| Know Your Rights Handbook |  |
Want to be your own advocate? Learn how by ordering the Know Your Rights Handbook today.
Learn about health and disability insurance, Social Security disability, employment discrimination, family and medical leave, school-based accommodations, resource location, and much more.
Click here for more information.
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Look What I Just Found!
Health Care for America Now has a new website. Learn about health reform and what you can do in your community to try to make sure we get coverage for pre-existing conditions in 2014.
BenefitsCheckUp.org is a website where seniors -- age 55 and up -- can find all of the benefits to which they are entitled. From help with medications to heating assistance to food, seniors can find out what they're entitled to. This website, created by the National Council on Aging, is really great.
In addition, I just came across the Dental Lifeline Network. This organization provides free (donated) dental services to the needy. How great is that?
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Living with Chronic Illness: A Prescription for Advocacy | 
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Read the results of our chronic illness survey, available FREE here.
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What I'm Reading
Last month was a big month for books, so I'm not going to feel too badly that I have nothing new for you this month. The truth is that I've been reading all of the Supreme Court briefs in the health reform case -- no leisure reading this month.
But let me remind you of one of the books I mentioned last month -- it's so great that it's worth making sure you didn't miss it in the long column from last month. It's also apropos of the Supreme Court case.
Health Care Reform is written by Jonathan Gruber, the MIT genius who designed Massachusetts's and federal health reform. Before you worry that it's a dry policy piece, let me assure you that it's not. It's actually in comic book format, sort of like a graphic novel, but non-fiction. If you want to explain to people -- or understand yourself -- why health reform matters and how it works, this is a great way to do it and a very fast read.
And if I may engage in a bit of self-promotion, I strongly urge you (do me a favor, please) to read this blog post. Because it's really important to remember how lucky we are. And why Advocacy for Patients exists.
Jennifer
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Get Your Guts In Gear
Ready to ride? The 2012 schedule is up.
New York: June 8-10, 2012 in the beautiful Hudson River Valley
Midwest: September 7-9 in Wisconsin
To learn more about Get Your Guts in Gear, see their website for details or call 866-9IGOTGUTS (866-944-6848).
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Advocacy for Patients on the Move!
We hibernate in the winter if we can, but we're starting to book for the spring, starting with the following:
March 24: Team McCready Global Fundraiser (we'll be in NY this year)
April 21: CCFA Chicago
May 16-20: Mike McCready and Flight to Mars, Los Angeles
Want us to come speak to your group? Now's the time to line it up. Can we do a webinar for your organization? Contact Jennifer and we'll be happy to accommodate your request.! |
It's Too Hard to Be Sick in America
Our book, It's Too Hard to Be Sick In America, is available FREE for your reading pleasure on our website. In it, we tell the stories of some of the patients with whom we've worked in order to show policymakers what chronic illness really looks like. Go have a read -- and the next time you talk to someone who clearly doesn't "get it," give them a copy of It's Too Hard to be Sick in America.
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Advocacy for Patients with Chronic Illness
We provide FREE information, advice and advocacy services to patients with chronic illnesses in areas including health and disability insurance, Social Security disability, employment discrimination, Family & Medical Leave Act, school-based discrimination, and resource location.
Need help?
Call (860) 674-1370
or email us.
Advocacy for Patients Needs Your Help!
To keep providing these services for FREE, we need your help.
WE DO NOT SOLICIT DONATIONS OUTSIDE OF THE FOLLOWING STATES:
CT, MA, WA, MN, CA, IL, NY, TX, VT, MT, ID, WY, NV, SD, NE, IA, IN.
Advocacy for Patients is committed to using its funds to support the work we do on behalf of patients. Accordingly, due to the cost of registering to solicit donations in other states, we do not solicit donations outside of the states listed above. Nevertheless, generous donors from many states make unsolicited donations for which we are very grateful.
THANK YOU!
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Ladies and Gentlemen, Introducing the Supremes!
You won't be able to get through the month of March without hearing about the Supreme Court's health reform case. Three days of oral argument will begin on March 26. So I thought I would give you a bit of a primer, both on the Court and on the issues in this case. This is not (at least to start with) an argument for or against; this is a guide to help you understand all you will be hearing later this month.
The Supreme Court is made up of nine Justices -- three women (Ginsburg, Sotomayor and Kagan) and six men (Chief Justice Roberts, Breyer, Thomas, Scalia, Alito and Kennedy). All three women and Justice Breyer make up a fairly reliably liberal wing; Justices Roberts, Thomas, Scalia and Alito make up a fairly reliably conservative wing, although some experts are saying that Chief Justice Roberts also is not quick to overturn Acts of Congress and he cares about his legacy as Chief Justice, so there is speculation that he may swing with wherever the majority is in this case. Justice Kennedy most often is the swing vote. It's very rare for the Court to hear multiple days of argument in one case; it has never happened, to the best of my recollection, in the years I've been a lawyer (which is a lot of years!). Although argument will take place this month, we should not expect a decision until late June, when the Court ends its Term.
There are four issues presented in this case: (1) Is the individual mandate -- the requirement that everybody purchase insurance -- a valid exercise of Congress's powers? (2) Is the Medicaid expansion an encroachment on state sovereignty? (3) Is the case barred by the Anti-Injunction Act? and (4) If the Court strikes down the individual mandate, should the rest of the law remain, or must the Court strike down the whole thing (called severability)?
The case will be argued by the Solicitor General of the United States, Donald B. Verrilli, Jr. in favor of upholding the law; Paul D. Clement on behalf of 26 states and Michael A. Carvin on behalf of the National Federation of Independent Business (NFIB) against upholding the law -- and, in another unusual turn, although the parties actually agree that the Anti-Injunction Act doesn't apply, the Court wanted to consider this issue, so it appointed Robert A. Long, Esq. to brief and argue that issue; it also appointed H. Bartow Farr III, Esq. to argue that the individual mandate is severable from the rest of the case.
Let's first get the Anti-Injunction Act out of the way since it's very technical and not likely to determine the outcome in the case. The Anti-Injunction Act prohibits a court from enjoining a federal tax unless and until it is being collected, which, in this case, would be 2015. If the Court finds that the penalty for violating the individual mandate is a "tax" under the Anti-Injunction Act -- not the same definition of "tax" as, for example, used in the tax code -- then it could find that no challenge to that provision can be brought until 2015. It would, then, dismiss all of the pending health reform cases. As best I can tell, nobody thinks that is going to happen. The case is really focused on the individual mandate, not the penalty for violating it. And by 2015, most of the law would be implemented and it would be impossible to turn back the clock. However, the Court and the government, especially, are likely to take this issue very seriously because anything they say about the Anti-Injunction Act could make a difference in future cases.
The argument on the individual mandate is the one all of us are most familiar with. This part of the law requires everybody to purchase insurance (and if they can't afford it, there will be subsidies, and if they still can't afford it, they are exempt from the penalty and may be Medicaid-eligible). The States and NFIB argue that Congress does not have the power under the Constitution to require people to buy anything, including health insurance. Congress anticipated this argument and made findings that sought to legitimize this exercise of power by finding that the entire health care system is in crisis, and fixing it certainly involves "commerce," so since the individual mandate is part of that "fix," requiring people to purchase insurance is a valid exercise of the Commerce Clause. However, under the Constitution, Congress cannot regulate purely intrastate commerce -- commerce that occurs only within state lines. The Supreme Court has interpreted the Commerce Clause to permit Congress to pass laws that have an "effect" on interstate commerce, though, so even if an activity occurs within state lines, Congress can regulate it if it has an interstate effect. The Government argues that the individual mandate is part of a comprehensive regulatory scheme involving the entire health care system, which operates in interstate commerce. The individual mandate is "necessary" to this comprehensive regulatory scheme, and it regulates conduct with a substantial effect on interstate commerce, the Government says. The argument that the individual mandate is necessary to carry out a broader regulatory scheme rests on the Necessary and Proper Clause of the Constitution, which allows Congress to do whatever is Necessary and Proper in carrying out its powers under the Constitution, including its powers under the Commerce Clause.
There's also an argument that the penalty that is assessed if you violate the individual mandate is a tax, not a penalty, and as such, it comes within Congress's taxing powers (and the meaning of "tax" here is different than its meaning in the context of the Anti-Injunction Act). The States say no, it's a penalty. The parties did not devote much of their briefs to this argument.
The States and the NFIB argue that the Commerce Clause does not allow Congress to compel people to engage in commerce; it only allows Congress to regulate commerce that already exists. The Government responds that everybody eventually uses health care and, as such, they are engaged in commerce, and the health reform law only regulates the means by which they pay for their health care. The States and the NFIB argue that the individual mandate cannot be "necessary and proper" to enforce the commerce power because, they say, there is no legitimate exercise of the commerce power. The Government responds that this is a complex regulatory scheme affecting the health care market, which is a legitimate regulation of the commerce power -- after all, Congress has passed a lot of laws that affect health care, like COBRA, HIPAA and ERISA -- and that the individual mandate is necessary because, without it, healthy people will wait until they get sick to buy insurance, uninsured people will keep going to emergency rooms for health care that they don't end up paying for (so the government pays for it), and all of that affects commerce. The States and NFIB argue that if Congress is allowed to do this, they can do pretty much anything, and that contradicts the Constitution's notion of a limited federal government. The Government responds that this is a complex regulatory scheme, and because of its complexity and the fact that many legitimate exercises of Congressional authority are part of this complex regulatory scheme, this exercise of Congressional power is permitted, in contrast with laws that have been struck down, which were stand-alone bills and not part of complex regulatory schemes.
The Medicaid expansion issue sort of surprised most of us; we really didn't expect the Court to hear that issue. Medicaid has existed for a long time (since 1965), and federal law always has imposed eligibility requirements, allowing states to EXPAND those requirements, but requiring all states that participate in Medicaid (which is all states) to meet those basic eligibility rules. For Congress to expand Medicaid eligibility to cover childless and non-disabled adults up to 133% of the federal poverty level is just a new eligibility rule. And from 2014 to 2016, the federal government would pay 100% of the cost of this expansion; that amount will gradually decrease until, in 2020 and thereafter, the federal government will pay 90% of these costs.
Nevertheless, the States challenged this expansion under the state sovereignty granted by the 10th Amendment. They claim that they really have no choice but to participate in Medicaid, and that, therefore, Congress is forcing them to pay their share of the costs of this expansion. The Government says the States are not being forced to participate in Medicaid; they choose to do so. While everybody expects every state to continue to participate in Medicaid, that's not coercion; it's still a choice. I confess, I have a hard time seeing the weight of the States' position on this issue; Congress has expanded and elaborated Medicaid so many times without challenge, and this time is no different.
Finally, there is the argument regarding severability. The question here arises only if the Court strikes down the individual mandate. There are very strong arguments that the individual mandate is very critical to the entire statutory scheme. As we argued in our amicus brief, in order to cover people with pre-existing conditions without premiums skyrocketing, there must be healthy people in the pool. (Indeed, in our brief, we argue that the individual mandate was "necessary and proper" to ensure coverage of people with pre-existing conditions.) There are states that have gone to "guaranteed issue" -- the elimination of pre-existing condition exclusions -- and in those states, premiums have increased dramatically because all of the sick people are in the pool, but many of the healthy ones are not. So there's a real question as to whether the system would work without the individual mandate. On the other hand, only one court that found that the individual mandate is unconstitutional also found that it was not severable, and that the entire law had to be struck down. It is unlikely that the Supreme Court would invalidate the entire statute, but anything's possible.
Of course, at the heart of all of this is a question about the role of the federal government in the lives of Americans. Does government have a responsibility to care for our most vulnerable, including the sick and uninsured; or should government stay out of our lives and hope that private charities care for the needy? In light of the fact that there are 50 million people in the United States who are uninsured, and the fact that private charity has not been able to meet their needs or even come close to it, I come out on the side of believing that government has a role in caring for those who need help. In my view, it's no different from Social Security, Medicare, Medicaid, and so on -- all of which were challenged when they first were initiated. But then again, there are those who think those entitlements are wrong, too.
The health reform law already has done a lot of good. over 1 million people up to age 26 were allowed to enroll in their parents' plan because of this law. Children under age 19 have gotten insurance despite pre-existing conditions. Seniors have gotten help with prescription drug costs. About 50,000 people have enrolled in the Pre-existing Condition Insurance Plan (PCIP).
And I believe that coverage of pre-existing conditions would be the most important civil rights advance for people with chronic illnesses -- ever. Sure, the Americans with Disabilities Act helps some, as does the Family and Medical Leave Act. But you can't get coverage under the FMLA until you've been working somewhere for a full year. And under the ADA, if you're unable to perform the essential functions of your job -- including not being absent from work, even if due to illness -- the law doesn't protect you. But what would protect you is to know that you can always buy insurance, change insurance, and not be penalized by your insurer due to having a pre-existing condition. More of us could stay employed and healthy. Fewer of us would end up on disability. We would be equal, really, for the first time. For me, this is the most important part of the health reform law. Every one of us could get insurance, regardless of pre-existing conditions. I can't think of anything that would be more meaningful to people with chronic illnesses than to be treated like everyone else when we are sick.
We'll find out in late June how the nine Justices of the Supreme Court feel.
Jennifer
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Team McCready Global Benefit 
It's that time of year again, when the Wishlist Foundation kicks into gear with the global Team McCready benefit for Advocacy for Patients. The date is March 24, from the UK to Seattle and then some. We'll be at the New York event this year. And if you can't make it but would like to donate an auction item, please let me know.
Here are all the details to date:
NEW JERSEY CHAPTER (location: New York City)
Houndstooth Pub
520 8th Ave
(between 36th St & 37th St)
New York, NY 10018
(212) 643-0034
www.houndstoothpub.com
Acts:
NO CODE
https://www.facebook.com/nocodejam
The Tangiers Blues Band
http://www.facebook.com/pages/The-Tangiers-Blues-Band/55937559812?ref=ts
http://www.reverbnation.com/tangiersbluesband
More Acts TBA!!!
Time: 1-7 pm
All ages
Donation: $15 (all door covers donated to The Wishlist Foundation)
One of a kind auction items and merchandise will be available!
SEATTLE CHAPTER
Location: Tractor Tavern
5213 Ballard Ave NW
Seattle, WA 98107
To purchase tickets:
http://www.ticketweb.com/t3/sale/SaleEventDetail?dispatch=loadSelectionData&eventId=4276315&pl=tractor
Acts :
Star Anna and the Laughing Dogs
http://www.staranna.com/
Kim Virant
http://www.myspace.com/kimvirant
Shelby Earl
http://www.shelbyearl.com/
Time: 9:30pm until 1:00am
Charity Auction and Raffle
21+
Donation: $12 (all door cover donated to The Wishlist Foundation)
http://www.firstgiving.com/fundraiser/tammi-laster/tammilaster
UK CHAPTER
Location: The Cavendish Arms
128 Hartington Rd, Stockwell, London, SW8 2HJ
http://www.thecavendisharmsstockwell.co.uk/
(6 Min walk from Stockwell tube)
Main Act : Pearl Jammed
Support Act : TBA
Plus Charity Auction and Raffle
Time : 6:00pm till 11:30pm
Donation: £5 on the door (all door covers donated to The Wishlist Foundation)
There will be a merch stall with Team McCready Shirts and Various other goodies.
More Info on Auction items coming soon!!!!!!
NEBRASKA/IOWA CHAPTER
Location: PIZZA SHOPPE
6056 Maple Street
Omaha, NE 68104 · Get Directions
http://www.pscollective.com/
TIME: Event Times 4:00 PM - 12:00 AM
4:00 PM - 6:00 PM Pearl Jam Collector's Museum
7:00 PM - 12:00 AM Live Music Entertainment - Featuring The Garrett Nordstrom Situation followed by the amazing Ten Club Pearl Jam Tribute Band!
12:00AM - 12:15AM Pay/Play Homage to the Master, Mike McCready! Contest
Team McCready and Wishlist Foundation Merchandise on hand.
*Buy/Sell/Trade Collector's Museum
{A Pearl Jam Collector's Dream ♥ Stop by and take a look.
Show off your Proud Collection or have fun buying, selling or trading your PJ loot. "It's up to you". Just have fun doing it!
Museum will Close at 6:00 PM
Museum ENTRANCE viewer - $3.00 donation
Donation: $7 After 7:00 PM at Door $ (All Proceeds to The Wishlist Foundation)
LOS ANGELES CHAPTER
Location: Brennan's Pub
4089 Lincoln Boulevard
Marina Del Rey, CA 90292-5613
http://www.brennanspub-la.com/
Acts TBA!
Time: 3pm - 8:30pm
One of a kind auction items and merchandise will be available! Hope to see you in New York. If you're in Seattle, though, don't miss a chance to see Star Anna. And I hear the Nebraska chapter has great auction items. These events are a blast, so please enjoy and support Advocacy for Patients, too! And while you're at it, check out Mike McCready and Flight to Mars's West Coast Tour to benefit Advocacy for Patients and CCFA, May 14-24. Info here and here. Check out the VIP packages on eBay. Jennifer |
Nicole's Corner: What is Prior Authorization?
In a perfect world, our health insurance companies always would cover the treatments, drugs, and services that we need. Unfortunately, insurance companies routinely deny coverage of treatments for a variety reasons and one of these reasons can be for "lack of prior authorization." For certain treatments -- for example, surgery, inpatient hospitalizations, mental health services, and particularly expensive drugs -- insurance companies can require that a request be submitted to them before the treatment is performed so that they can decide whether or not they will cover it. If no request is submitted or if the request is denied and never appealed, the insurance company can deny coverage simply for failing to get prior authorization. Although health care providers generally take care of these requests without our knowledge, it is important for us to be sure that we have the "go ahead" from our insurance companies before we receive certain treatments so that we don't find ourselves stuck with large medical bills. For example, we've received several calls from patients who were admitted to inpatient mental health facilities for a variety of emergent reasons. From the sound of it, each person's treatment was medically necessary. Nevertheless, they are fighting an uphill battle as they appeal their noncoverage decisions because their denials do not dispute medical necessity; instead, they state that no prior authorization was obtained. Although it is always worth a try to appeal, their insurance companies have every right to deny coverage because they failed to get prior authorization. As such, always be sure that prior authorization has been requested if it needs to be. And, if it is denied, please feel free to call us so that we can either walk you through the appeals process or take on the appeal for you. |
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The Chronicity Project
This is the space in our newsletter where we talk about health care policy affecting the chronically ill.
Here's an update on what's happening in the legislative arenas:
Federal
As you know, Congress passed an extension of the payroll tax cut and also delayed the effective date of a huge cut in Medicare reimbursement rates for doctors. Congress also extended unemployment compensation, but cut it from 99 weeks to somewhere between 63 and 73 weeks, depending on the state. Obviously, this is bad news for so many.
Contact your members of Congress and tell them what you think. To find your Representative, go here; to find your Senator, go here.
Connecticut The Insurance and Real Estate Committee heard testimony on a bill that would add consumers and small business people to the Health Insurance Exchange. We testified in favor. This is REALLY important -- without consumers on the Exchange, people who don't know our experiences will be making really big decisions that will affect us. The draft legislation would add only 1 consumer and 1 small business person; we are holding out for 2 of each. In addition, the draft legislation would be effective on July 1; we strongly urged immediate passage and an immediate effective date. Please -- if ever you are going to contact your state legislators, please do it now. To find your Representative, go here; to find your Senator, go here. We're still working with the Insurance Department on health insurance premium rate review. At the request of Commissioner Leonardi, the insurers have agreed to provide written notice of a rate increase to individual consumers; the Department is still working out the details on group plans, and we don't have an effective date yet, but we are making progress, thanks to Commissioner Leonardi and his staff. Your State
If you live in Washington state, are insured through Premera, and are on 6MP, azathioprine or any other oral "cancer" medication, you already know that Premera used a bill intended to make these drugs less expensive for cancer patients as a way to charge a huge coinsurance (percentage of cost rather than flat rate) instead. With the help of Representative Jinkins, we have been successful in getting Premera to change this policy effective August 1. So if you were affected by the increase, hang in -- it's only until August. Hawaii specialty tiers bill (SB 2106) was the subject of a February 28 hearing. The bill would prohibit co-insurance (percentage of cost rather than flat rate) and limit copays to $150 per month. Contact your legislators. Maine specialty tiers bill made it out of committee, so now it will go to the whole legislature. Contact your legislators. Also in Maine, the state budget bill includes a provision that would limit Medicaid recipients (MaineCare) prescription pain meds to 45 days unless you are inpatient or unless you have HIV/AIDS or cancer. Having seen the suffering of people in Washington State over their draconian pain med law, this concerns me greatly. Please contact your legislators. Something going on in your state? Let us know. In the meantime, keep up the fight. First, be aware. Read your local newspapers. Find the website for your state legislature. Read. Write your state legislators about things that concern you. One tool we like is the Kaiser Health News, to which you can subscribe for free. But don't just read: ACT. Go to hearings and testify. Tell your story. Put a real face on the healthcare crisis. |
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Jennifer C. Jaff, Esq.  Executive Director
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