The Ritter Family's Story

This is the first in a new series called "Faces from the Frontline".  Join "Health on the Horizon" on Facebook and Twitter.

The Ritter Family:  Marlboro County, PA

Motherhood prepared Stacie Ritter for more than any woman could ever imagine.  When I met Stacie Ritter speaking to a sizable crowd on the steps of the Supreme Court on March 27, 2012 advocating for the PPACA, I met a mother on a mission.  I soon discovered that the advocacy training of this mother of four was unknowingly thrust upon her 10 years prior when her twin daughters, Hanna and Madeline, were diagnosed with cancer at the age of 4.  Now age 14, Hanna and Madeline looked with admiration at their mother that morning.  It had been a long road to get to this point.

In 2002, Stacie and Ben were embracing the American Dream.  Married for a few years, they owned a home in Marlboro County and were beginning their family with a set of twin girls, a toddler and another baby on the way.  No parent can imagine the fear and horror of being on the receiving end of a doctor’s diagnosis when you are told your children have cancer.  Stacie and Ben lived that nightmare-bone marrow transplants, chemotherapy and radiation.  Unbeknownst to them at the time, this nightmare was a multi-part series.

Within a few months of treatment, the girls reached the lifetime caps allowed by many insurance plans.  Prepared for this possibility, they purchased secondary insurance through the State’s CHIP program.  Ben ultimately had to take an unpaid medical leave from his job in order to take care of his two sick daughters, a toddler and a pregnant wife.  In order to make sure the rest of the family was not left without health insurance, he took out a COBRA plan at the cost of almost $800 month.  With the cost of the COBRA plan, a mortgage, groceries, electricity, gas and other monthly expenses, the family went through their savings and all their assets in less than one year and ultimately filed for bankruptcy.  While Stacie and Ben were filing for bankruptcy, the health insurance industry recorded a 162% profit for the first quarter of that year (weiss).

This is the state of healthcare in America.

In fact, half of all bankruptcies in the US are triggered by costly medical expenses (Warren).  Most would presume that these individuals are uninsured, however, the reality is quite the opposite.  According to Health Affairs, 60% of those that filed for medical bankruptcy in 2005 were insured (Himmelstein).  Stacie describes their medical bankruptcy like many others that have been victims of  a broken healthcare system, “until you’ve been there, see it and feel it, people don’t understand the reality of this issue”.

Political contributions of America's Health Insurance Plans
during the healthcare reform debates

While the girls experienced a remission from their cancer, the nightmare wasn’t over.  A few years later the girls began to experience problems with their pituitary and hypothalamus from the radiation and chemotherapy treatments, which required an expensive prescription.  It was covered by the family’s insurance, but when Ben’s company switched plans they ran into problems.  Even though it was recommended by their world renowned endocrinologist, the insurance plan denied coverage.  For months, Stacie and the physicians fought for the girls.  They administered unnecessary tests requested by the insurance company and the physicians wrote 4 letters of appeal that were denied each time.  As the Ritter family and their doctor’s fought to get the girls the care they needed, the national debate to reform our health insurance system began to heat up.  In 2008, the health insurance industry spent $7,540,000 in lobbying and $617,200 in direct contributions to members of congress (opensecrets.com).

This is the state of healthcare in America.

As the years passed, the Ritter family stayed very active and involved in the National debate for access to fair and affordable healthcare.  They testified before the house steering committee for healthcare reform.  While not perfect, the passage of the PPACA in 2010 has given them some relief and offers them some basic consumer protections, protections that they did not have along their journey.  One very important protection is the elimination of the Lifetime Cap.  Additionally, because the twins now have a pre-existing condition, they are grateful that in the future they will never be able to be turned down for health insurance. Furthermore, until they are independent adults, they will be able to stay on their parent’s plan until age 26.    The family sees the medical-loss-ratio as a success for consumers like themselves because insurance companies will have to spend 85% of their premiums on care and not profits, administrative costs, advertising and lobbying.  

Even after its passage, the Ritter family continues to advocate for an issue and law that the general public has very little knowledge about.  On March 27, 2012, a full decade into this family’s battle for fairness in the health marketplace, Stacie and her family took their last stand.  On the steps of the Supreme Court they made an appeal before an army of press and spectators.  

From the beginning of time, mothers have gone to great lengths in order to provide the basic necessities for their children.  Stacie Ritter’s journey to care for her children brought her to the steps of the highest court in the free world. 

March 27, 2012
Meeting the Ritter Family in Washington DC

See a recent Video featuring the Ritter Family

¹ Weiss Ratings, December 18, 2002
² The Fragile Middle Class: Americans in Debt; by Elizabeth Warren, Harvard Law School and Smith Business Solutions
³ Himmelstein et al.  Health Affairs, 2/2005

⁴ www.opensecrets.com

So where do we go from here?: The future solvency of medicare

This is the last of a five part series on medicare.  Please join "Health on the Horizon" on Facebook.

Kaiser Family Foundation: Health Reform and Medicare’s overview of key provisions

One of the loftiest concerns looming over the health of the nation is the potential, and very real, threat of medicare insolvency.  Prior to the implementation of the PPACA, the Medicare Trust Fund A (which funds hospitalization) was due to no longer have sufficient funds to cover all patient hospital care by 2017.  Since its passage, the life of this fund has increased to 2029.  This is due to shifting the overpayments that have been made to Medicare Advantage (the private alternative) back to traditional Medicare.  While this provision in the PPACA gives us some relief in the short-term, it stands as a warning that the future of our senior populations is in dire straights if we don’t make some difficult choices.

According to Barbara Dickman, a volunteer representative for the Pennsylvania’s AARP and sat on the legislative counsel for 2 years, the 2010 Healthcare Reform law has begun to address the long-term solvency of Medicare.  However, there are many elements of the law that need to be allowed to work in order to give the program the security it needs.  She explains, “The law calls for providers to be more efficient with the money given to them from Medicare by examining how physicians get paid. Furthermore, it will set up the Independent Payment Advisory Board which will analyze the growth of national health expenditures.  This law also provides for means to target weeding out waste, fraud and abuse.”

First of all, there will be incentives for primary care services by providing a 10% bonus payment to providers if at least 60% of their medicare allowed charges in the prior period were for primary care as opposed to specialized or emergency care, which is more expensive.  More focus will be given on keeping patients well and preventing hospital readmissions where costs are higher.  To do this, a Medicare pilot program will be launched which will look at bundling payments.  In other words, physicians will be paid a set amount to treat a specific condition and not for each individual test and procedure.  Electronic medical records will play a big role by prevention of duplicated services and enhance the ability of physicians to share records and tests.

According to the Dartmouth Institute for Health Policy and Research’s infamous “Atlas Project”, 30% of Medicare dollars are wasted.  Weeding out waste and abuse is essential to lowering overall healthcare costs.  This includes money spent on such things as duplicated and unnecessary care.  The PPACA calls to develop a database to capture and share data across federal and state programs.  Funding has also been increased for anti-fraud activities and steeper penalties for those who commit fraud.    

Furthermore, another important aspect of enhancing the longevity of medicare is the medicare payroll tax on high income earners which will begin in 2013.  This will be a .9% medicare tax increase on individuals making $200,000 and couples making over $250,000.

In the end, because of the reforms put in place, the Kaiser Family Foundation projects that the growth of medicare spending on a per person basis is expected to be slower than those of private insurance plans.  For now it is a start, but now we need to ask ourselves, "Where do we go from here?"

   

Maybe those "Death Panels" weren't such a bad idea

This is the fourth piece in a five part series on Medicare.  Join "Health on the Horizon" on Facebook!

My first job out of college was in a rehabilitation hospital for people with traumatic brain injury, an experience that changed my life.  My primary placement was on the floor for people on ventilators, feeding tubes and in level I and II comas.  In the time I spent there I observed the pain and heartbreak confronted by thousands of families every day in this country, the inability to care for their loved ones because there were no advance directives, including a living will (a document indicating the type of medical treatment one desires if in a vegetative state).  I watched families unable to make healthcare decisions for their loved ones that were in vegetative states because there was no health care proxy (a legal document designating another person to make healthcare decisions if you are ever rendered incapable of making them known).  For some of these families this nightmare went on for decades.  

Soon after my experience working with these patients and their families, I made the decision to do everything in my power to never put my own loved ones through the same trauma.  I called a lawyer and completed a “health care proxy” and “a living will”.  I was in my late 20’s and the lawyer chuckled that I was not only the youngest client, but among the few he had ever issued this legal documentation to.  A sad statement, but true.  In fact, according to the University of Minnesota Center for Bioethics, less than 5% of people over age 65 have advanced directives.

When the Patient Protection and Affordable Care Act was first signed into law in March 2010, there included a provision for voluntary end of life counseling for Medicare patients.  This would have allowed Medicare patients access to completing a health care proxy and living will.  However, in January of 2011, Obama reversed course on the provision and it was removed (New York Times, January 5, 2011).  This voluntary access to end of life counseling would not only save thousands of families from the years of heartache I observed, but would also save our Medicaid and Medicare system millions of dollars by no longer performing costly medical interventions that are being done against a patient’s  will.  Estimates show that 27% of Medicare’s annual budget goes to recipients in their last year of life.   

To understand why Obama did this we need to reflect back upon those chaotic days of when we were debating health care reform.  The misinformation, political grandstanding and lobbyists in Washington were abundant.  The volume was high and the noise was loud.  The ignorant fears that labeled these advanced directives as “Death Panels” flooded the news.  The opposition was willing to say anything for political gain.  Guess what?  It worked.

While the provision made it into the original legislation, Obama removed it soon after when the noise started going up again.  He caved to the political pressure at the expense of public health.  It’s been about 15 years since my days working with coma patients and their families and I think about them often.  These family members came loyally each day for decades to support their loved ones.  In the end, they were powerless.  This heartache would have been prevented if only these patients had access to “death panels”.

Is the PPACA killing Granny?

This is the third in a 5 part series on Medicare.  Join "Health on the Horizon" on Facebook!

Artwork by Norman Rockwell

When the PPACA was passed, you heard all kinds of political rhetoric from massive cuts in medicare to “granny killings”.  While “granny killings” were just outright ridiculous, the impact upon medicare is something to take seriously.  After all, with the official retirement of the “baby boomers” in 2011, the rapidly aging population and a reduction of younger workers to support programs like social security and medicare, this was a reasonable concern.  Furthermore according to the Kaiser Family Foundation, Medicare’s Insurance Trust Fund (Medicare Part A) is expected to become insolvent in 10-15 years.  

So what does this mean to Pennsylvanians?  Let’s simplify how the PPACA impacts medicare by categorizing into 3 basic points: (1) Basic Medicare benefits will remain the same but will be improved with the new access to free preventive care and reduction of the “donut hole”, (2) it implements instruments to reduce waste, fraud and abuse, with part of this being (3) a reduction of payments to Medicare Advantage. 

Ah ha!  That was it! That was the language that sparked the political rhetoric to claim that the PPACA was choking our seniors and possibly even killing your grandmother!  

Ok, now back to reality.  In fact, Medicare Advantage is NOT traditional Medicare at all.  It arose out of a private insurance program  that was developed in the 1970’s as an alternative to those eligible for Medicare.  The original intention was for the private sector HMO/PPOs to provide health insurance at a lower cost.  However, over the years they have resulted in the government paying more per enrollee than those on traditional Medicare.  The government has actually been paying 9-13% higher for these plans. 

Regardless, it is still an important concern because 25% of Americans and 38% of Pennsylvanians are on Medicare Advantage.  According to Jean Friday, President for the Pennsylvania Alliance for Retired People, “many retirees in the western part of the state are very anxious about this piece of legislation.  In the 1990’s many retirees lost their health care benefits and resorted to managed care plans for their coverage. Others were given the option to enroll in Medicare Advantage plans when their employer no longer offered traditional Medicare as an option.”

While this shifting of overpayments from Medicare Advantage to traditional Medicare will allow for the closure of the “donut hole”, the free preventive care and assist with the long-term solvency of the Medicare program, this isn’t a consolation to those possessing these plans.  However, with the PPACA, some consumer protections have been strengthened for Medicare Advantage enrollees.  One of the main ones is that like all other large and small group insurance plans, Medicare Advantage is now subject to Medical Loss Ratio.  This will mean that 85% of the consumer’s premium dollars must now be spent on healthcare and not administrative costs, advertising, CEO bonuses and lobbying.  This will also help in curtailing the future solvency of the Medicare Fund.  Furthermore, the PPACA provides bonuses payments to Medicare Advantage plans based on quality ratings and limits the out of pocket costs or no more than $6700 for the consumer.  Current enrollees have the option of switching plans during the open enrollment period.

Ms. Friday concluded that “In 2010 many politicians claimed the Healthcare Law would be bad for seniors, but here we are, two years later, and the facts do not look bad.  Many have seen the benefits of the closing of the “donut hole” and access to preventive care.  The evidence is in, the Healthcare Law has been and will continue to be good for Pennsylvania Seniors.”

An ounce of prevention: Barbara's Story

This is the second in a five part series on Medicare.  Please join "Health on the Horizon" on Facebook!

Barbara Dickman:  Senior from Westmoreland County PA

It is a common saying among public health professionals that in the United States we don’t have “Healthcare”, we have “sickcare”.  In other words, our cultural attitude perceives medical services as the place to go only when we are ill.  This cultural practice changed recently for Barbara, a 74 year old Westmoreland County resident.  

This year Barbara went to see her doctor for an annual physical.  Most of us wouldn’t see this simple action as something too earth shattering, but in reality, Barbara represents the first generation of seniors that can now access annual physicals free of charge.  

Prior to the passage of the Patient Protection and Affordable Care Act, there was a one-time only introductory physical for Medicare patients and then anything after that was subject to a copay and deductible.  As of January 2011, the PPACA began covering annual physicals in full, as well an array of other research proven preventive health measures.

According to the Alliance for Retired People, in 2006, the state of senior’s health practices were pretty bleak.  In their August 2006 issue brief, they stated that approximately half of all medicare beneficiaries were not taking advantage of preventive services available to them--services that if utilized could prevent, postpone the onset of serious illnesses and ultimately control costs.  There are two explanations for this.  One is the cultural belief among a generation that perceives healthcare as primarily a tool to treat illness, not one to prevent it.  The second reason is cost.  Prior to the passage of the PPACA, many of these services required a 20 percent coinsurance and deductible.

    

Let’s look at the stats:  Colon cancer and cervical cancer are among the most preventable forms of cancer.  According to the American Cancer Society, 90% of all colorectal cancers occur in people over the age of 50.  Yet, 31% of seniors received a colonoscopy in 2006.  With that said, in the past 20 years, with advances in screening technology and polyp removal, incidence and deaths from colorectal cancer have drastically decreased.  Likewise, with the advanced technology of the Pap Test (test used to detect cervical cancer), we have seen a 67% decrease in incidence and mortality rates over the past 3 decades.  Yet, only 36% of senior women utilized the pap test/pelvic exam to prevent cervical and vaginal cancer.

Transforming the cultural attitude of seniors to see medical services as “healthcare” instead of “sickcare” may continue to be an obstacle for us.  However, the advances and success in medical technology is showing that our societal attitude is turning the corner.  As of January 2011, our public health policy validated this shift.

Inside the "Doughnut Hole": Barbara's Story

This it the first of a five part series on Medicare.  Join "Health on the Horizon" on Facebook!

Barbara Dickman:  Senior Citizen from Westmoreland County PA

“Doughnut Hole”.  As someone that has spent most of my career in public health, I found this an odd term to use when referring to healthcare.  However, it has become a legitimate term to use when referring to the gap that many seniors on medicare experienced when they max out their basic drug benefits--at which point, they are now in the “doughnut hole”--until catastrophic drug benefits kick in (usually costing them a few thousand dollars).

In 2010 the Department of Health and Human Services estimated that almost 4 million seniors reached the doughnut hole (177,00 in Pennsylvania) and were therefore faced with the financial challenge of meeting 100% of their prescription drug costs at a time when most seniors are on a fixed income.  According to the Pennsylvania Alliance for Retired Americans, as of October 2011, 70% of Pennsylvanians reached the “doughnut hole”.  The public health challenge to this coverage gap is that the DHHS also projected that one quarter of these people stop following the prescribed regimen of drugs once they hit the donut hole.  The personal health implications and healthcare costs that follow go without saying.  

In 2010 when the PPACA was passed, all seniors that reached the doughnut hole received a $250 rebate check and beginning in 2011the doughnut hole began to close and will continue to shrink until 2020.  As a result, in 2011, 3.6 million Americans saved $2.1 billion and Pennsylvania Seniors saved $109 million ($617 for each Pennsylvanian).  

One of these seniors is Barbara Dickman, a retired stockbroker from Westmoreland County, PA.  Barbara suffers from diabetes and congestive heart failure and prior to the passage of the PPACA was paying approximately $14,000 a year out of pocket for medical costs for her and her husband.  After the passage of PPACA she shopped on the government web site where she found a more affordable medicare supplement for her and an HMO for her husband.  Their healthcare costs have decreased by almost $6,000 (most of which comes from the ‘doughnut hole‘ relief).  

¹ US Dept. of Health and Human Services Press Release, February 2, 2012

² PA Alliance for Retired People,  December 22, 2011 Press Release

³ MoscowVillager, February 3, 2012

        

Easter Holiday Weekend Break

March 27, 2012:  PPPACA supporter in front of the Supreme Court

"Health on the Horizon" will be taking the week off for the Easter Holiday Weekend.  In the meantime,  be sure to "Like" it on Facebook and follow on Twitter.

Coming up this spring: A five part series on Medicare, A series called "Questions from the Community", we'll meet the "Healthcare Serf" and many other Pennsylvania neighbors that are benefiting/will benefit from the Patient Protection and Affordable Care Act.  Of course, we continue to wait the Supreme Court's decision due to be released in June or early July.

As we turn to a higher power

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March 27, 2012: At the Supreme Court

On Tuesday March 27 I entered a time machine.  The biting cold of a March day hung over the Supreme Court as it cast a cold gray shadow over the early morning events, events that delivered me back to August 11, 2009.  

This was the day my then senator, Arlen Spector, hosted the first of the infamous “town hall” meetings in Lebanon, PA.    That day, almost 3 years ago, I went to hear my senator speak about what I thought would be “wonky” healthcare policy about an issue that I held near and dear to my heart.  I craved to hear and thoughtfully discuss solutions to an issue I constantly struggled to wrap my head around because there are so many complexities lying behind it.  As I went to engage in what I thought would be a serious policy discussion, I found anything but that.

That August morning I wasn’t able to get anywhere near the building that held the meeting and I never got in.  Instead, I spent the time in the streets with thousands of screaming protesters making rhetorical and shallow claims about broad ideology:  socialism, big government and the like.  The sound was deafening.  As I stood in the streets, the chaos permeated into every pore of my being and settled into my core leaving  me with a pit that hung heavy inside me for the next 2 ½ years.    I was disheartened, confused and scared.

While I continued to grapple with the complexities of this issue, I knew that it lay at the heart of a complex sociological picture of a changing global economy, a decreasing middle class and exponentially rising costs of healthcare.  These ideas I simply could not put it into a 4 word protest sign.  It required deep and thoughtful analysis.  I grew scared that this noise and politics was overshadowing a real and serious dialogue.  The 2 ½ years that followed that day I dug deeper to study this issue and engaged in personal self-reflection as a stroke survivor.  Out of that, “Health on the Horizon” was born.

This Tuesday March 27 I stood in the chilling shadow that the Court cast over the crowd.  The cold penetrated my thick wool coat and sent me into a shiver, as did the shouting that resonated from the crowd.  As the opposing sides fought to overshadow and out-scream each other, the decibel wars of the speaker systems began.  While one group spoke over a speaker, the other raced to turn up their volume and shout louder.  Under this shadow of noise, paraded an array of people dressed in an assortment of characters:  The Statue of Liberty, Ben Franklin, George Washington and even Mickey Mouse (or at least his hands).   I was disappointed in this scene, but also in myself.  I was participating in the very thing I was striving to move beyond.  I regretted my trip to DC.  

Under the aura of regret, I made my way to the perimeter of the crowd.   I found my own space at the edge of the Court steps.  I turned around and put my back to the shouting crowd and stared at the awesome pillars that supported the high court.  Staring at this great building I was filled with a presence, a power that was greater than me and I was absorbed by its mightiness.  Radiating from the marble walls I could hear the voices and struggles of generations past that had also come to this place to find their answers.  They sought answers to questions that challenged the era in which they lived, a process that has withstood the test of time.  They had faith in it and now it was our turn.

A sense of peace overcame me and the noise that echoed through my head began to disintegrate.  As I turned back around to find my own way to engage in democracy, an amazing thing began to happen.  Two of the main organizers for the opposing sides had come to an agreement to take turns with the microphone, whereas each would have their individual opportunities to have their voices heard without interruption.  It worked.

As I listened to often sad, but real stories of people and their challenges with healthcare, the group began to discuss specific provisions in the law.  After that, I found my place at the periphery of the crowd with the sign I had created about Pennsylvanians and details of the law.  I waited for people to approach me.  For over 6 hours people read my sign, asked questions and we discussed detailed pieces of the legislation.

Not everyone I spoke with supported the law and some were skeptical.  As the late afternoon began to set in, I engaged in a conversation with a physician.  He was not a supporter of the law but as I spoke with him I found our only option was to seek common ground.  We agreed on the Medical Loss Ratio, Rate Review and the things that are driving up healthcare costs.  Where we didn’t agree with each other was on the lifetime cap provision and the sustainable funding of the law.  He did not believe the CBO report to be accurate and he also believed the law would weigh heavy costs on his practice.  He also felt the lifetime caps would disrupt the business model and cause insurance companies to go bankrupt.

While the CBO states that the new healthcare law is fully financed through a combination in savings from medicare and medicaid, taxes and fees, it also projects a reduction in the deficit.  He refused to believe this.  For me, a business model of allowing people to die or slip into poverty trying to treat illness is simply unacceptable in the wealthiest nation in the world. 

However, as I watched him speak, the intensity of his voice, his veracious tone and the sharp gestures created in his body language sent me another message.  I have seen this message in many people I have met for this project.  It was the message of anxiety and uncertainty.  Maybe everyone expresses it in their own unique way.  I was beginning to understand this and this anxiety needs to be acknowledged.

As the late afternoon sun now illuminated the awesome pillars of the Court, I graciously shook the physician’s hand and thanked him for the thoughtful dialogue.  I panned over a new crowd that was beginning to descend upon the area.  Ben Franklin and The Statue of Liberty had returned. 

Click HERE for Video of my statement to CCTV

Click HERE for my statements to The Guardian Newspaper

Click HERE for photos and overview from Democracy in Action

With Theresa Brown Gold 

The crowd

My sign

Supreme Spirit

Today we recognize the Second Anniversary of the day congress passed The Patient Protection and Affordable Care Act, 2010.  As the law goes before the Supreme Court this week, it seemed fitting to revisit Theresa BrownGold as she is currently spending her days at the Supreme Court.  I will be joining her this week.  Please follow me on Facebook.

Theresa BrownGold with Courtney:  January 2012 US Supreme Court

As the unforgiving bite of the winter winds whip through the mall in Washington DC this year, they eventually make their way around the US Capitol.  Behind the Capitol, their relentless bitterness ultimately encircles the majestic pillars of the Supreme Court.  Positioned between these two forces of authority stands Theresa BrownGold and Courtney.  Theresa, a gray-haired 57 year old woman from Bucks county, carries herself with a sense of purpose.  Courtney however, is held in the nurturing embrace of Theresa in the form of a painting, representing a soul that our healthcare system left behind.  

Courtney

Courtney was a Type I diabetic woman in her 20’s.  She attended college on a full scholarship in track and field.  Upon graduation, like many young people out of school, she was uninsured.  In order to save money, she cut back on her nighttime insulin medication.  In 2010, she slipped into a diabetic coma and died.

My healthcare journey around Pennsylvania this year led me to Theresa last fall where she did a guest blog for “Health on the Horizon”.  Theresa is a portrait artist that began a project called “Art As Social Inquiry” over 3 years ago. In this project, she documents the plight of the uninsured/underinsured though the use of portrait art.  Recently, in light of the upcoming Supreme Court decision about the constitutionality of the PPACA, Theresa has taken her project to a new level.  Each day the Supreme Court is in session this winter (6 days a month), you will find Theresa outside on the steps with one of the many subjects she has painted over the years.  Additionally she spends 4 days a month in front of the Capitol for a total of 50-55 hours a month in DC.  Each day she is in DC she has updated her followers on her Facebook page with the events of the day.

On this day in late January, the winter wind was particularly unforgiving.  As the winds whipped through the Romanesque pillars of power, Theresa fought to keep Courtney stable.  As the southern winds pushed, they gave way to the tug of the northern gusts--A dance that went on for hours.  Theresa held on tight and Courtney never budged.  

Later that day, Theresa posted her experience fighting the power of the wind on her Facebook page and concluded that it was with Courtney’s help that the painting stood strong in the forceful powers of wind and the channels created by the mighty buildings.  In response to Theresa’s post I commented with words of encouragement to keep up the fight for Courtney and all those like her.  I logged out and went about the day to day activities of my life.  

A few days later I revisited Theresa’s pursuit in order to find out the latest news.  I returned to the story of Courtney and Theresa’s battle with the wind and found someone had given my comment a “Like”, the 21st century version of fellowship and camaraderie.  It was from Courtney’s mother.

I was humbled. Just as Courtney’s sturdy hand reached out to Theresa that windy afternoon, through her mother, Courtney was reminding me that this issue lies at the very soul of the human condition.  Regardless of the powerful force of human or nature, the spirt of those who have slipped into the cracks of a broken system refuse to be silenced.  Theresa and Courtney are making sure that they aren’t.

Today's Anniversary Post is done in memory of Courtney Leigh Huber

Courtney Leigh Huber died on January 5, 2010 because she wasn't able to access health care to take her prescription diabetes medication.  In her honor, her family and friends have created "Courtney's Keepers", an organization dedicated to providing diabetes supplies to those in need.  


On September 23, 2010, 8 months and 18 days after Courtney passed away, the provision in The Patient Protection and Affordable Care Act became effective that states that all young people under the age of 26 are eligible to stay on their parent's health insurance.

In the Fall of 2011, I was honored to be a part of Theresa’s collection (see My Story).  Theresa and I have called ourselves “kindred spirits”, each telling this story in our own way.  I am often reminded of a conversation that we had last fall when she said, “With each stroke we need to keep telling this story.  Mine is with the paintbrush, yours is with the keyboard”.  And so the story goes on........

Domestic Violence Screening in the PPACA

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Screening for Domestic Violence is a provision in the PPACA

A doctor’s examination room is often perceived as simply a sterile and routine place to most of us.  However, to a woman who is a victim of domestic abuse, it can be a sanctuary, a refuge and escape from the confining trap of shame that she has often endured for decades.  Emotional and physical trauma eats away at the soul of its victims and they often do not know where to turn.

Since the early 1990’s the Pennsylvania Coalition Against Domestic Violence (PCADV) has been a trailblazer in the field of screening for domestic violence in the health care setting through its Medical Advocacy Project.  The basic components of this project include training medical staff on how to accurately and effectively screen, counsel and refer victims to domestic violence programs.  This project has found that when a woman is routinely screened by a trained professional within the confidential doctor/patient privilege, she is more likely to disclose and therefore receive help.  

This is a vital service for an often overlooked public health issue.  Traumatic Brain Injury (TBI) from physical abuse is a common injury among domestic abuse victims leaving them with lifelong physical, cognitive and emotional challenges.  Research has shown that 90% of all injuries related to domestic abuse involve the head, neck and face (Monohan and O'Leary 1999). 

As of August 1, 2012, the Patient Protection and Affordable Care Act will require that all insurance plans cover screening and counseling for domestic abuse, a provision found under preventive services for women’s health.  According to Nicole Lindemyer, Policy and Special Project Manager at PCADV, when a victim who is at a high risk of being killed receives intervention services, she has a 60-70% reduction in risk of being re-assaulted and killed.  Therefore, this early intervention is critical to curtailing the incidence of TBI and often preventing homicide.

In 2014, more people will have access to healthcare because of the PPACA, and hence more victims will be screened for domestic violence and connected to these life-saving services.  Ms. Lindemyer is expecting a greater request for trainings for practitioners because they will now be reimbursed for this service.  She finds the provision in the PPACA as a validation of what they have known for decades: that in order to curtail domestic violence, you need to meet women “where they are at”.  Ms. Lindemyer proclaims that this provision in the PPACA is a “victory for women” in that “It’s a paradigm shift from seeing domestic violence a simply a criminal justice issue and now recognizing it for what it is: a public health issue.” 

Nicole Lindemyer is the Public Policy and Special Projects Manager for the Pennsylvania Coalition Against Domestic Violence, Pennsylvania’s statewide network of domestic violence programs.  In this role, she leads the development and implementation of the Coalition’s legislative and public policy agenda—analyzing and drafting legislation, lobbying and testifying before the legislature, and encouraging civic engagement in the political process.

Prior to her current role, Nicole was a civil rights litigator in Minneapolis and Chicago in the areas of housing and employment discrimination and in poverty law, specializing in violence against women issues within these contexts.  She was an Equal Justice Fellow from 2001 to 2003, and has written and lectured extensively on violence against women in housing.  A survivor herself, Nicole is a zealous advocate for women’s rights, particularly the right to be free of physical and sexual violence.