minimum standards. This is the so-called “employer mandate.” The White House this summer put that provision on hold until 2015 to give medium and large employers the opportunity to better prepare and plan for the changes and reporting requirements. But once that provision finally takes hold, union leaders say that companies will cut the hours of workers below 30 hours per week to get under the 50-worker threshold for providing health care coverage.

With salaries remaining relatively static during this tepid economic recovery, a cutback in hours would be tantamount to a substantial pay cut for many union and other workers who are struggling to make ends meet.

“Employers are trying to plan their future by creating a work force that gets 29-and-a-half hours or less a week, so that they don’t have to pay health care,” Trumka said yesterday. “That is obviously something that no one intended….Is that an issue? Yeah, that’s an issue.”

Labor leaders also fear that Obamacare may end up “destroying” the union’s multi-employer health plans unless it is changed.

At issue are “Taft-Hartley plans” – the non-profit health care plans long used by union-ized workers in the building trades and service industries and jointly administered by participating companies and unions. Those plans have traditionally allowed workers in transient industries to move between employers while still preserving the same quality of health care. Because union leaders have helped negotiate those plans, they typically offer strong coverage at a low out-of-pocket cost to workers.

Under the Affordable Care Act as currently interpreted by the administration, union members with this form of health insurance coverage would not be entitled to federal tax subsidies available to others who purchase policies from private companies in the new insurance exchange, according to labor leaders. Moreover, many union members who hold these “non-profit” policies may get hit with federal taxes to help offset the cost of the subsidies offered in the new state exchanges.

“Taken together, these restrictions will make non-profit plans like ours unsustainable, and will undermine the health-care market of viable alternatives to the big health insurance companies,” according to the letter sent to Reid and Pelosi by the labor chiefs.

The Treasury Department has signaled it views the Taft-Hartley plans as equivalent to other employer-based plans, which aren’t eligible for subsidies. And the Congressional Research Service, a nonprofit legislative analysis group, published a paper saying Taft-Hartley plans likely wouldn’t be eligible for subsidies based on the way the law is written.

The health care law is likely to be a prime topic of conversation when Obama addresses the AFL-CIO’s Quadrennial Convention next month in Los Angeles. Obama’s relations with labor have been rocky at times, for sure. Yet while he’ll talk about his plans to create jobs, provide better pay and strengthen workplace protections, the president’s speech on Sept. 9 may not include every reassuring word that labor leaders are right now longing to hear.

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Spaniards Protest Health Care Reforms: privatization, closures of public facilities

Spaniards Protest Health Care Reforms

By HAROLD HECKLE
Associated Press

Protestors march as they carry a banner reading, “Public health care” and “24 hours strike” during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

MADRID — Thousands of people marched in Madrid on Sunday to protest plans to privatize parts of their public health care system, with some questioning the motives behind the government’s actions.

The march by employees and users of the system is the year’s second large “white tide” demonstration, named after the color of the medical scrubs many protesters wear. Several similar marches took place last year.

Demonstrators thronged main boulevards in the center of the Spanish capital, carrying banners saying, “Public health care should be defended, not sold off.”

The Madrid region has proposed selling the management of six of 20 large public hospitals in its jurisdiction and 10 percent of its 268 public health centers. It says these reforms are needed to secure health services during Spain’s economic crisis.

A protestor carries a banner reading, “Spanish Prime Minister Mariano Rajoy, serial fraudster” during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

But protesters were skeptical.

“This measure is politically inspired and not financial,” said mechanical engineer Mario Sola, 47. “If public hospitals were unsustainably loss-making as we’re being told, private enterprise wouldn’t be interested.”

Health care and education are administered by Spain’s 17 semi-autonomous regions rather than by the central government.

Many regions are struggling financially as Spain’s economy has shrunk due to a double-dip recession following the 2008 implosion of the once-prosperous real estate and construction sectors.

Some regions overspent during boom years, but are now excluded from borrowing on the financial markets to repay their accumulated debts, forcing them to seek savings and even request rescue aid from the central government.

Regional health councilor Javier Fernandez-Lasquetty called the protests irresponsible and said that “everyone has their point of view, but we are all fighting to defend the same thing.”

Jose Gabriel Gonzalez Martin, president of Spain’s Independent Civil Service Trade Union Center, said many people’s suspicions were aroused when former government health officials acquired jobs with private companies lining up to take over medical analysis functions.

“It might be purely coincidental, but some coincidences are surprising,” Gonzalez said.

Protestors shout slogans during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

 

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Fight Foreclosures and Evictions: Take Your Money Out of Wells Fargo

Indybay Media, December 18, 2012

Take Your Money Out of Wells Fargo

by Patricia Jackson

Gray Panthers leaving WF Bank after closing account

On Tuesday, December 18, two senior organizations took their money out of Wells Fargo and joined a protest rally outside at Grant and Market in San Francisco. James Chionsini of Senior Disability Action and Michael Lyon of Gray Panthers addressed the rally after they had closed their organizations’ accounts and called on other organizations to also take their money out of predatory banks. Prior to the rally and while members of Gray Panthers and Senior and Disability Action were inside closing their accounts, a Wells “undercover spy” approached several protesters and took our pictures. He then tried to pass himself off as “one of us.” All morning Wells Fargo customers had to show ID and Wells ATM cards before guards would allow them into the bank. Protesters engaged in conversations with customers and passersby to talk about alternative ways of banking, local credit unions. Speakers educated them about Wells Fargo’s foreclosures.

Senior & Disability Action is welcomed by WF Bank undercover men

Setting up for the protest

Tony Robles, a member of Senior and Disability Action and a 4th generation San Franciscan, started the rally citing case after case of folks who are in foreclosure, forced out of homes they have lived in for decades. Like Larry Fox being thrown out of his home he has lived since as a child when his father took him watch as it was being built.And Robert Moses, 92. year old WWII Veteran, refinanced his nearly paid-off loan with Deutsche Bank to bring his home up to city code. Deutsche raised his interest rate and payment to $3,400 a month. Many seniors living on Social Security and/or fortunate enough to have a pension usually average far less that that amount a month to live on.

Foreclosure Fighters speaking out

Another Foreclosure Fighter

Wells Fargo has been fraudulently processing mortgage documents with a practice called robo-signing for years. Placing quotas on employees and forcing them to sign a certain number of foreclosure files each day. While other documents required for homeowners to avoid foreclosure were ignored, left sitting on unattended fax machines. Wells Fargo has double the number of foreclosures of other banks- a despicable record of evicting record numbers of seniors, disabled and people of color with a $4.8 billion profit. Protesters call for them to negotiate with the 27 families who are in foreclosures.

Archbishop Franzo King, of St. John Coltrane African Orthodox Church and NAACP told us that Wells Fargo made money off trading slaves and now it is foreclosing on the African American decedents of slaves. These banksters have no morality if they continue to put seniors and poor people out of their homes and on to the streets!

Tommi Avicolli Mecca told us to come to a rally Wednesday, December 19th, at 8th & Castro to protest the evictions caused by the Ellis Act- currently 25 buildings in the Mission are being “Ellised”, throwing out people with AIDS, parents and children.

Henne Kelly of California Alliance of Retired Americans (CARA) warned us about the ads Wells Fargo is running in the SF Chronicle offering $20,000 loans, which would not have to be paid back if people stay in a home for 5 years. “Do we trust Wells Fargo?” We roared back, “No!” Chants followed- “Wells Fargo’s impunity Destroys Community!”

It feels good to fight back!

Speaking out against the Grinch that stole our homes.

All groups should take their money out of Wells Fargo!

John Stumpf, Wells Fargo CEO

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Drug Companies Refuse to Produce Generic, Less-Profitable Anti-Cancer Drug, Leading to Recurrence of Lymphoma.

Drug Companies Refuse to Produce Generic, Less-Profitable Anti-Cancer Drug, Leading to Recurrence of Lymphoma. This is a particularly eloquent illustration of the deadly effects of production for profits, rather than production for our needs. It also illustrates how the capitalists’ ownership of intellectual property (drug patents, in this case) is as toxic as their ownership of the factories, farms, hospitals etc, where we have to work to earn the money to buy back what we make in these places of employment. Bear in mind that the government pays for 80% of the research on drugs which the pharmacy companies then get patents on.

SF Chronicle, Thursday, December 27, 2012

Drug shortage, cancer recurrence linked

A drug given to lymphoma patients as a substitute for a chemotherapy medication that is in short supply has been linked in a study to an early recurrence of the cancer, according to a report released Wednesday that provides the first actual evidence of patient harm caused by a national shortage of drugs.

The shortage specifically includes older, generic medications needed for a wide range of uses such as cancer, surgery and pain management, say authors of the report, which involved Stanford University School of Medicine and Lucile Packard Children’s Hospital in Palo Alto.

“These are drugs that have gone off patent a long time ago. They are drugs that are all generic and they are quite cheap, so there’s not much incentive for the manufacturers to make them,” said Dr. Michael Link, professor of pediatrics at Stanford’s School of Medicine and senior author of the report.

Drug shortages throughout the country have been attributed to various factors, including problems in production, difficulties in getting raw materials, federal recalls and enforcement actions, and corporate decisions to discontinue making certain medications for lack of profit or other reasons.

From 2006 to 2011, the number of pharmaceutical drugs considered in short supply by the U.S. Food and Drug Administration jumped from 70 to 250. Some reports show that the drug shortage rate has slowed, but some drugs that at one point came off the short-supply list are in short supply once again, and many drugs have consistently remained scarce.

Behind the report

Wednesday’s report, led by researchers at St. Jude Children’s Research Hospital in Memphis and published in the New England Journal of Medicine, looked at more than 200 children, teenagers and young adults who had been enrolled in an ongoing national clinical trial to treat intermediate or high-risk Hodgkin’s lymphoma. This type of cancer, which accounts for about 6 percent of childhood cancers, originates from white blood cells called lymphocytes.

The trial focused on tailoring radiation therapy for patients, but had to be modified when one of the drugs used in the trial – an injectable drug called mechlorethamine, also known as Mustargen or nitrogen mustard – became unavailable in 2009. The shortage, brought on when production was moved to a new plant, forced researchers to replace mechlorethamine with a decades-old chemotherapy drug called cyclophosphamide, or Cytoxan.

Because cyclophosphamide is used almost interchangeably with mechlorethamine, researchers were not expecting much of a difference in outcomes for the patients, but while none of the patients died, the percentage of patients who remained cancer free two years after treatment fell from 88 to 75 percent.

“We were totally blindsided by the results,” Link said.

Study results end trial

Those who relapsed had to receive additional intensive therapy, which is associated with higher odds for infertility and other health problems. Researchers stopped enrolling new patients in the trials once the negative results from the substitute became apparent. The drug shortage was resolved in early November.

Hospital administrators, pharmacists and doctors have routinely found alternative medications when a preferred drug became hard to come by. But Link said his fellow physicians have long suspected that patients were being harmed by these substitutions.

The national drug shortage prompted new federal legislation this summer that requires drug manufacturers to report production interruptions and gives the FDA authority to speed approval of applications for drugs in short supply.

Maria Serpa, senior pharmacist at Sutter Medical Center in Sacramento and former president of the California Society of Health-System Pharmacists who was not involved in the St. Jude study, wasn’t surprised that the results showed patients were being harmed by the inability to get certain drugs. She said she regularly sees shortages of various drugs such as those used in anesthesia and to control pain.

“I don’t think the list is getting any smaller,” Serpa said, referring to the FDA’s shortage list. “What’s frustrating is the re-emergence of some of the older shortages from two or three years ago. This just seems to keep coming back.”

More information

For more information about the drugs in short supply, visit the U.S. Food and Drug Administration’s website: http://www.fda.gov/drugs/drugsafety/drugshortages/default.htm.

Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com

Read more: http://www.sfgate.com/health/article/Drug-shortage-cancer-recurrence-linked-4147866.php#ixzz2GGqG9Qaf

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Social Security Chained CPI explained


Under pressure from seniors, people with disabilities, anti-racists, women, and unions, Obama had finally conceded that Social Security did not contribute to the debt and should not be part of a discussion on the debt.  He is now prepared to ditch that position and embrace cost-of-living cuts to Social Security benefits in exchange for (weakened) restoration of higher taxes on the rich.  This NT Times article explains the “chained CPI,”  the cut in Social Security inflation adjustments.

New York Times, Dec. 18, 2012

Social Security Checks Enter the Debate

Annie Lowrey

WASHINGTON — As part of a deal being negotiated by President Obama and Speaker John A. Boehner to avert the worst of the year-end tax increases and spending cuts, Social Security payments might be lower in the future for millions of Americans.

On Tuesday, Democrats and Republicans were examining a multitrillion-dollar deficit reduction package put forward by the president, though the two sides were trading barbed remarks and aides were emphasizing that nothing was final until the whole deal was done.

But the White House seemed willing to make a concession to Republicans with a switch in the formula that ensures that Social Security payments keep up with the pace of inflation — an idea that immediately proved unpopular with its liberal base.

“Any talk of shrinking the program to save money is flawed from the start because Social Security is not part of the national budget in the same way as military spending,” Representative Raúl M. Grijalva of Arizona said in a statement. “It’s paid for through a dedicated payroll tax separate from general budgeting.”

Representative Charles B. Rangel of New York was among many on the left who echoed that sentiment. “Everyone has a grandparent, a friend or a neighbor who relies on the Social Security benefits they earned to pay for medical care, food and housing,” he said in a statement. “A move towards chained Consumer Price Index would be a long-term benefit cut for every single person who receives a Social Security check.”

Democrats and Republicans are considering switching Social Security payment adjustments to a “chained” Consumer Price Index. The Consumer Price Index tracks the price of a basket of commonly purchased household goods. A chained index accounts for consumers’ tendency to substitute similar items for one another as prices fluctuate. A consumer might buy more apples when the price of oranges increases, for instance.

Though it sounds like nothing more than a technical fix, adopting a chained index would squeeze benefits over time. The chained index ends up, in a given year, about 0.3 percentage points lower than the unchained index. That difference accumulates, so after five years, it might be 1.5 percentage points lower. Using a chained index would cut Social Security spending by about $112 billion over a decade, according to an estimate by the Congressional Budget Office.

AARP, the lobbying and research group for older Americans, immediately criticized the proposal. “We would rather see a broader discussion addressing retirement security,” said Debra Whitman, an executive vice president at AARP. “We object to the context in which it’s being discussed, which is a few weeks before Christmas, without people understanding what the change really means.”

Because the payment reductions would accumulate over time, AARP and other groups argue that they would hit the oldest Americans disproportionately hard. They might also unduly burden women, who tend to live longer than men, and the lowest-income older people, who are most dependent on Social Security checks, the groups warned.

Some economists and policy experts have also argued that both the current and the chained indexes underestimate the inflation that older Americans experience. The government produces an experimental “elderly index,” for instance, that tries to capture the consumption habits of people over 62 more accurately than other measures. For instance, older people buy more health care and less education than the average family, so the elderly index puts more weight on the former and less on the latter.

In no small part because of spiraling health care costs, inflation as measured by the elderly index has grown faster than inflation as calculated by the standard index that Social Security uses. That implies that the purchasing power of Social Security payments linked to a chained index would erode more over time, given what older Americans buy.

Andrew G. Biggs of the American Enterprise Institute.Jason Reed/Reuters Andrew G. Biggs of the American Enterprise Institute.

Still, other economists and policy experts from across the political spectrum have argued that a chained index is a more accurate measure of the inflation that households actually experience, and therefore is a better policy tool. They note that the elderly index is still experimental, and that not just older people receive or spend Social Security payments.

“We know that the current measure of inflation is not adequately measuring experienced inflation, and we should hence go with the better measure,” said Christian E. Weller, a senior fellow at the Center for American Progress, a liberal research group based in Washington, and the author of a plan to modernize Social Security.

Both liberals and conservatives have at times argued against making changes to Social Security outside the context of a broader overhaul. Many analysts — particularly Democrats — argue that Social Security does not contribute to long-term deficits because it has its own financing stream in payroll taxes. But it does have a long-term fiscal challenge, as payouts would eventually overwhelm its trust fund and revenues.

“Back when the system started, the demographics were really favorable,” said Andrew G. Biggs of the American Enterprise Institute, a right-leaning research group in Washington. “You could provide decent benefits for the rich and poor alike at low cost. You can’t do that anymore, mathematically. We could provide decent benefits for the rich and the poor by raising taxes a lot, but we need to raise taxes for other things.”

Mr. Biggs said Social Security changes that provided more ample benefits to vulnerable low-income older people and less to the well-off might prove to be a better path forward.

“We oppose chained C.P.I.,” Representative Peter Welch, Democrat of Vermont, said in an interview. “But I think all of us are waiting to see the details in the final package, and we’ll make our determination then.”

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Healthcare Crisis: Not Enough Specialists For The Poor, but Calif to Cut Medi-Cal Spending

Healthcare Crisis: Not Enough Specialists For The Poor

LA Times, December 15, 2012

With months-long waits for Medi-Cal patients to see specialists, some turn to emergency rooms — exactly what healthcare reform is banking on avoiding.

By Anna Gorman, Los Angeles Times

The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor.

He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery.

Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. His vision has deteriorated so much he is considered legally blind.

PHOTOS: Waiting in vain to be seen

“I want to see again,” he said. “I’ve been waiting a long time.”

Lawrence, 49, and patients like him are posing a critical challenge for the planned overhaul of the nation’s healthcare system. Federal officials are investing billions in community health centers like the To Help Everyone (T.H.E.) Clinic, where Lawrence’s problem was diagnosed, with the hope that they can keep more patients out of high-cost emergency rooms.

But a dearth of specialists available to low-income patients presents one of the bigger hurdles facing the country as it tries to bring spiraling healthcare costs under control. Doctors say meeting new government mandates to keep patients healthy and out of hospitals — a linchpin in reducing medical spending — will be virtually impossible without the ability to make timely patient appointments with specialists.

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

The healthcare overhaul includes initiatives aimed at reducing shortages of general medicine professionals but does little to increase the availability of specialists.

In Los Angeles County, the sheer volume of poor or uninsured patients needing specialist services has long overwhelmed the public health system, creating costly inefficiencies and appointment delays that can stretch as long as a year and half.

Patients’ conditions often must be dire for them to see a neurologist, cardiologist or other specialist quickly. Community clinics try to bypass the backed-up formal government referral system by pleading, cajoling and negotiating to get less critically ill patients like Lawrence moved up on waiting lists.

“Where needs are absolutely critical, we are able to work out special arrangements,” said Rise Phillips, chief executive of T.H.E. Clinic. “That is not the norm. That is, rather, the exception.”

At times, clinic staff members are forced to work against one of their key missions by sending patients to emergency rooms to increase the odds of their seeing a specialist more quickly.

The challenge can be seen in Belinda De Leon’s cubicle in a small, windowless back corner of T.H.E. Clinic. A referral specialist, De Leon spends her days trying to speed up appointments for the center’s clients — and fielding calls from patients wanting to know how much longer they have to wait. At any given time, she’s juggling more than 1,000 pending referrals.

One involves uninsured housekeeper Juana Barrera. Barrera, 45, has been waiting since April 2011 to see a gastroenterologist and get a colonoscopy. She has had bleeding off and on and recently started having pain in her stomach.

On a recent visit, she told De Leon she is scared to wait any longer. But she can’t afford to pay for the test out of pocket. “I’m hoping it’s not anything like cancer,” she said.

De Leon promised to update Barrera’s referral paperwork to indicate she is experiencing pain. “Hopefully that will help,” she said.

Waits for specialist appointments vary dramatically, depending on the type of specialist needed. Patients willing and able to travel across L.A. County to specialty clinics may be able to see a doctor within a month or two. Others who lack transportation and must go to a nearby facility can wait up to a year for a dermatologist or neurologist and up to 18 months for a cardiologist or ophthalmologist.

The county is trying to make the system more efficient, reduce wait times and ensure that those who don’t need more advanced care don’t overburden the system, said Mitch Katz, head of the L.A. County Department of Health Services. County officials risk losing newly insured patients, along with government funding, if they can’t find ways to reduce the bottleneck.

One focus is using technology to improve communication and better screen patients. A pilot program, for example, is allowing primary care doctors at community and public clinics to quickly transmit patients’ medical information via computer to a public health specialist for a consultation.

The electronic consults are streamlining referrals and helping clinic doctors make better treatment choices, said Louise McCarthy, executive director of the Community Clinic Assn. of Los Angeles County.

During an August visit to T.H.E. Clinic, Lawrence saw nurse practitioner Sandeep Lehil for the first time. He told her he was controlling his diabetes with medication and a modified diet. But his vision wasn’t getting any better.

“My eyes are really bad,” he told Lehil. “I can barely see.”

Lawrence’s medical record showed that he wouldn’t be seeing an ophthalmologist for many months.

“That’s a long time to live with blurry vision,” Lehil said.

“By that time, I’ll be blind maybe,” Lawrence responded.

Lawrence, who has a soft voice, an accent and a lanky frame, arrived in the U.S. nearly 20 years ago to pick apples, and overstayed his visa. He can’t work or drive, and he relies on others to cook meals to avoid burning himself. His immigration status prevents him from getting health insurance or unemployment benefits. He lives with a friend, spending most days listening to a television he can barely see. When the phone rings, he lifts it almost to his nose to see who is calling.

In mid-October, Lawrence was back at the clinic and saw a different, fill-in doctor who knew nothing about his situation, nor when his surgery would be scheduled. “You haven’t received any notice?” asked physician David Hwang. “No, not yet,” Lawrence answered, adding that he checks his mailbox every day.

De Leon, the referral clerk, later gave Lawrence unwelcome news: The wait to see an ophthalmologist at the county’s Harbor-UCLA Medical Center was still about a year. She said she was trying to get him an appointment elsewhere sooner.

Weeks later, Lawrence took matters into his own hands. With the help of a friend, he took three buses to reach the emergency room at Los Angeles County/USC Medical Center northeast of downtown. He waited several hours but finally saw an emergency room physician, who managed to get him an appointment the next day with an eye doctor.

“You have to do what you have to do,” Lawrence said.

At the medical center’s specialty clinic, ophthalmologist Simon Bababeygy told Lawrence his cataracts probably were caused by his diabetes, high blood pressure and high cholesterol.

He described the surgery he would perform, on one eye at a time. And he spoke the words Lawrence had been waiting for: He should be seeing much more clearly by the end of the year.

Preparing for the surgery, doctors got an abnormal result on a heart test. Now, Lawrence has to wait to see a county cardiologist before going back to Bababeygy to schedule the eye operation. He has no idea how long that could take.

“Every time, it’s something else,” he said. “My eyes are getting worse. And now it’s my heart.”

anna.gorman@latimes.com

Times staff writer Anna Gorman reported aspects of this story while participating in the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.

Copyright © 2012, Los Angeles Times

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LA Times, December 13, 2012

Court Ruling Could Cut California Spending On Medi-Cal

A 9th Circuit appeals panel decides California can reduce its Medi-Cal reimbursements to doctors, pharmacies and others. Providers say the doctor shortage will worsen.

By Maura Dolan and Chris Megerian, Los Angeles Times

SAN FRANCISCO — In a potential windfall for the state, a federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.

The ruling could make it harder to find doctors for as many as 2 million new patients who could become eligible for Medi-Cal under President Obama’s healthcare law — a possible 25% expansion of the program. California already provides one of the lowest rates of reimbursement in the nation for medical services to the poor, and there is a shortage of doctors to serve those patients.

Lynn S. Carman, an attorney for a group of pharmacies, said the decision would be costly for providers, worsen the doctor shortage and would be appealed.

“If this decision stands it will not only destroy the Medicaid program in California, but it will destroy the Obamacare program for millions of Americans who are now being shoved into the Medicaid program under the Affordable Care Act,” Carman said.

“They will not be able to obtain quality healthcare or access to services because providers cannot provide services at less than what it costs to furnish them,” Carman said.

The ruling could make it considerably easier for the state to close its budget gap.

The state is facing a $1.9-billion deficit next year, although Proposition 30’s temporary tax hike and an improving economy are projected to shift the state back into surpluses in the near future.

Medical providers said Thursday that the cutback should be lifted now that the state’s fiscal outlook has improved. The ruling can be applied retroactively to June 1, 2011.

“Now that the state has money, it would be like Scrooge for Gov. Brown not to pass a bill to eliminate at least the retroactivity part of it,” Carman said.

For the governor, Medi-Cal cuts could serve one policy aim at the expense of another.

Balancing the budget has been Brown’s first priority since taking office, and cutting healthcare — the state’s second-biggest cost after education — has been key to his fiscal goal.

But at the same time, he has wanted California to be out front in healthcare reform, and lead the country in efforts to put the federal law into place.

A spokesman for Gov. Brown released a statement Thursday that implied that Brown was inclined to put his budget priorities first, and was not likely to rescind the cuts.

“Today’s decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs,” the spokesman wrote.

In a ruling written by Judge Stephen S. Trott, appointed by President Reagan, the panel said the lower court injunctions were unwarranted because the federal government had approved the cuts.

“Neither the State nor the federal government ‘promised, explicitly or implicitly,’ that provider reimbursement rates would never change,” Trott wrote.

California has estimated that the 10% cut to medical providers and pharmacies would save the state $50 million a month.

Medi-Cal typically covers families and disabled Californians. The federal law will extend its coverage to single, childless adults beginning in 2014.

The California Medical Assn., which joined dentists, pharmacists, medical suppliers and medical response companies in trying to block the cutbacks, urged Brown to repeal them.

Dr. Paul R. Phinney, president of the doctors’ association, said the cuts shrink the number of providers who could afford to serve both existing Medi-Cal patients and the new ones who could become eligible for coverage in 2014.

“We need to ensure that health insurance isn’t just an empty promise for these patients,” Phinney said.

According to the California HealthCare Foundation, Medi-Cal patients already have difficulty finding doctors.

A foundation study published in July 2010 said 25% of physicians provided care to 80% of Medi-Cal patients.

Although 90% of physicians told the foundation they were accepting new patients, only 57% said they were taking on new Medi-Cal patients.

Dr. Ted Mazer, a San Diego ear, nose and throat surgeon, said he had to stop taking fee-for-service Medi-Cal patients several years ago because the reimbursements didn’t cover his costs and Medi-Cal patients were inundating his practice.

“So few doctors will see Medi-Cal patients that I was seeing them from the Mexican border to Riverside County to Orange County,” said Mazer, an officer of the California Medical Assn. “The reimbursement costs are so poor they don’t even cover costs, let alone pay for the administrative hassle. I can only see so many until I go under.”

Chris Perrone, deputy director of the foundation, said Thursday’s ruling will make it harder to block rate cuts in the future.

“The hurdles for people who want to block these rate cuts are little higher,” said Perrone.

maura.dolan@latimes.com

chris.megerian@latimes.com

Dolan reported from San Francisco and Megerian from Sacramento.

Times staff writer Anna Gorman contributed to this report.

Shortlink to this posting:  http://wp.me/p3xLR-to

CARA Flash Mob: Hands Off Social Security, Medicare, Medicaid! Tax the Top 2%!

The nation’s richest banks and corporations have rung up billions in deficits with wars, tax cuts for the richest, bank bailouts, and reckless speculation, and now they want us to pay by sacrificing Social Security, Medicare, Medicaid, and every other part of the Safety Net!

Democrats and Republicans alike are burning the midnight oil in search of a bi-partisan Grand Bargain to screw seniors, people with disabilities, kids, and low-income workers.

No Way! Join our Flash Mob for social justice: We demand:

* No cuts to Social Security, Medicare, Medicaid, or services to low-income people.

* End the tax cuts for the rich

* Create millions of jobs

Our goal is to video our flash mob and have it go VIRAL – so the whole country puts pressure on Congress to demand that we do not cut our essential programs in order to make the Grand Bargain on the deficit and avoid sequestration before the end of the year.

Sponsored by the California Alliance for Retired Americans (CARA) and Jobs With Justice (JwJ).

See the Resolution on Social Security, Medicare, and Medicaid written by SF Gray Panthers and passed by the SF Central Labor Council.

Shortlink to this posting:  http://wp.me/p3xLR-tg


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