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Katheryne Lawrence

POSTED: Sunday, August 18, 2013, 12:00 AM
Filed Under: Katheryne Lawrence

One of the biggest challenges facing disabled people is how to enter the workforce and still maintain the health care coverage they need.

According to the 2000 Census, there are 33.1 million working age people with disabilities between the ages 16 and 64 in the United States. For those individuals, the current framework of health care coverage provides a disincentive to work.

Public health insurance for the disabled is usually contingent on not working. In Pennsylvania, a disabled person seeking coverage under Medicaid must be receiving Supplemental Security Income (SSI) benefits. An individual only qualifies for those benefits if they maintain no more than insubstantial work activity. In other words, because of the link to SSI, individuals with disabilities who need Medicaid coverage often have to choose between working and having insurance.

POSTED: Friday, August 9, 2013, 6:00 AM
Filed Under: Katheryne Lawrence

The Obama Administration announced another delay in implementing a part of the Affordable Care Act. And as if on cue, the criticisms came flying in. This time the concern is one of widespread fraud and abuse.

The problem lies in the delay of verification provisions for subsidies for policies purchased on the insurance exchanges. For the first year, the IRS will not verify incomes to ensure that applicants are in fact eligible for the subsidies they claim.

Exchanges are marketplaces designed to offer insurance to individuals who don’t have it and aren’t eligible for an affordable employer plan. If an individual has an offer of affordable health insurance from their employer, they do not qualify for a subsidy in the form of a federal tax credit to help them buy it on an exchange.

POSTED: Tuesday, August 6, 2013, 6:00 AM
Filed Under: Katheryne Lawrence

Cancer screening isn’t working. That’s what a study panel from the National Cancer Institute concluded in a new article published recently in The Journal of the American Medical Association.

Cancer kills thousands of people in the United States each year. A total of 580,350 cancer deaths are projected to occur in the United States in 2013.  That comes to about 1,600 people per day.       

Early detection resulting from some cancer screening tests (like mammography) has dramatically increased public awareness of the disease. However, screening has also increased findings of “incidentalomas”. That is the name given to incidental findings of cancer-like conditions detected during screening that are unlikely to cause harm.

POSTED: Wednesday, July 31, 2013, 6:00 AM
Filed Under: Katheryne Lawrence

When most of us head to the doctor, chances are that the person wielding the stethoscope has been certified to practice in their specialty by a member board of the American Board of Medical Specialties (ABMS). Board certification is an important measure of competence for American physicians. But just when did your doctor receive that badge of approval?

Until recently, most doctors who gained board certification did so at the start of their careers. That means a doctor who is 65 years old could have been certified as far back as 1973. What does this say about his or her competence today, 40 years later?

The answer given by most physicians is that they are as competent as ever. But how can you be sure? One approach to providing an answer is recertification - requiring that doctors retake the certification exam every few years.

POSTED: Thursday, July 18, 2013, 2:44 PM
Filed Under: Katheryne Lawrence

The United States has too few doctors, and the Association of American Medical Colleges (AAMC) is projecting that the shortage will grow to more than 90,000 by 2020. The statistics are particularly troublesome for primary care, which accounts for half of the shortage.

Nearly 1 in 5 Americans lacked access to a primary care physician in 2009. That means we have only about half the needed supply for an optimal patient load of 2,500 patients per primary care doctor nationwide. The shortage continues to grow due to several factors, including low reimbursement rates for primary care, lower incomes than for specialty doctors, and high workloads.

Part of the problem is that doctors are retiring faster than students are graduating. They are aging along with the rest of the population, and 250,000 are expected to retire in the next decade. It takes 7 years from the start of medical school until a new doctor can enter practice. That forces many to accumulate a large amount of debt, so they are reluctant to take primary care positions that are lower paying than most specialist slots. Health reform will likely make the shortage worse, because it will add and estimated 32 million more people to health insurance rolls.

POSTED: Thursday, July 11, 2013, 5:30 AM
Filed Under: Katheryne Lawrence

In a major victory for gay rights, the Supreme Court last month struck down part of the Defense of Marriage Act (DOMA), the federal law that had limited recognition of marriage to one between a man and a woman. This judicial move may herald major changes for the gay community with regard to health care access and cost.

The decision in the case of United States v. Windsor found Part 3 of DOMA to be unconstitutional because it denies legally married same-sex couples equal treatment under federal law. One of the clear effects of this ruling is that same-sex spouses of federal employees can receive coverage through the Federal Employees Health Benefits Program for civilians and the Tricare program for military personnel.

Dr. Ardis D. Hoven, the president of the American Medical Association told that overturning the DOMA will help eliminate health disparities in same-sex households by ensuring that they are afforded the same health care rights as others.

POSTED: Friday, June 28, 2013, 6:00 AM
Filed Under: Katheryne Lawrence

No matter how the organs are distributed, organ donation in the United States is a win-lose equation. When one person on a waiting list receives a lung, another person who is also on that list does not. As of Tuesday June 25, 2013 at 1:59am, 75,945 people across the United States were on active waiting lists for organs.

America has been rooting for 10-year-old Sarah Murnaghan through her successful battle to receive a lung transplant. Throughout her struggle, the spotlight has been on the appropriateness of the rules for organ allocation. While those rules attempt to ensure fairness, they do not change the fact that there are not enough organs for everyone.

Eighteen people die every day waiting on the list. To solve this organ shortage crisis we need more organ donors. In the wake of Sarah’s story, many people have signed up. However, only about 45 percent of adults in the United States are registered organ donors. 

POSTED: Friday, June 7, 2013, 6:00 AM
Filed Under: Katheryne Lawrence
In this photo taken Thursday, March 25, 2010, Dr. Carlos Ruvalcaba, left, examines Paula Medrano, one of the many patients he treats, at the Clinica Sierra Vista Elm unit in Fresno, Calif. Medrano is an undocumented immigrant. One of the 7 million uninsured people living in the United States who were explicitly excluded from the legislation, according to estimates by the Congressional Budget Office. The question of whether to extend coverage to illegal immigrants was so politically contentious that, under the approved legislation, they will not even be able to buy health insurance in the newly created purchasing pools called exchanges if they pay entirely out of their own pocket. (AP Photo/Marcio Jose Sanchez)

While Congress debates immigration and health reform, one aspect of care for undocumented immigrants is not likely to change. That is the often invisible hospital practice of transporting sick and sometimes comatose patients to other countries. Stephen Colbert recently covered the issue after the story broke of two undocumented but insured immigrants in Iowa being deported back to Mexico while unconscious.

Stories like this seem like nightmares. In one instance, an Arizona hospital processed the deportation of a two-day-old American citizen born with Down’s syndrome from the neo-natal unit because his parents were undocumented. In another, a nineteen-year-old girl died after being wheeled out of a hospital’s back entrance used for garbage disposal and transferred to Mexico.

The practice of deporting hospital patients after discharge is called medical repatriation. Hospitals send patients back to their home country because of the cost of treating them as inpatients. This occurs with the tacit approval of American immigration authorities, although without their overt involvement. Two public interest organizations, the Center for Social Justice at Seton Hall University School of Law and New York Lawyers for the Public Interest, have cited more than 800 cases of attempted or actual medical reparations in recent years.  

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
Neil I. Goldfarb President & CEO of the Greater Philadelphia Business Coalition on Health
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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