Thursday, April 17, 2014
Inquirer Daily News

Krystyna Dereszowska

POSTED: Friday, April 11, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

Open enrollment may have just ended, but preliminary data on health care utilization is already beginning to trickle in.  Although the numbers are bound to change with time, it appears that those who are already making use of their new marketplace coverage are sicker than average.  And that’s not bad news.

The US has consistently spent more on health care per capita than other high-income countries in return for higher infant mortality rates and shorter life expectancies.  Obamacare was passed in an attempt to halt this trend and improve the cost, access, and quality of the nation’s healthcare.  Or more concretely, to stop the healthy from getting sick, and the sick from getting sicker.

A study just released by Express Scripts—the nation’s largest pharmacy benefit management company, indicates that Obamacare may be achieving this concrete goal.  In January and February of this year, those who were newly insured through a marketplace plan bought more specialty medication than the commercially insured. Such medication tends to be more expensive because it treats chronic conditions with limited treatment options such as HIV/AIDS or Hepatitis C.  The rate of purchase of pain, depression, and seizure medication was also higher among marketplace enrollees.

POSTED: Friday, April 4, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska
The federal health-care website. (AP Photo/Jon Elswick, File)

The Obama administration announced that 7.1 million Americans obtained individual health insurance coverage through the marketplace exchanges by the March 31st deadline.  However, if you missed the deadline, you are not out of luck.  You still have four options for getting coverage in 2014.

You can still apply for a policy if one of the following applies to you:

1. You tried to get insurance through an exchange but couldn’t complete the application

POSTED: Monday, March 31, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

There has been no shortage of opposition against the nomination of Dr. Vivek Murthy for Surgeon General, a Harvard and Yale educated physician who trained at one of the nation’s best hospitals.  Often referred to as “America’s Top Doc,” the Surgeon General leads the U.S. Public Health Service Commissioned Corps.  Notably absent from that job description is the power to pass or enforce legislation and regulation. 

And yet, Dr. Murthy has drawn the ire of the National Rifle Association because of his support for gun control.  Support that he expressed in 2012 in a single tweet.  With his confirmation process stalled, the White House is considering its options.  However, it’s important to highlight that this smear campaign against Dr. Murthy is disturbingly off target. 

1)    We should expect doctors to oppose gun violence and promote gun control

POSTED: Monday, March 24, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

With the enrollment deadline for Obamacare approaching, the Administration’s focus has been on convincing the uninsured that they cannot afford to remain uncovered.  But in states that have declined to expand Medicaid, many of these people will remain unable to afford insurance.  And as serious as their plight may be, they are not the only casualties of the political battles.  Hospitals stand to suffer major collateral damage, as well.

When they make financial projections, hospitals plan for the need to provide a certain amount of uncompensated care for patients who are unable to pay.  Some of this cost is recovered from the federal government through Medicare.  However, Obamacare reduced the amount available for these “disproportionate share hospitals” by billions of dollars on the assumption that the cuts would be offset by Medicaid expansion.  The thinking was that since more of the uninsured will have coverage, less hospital care will go unpaid.  Although Medicaid payment rates tend to be much lower than those of private insurance, hospitals would still stand to gain because the lower Medicaid rates would be offset by revenue from the large number of newly insured.

However, Medicaid expansion is optional for the states, and half them have refused to take part.  Sadly, many of the holdout states are the ones that have the most to gain with populations that are among the country’s poorest and least healthy.  Some governors in these states have cited the cost of expansion as unsustainable, but with federal money covering 100% of the cost for the first three years, and never less than 90% after that, the decision seems to be more political than practical. 

POSTED: Friday, March 21, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

The Web is filled with valuable information for staying informed about health care and ahead of the all-too-prevalent myths, if you know where to find it.  I am pleased to offer a regular round-ups of the most intriguing and informative blog posts and stories from around the Internet to help Field Clinic readers keep on top of a wide range of developments.  Here are some recent posts I’ve found myself starring, subscribing to, and sharing:

1.            The role of hashtags in healthcare: Forecasting The Flu, Tweet By Tweet (NPR, Weekend Edition)

NPR profiles how social media can help government agencies and health systems track and predict health care outbreaks.

POSTED: Monday, January 13, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

Over the past month, the media has been following the untimely deaths of Jahi McMath and Marlise Munoz—two bodies kept on ventilator support despite brain death diagnoses.  Much of the discussion surrounding these high-profile cases perpetuates the misconception that brain death is not as final as cardiac death; that somehow these women can recover.  Unfortunately, these tragedies highlight the importance of separating specialists from charlatans.

On December 9, 2013, thirteen year old Jahi underwent an elective procedure to treat her sleep apnea.  Complications caused her to be placed on a ventilator, and despite several determinations of brain death, her family obtained a court order that prevented the hospital from withdrawing support.  Earlier this week, her body was released to the county coroner who then released it to her family to take to an undisclosed location.  Despite a death certificate, she continues to be kept on a ventilator.

Marlise collapsed in her kitchen on November 26th due to a pulmonary embolism.  Although she has been declared brain dead and her family wants support withdrawn, the hospital has kept her on a ventilator because at the time of admission she was 14 weeks pregnant.  Texas law prohibits a hospital from withdrawing support from a pregnant patient, although a court has yet to decide whether the law was meant to apply to a patient who is deceased.

POSTED: Monday, December 30, 2013, 5:49 PM
Filed Under: Krystyna Dereszowska

Every family has its holiday traditions, and every year members of my family decide who will play Santa and hand out gifts on Christmas.  Meanwhile, everyone else assumes the role of pundit, starting conversations that make me wonder how we’re all related.  Not surprisingly, this year seemed to focus on critiques of the health care law, and I bit my tongue as the retelling of elaborate personal experiences contradicted logic and facts. 

I don’t mean to be rude.  My family members have real concerns about a complicated law that I don’t claim to fully understand myself.  But call me the bitter ghost of Christmas Past because here’s the speech I developed in my head as the evening progressed:

Let’s start with the concept of health insurance.  Much like other forms of insurance, it operates by pooling risk so that individual claims are paid out from premiums accumulated over time.  Except unlike the renters or car insurance you love to cite, everyone will make use of their health insurance at some point.  Problems develop when the sick max out their coverage, are dropped for being too sick, or are denied coverage altogether.  This is an area where governmental regulation has long attempted to intervene.

POSTED: Monday, October 21, 2013, 6:00 AM
Filed Under: Krystyna Dereszowska

As a kid growing up in New York, my mom enrolled me in the state’s CHIP program while she went back to school to be a teacher.  Once employed, her health plan covered my care until I graduated from college.  Then, fortuitously, New York extended coverage to age 29 for qualifying jobless dependents like myself, as long as we covered our own premiums.  I had just started my master’s program and the school required that students obtain insurance.  A few months later, Obamacare became law and those premiums disappeared from my consciousness, absorbed again by mom’s employer, until now.

I turned 26 this year, and I had to make a decision about where to get my health insurance and how much I was willing to spend.  Until then, my insurance decisions were effectively made for me, and I never used the coverage for anything more than stitches, sprains, and sore throats.  So why start proactively spending money for care I probably won’t use?

The reason is that I’m not always in charge of my health.

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 Inquirer.com 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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