Hospitals Participating in Drug Trial for COVID-19 Across the US

Here is the official government website for a nationwide trial to evaluate the safety and efficacy of various novel therapeutic agents in hospitalized adults with COVID-19:

https://clinicaltrials.gov/ct2/show/NCT04280705

Here are the study site locations across the us:
United States, Alabama
University of Alabama at Birmingham School of Medicine - Infectious Disease Recruiting
Birmingham, Alabama, United States, 35233
United States, California
University of California San Diego Health - Jacobs Medical Center Recruiting
La Jolla, California, United States, 29037
University of California Los Angeles Medical Center - Westwood Clinic Recruiting
Los Angeles, California, United States, 90095
University of California Irvine Medical Center - Infectious Disease Recruiting
Orange, California, United States, 92868-3298
VA Palo Alto Health Care System - Infectious Diseases Recruiting
Palo Alto, California, United States, 94304-1207
Stanford University - Stanford Hospital and Clinics - Pediatrics - Infectious Diseases Recruiting
Palo Alto, California, United States, 94304-1503
University of California Davis Medical Center - Internal Medicine - Infectious Disease Recruiting
Sacramento, California, United States, 95817-1460
Naval Medical Center San Diego - Infectious Disease Clinic Not yet recruiting
San Diego, California, United States, 92314
University of California San Francisco - Zuckerberg San Francisco General Hospital - Division of Human Immunodeficiency Virus, Infectious Disease, and Global Medicine Recruiting
San Francisco, California, United States, 94110-2859
United States, Colorado
Denver Health Division of Hospital Medicine - Main Campus Recruiting
Denver, Colorado, United States, 80204
United States, Georgia
Emory Vaccine Center - The Hope Clinic Recruiting
Decatur, Georgia, United States, 30030-1705
United States, Illinois
Northwestern Hospital - Infectious Disease Recruiting
Chicago, Illinois, United States, 60611-2908
University of Illinois at Chicago College of Medicine - Division of Infectious Diseases Not yet recruiting
Chicago, Illinois, United States, 60612
United States, Maryland
University of Maryland School of Medicine - Center for Vaccine Development - Baltimore Not yet recruiting
Annapolis, Maryland, United States, 21401-1527
Johns Hopkins Hospital - Medicine - Infectious Diseases Not yet recruiting
Baltimore, Maryland, United States, 21287-0005
National Institutes of Health - Clinical Center, National Institute of Allergy and Infectious Diseases Laboratory Of Immunoregulation, Clinical Research Section Recruiting
Bethesda, Maryland, United States, 20892-1504
Walter Reed Army Institute of Research - Clinical Trials Center Not yet recruiting
Silver Spring, Maryland, United States, 20910-7500
United States, Massachusetts
Massachusetts General Hospital - Infectious Diseases Recruiting
Boston, Massachusetts, United States, 02114-2621
United States, Minnesota
University of Minnesota Medical Center, Fairview - Infectious Diseases and International Medicine Recruiting
Minneapolis, Minnesota, United States, 55455-0341
United States, Missouri
Saint Louis University - Center for Vaccine Development Recruiting
Saint Louis, Missouri, United States, 63104-1015
United States, Nebraska
University of Nebraska Medical Center - Infectious Diseases Recruiting
Omaha, Nebraska, United States, 68198-5400
United States, New York
Montefiore Medical Center - Infectious Diseases Recruiting
Bronx, New York, United States, 10467-2401
New York University School of Medicine - Langone Medical Center - Microbiology - Parasitology Not yet recruiting
New York, New York, United States, 10016-6402
University of Rochester Medical Center - Vaccine Research Unit Not yet recruiting
Rochester, New York, United States, 14642
United States, North Carolina
Duke Human Vaccine Institute - Duke Vaccine and Trials Unit Recruiting
Durham, North Carolina, United States, 27704
United States, Pennsylvania
Hospital of the University of Pennsylvania - Infectious Diseases Recruiting
Philadelphia, Pennsylvania, United States, 19104-4238
United States, Tennessee
Vanderbilt University Medical Center - Infectious Diseases Recruiting
Nashville, Tennessee, United States, 37232-0011
United States, Texas
Brooke Army Medical Center Not yet recruiting
Fort Sam Houston, Texas, United States, 78234
University of Texas Medical Branch - Division of Infectious Disease Recruiting
Galveston, Texas, United States, 77555-0435
Baylor College of Medicine - Molecular Virology and Microbiology Recruiting
Houston, Texas, United States, 77030-3411
University of Texas Health Science Center at San Antonio - Infectious Diseases Not yet recruiting
San Antonio, Texas, United States, 78229-3901
United States, Virginia
Naval Medical Center Portsmouth - Infectious Disease Division Not yet recruiting
Portsmouth, Virginia, United States, 23708
United States, Washington
EvergreenHealth Infectious Disease Service Recruiting
Kirkland, Washington, United States, 98034
The University of Washington - Virology Research Clinic Recruiting
Seattle, Washington, United States, 98104-2433
Providence Sacred Heart Medical Center Recruiting
Spokane, Washington, United States, 99204
Madigan Army Medical Center - Infectious Disease Clinic Not yet recruiting
Tacoma, Washington, United States, 98431
Japan
National Center for Global Health and Medicine Hospital - Disease Control and Prevention Center Recruiting
Tokyo, Japan, 162-8655
Korea, Republic of
Seoul National University Bundang Hospital - Division of Infectious Diseases Recruiting
Bundang-gu Seongnam-si, Gyeonggi-do, Korea, Republic of, 13620
Seoul National University Hospital Recruiting
Seoul, Jongno-gu, Korea, Republic of, 03080
Singapore
National Centre for Infectious Diseases (NCID) Recruiting
Singapor
https://clinicaltrials.gov/ct2/show/NCT04280705

Adaptive COVID-19 Treatment Trial - Full Text View.

clinicaltrials.gov

Adaptive COVID-19 Treatment Trial - Full Text View - ClinicalTrials.gov

Adaptive COVID-19 Treatment Trial - Full Text View.

Adaptive COVID-19 Treatment Trial - Full Text View.

COVID-19 Stay At Home Order - State of Illinois

Under the order, dry cleaners, laundromats, any business that sells equipment/materials needed to work at home, computer stores, law offices, payroll services, hardware stores, cabbies, Uber, and of course grocers, pharmacies and carry-out/delivery restaurants may stay open.

If you keep your office open, for example, you must provide 1.) six foot distances, 2.) hand sanitizer and disenfectant, 3.) separate operating hours for vulnerable populations, and 4.) posting online... if you are open and how best to reach the facility and contact by phone or remotely.

Individuals can go outside for:

Health and safety: seeking emergency services, obtaining medical supplies or medication or visiting a health care professional

For necessary supplies and services: obtaining groceries and food, household consumer products, supplies they need to work from home, and products necessary to maintain the safety, sanitation and essential operation of residences

For outdoor activity: walking, hiking, running or biking – including going to public parks and open outdoor recreation areas, except for playgrounds

For certain types of work: Providing essential products and services at Essential Businesses or Operations or otherwise carrying out activities specifically permitted in the order, including

Minimum Basic Operations
To take care of others: Caring for or transporting a family member, friend or pet in another household

What Is the Effect of the Recent Court Decision in Texas That Ruled the Entire Affordable Care Act is Unconsitutional?

There is no immediate effect to yesterday's court ruling.  You can still enroll in health care plans on the exchange through the end of today and any plan that you enroll in will be in effect for all of next year.  But there could be long term effects and the decision once again throws uncertainty into the health care insurance industry, which is an industry that does not fare well under, or appreciate, uncertainly.

 

Technically, that court ruling only effects the federal district in Texas where the court resides and the judge did not order cessation of the law even in that district.  However, the case will be appealed first to the appeals court and then almost certainly to the Supreme Court of the United States where there is a possibility that the Supreme Court could uphold the ruling and invalidate the entire law nationwide.

 

Such a ruling would be devastating because it would invalidate unrelated portions of the law that have nothing to do with the insurance mandate, such as the expansion of Medicaid and Medicare reforms, and remove protections for pre-existing conditions.

 

There are two prongs to the court's ruling.  First, the judge ruled that the law can no longer be upheld as a constitutional tax because Republicans removed the tax penalty in 2017.  In 2012, the Supreme Court upheld the law as an acceptable use of Congress's power to tax.

 

Second the judge ruled that if the insurance mandate part of the law is unconstitutional, the entire law must be unconstitutional because the insurance mandate is a critical component of the law.

 

However, the entire law is so massive and comprehensive I do not agree that the individual mandate is critical to many of the unrelated provisions of the law which have little to do with insurance coverage.  In addition, there are other parts of the law that do pertain to health care coverage, such as the expansion of Medicaid for the states, that are not affected by the individual mandate.   I do not agree that the entire law should be declared unconstitutional.

 

Regardless, if the individual mandate is ultimately declared unconstitutional nationwide, this will cause all sorts of problems for the insurance industry and many people will lose their coverage either under their insurance plans or Medicaid.

 

The bottom line as usual is that you get what you vote for.  If you live in one of these states and ultimately lose you health care as a result of this decision, you have your government to thank: Plaintiffs are the States of Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, Governor Paul LePage of Maine (the “State Plaintiffs”), and individuals Neill Hurley and John Nantz (the “Individual Plaintiffs” and, collectively with the State Plaintiffs, “Plaintiffs”).  If you live in one of these states, your Republican Attorney General filed this suit specifically in an attempt to achieve this result.

 

Also, if you voted for a Republican congressman or senator and they voted to repeal the tax penalty of the Affordable Care Act, this was an intended consequence.

 

The chances of a Democrat Congress, a Republican Senate and the President agreeing upon a fix to this problem is very slim indeed.

 

Below is some of the critical text of the decision:

 

Texas District Court: Repeal of Penalty Renders Individual Mandate Unconstitutional -- Entire ACA Ruled Invalid (PDF)

55 pages. "Plaintiffs allege that, following passage of the Tax Cuts and Jobs Act of 2017 (TCJA), the Individual Mandate in the [ACA] is unconstitutional. They say it is no longer fairly readable as an exercise of Congress's Tax Power.... The Supreme Court's reasoning in [NFIB v. Sebelius] ... compels the conclusion that the Individual Mandate may no longer be upheld under the Tax Power. And because the Individual Mandate continues to mandate the purchase of health insurance, it remains unsustainable under the Interstate Commerce Clause -- as the Supreme Court already held....

"Congress stated many times unequivocally -- through enacted text signed by the President -- that the Individual Mandate is 'essential' to the ACA.... All nine Justices to review the ACA acknowledged this text and Congress's manifest intent to establish the Individual Mandate as the ACA's 'essential' provision.... Because rewriting the ACA without its 'essential' feature is beyond the power of an Article III court, the Court thus adheres to Congress's textually expressed intent and binding Supreme Court precedent to find the Individual Mandate is inseverable from the ACA's remaining provisions....

"Under the law as it now stands, the Individual Mandate no longer 'triggers a tax' beginning in 2019. So long as the shared-responsibility payment is zero, the saving construction articulated in NFIB is inapplicable and the Individual Mandate cannot be upheld under Congress's Tax Power....

"The Court today finds the Individual Mandate is no longer fairly readable as an exercise of Congress's Tax Power and continues to be unsustainable under Congress's Interstate Commerce Power. The Court therefore finds the Individual Mandate, unmoored from a tax, is unconstitutional and GRANTS Plaintiffs' claim for declaratory relief ...

"All told, Congress stated three separate times that the Individual Mandate is essential to the ACA. That is once, twice, three times and plainly. It also stated the absence of the Individual Mandate would 'undercut' its 'regulation of the health insurance market.' Thirteen different times, Congress explained how the Individual Mandate stood as the keystone of the ACA. And six times, Congress explained it was not just the Individual Mandate, but the Individual Mandate 'together with the other provisions' that allowed the ACA to function as Congress intended....On the unambiguous enacted text alone, the Court finds the Individual Mandate is inseverable from the Act to which it is essential....

"For the reasons stated above, the Court grants Plaintiffs partial summary judgment and declares the Individual Mandate, 26 U.S.C. Section 5000A(a), UNCONSTITUTIONAL. Further, the Court declares the remaining provisions of the ACA, Pub. L. 111-148, are INSEVERABLE and therefore INVALID. The Court GRANTS Plaintiffs' claim for declaratory relief[.]"

[Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018)]

 

 

 

How To Vote If You are In a Health Care Facility During Election Time

Can you still vote if you are stuck in a hospital or a health care facility around election time?  In Illinois and Indiana, yes.

ILLINOIS
 
 In Illinois, the following instructions are given by the state board of elections:

 THE FOLLOWING CONDITIONS MUST BE MET:

1. Voter must obtain an Application for Ballot for Qualified Voter Admitted to Hospital, Nursing Home or Rehabilitation Center . The application can be obtained from the election authority (county clerk or board of election commissioners, depending on where the voter is registered to vote).

2. Voter must complete his/her application and his/her physician must complete and sign the Ce rtificate of Attending Physician section of the application.

 3. After the form is completed and signed by the voter and his/her physician, a registered voter from the voter’s precinct or any legal relative can then hand deliver the application to the election authority’s office.

4. After signing an affidavit, the precinct voter or legal relative may personally hand deliver the ballot to the voter at the health care facility he/she has been admitted to.

5. Once the voter receives the ballot, he/she will vote the ballot in secret and complete the certification on the ballot return envelope.

 6. After depositing his/her voted ballot in the return envelope, the voter will securely seal the envelope, and give the envelope to the precinct voter or to the legal relative.  The ballot must be delivered back to the election authority before 7:00 p.m. on Election Day.

Assistance is the actual casting of votes for a voter in accordance with the voter’s wishes. Assistance can be given by a friend or relative, but cannot be given by an officer or agent of the voter’s employer or the voter’s union.  A candidate whose name appears on the ballot is also prohibited from assisting a physically incapacitated voter unless the candidate is the spouse, parent, child, brother, or sister of the incapacitated voter.  This would prohibit precinct committeemen from giving assistance in a primary election.  If assistance is given, the name and address of the person giving assistance must be provided on the certification envelope.

file:///C:/Users/Steven/AppData/Local/Microsoft/Windows/INetCache/IE/8MYUBQOO/hospital2.pdf

Indiana

You may vote by absentee ballot In Indiana if:

• You have a specific, reasonable expectation that you will be absent from the county on Election Day during the entire 12 hours that the polls are open (6:00 a.m. until 6:00 p.m.).
• You have a disability.
• You are at least 65 years of age.
• You will have official election duties outside of your voting precinct.
• You are scheduled to work at your regular place of employment during the entire 12 hours that the polls are open.
• You are prevented from voting due to the unavailability of transportation to the polls.
• You will be confined due to illness or injury or you will be caring for an individual confined due to illness or injury during the entire 12 hours that the polls are open.
• You are prevented from voting because of a religious discipline or religious holiday during the entire 12 hours that the polls are open.
• You are a participant in the state’s address confidentiality program.
• You are a serious sex offender as defined in Indiana Code 35-42-4-14(a).
• You are a member of the military or a public safety officer.

Per Indiana law, a disabled person or one who is unable to read or write English may request assistance in the voting booth:

"Sec. 2 . (a) A voter who:

(1) is a voter with disabilities;  or

(2) is unable to read or write English;

may request assistance in voting before entering the voting booth and designate a person (other than the voter's employer, an officer of the voter's union, or an agent of the voter's employer or union) to assist the voter in voting at an election, as required by 52 U.S.C. 10508 .

(b) The person designated must execute a sworn affidavit on a form provided by the absentee voter board or the precinct election board stating that, to the best of the designated person's knowledge, the voter:

(1) is a voter with disabilities or is unable to read or write English;  and

(2) has requested the designated person to assist the voter in voting under this section.

(c) The person designated may then accompany the voter into the voting booth and assist the voter in marking the voter's paper ballot or ballot card or in registering the voter's vote on the electronic voting system.  IC 3-11-9-2.

https://www.in.gov/sos/elections/

MacArthur Amendment to the Federal Healthcare Law

Below is the congressional link to the recent proposed Amendment related to healthcare reform.  It is only a draft document at the present.  There has been no official action on the bill.

docs.house.gov/billsthisweek/20170424/MacArthur Amendment.pdf

Amendment to H.R. 1628 Offered by Mr. MacArthur

The eight page amendment would allow a particular state to request waivers to 1.) charge the elderly more for premiums, 2.) to consider pre-existing conditions when offering plans, and 3.) to offer plans that do not cover all of the Affordable Care Act's Essential Benefits.  The Essential Health Benefits are:
 

Essential Health Benefits. A qualified health plan must provide the following: ambulatory (“one-day”) patient services, emergency services, hospitalization, maternity and newborn care, “mental health and substance use disorder services, including behavioral health treatment”, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness and chronic disease management, and pediatric services including oral and vision care. 

 

A state's application for a waiver would be approved by default if, among other things, it declares:

 

"(B) The application specifies how the approval of such application will provide for one 2 or more of the following: 

 

(i) Reducing average premiums for 4 health insurance coverage in the State.

(ii) Increasing enrollment in health 6 insurance coverage in the State. 

(iii) Stabilizing the market for health 8 insurance coverage in the State.

(iv) Stabilizing premiums for individuals with pre-existing conditions.

(v) Increasing the choice of health plans in the State."

 

On major problem that I see is that any specification in the application for the waiver as to how the granting of the waiver would accomplish any of the above five goals would be pure conjecture and would not be evidence based.  Hence I view the above requirements for approval of the waiver as merely an ostensible (stating or appearing to be true, but not necessarily so) justification for its application.  In practical effect, if a state requests a waiver, they will receive it, at least under the current administration.

Answers to FAQs Re: Obamacare, Prepared for Congressional Staff

Below is a link to FAQ regarding the Affordable Care Act.  35 pages. "This report provides resources to help congressional staff respond to constituents' frequently asked questions about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions."

 

https://fas.org/sgp/crs/misc/R43215.pdf

 

Patient Protection and Affordable Care Act

(ACA): Resources for Frequently Asked

Questions by Angela Napili, Senior Research Librarian, Congressional Research Service

Would Selling Health Insurance Across State Lines Reduce Our Health Insurance Premiums?

Health insurance and insurance in general has traditionally been regulated by the individual states.  Companies are licensed by the state to sell insurance, and insurance laws and requirements are different in each state. 

Republicans, including Donald Trump, have often advocated allowing insurance to be sold nationwide, i.e., across state lines, to increase competition and therefore reduce rates, as part of their efforts to replace the Affordable Care Act (ACA).  Would this have the desired effect?

Currently, 21% of enrollees in states using the federal exchange have only one participating insurer for 2017.  This is hardly a competitive marketplace and is viewed by many as one of the failures of the Affordable Care Act (ACA).

Insurance rates are determined by actuaries.  An actuary is a business professional who deals with the measurement and management of risk and uncertainty.  The American Academy of Actuaries has released a February 2017 Issue Brief to address the issue of selling health insurance across state lines.  As you are about to find out, selling health insurance across state lines is not as simple as it sounds.  In their brief, the actuaries arrive at three key points:

1.       “Allowing insurers to sell coverage across state lines has limited potential for premium savings, as premiums would continue to reflect local health care costs.”  An individual living in a high-cost area would not necessarily enjoy lower premiums by purchasing coverage from an insurer licensed in a low-cost state.  Per the actuaries, premiums will reflect local health costs, regardless of where the coverage is purchased.

2.       “Out-of-state insurers would have difficulty developing provider networks and negotiating provider or payment discounts.”  In order for insurers to sell across state lines, they would first have to develop provider networks via reimbursement agreements with local hospitals and physicians, or buy into an existing network.  Unless the out-of-state insurers were able to accomplish large enrollment, they would have little leverage in negotiating with providers.  Health Maintenance Organizations (HMOs), who limit out-of-network coverage, would have even more difficulty operating in other states.

3.       “Unintended consequences could result if states are given more flexibility regarding benefit requirements or issue and rating rules.  Adverse selection would occur, threatening the viability of insurers licensed in states with more restrictive requirements.  The ability of high risk individuals to obtain coverage could be compromised as a result.”  The actuaries say that the establishment and regulation of state-level consumer protection laws is often ignored during discussions of selling insurance across state lines.  These laws vary from state to state as to whether they require minimal network adequacy or, for example, if they require an appeal processes for denied services.  Not only would this be terribly confusing, it would be difficult for state regulators to regulate out-of-state provider networks.

For a health insurance market to be sustainable, competing insurers must all operate under the same rules, according to the actuaries.  Allowing an insurer licensed in their home state to sell insurance in another state under their home state rules would violate that principal.  Per the actuaries, “The ACA harmonized many of the rules applying to the individual and small group markets.  Although states have mandated benefits to varying degrees, the ACA’s essential health benefit requirements narrowed the differences in covered benefits across states.”  Also, the actuarial requirements for the platinum, gold, silver and bronze tiers of the ACA set a “floor” for plan coverage.

Finally, the ACA harmonized issue and rating rules, which previously varied from state to state.  Medical underwriting is now prohibited by the ACA, which means insurers can no longer deny coverage or charge higher premiums to individuals based upon their health.  The ACA also limited the extent that premiums could be adjusted due to an applicant’s age. 

If the ACA is repealed but not replaced, or these rules are abolished or relaxed, and as a result the states are allowed more flexibility, insurers licensed to operate in a state that permits less generous coverage would attract the healthier residents of other states.  Premiums for insurance licensed in states with more comprehensive benefit requirements would increase as a result, and individuals with health problems could find it more difficult to obtain coverage.

In conclusion, if rules governing insurance are consistent across state lines (like they are now with the ACA) premium reductions would be minimal because they would continue to reflect local health care costs, no matter where the insurer is located.  If rules governing insurance vary from state to state, insurers based in states with more restrictive requirements would be at a disadvantage compared to insurers based in states with less restrictive requirements.  Regardless, regulatory authority and consumer protection laws would need to be very clearly defined.

Here is a link to the American Academy of Actuaries' brief, entitled, "Selling Insurance Across State Lines":  http://www.actuary.org/content/selling-insurance-across-state-lines-0

Senators Propose Importation of Less Expensive Pharmaceuticals from Canada If US Prices Rise

Several Senators call for the allowance of importation of expensive medications from Canada under certain circumstances.  This has been expressed in a letter to the new Secretary of Health and Human Services, Tom Price.  Attached is the letter from Senators Chuck Grassley (R-IA), John McCain (R-AZ) and Amy Klobuchar (D-MN):  http://www.grassley.senate.gov/sites/default/files/constituents/20170214%20Secretary%20Price%20reimportation%20letter.pdf

 

"Those circumstances are: If a drug is off patent or no longer marketed in the US by the innovator company that initially developed that drug; if there are “significant and unexplained increases in price”; if no direct competitor drug is currently marketed and the introduction of such a competitor will lower prices for taxpayers and consumers; or if the drug is produced in another country by a brand name manufacturer or by a “well-known generic manufacturer that commonly sells pharmaceutical products in the US.”  - Zachary Brennan, Regulatory Affairs Professionals Society

 

The unknown receipt of counterfeit drugs from illegitimate destinations can be a problem if ordered from a Canadian Pharmacy but this can be avoided by proper screening and vetting of the approved pharmacies.  I am in favor of this policy if it can be implemented properly.

 

See the attached newsletter from the Regulatory Affairs Professionals Society (RAPs):

http://www.raps.org/Regulatory-Focus/News/2017/02/14/26832/Senators-Call-on-HHS-to-Allow-Canadian-Drug-Imports-if-Prices-Spike/

What is the Current Legal Status of the Affordable Care Act?

This linked article explains, without the hype, what the true legal status of the Affordable Care Act is right now:

"A popular meme suggests that the Senate voted to eliminate virtually all of the provisions of the ACA, including the ability to obtain insurance in spite of pre-existing conditions, the requirement to cover adult children up to the age of 26, etc. This is not the case.
....
...

It is clear that President Trump, and the majority of Republicans in Congress, want to pass some sort of repeal of the ACA as quickly as possible. However, neither the resolution passed by Congress nor the Executive Order makes any changes in current law. Many of the provisions of the ACA would be difficult or impossible for Republicans to repeal without Democratic support. And with only a narrow majority in the Senate, it is not even clear that the votes are there for repeal before a replacement plan can be developed. Thus, for now, employers should continue to assume that they will need to comply with the ACA mandates"

.http://benefitsattorney.com/whats-happening-with-the-affor…/

DO AMERICANS DESERVE TO HAVE HEALTH CARE?

My answer is a resounding “NO!”  Prior to this recent fall 2016 local and presidential election, I was one of those naïve idealists who actually believed that everyone in America deserved health care.   I had three reasons: 

1.)  First, it is necessary to maintain your health, which falls under our inalienable right to “life, liberty and the pursuit of happiness” guaranteed to us in the Declaration of Independence;

2.)  Second, it is in everyone’s economic best interest to have broad health care coverage, both from a micro and macro viewpoint; and

3.) Third, we are the richest county in the world, and if other much poorer countries like Cuba can afford to provide health care to all its citizens, we certainly should be able to as well, if we make it a priority.

WHY I CHANGED MY MIND

The phrase “if we make it a priority” is the caveat that changed my mind about the answer to the question above.  You can tell from the results of the recent election that receiving good health care and possessing good health insurance for ourselves, our families and our fellow Americans is not a priority for the majority of Americans.  Most Americans put one or more other issues way ahead of having access to health care.  I can’t cite and don’t even know all of the issues that were given a higher priority, but examples are issues such as fear of a transgender in the restroom (even though they have been there for years and we just haven’t known it), fear of a gay married couple living next door, fear of having their guns taken away (which was never going to happen), the importance of making a protest vote or no vote at all to prove a political point, zealous concern about the environment, change for change’s sake without a clue as to whether the alternative would be better, dislike of a particular candidate, dislike of President Obama and anything even remotely associated with him, hatred of minorities and foreigners,  fear of big government in general, not to mention just an overall apathy or too little concern to bother to vote.   All of these non-healthcare issues seem trivial to me when compared to the threat to the physical and financial welfare of an individual and his/her family that result from having an accident or becoming ill without health insurance. Obviously, most Americans do not agree with me.  About the only issue that veers close to the importance of insurance coverage in its immediate effect on the health and quality of life of us and our loved ones is the fear of a terrorist attack.  The terrorist threat is frightening and is very real, but it is much less likely statistically to afflict any one individual versus the chances of becoming ill from any variety of diseases or accidents.  Another competitive possible threat is harm due to crime such as in the more violent neighborhoods in Chicago.  But even the survivor of a terrorist attack or a random crime will need good medical care and mental health care after the attack.  Let's remember how we let down our first responders to 911 who later became ill as a result of their heroic efforts.  Let's also remember the many domestic shootings that have occurred because the shooter could not get adequate mental health care.  And let us also not forget that we will all get old and frail if we are lucky, no matter what we do or believe.

DO WE DESERVE HEALTH CARE BECAUSE IT IS PART OF OUR INALIENABLE RIGHT TO LIFE, LIBERTY AND THE PURSUIT OF HAPPINESS?

Is it necessary to maintain your personal health and the health of your friends and loved ones to achieve “life, liberty and the pursuit of happiness”?  I think everyone would agree that maintaining your personal health is necessary to maintain one’s life.  While the sick are often happy (God bless them), it is easier to be cheerful when one has good health.  I’ve never met anyone who has ever said they would rather be sick than healthy.  It is also easier to pursue other personal and professional goals if you are in good health versus battling a physical or mental affliction.

So, in the United States, is it necessary to have health care insurance to maintain this good health?  In America, I would say “yes” due to the way our health care system is structured and financed.  Some people may argue that you can get free care at the emergency room if you don’t have insurance, so why pay premiums?  This has been true in the past but the health care received in the ER is more like a bandage than a fix.  There are provisions in the Affordable Care Act designed to encourage hospitals to perform post-discharge follow-up for hospitalized patients and to financially punish hospitals when they fail to do so.  A person needs routine medical evaluations, preventive medicine, pharmaceuticals and diagnostic procedures to remain healthy.  And don’t forget about hip and knee replacements!  You won’t die without these, our ancestors lived without them, but they certainly can improve your quality of life.

The real reason that I think health insurance is necessary in America to maintain good health is that EVEN THE RICHEST AMERICANS POSSESS HEALTH INSURANCE.  (On my trips to the Mayo or Cleveland Clinic I often see rich foreign leaders staying at the hotels and paying out of pocket for their US care.)  Yet the wealthy in the US buy health insurance even though they could easily afford to pay for their own. They purchase it because it helps them maintain financial stability and shifts the financial risk to the insurance companies.  If it were such a trivial matter, the wealthy would not bother.  Wealthy individuals have the extra benefit that if they do not like the treatment offered to them by the insurance company, they can buy their own if necessary.  This is why we don’t see Congress giving up their health care.  We pay for their health care while they take ours away.

If I were to ask you, do you accept the premise that we have an inalienable right to “life, liberty and the pursuit of happiness” as stated in the Declaration of Independence, most Americans would answer “yes” without even giving it a thought.   An argument can be made that all Americans are entitled to health insurance because they need health insurance to have access to health care, and they need access to health care to remain healthy.  An “inalienable” right is a right which cannot be taken away or given away by the possessor.  Ironically, that is exactly what the repeal of the Affordable Care Act will do, take away an inalienable right from many Americans, most of whom knew they were taking that risk when they made their votes in the 2016 election.

DO WE DESERVE HEALTH CARE BECAUSE IT IS IN THE ECONOMIC INTERESTS OF EVERYONE?

Prior to the Affordable Care Act, many talented company employees with a pre-existing condition, such as a cancer diagnosis within the past five years, or a chronic incurable condition such as diabetes, were afraid and/or unable to move to a better job because they were dependent on their current employer for their insurance.  If they jumped to a better job, their new employer’s insurer could declare their pre-existing condition uninsurable.  As a result they would be without insurance, and quite frankly, it just wasn’t worth it.  This holds back the economy on a micro level.  Likewise, those employees that were thinking of striking out on their own and starting their own business found it difficult, if not impossible, due to the availability of insurance and its cost.  How often has a politician told you it is the small businesses that drive the economy? This economic benefit on a personal level is not a priority to most Americans, as I have stated above.

At a macro level, uninsured people increase overall health care costs because they wait until they are seriously ill to get treatment and go to the Emergency Room to get their care, which is much more expensive than a routine visit to a neighborhood clinic.  A healthy citizen is more likely to be a productive citizen.  Addicts who cannot receive treatment will remain addicts.  In addition, health care costs gobble up a large portion of our Gross Domestic Product compared to other countries.  On a macroeconomics level, this is a complex issue that few understand.  But I can guarantee you there will always be a market and a demand for health care because it is not a luxury item.  It will not go away, and it will always be the elephant in the room when analyzing the competitiveness of our economy.

DO WE DESERVE HEALTH CARE BECAUSE AMERICA CAN AFFORD IT?

This argument is raised the most frequently, and its rejection is the most puzzling to me.  It is the strongest evidence I have that we, individually and collectively, as Americans, do not value and/or prioritize access to health care.  I think of a Latin phrase I learned in law school, “res ipsa loquitur”, which means "The thing speaks for itself”.  The mere fact that we are the richest country in the world yet many of our citizens are not covered is really all you need to know.  And the recent fact that many citizens voted against the recent enhancement of health insurance coverage in the 2016 election, even when it may have been against their own personal interest to do so, confirms my point.

NO, WE DON’T DESERVE TO HAVE HEALTH INSURANCE AND WE DESERVE IT EVEN LESS NOW, SO PLEASE STOP COMPLAINING ABOUT THE REPEAL OF THE AFFORDABLE CARE ACT UNLESS YOU PERSONALY VOTED TO RETAIN IT!

I used to believe in health care for everyone.  Now I no longer do because this recent vote was a repudiation of expanded health care coverage.  Politicians were very clear during the election where they stood in regards to the upcoming repeal of the Affordable Care Act.  I hope the people that are complaining at the personal level, and on social and traditional media, voted in this past election to keep America insured.  If so, I feel sorry for you and I wish you the best.  If you did not vote to retain expanded coverage, but now complain, shame on you. You are getting what you deserve, which very well may be nothing.

Is it Safe to Use Imported Drugs from Canada?

The Senate recently voted against an Amendment that would have allowed " the importation of safe and affordable prescription drugs by American pharmacists, wholesalers, and individuals with a valid prescription from a provider licensed to practice in the United States".  The amendment was proposed because the same, exact chemical medications purchased from outside the country can be far less expensive than their identical counterparts sold in the US.  In many instances, the comparative drugs are even made at the same FDA-approved facility, which may or may not be in the United States. 

While this Amendment sounds like a good idea and sounds very simple (we all know that pharmaceutical prices are way too high in the US), it is not that straightforward to guarantee that medications you may purchase from a Canadian pharmacy, for example, are exactly the same, just as safe, and just as effective, as their US-purchased counterparts.  In addition, even if they are, there are certain legal issues that arise.  Just because you purchase a medication from a Canadian pharmacy, that does not guarantee that the drug is authentic or of the same quality as its US-purchased counterpart.  Such  imported drugs that appear to be from Canada may actually have been manufactured in places like India or Turkey.  There have been instances where individuals have been criminally convicted for importing drugs into the US, including cancer drugs, that have been counterfeit and/or dangerous in their own right. 

Furthermore, even if an imported drug is chemically identical to its US counterpart, the imported drug's product labeling, which includes directions for use and important warnings about side effects, would be different from the current product labeling that is approved for use by the FDA.  Such labeling may not even be in the same language, may not even be readable to the US purchaser, and may not include the FDA's latest warnings or instructions. 

Finally, even if the US-sold and the imported drug are chemically the same, yet the labelling of the imported drug is not the FDA-approved version, the imported drug is considered "misbranded" under US drug law, which means its importation is technically illegal, except for very narrow exceptions.  To ensure these imported medications are "safe" is not that easy, and to declare their importation as legal, is not that simple.

Illinois Health Insurance - Increase in Contraceptive Coverage Starting 2017

While it lasts, many women in Illinois now have easier access, more options, and no out-of-pocket costs for birth control.

Illinois House Bill 5576 took effect at the start of the new year, expanding access to birth control in Illinois beyond the requirements of the Affordable Care Act.

The new bill requires all brands and types of pills to be covered without cost sharing. 

It does not mandate coverage of abortions.

The law only applies to those who are under the umbrella of the Illinois Department of Insurance, so it does not apply to women insured through their employer or self-insured.  P.A. 99-0672 

Illinois Health Care Workers Get a Second Chance

Prior health care workers in Illinois with a past felony conviction can now seek to get a license issued or restored.  The procedure is to petition the Illinois Department of Financial and Professional Regulation, which is required to consider three issues:  1.) the seriousness of the offense, 2.) how long ago it happened and 3.) whether there was professional disciplinary action against the practitioner.  If you have been convicted of a sex crime you are ineligible for a health care license.  P.A. 99-0886.

Revision to the Illinois Health Care Right of Conscience Act and Court Injunction

This 40-year old Illinois law has been updated to require medical providers who have ethical or religious objections to certain procedures, such as providing abortions or contraception, and therefore choose to decline to offer them, to now offer to their patients information on any treatment options they will not perform.  This law technically goes into effect January 1, 2017.  However it cannot presently be enforced because a Winnebago County Circuit Court Judge issued a preliminary injunction on December 20, 2016 preventing the state from enforcing the law against providers during the duration of an ongoing lawsuit that was filed last year.  The judge ruled that the anti-abortion providers who sued had "raised a fair question" on whether the law violates "their right to be free from government-compelled speech".  For a copy of the court's injunction, see Pregnancy Care Center of Rockford, Inc. v. Rauner, (IL Cir. Ct., Dec. 20, 2016).  For a copy of the amended law, the Illinois Health Care Right of Conscience Act, view P.A. 99-0690. 

OBAMACARE: Repeal AND REPLACE?

The new Republican congress took its first steps today to repeal and replace the Affordable Care Act.  But will they really repeal all of the law, or only portions, and if so what happens? When will the repeal take effect?  And if they do repeal, will they really replace it with anything at all, let alone something that works better?   Will President-Elect Trump keep his promise to replace it with something "terrific"? Do any of them really know what they are going to do? 

Any answers that I could provide right now would be pure conjecture, but I will have plenty to say when the details become known in the very near future.  Stay tuned!  Steve

Measles and Vaccination Lawsuits

 

Can I sue someone if my child contracts measles from a child whose parents refused to vaccinate their child?

 

This would be a difficult lawsuit to win because you would have to prove that the parent was negligent in their decision not to immunize their child, while an exemption for religious or medical reasons is allowed per state law.  Second, you would have to prove that your child contracted the measles directly from the unvaccinated child (i.e., proximate cause) which would be difficult. 

 

Measles and Vaccines in Illinois

Should you vaccinate your children for measles?

Both Indiana and Illinois grant and exemption for the requirement to vaccinate due to medical or religious reasons.  Otherwise, you are required to get your children vaccinated.

Fifteen years ago, the federal Center for Disease Control declared measles eradicated in the United States.  We know now that is not true.

 ILLINOIS

 

As you have probably heard, we have an outbreak of measles in Illinois.  In Chicago, only 88.8% of adolescents have received the vaccine.  In the state as a whole, the vaccination rate is 93.5%

 

The Illinois State Board of Education (ISBE) has issued guidelines to help school administrators determine if a request for an immunization exemption should be allowed and whether medical exemption should be referred to the Illinois Depart of Public Health (IDPH).  http://www.isbe.net/research/pdfs/Immunization_gdlines_med_rel.pdf

 

Section 665.510  Objection of Parent or Legal Guardian

 

Parents or legal guardians who object to health, dental or eye examinations or any part thereof, or to immunizations, or to vision and hearing screening tests, on religious grounds shall not be required to submit their children or wards to the examinations or immunizations to which they so object if such parents or legal guardians present to the appropriate local school authority a signed statement of objection, detailing the grounds for the objection. (Section 27-8.1(8) of the School Code)  The objection must set forth the specific religious belief that conflicts with the examination, immunization or other medical intervention. The religious objection may be personal and need not be directed by the tenets of an established religious organization.  General philosophical or moral reluctance to allow physical examinations, eye examinations, immunizations, vision and hearing screening, or dental examinations will not provide a sufficient basis for an exception to statutory requirements.  The local school authority is responsible for determining whether the written statement constitutes a valid religious objection.  The local school authority shall inform the parent or legal guardian of measles outbreak control exclusion procedures in accordance with the Department's rules, Control of Communicable Diseases Code (77 Ill. Adm. Code 690) at the time the objection is presented.

 

Questions regarding religious objections to vaccinations in Illinois should be directed to ISBE Specialized Instruction, Nutrition and Wellness Division, School Health, at 312-814-5560.

 

Questions regarding medical exemptions for vaccinations in Illinois should be directed to the IDPH at 217-785-1455.

For more information on immunizations from the Illinois Department of Public Health:  http://www.idph.state.il.us/about/shots.htm

 

Measles and Vaccines in Indiana

Should you vaccinate your children for measles?

Both Indiana and Illinois grant and exemption for the requirement to vaccinate due to medical or religious reasons.  Otherwise, you are required to get your children vaccinated.

Fifteen years ago, the federal Center for Disease Control declared measles eradicated in the United States.  We know now that is not true.

INDIANA

Presently, there have been no outbreaks of measles in the state of Indiana.

Per Dr. Joan Duwve, chief medical consultant with the Indiana State Department of Health. "Only one case of measles constitutes an outbreak for that disease here in the state of Indiana."

The measles virus is incredibly hardy, is airborne and can be passed on before an infected person becomes symptomatic. If an infected person is in a room with 100 unvaccinated people, 90 of them will become ill, Duwve has said.

About 0.81 percent, or 493, of all Indiana sixth-graders and 0.74 percent, or 456, of all kindergartners had a religious exemption in the 2013-14 school year, according to state statistics. That same year 4,455 kindergarten students did not have the MMR vaccine, which includes protection against measles, meaning only 92.7 percent of the grade was fully vaccinated.

 Indiana requires parents to submit exemptions annually, ensuring that they remain firm in their commitment not to vaccinate their children.

Currently, the state's immunization registry does not necessarily include children who are home-schooled or younger than school age, unless a provider or school opts to enter the records.

Because some Amish don't believe in vaccination and there's a strong anti-vaccination movement in southern Michigan, there are pockets with low vaccination rates in Northern Indiana, Duwve said. These areas have seen outbreaks of another preventable disease, pertussis, or whooping cough, in recent years.

VACCINATION EXEMPTION PURSUANT TO

INDIANA CODE § 20-34-3-2 Religious objections

 

    Sec. 2. (a) Except as otherwise provided, a student may not be required to undergo any testing, examination, immunization, or treatment required under this chapter or IC 20-34-4 when the child's parent objects on religious grounds. A religious objection does not exempt a child from any testing, examination, immunization, or treatment required under this chapter or IC 20-34-4 unless the objection is:
        (1) made in writing;
        (2) signed by the child's parent; and
        (3) delivered to the child's teacher or to the individual who might order a test, an exam, an immunization, or a treatment absent the objection.

Clay Hunt Suicide Prevention for American Veterans Act

"Legislation designed to help combat suicide by U.S. military veterans passed in the Senate 99-0 on Tuesday, setting the stage for it soon to become federal law.

Approval of the Clay Hunt Suicide Prevention for American Veterans Act was lauded by veterans and suicide prevention groups as a victory that will save lives. The legislation is named after a Marine Corps veteran who served in Iraq and Afghanistan and later took his own life in 2011."

http://www.washingtonpost.com/news/checkpoint/wp/2015/02/03/clay-hunt-veterans-suicide-prevention-act-passes-in-senate-will-head-to-white-house/

"An estimated 22 veterans commit suicide each day, adding up to more than 8,000 deaths each year. Klobuchar is an original cosponsor of the Clay Hunt Suicide Prevention for American Veterans (SAV) Act, which will help expand access to mental health services for veterans by establishing a loan repayment program to help the Department of Veterans Affairs (VA) recruit more psychiatric specialists, enhancing resources for veterans transitioning to civilian life, and improving the VA's ability to address traumatic brain injuries. Congressman Tim Walz (D-MN) led the bill in the House."

http://www.brainerddispatch.com/news/politics/3670882-veterans-suicide-prevention-measure-important-step-toward-ending-vet-suicide

Enrollment Deadline Under the Affordable Care Act

February 15, 2015 is the last day to enroll in a health care plan.  You can receive help at www.healthcare.gov or in Illinois a getcoveredillinois.com