Posts Tagged 'Healthcare'

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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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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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.

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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.

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Clinton’s savage program of Welfare Reform, effects on women and children

Sunday’s New York Times has a significant article on women’s’ and children’s poverty, and Welfare Reform of the 1990s.  It’s reprinted below, and is available at http://tinyurl.com/cubfjcn .

The next time you hear liberal Democrats prattle about the good old days under Clinton, with his budget surpluses, remember his 1996 Welfare Reform, the savage program that stole billions from welfare recipients and gave the money to the rich, who invested it in the stock market,  driving up stocks and giving us our vaunted “prosperity”.  Extreme poverty has doubled since Welfare Reform, and poverty and near-poverty have jumped hugely, but Obama and Pelosi say nothing about this, only talking about the “middle class.”  Clearly Democrats are as devoted to corporate profits and enriching the rich as Republicans.

Here’s the facts of the New York Times article in a nutshell

This is the fallout from the 1996 Welfare Reform, which was

  • promoted by Clinton as “ending welfare as we know it,” and
  • supported by Obama in his 2008 campaign, when he bragged about his role cutting welfare rolls as an Illinois legislator.

Welfare Reform replaced AFDC (Aid to Dependent Children) which

  • dated from New Deal,
  • gave states unlimited matching funds
  • with no time limits and little requirements for recipients
  • with TANF (Temporary Assistance for Needy Families), which
    • imposed time limits on how long you could receive welfare, (usually 5 years)
    • imposed work requirements on recipients,
    • capped payments.
    • Gave states fixed federal payments, which encouraged states to withhold aid. Since then:
      • 32 states have reduced rolls by at least 66%
      • Welfare rolls are now down 68% from the 1990s peak

Those dropped or turned away were mostly single moms and their kids. Now

  • 25% of low-income single moms are without jobs or welfare;
    This is 4 million women and children, twice the rate under AFDC.
    Over 40% of them are jobless and without assistance for over one year.
  • Since 1996, the share of households with kids living on a average of $2 per person per day has almost doubled, to almost 4%.
  • Only 20% of poor children get welfare money, lowest level in 50 years.
  • 10%  of households headed by women are in “deep poverty” (under $4,500 for family of three)

Since start of 2007 recession:

  • Welfare roles have risen only 15% during the worst unemployment since 1930s
  • 16 states have cut welfare rolls
  • 11 states cut welfare rolls by 10% or more, including states with highest unemployment
  • Benefits are cut to a national average of $350/mo for family of three
  • Arizona alone
    •  Cut welfare rolls by 50%, is using federal welfare money to plug state deficits
    • Shortened time limit from five to two years
    • Cut benefits 20%

For more information on the growth of poverty and its effects on women and children read

Center on Budget and Policy Priorities: “Poverty Rate Second-Highest in 45 years” Sept 14, 2011

Available at http://tinyurl.com/3ct69xs

World Socialist Web Site: “Extreme poverty in US has more than doubled since 1996” Feb 25, 2012

Available at http://tinyurl.com/82t6wyk

World Socialist Web Site: “(California Budget Project) Study shows harmful impact of economic crisis on California’s women.”  Available at http://tinyurl.com/7jxdoah

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The article:

New York Times, Sunday, April 08, 2012

Welfare Limits Left Poor Adrift as Recession Hit

Welfare Limits Left Poor Adrift as Recession Hit

By JASON DePARLE

PHOENIX — Perhaps no law in the past generation has drawn more praise than the drive to “end welfare as we know it,” which joined the late-’90s economic boom to send caseloads plunging, employment rates rising and officials of both parties hailing the virtues of tough love.

But the distress of the last four years has added a cautionary postscript: much as overlooked critics of the restrictions once warned, a program that built its reputation when times were good offered little help when jobs disappeared. Despite the worst economy in decades, the cash welfare rolls have barely budged.

Faced with flat federal financing and rising need, Arizona is one of 16 states that have cut their welfare caseloads further since the start of the recession — in its case, by half. Even as it turned away the needy, Arizona spent most of its federal welfare dollars on other programs, using permissive rules to plug state budget gaps.

The poor people who were dropped from cash assistance here, mostly single mothers, talk with surprising openness about the desperate, and sometimes illegal, ways they make ends meet. They have sold food stamps, sold blood, skipped meals, shoplifted, doubled up with friends, scavenged trash bins for bottles and cans and returned to relationships with violent partners — all with children in tow.

Esmeralda Murillo, a 21-year-old mother of two, lost her welfare check, landed in a shelter and then returned to a boyfriend whose violent temper had driven her away. “You don’t know who to turn to,” she said.

Maria Thomas, 29, with four daughters, helps friends sell piles of brand-name clothes, taking pains not to ask if they are stolen. “I don’t know where they come from,” she said. “I’m just helping get rid of them.”

To keep her lights on, Rosa Pena, 24, sold the groceries she bought with food stamps and then kept her children fed with school lunches and help from neighbors. Her post-welfare credo is widely shared: “I’ll do what I have to do.”

Critics of the stringent system say stories like these vindicate warnings they made in 1996 when President Bill Clinton fulfilled his pledge to “end welfare as we know it”: the revamped law encourages states to withhold aid, especially when the economy turns bad.

The old program, Aid to Families with Dependent Children, dates from the New Deal; it gave states unlimited matching funds and offered poor families extensive rights, with few requirements and no time limits. The new program, Temporary Assistance for Needy Families, created time limits and work rules, capped federal spending and allowed states to turn poor families away.

“My take on it was the states would push people off and not let them back on, and that’s just what they did,” said Peter B. Edelman, a law professor at Georgetown University who resigned from the Clinton administration to protest the law. “It’s been even worse than I thought it would be.”

But supporters of the current system often say lower caseloads are evidence of decreased dependency. Many leading Republicans are pushing for similar changes to much larger programs, like Medicaid and food stamps.

Representative Paul D. Ryan of Wisconsin, the top House Republican on budget issues, calls the current welfare program “an unprecedented success.” Mitt Romney, who leads the race for the Republican presidential nomination, has said he would place similar restrictions on “all these federal programs.” One of his rivals, Rick Santorum, calls the welfare law a source of spiritual rejuvenation.

“It didn’t just cut the rolls, but it saved lives,” Mr. Santorum said, giving the poor “something dependency doesn’t give: hope.”

President Obama spoke favorably of the program in his 2008 campaign — promoting his role as a state legislator in cutting the Illinois welfare rolls. But he has said little about it as president.

Even in the 1996 program’s early days, when jobs were plentiful, a subset of families appeared disconnected — left with neither welfare nor work. Their numbers were growing before the recession and seem to have surged since then.

No Money, No Job

While data on the very poor is limited and subject to challenge, recent studies have found that as many as one in every four low-income single mothers is jobless and without cash aid — roughly four million women and children. Many of the mothers have problems like addiction or depression, which can make assisting them politically unpopular, and they have received little attention in a downturn that has produced an outpouring of concern for the middle class.

Poor families can turn to other programs, like food stamps or Medicaid, or rely on family and charity. But the absence of a steady source of cash, however modest, can bring new instability to troubled lives.

One prominent supporter of the tough welfare law is worried that it may have increased destitution among the most disadvantaged families. “This is the biggest problem with welfare reform, and we ought to be paying attention to it,” said Ron Haskins of the Brookings Institution, who helped draft the 1996 law as an aide to House Republicans and argues that it has worked well for most recipients.

“The issue here is, can you create a strong work program, as we did, without creating a big problem at the bottom?” Mr. Haskins said. “And we have what appears to be a big problem at the bottom.”

He added, “This is what really bothers me: the people who supported welfare reform, they’re ignoring the problem.”

The welfare program was born amid apocalyptic warnings and was instantly proclaimed a success, at times with a measure of “I told you so” glee from its supporters. Liberal critics had warned that its mix of time limits and work rules would create mass destitution — “children sleeping on the grates,” in the words of Senator Daniel Patrick Moynihan, a New York Democrat who died in 2003.

But the economy boomed, employment soared, poverty fell and caseloads plunged. Thirty-two states reduced their caseloads by two-thirds or more, as officials issued press releases and jostled for bragging rights. The tough law played a large role, but so did expansions of child care and tax credits that raised take-home pay.

In a twist on poverty politics, poor single mothers, previously chided as “welfare queens,” were celebrated as working-class heroes, with their stories of leaving the welfare rolls cast as uplifting tales of pluck. Flush with federal money, states experimented with programs that offered counseling, clothes and used cars.

But if the rise in employment was larger than predicted, it was also less transformative than it may have seemed. Researchers found that most families that escaped poverty remained “near poor.”

And despite widespread hopes that working mothers might serve as role models, studies found few social or educational benefits for their children. (They measured things like children’s aspirations, self-esteem, grades, drug use and arrests.) Nonmarital births continued to rise.

But the image of success formed early and stayed frozen in time.

“The debate is over,” President Clinton said a year after signing the law, which he often cites in casting himself as a centrist. “Welfare reform works.”

The recession that began in 2007 posed a new test to that claim. Even with $5 billion in new federal funds, caseloads rose just 15 percent from the lowest level in two generations. Compared with the 1990s peak, the national welfare rolls are still down by 68 percent. Just one in five poor children now receives cash aid, the lowest level in nearly 50 years.

As the downturn wreaked havoc on budgets, some states took new steps to keep the needy away. They shortened time limits, tightened eligibility rules and reduced benefits (to an average of about $350 a month for a family of three).

Since 2007, 11 states have cut the rolls by 10 percent or more. They include centers of unemployment like Georgia, Indiana and Rhode Island, as well as Michigan, where the welfare director justified cuts by telling legislators, “We have a fair number of people gaming the system.” Arizona cut benefits by 20 percent and shortened time limits twice — to two years, from five.

Many people already found the underlying system more hassle than help, a gantlet of job-search classes where absences can be punished by a complete loss of aid. Some states explicitly pursue a policy of deterrence to make sure people use the program only as a last resort.

Since the states get fixed federal grants, any caseload growth comes at their own expense. By contrast, the federal government pays the entire food stamp bill no matter how many people enroll; states encourage applications, and the rolls have reached record highs.

Among the Arizonans who lost their checks was Tamika Shelby, who first sought cash aid at 29 after fast-food jobs and a stint as a waitress in a Phoenix strip club. The state gave her $176 a month and sent her to work part time at a food bank. Though she was effectively working for $2 an hour, she scarcely missed a day in more than a year.

“I loved it,” she said.

Her supervisor, Michael Cox, said Ms. Shelby “was just wonderful” and “would even come up here on her days off.”

Then the reduced time limit left Ms. Shelby with neither welfare nor work. She still gets about $250 a month in food stamps for herself and her 3-year-old son, Dejon. She counts herself fortunate, she said, because a male friend lets her stay in a spare room, with no expectations of sex. Still, after feeding her roommate and her child, she said, “there are plenty of days I don’t eat.”

“I know there are some people who abuse the system,” Ms. Shelby said. “But I was willing to do anything they asked me to. If I could, I’d still be working for those two dollars an hour.”

Diverting Federal Funds

Clarence H. Carter, Arizona’s director of economic security, says finances forced officials to cut the rolls. But the state gets the same base funding from the federal government, $200 million, that it received in the mid-1990s when caseloads were five times as high. (The law also requires it to spend $86 million in state funds.)

Arizona spends most of the federal money on other human services programs, especially foster care and adoption services, while using just one-third for cash benefits and work programs — the core purposes of Temporary Assistance for Needy Families. If it did not use the federal welfare money, the state would have to finance more of those programs itself.

“Yes, we divert — divert’s a bad word,” said State Representative John Kavanagh, a Republican and chairman of the Arizona House Appropriations Committee. “It helps the state.”

While federal law allows such flexibility, critics say states neglect poor families to patch their own finances. Nationally, only 30 percent of the welfare money is spent on cash benefits.

“It’s not that the other stuff isn’t important, but it’s not what T.A.N.F.” — the Temporary Assistance program — “was intended for,” said LaDonna Pavetti of the Center on Budget and Policy Priorities, a Washington research and advocacy group. “The states use the money to fill budget holes.”

Even in an economy as bad as Arizona’s, some recipients find work. Estefana Armas, a 30-year-old mother of three, spent nine years on the rolls, fighting depression so severe that it left her hospitalized. Once exempt from time limits because of her mental health, Ms. Armas joined support groups, earned a high school equivalency degree and enrolled in community college.

Just as her time expired last summer, Ms. Armas found work as a teacher’s aide at a church preschool.

“It kind of pushed me to get a job,” she said.

Supporters of Temporary Assistance cite stories like that to argue that it promotes a work ethic. Despite high unemployment, low-skilled single mothers work as much now, on average, as they did under the old welfare law — and by some measures, a bit more. As a group, their poverty rates are still lower. And those without cash aid, they say, can turn to other programs.

“We have reduced our caseload, and we don’t have people dying in the street,” Mr. Kavanagh said. “There were an awful lot of people who didn’t need it.”

But the number of very poor families appears to be growing. Pamela Loprest and Austin Nichols, researchers at the Urban Institute, found that one in four low-income single mothers nationwide — about 1.5 million — are jobless and without cash aid. That is twice the rate the researchers found under the old welfare law. More than 40 percent remain that way for more than a year, and many have mental or physical disabilities, sick children or problems with domestic violence.

Using a different definition of distress, Luke Shaefer of the University of Michigan and Kathryn Edin of Harvard examined the share of households with children in a given month living on less than $2 per person per day. It has nearly doubled since 1996, to almost 4 percent. Even when counting food stamps as cash, they found one of every 50 children live in such a household.

The Census Bureau uses a third measure, “deep poverty,” which it defines as living on less than half of the amount needed to escape poverty (for a family of three, that means living on less than $9,000 a year). About 10 percent of households headed by women report incomes that low, a bit less than the peak under the old law but still the highest level in 18 years.

Some researchers say the studies exaggerate poverty by inadequately accounting for undisclosed income, like help from boyfriends or under-the-table jobs. They note that asking poor people about their consumption, rather than their income, suggests that even the poorest single mothers have improved their standard of living since 1996.

Mr. Haskins, the Temporary Assistance program’s architect, agrees that poverty at the bottom “is not as bad as it seems,” but adds, “It’s still pretty darn bad.”

Trying to Make Do

Asked how they survived without cash aid, virtually all of the women interviewed here said they had sold food stamps, getting 50 cents for every dollar of groceries they let others buy with their benefit cards. Many turned to food banks and churches. Nationally, roughly a quarter have subsidized housing, with rents as low as $50 a month.

Several women said the loss of aid had left them more dependent on troubled boyfriends. One woman said she sold her child’s Social Security number so a relative could collect a tax credit worth $3,000.

“I tried to sell blood, but they told me I was anemic,” she said.

Several women acknowledged that they had resorted to shoplifting, including one who took orders for brand-name clothes and sold them for half-price. Asked how she got cash, one woman said flatly, “We rob wetbacks” — illegal immigrants, who tend to carry cash and avoid the police. At least nine times, she said, she has flirted with men and led them toward her home, where accomplices robbed them.

“I felt bad afterwards,” she said. But she added, “There were times when we didn’t have nothing to eat.”

One family ruled out crime and rummaged through trash cans instead. The mother, an illegal immigrant from Mexico, could not get aid for herself but received $164 a month for her four American-born children until their time limit expired. Distraught at losing her only steady source of cash, she asked the children if they would be ashamed to help her collect discarded cans.

“I told her I would be embarrassed to steal from someone — not to pick up cans,” her teenage daughter said.

Weekly park patrols ensued, and recycling money replaced about half of the welfare check.

Despite having a father in prison and a mother who could be deported, the children exude earnest cheer. A daughter in the fifth grade won a contest at school for reading the most books. A son in the eighth grade is a student leader praised by his principal for tutoring younger students, using supplies he pays for himself.

“That’s just the kind of character he has,” the principal said.

After losing cash aid, the mother found a cleaning job but lost it when her boss discovered that she was in the United States illegally. The family still gets subsidized housing and $650 a month in food stamps.

The boy worries about homelessness, but his younger sisters, 9 and 10, see an upside in scavenging.

“It’s kind of fun because you get to look through the trash,” one of the girls said.

“And you get to play in the park a little while before you go home,” her sister agreed.

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Bipartisan plan to gut Medicare: Vouchers, Premium Support, and Competition

Bipartisan plan to gut Medicare: Vouchers, Premium Support, and Competition

Democrat Ron Weiden and Republican Paul Ryan are pushing a plan to send the Medicare we know into a death spiral.  Medicare would become voucher system, with recipients receiving checks based on the premiums of the second-cheapest Medicare-HMO in an area.  Annual voucher increases would be limited to Gross National Product  growth plus one percent, far less than the historical growth rates of Medicare costs.  Medicare’s premiums would be higher than HMOs premiums, because Medicare would be forced to accept sicker, more expensive patients, who would not survive under HMOs managed care.  Medicare recipients would have to pay the difference between Medicare’s higher premiums and the vouchers based on the 2nd-cheapest-HMO plan, out of their own pockets, which would steadily drive healthier patients out of Medicare.  Medicare would fall into a death spiral of higher premiums, fewer, sicker patients, and less funding.  This plan was also promoted in the 2003 Medicare Modernization Act.  See http://tinyurl.com/7enm8eo .

New York Times, December 14, 2011

Lawmakers Offer Bipartisan Plan to Overhaul Medicare

By ROBERT PEAR

WASHINGTON — A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary.

The lawmakers aim to reshape the debate over the giant health insurance program by addressing concerns that have provoked fierce opposition to similar ideas in the past.

Just as important as the details of their proposal was the fact that the two were working together on an issue that both parties have exploited for political advantage.

In 2010, many Republicans won House seats — and the support of older voters — by arguing that President Obama’s health care law would damage Medicare. Democrats are hoping to retake the House by arguing that Mr. Ryan and other House Republicans are pushing for the privatization of Medicare, which they say could greatly increase costs for beneficiaries.

The new Wyden-Ryan proposal, by blurring the contrast between the parties on this issue, could make it more difficult for Democrats to win the argument.

The proposal would make major structural changes in Medicare and limit the government’s open-ended financial commitment to the program.

Under the proposal, known as premium support, Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government.

Congress would establish an insurance exchange for Medicare beneficiaries. Private plans would compete with the traditional Medicare program and would have to provide benefits of the same or greater value. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare.

In addition, the growth of Medicare would be capped. In general, spending would not be allowed to increase more than the growth of the economy, plus one percentage point — a slower rate of increase than Medicare has historically experienced.

To stay under the limit, Congress could cut payments to providers and suppliers responsible for the overspending and could increase Medicare premiums for high-income beneficiaries, the lawmakers said.

The proposal is sure to come under fire from beneficiaries and Democratic lawmakers who see themselves as the pre-eminent defenders of Medicare.

For his part, Mr. Wyden said: “Medicare is the most important fiber in the social safety net. I would never do anything to shred it, weaken it or harm it in any way. Our proposal places traditional Medicare, long supported by progressives, alongside a menu of private alternatives that provide the choice and competition long supported by conservatives.”

Unlike the Ryan budget blueprint approved by the House in April, Mr. Ryan said, the new proposal would preserve the traditional fee-for-service Medicare program as an option for all beneficiaries. “Our proposal harnesses the power of competition to address the root cause of medical inflation,” said Mr. Ryan, the chairman of the House Budget Committee.

Democrats expressed concerns about the proposal based on policy and politics. A senior Democratic Congressional aide said, “This plan gives bipartisan political cover to Ryan and other Republicans against whom we have been waging a very successful political offensive.”

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Severe, Long-Term Medicare and Medicaid Cuts Planned Will Impact Jobs Picture

The New York Times says cutbacks in healthcare planned in future years are so severe that the resulting layoffs and hiring freezes will  worsen the nation’s unemployment.   We need to take this very seriously. Half the Obama’s health plan is funded by scaling back $575 billion in planned increases in Medicare spending over the next decade, money intended to care for baby-boomers as they age into Medicare. Democrats and Republicans alike are calling for hundreds of billions in additional Medicare cuts.  All of these Medicare cuts are aimed at the doctors, hospitals, nursing homes, rehab facilities serving Medicare patients.  The cuts will result in many of these providers either dropping out of Medicare or giving dangerous care because of short-staffing.  Read more at http://wp.me/p3xLR-pJ . Proposed cuts to Medicaid providers, and cuts in Medicaid enrollment and services are even worse.

Capping and even cutting Medicaid and Medicare spending while allowing costs to rise to accommodate insurance, drug, and hospital profits means that government and its corporate partners are tossing away the notion of equal care for seniors, children, people with disabilities, and low-income workers.

New York Times, Thursday, August 18, 2011

Cuts in Health Care May Undermine Role in Labor Market

By REED ABELSON and KATIE THOMAS

Even during months of stubborn unemployment, the health care industry has provided a solid underpinning, reliably adding jobs in an otherwise dismal environment.

For example, hospitals, nursing homes and the like added about 430,000 jobs during the recession, as the country shed 7.5 million jobs. With the latest government reports showing a meager overall gain of 117,000 jobs in July, health care remained a significant contributor with an additional 31,000 jobs for the month, a tad higher than an average monthly addition of 25,000 health jobs in the last year. Hospitals, which had a slight decline in June, added 14,000 jobs in July.

While few experts can predict how the stock market’s gyrations and government cutbacks this month will affect the health industry, several health industry analysts warn that the sector is showing signs of economic sluggishness that has long kept other business sectors beleaguered.

The situation has led many in the health industry to caution that it cannot be relied upon to keep hiring workers. “It’s not realistic to believe that we’re going to continue to generate job growth when you’re speaking about Medicare and Medicaid reductions in the hundreds of billions of dollars over the next few years,” said Daniel Sisto, president of the Healthcare Association of New York, which represents the state’s hospitals and health systems.

Companies that rely on government spending have been bracing for deeper reductions, and President Obama recently alluded to another round of belt-tightening from one of the industry’s bedrock payers — Medicare.

Signs of a gloomier outlook have been surfacing in various spots, from a slowing in new construction plans to falling share prices of nursing home companies to announced layoffs among hospital support staff.“Nobody is sure what will happen,” said Alan M. Garber, a physician and health policy expert at Stanford. The cuts in government programs like Medicare and Medicaid, and pressure to reduce costs, are thwarting health care employers in trying to meet the rising demand for their services.

“The health care industry is facing greater uncertainty than in any time in memory,” Dr. Garber said.

Yet even though economists and other experts still predict increasing demand for health care as the population ages, with an accompanying demand for job growth, health care officials and executives cite a daunting cascade of recent events as reasons to reassess any expansions.

They point to Congress’ intent to reduce spending, economically depressed states struggling to deal with a rash of cuts in Medicaid programs and the continued uncertainty of financial costs that will be imposed by the federal health care law, including contradictory lower court decisions about the constitutionality of various provisions.

A survey by the Conference Board, a business research group, found that help-wanted ads for health care providers and technicians fell by 61,200 listings in July.

In Florida, for example, health care led the state in job gains during the recession — it was the only industry that did not lose jobs during that time. But since September of last year, the leisure and hospitality industry has been adding more jobs, according to a state economist.

The Palo Alto Medical Foundation, a large physician group in Northern California that employs 5,500 people, including 1,000 doctors, says it has no plans to add many more people in the near future. “Really our focus these days is to do more with the assets we have,” said Cecilia Montalvo, the vice president for strategic development for the medical group.

Hospitals also appear to be slowing the pace of building, as projects begun before the recession started are now being completed. The volume of tax-exempt debt for hospitals in the first half of the year has fallen by nearly half from a year ago, said David Johnson, a managing director at BMO Capital Markets. “We’re overinvested in hospitals and hospital beds,” he said.

The University of Michigan Health System, for example, is adding some 560 jobs as a result of new children’s and women’s hospitals it plans to open soon and an expansion of its emergency department. But Doug Strong, who heads the system’s hospitals, said his overall goal is to shrink his work force in future years as he tries to make the system more efficient.

While he expects the demand for health care services to rise, he believes he needs to deliver that care with fewer people at less cost. “I think that is what the nation is asking of all of us,” he said.

The impact of state cuts in Medicaid are already being felt in doctor’s offices, hospitals, nursing homes and home health agencies around the country. Hospitals experienced reductions in Medicaid reimbursement in 37 states for next year’s budgets, according to Lisa Goldstein, an analyst at Moody’s, who predicts further cuts.

At the Elliot Health System in Manchester, N.H., the seemingly abrupt decision by state lawmakers to sharply reduce hospital reimbursements led the hospital to recently lay off 182 people.

“For the last 10 years, we’ve been pretty stable and we’ve been able to grow,” said Elliot’s chief executive, Doug Dean. But faced with the loss of millions of dollars in Medicaid revenue that would wreak havoc on the coming hospital budget, Mr. Dean said he had no choice but to cut jobs. “It was simply because of the economics of Medicaid,” he said. Elliot is among a group of hospitals filing a lawsuit to stop the cuts.

Health care employers are also confronting cuts to the federal Medicare program. In July, nursing home operators learned their reimbursements would be cut by 11 percent in October, and hospitals expect further reductions in what they are paid under the new health care law as well as in future efforts to reduce the federal deficit.

Still, these continue to be boom times in many corners of the industry. Partners in Care, a New York nonprofit provider of home health care services, is hiring so many home health aides that it recently opened a second training center to handle the flood of new employees.

Its staff of aides has grown from close to 5,800 in 2006 to about 9,200 today. In June, the group, which is part of the Visiting Nurse Service of New York, hired 374 new people, the second-biggest month in its history.

Jay Conolly, vice president of human resources at Partners in Care, said his group is benefiting, not just from the growing elderly population, but also from the consolidation of nursing homes and hospitals in the New York area and a heightened interest in low-cost alternatives to inpatient care. The Bureau of Labor Statistics has predicted that jobs will grow faster in the home health care area than in any other section of the health care industry.

“There’s never been enough home health aides, and there never will be,” Mr. Conolly said.

And many expect that when the economy finally does rebound, hiring will, again, take off, especially when more people are expected to be insured under the federal health care law. Geraldine Bednash, chief executive of the American Association of Colleges of Nursing, expects there is pent-up demand for their services, especially for nurse practitioners and nurse midwives, who would work in primary care. “We are going to see this huge onslaught of need for nurses,” she said. “So we’re in a blip, that’s all.”

There are some who wonder whether the country should continue to rely on health care as a stalwart supplier of new jobs. If spending on health care continues at its current pace, it will choke out other vital sectors and end up hurting the rest of the economy, said Joshua Shapiro, chief United States economist at MFR Inc. “I think the path that we’re on now is clearly unsustainable,” he said.

Tom Torok contributed reporting.

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