My Brother's Keeper-part II: Billy Koehler's Story

This is the forth story in a 5-part series called "Faces from the Frontline".  Join "Health on the Horizon" on Facebook and Twitter.

Billy Koehler
March 18, 1951-March 7, 2009

Georgeanne Koehler still holds a scrapbook that she made for her brother, Billy, as a birthday present.  She was planning on giving it to him at a family birthday celebration on March 18, 2009.  Billy never made it to his 58th birthday.  Instead, the scrapbook was displayed at his funeral.    

Last week, “Health on the Horizon” presented the story of Billy Koehler, an electronics technician from Pittsburgh that died at the age of 57 because he was uninsured and could not afford to replace a battery in his AICD (defibrillator).  The device was necessary to live with his diagnosed heart condition of Torsades de pointes.  He passed away on March 7, 2009, when he was found slumped over the steering wheel of his car.  

Billy’s heart condition began in April of 1990 when he experienced a heart attack while in triage at the emergency room.  At the time, he had insurance, received a AICD and managed his condition with relative ease.  Over the next 10-13 years he was able to receive the needed battery replacement procedure necessary to maintain an AICD.  This procedure was done roughly every 5 years and usually cost the insurance company about $6000.  However, when Billy was uninsured, he was told to be prepared to pay between $60,000-$100,000, a reality that the uninsured back the burden of cost.   

A 2008 study published in the journal Health Affairs found this to be a common practice.  In their study they found that 49% of the uninsured treated in a California hospital in 2005 paid a higher price for services than those with private insurance, medicaid and medicare.  In Billy’s case, his sister, Georgeanne, tried to negotiate paying the price charged to insurance companies for the procedure, but was denied.  Instead, the hospital sent him a Christmas bouquet.  

Billy’s story is also telling of another reality in the challenges of the uninsured as they try to access healthcare.  In Billy’s story, when he was admitted to the hospital he was told by a resident that he would not get the “same care as those with insurance”.  According to the Institutes of Medicine, the uninsured do receive fewer services when they are hospitalized.  Furthermore, the uninsured have a 25% greater chance of dying than those with health insurance.  As a result, according to a Harvard University study, 45,000 people die prematurely each year in the US do to lack of access to healthcare.  

Billy is more than just an example of the uninsured that have fallen through the cracks in the system.  He is a human testament to the statistical realities that have been featured over the course of the past 10 months on this blog.  When Billy’s employer suddenly closed shop in the Spring of 2003, he was not offered a COBRA plan because the employer had (unbeknownst to the employees) cancelled the health insurance plans for all the employees months prior.  While unethical, this is not an illegal practice.  

In the United States, a vast majority of people rely on employers for access to healthcare- a reality that is beginning to take its toll on both the employer and employee/patient.  As we saw earlier this year in the story of Shontell, employer provided care has drastically declined in the past decade due to exponentially increasing costs.  In 2014, the PPACA calls states to set up state based exchanges/marketplaces (for individuals and small businesses) where people like Billy will be able to go when they no longer are able to get health insurance through their employer.  

Finally, following the loss of his job, Billy did try to apply for private insurance, but was denied due to his “pre-existing condition”, a situation common among 32% of the general public

 and drastically increases with age.  In January 2014, insurance companies can no longer deny coverage to people with a preexisting condition as part of basic patient protections that are written into the law.  

As Georganne Koehler turns the pages of the scrapbook that was never gifted to her brother for his 58th birthday, she sometimes wonders if Billy was a martyr in the fight for healthcare.  Georgeanne’s work as a healthcare advocate has taken her around the state of Pennsylvania and her message has hit the ears of thousands of people.  Above all however, Georgeanne’s mission is to ensure that Billy’s death will not be in vain.   

In 2010, The Pennsylvania Health Access Network, a consumer health advocacy group, named Georgeanne the “Pennsylvania Health Advocate of the year”.  Each year, PHAN awards someone in the state with the award that is now named after Georgeanne.  On April 29, 2012, I was honored to be given the “2012 Georgeanne Koehler Pennsylvania Health Activist of the Year” award for "Health on the Horizon".

I am My Brother's Keeper: Billy Koehler's Story

This is the third piece in a five part series entitled "Faces from the Frontline".  
Join "Health on the Horizon" on Facebook or Twitter.

Billy Koehler
March 18, 1951-March 7, 2009

While walking down the street one spring in the late 1980’s, Billy found a senior citizen crying on her porch.  When he approached her to find out why she was so upset, she explained, “my television is broken and it will cost $25 to fix.”  To many people this may not be a cause of such great sadness, but to a senior living alone on a fixed income, her only source of companionship was now gone.  

However, today was her lucky day.  Billy, an electronics technician, had found her.  He hurried home, got his tools and repaired the television.  After he finished the repair, the woman sifted through her purse and offered him $5 for his service.  Billy responded, “why would you give me $5 for 1 cent worth of work?”  With gratitude, the woman handed Billy a penny.  When asked by a friend later why he took the penny, Billy replied, “Even a poor senior needs to know that they can contribute.” 

A religious man, Billy’s life echoed the teachings of Luke 20:45- the story of the poor widow that enters the temple amongst the wealthy elite to give her last 2 coins.  

After the electronics company he worked for suddenly closed in the Spring of 2003, he was left uninsured with a heart condition that required him to have an Automatic Internal Cardiac Defibrillator (AICD).  While looking for another job that had insurance, Billy spent the rest of his days building a ramp for a man in a wheelchair and refused any payment for his services.  

Billy believed that he was was brother’s keeper.

By 2005, Billy began delivering pizza’s 31 hours a week for minimum wage with no health insurance.  Due to his pre-existing condition, health insurance companies deemed him a bad investment and society stigmatized him the same.  This stigma crystalized on December 14, 2007 after he collapsed while closing the pizza shop.  Upon his arrival at the Emergency Room, a resident opened his chart and replied, “oh, you’re uninsured.  I need to tell you that you won’t get the same tests as people that have insurance.”  

Are we our brother’s keeper?

Hours later, the cardiologist on staff informed him of his dire condition.  The battery that delivers the life-sustaining electronic charge to his heart was dangerously low and needed to be replaced immediately.  The procedure would cost between $60-100,000.  Unable to produce the money, Billy was discharged immediately and told by the cardiologist, “if you get your priorities straightened out, you’ll come up with the money.”

Are we our brother’s keeper?

Unable to find $60,000, Billy and his family lived the next 446 days wondering if this was going to be his last.  On Sunday March 6, 2009 Billy knelt before the alter of his church and asked his almighty healer to answer the will of his heart.  

The answer came at 5:00pm the next day.  On March 7, 2009 Billy left work, got behind the wheel of his car and headed home.  Without the battery, the defibrillator was still capable of giving him the “warning signal” that an electronic jolt was needed.  The signal came.  Billy pulled over to the side of the road, knowing that the life-sustaining jolt would not be delivered, he sat and waited to meet his creator.  At 5:07pm Billy was found dead over the steering wheel of his car. 

This story was written with the help of Georgeann Koehler, Billy’s sister.  Georgeanne has become an outspoken activist about the issue of access to healthcare.  In December of 2011, Georgeanne facilitated a postcard campaign entitled “No more empty chairs at the table” which produced 1200 cards in 12 days to every PA Congressman and Senator.  Georgeanne has dedicated herself to being her brother’s keeper.

Please return next week to learn more about the details of Billy’s experience and see how the PPACA help to prevent that there are no longer any more “Billy’s”.

The Healthcare Serf: Linda's Story

This is part of a 5 part series called "Faces from the Frontline".  Join "Health on the Horizon" on Facebook and Twitter.  

Linda:  Lancaster County, PA

It was a Friday in mid April when I met Linda in a Central Pennsylvania coffee shop.  It was the end of a good week.  On Monday Linda had received her certification as a licensed massage therapist and hours before our meeting, she received a position at a facility in Leola.  An aura of relief surrounded her.  It had been a long year.

With a Master’s Degree in public administration, Linda spent 17 years as a research project manager.  Her most recent job was at a large Central Pennsylvania Facility.  While her career had been a fulfilling one, the stress of this demanding profession began to take a toll on her health and wellbeing and it was time for a change.  After years of examining the practice of massage therapy, she saw this as her new calling.

At the age of 52, redefining yourself can be a frightening thing.  Leaving the security of a stable career that offers a good salary with benefits and going out on your own can often feel like walking a tightrope without a safety net.  Like Linda, many people can relate to reaching the point in their lives where it is time to change course and embrace independence, freedom and individualism.  After all, aren’t those the core principle’s America was founded on?

Not with our current healthcare system.

In 2008, nearly a quarter (23%) of Americans reported taking a job or staying at a job they no longer wanted to be at solely for healthcare benefits, according to the Kaiser Family Foundation.  Linda was one of them.  For months, Linda tried to balance school with her full-time job primarily to keep her healthcare benefits.  She explains that living without her salary for a time did not scare her, but the thought of not having health benefits was frightening.  She had never been without health insurance and she only stayed at her job because of them- she was a “serf” to her healthcare.

It was a grueling choice for her, but one that made her engage in deep self reflection to explore the priorities in life:  personal happiness and living a life with meaning.  Ultimately, Linda had to leave her job when the courses necessary for completing her degree were only offered during the day.  Unable to pay for a policy on the expensive individual market, she joined the ranks of the uninsured.  A recent study by the Commonwealth Fund found that individuals, like Linda, seeking policies on the individual market found it unaffordable and 45% went without a policy.  While she wasn’t alone, she felt vulnerable and alone.  Linda recalls harboring a sense of shame for not having health insurance, as if society viewed her as somehow inferior.  However, the irony, doesn’t our society celebrate personal independence?  

The United States is the only country in the industrialized world where individuals are left vulnerable when they leave their employer-based healthcare.  This makes me wonder that in a country that celebrates the ideas of “freedom” and “individualism”, how truly free are we when we are strapped to our employers in order to meet our most basic human need? 

In 2014, the Patient Protection and Affordable Care Act calls on states to set up individual exchanges/marketplaces for people such as Linda.  These exchanges are designed for uninsured people (people who don’t get insurance through their employer, people who are in between jobs or lost a job) to have a place to go for affordable healthcare.   The individual exchanges/marketplace will consist of a wide variety of private insurance plans where consumers “shop” on the internet.  By pooling many consumers together, it will be more affordable than going alone on the individual market.  Premium tax credits are also available for individuals up to 400% of poverty level.

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.