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Archive: February, 2013

POSTED: Thursday, February 28, 2013, 6:00 AM
Filed Under: Erica Cohen

Although the Supreme Court ruled that Obamacare’s Medicaid expansion could not be mandatory for states, as of now, the governors of 24 states and the District of Columbia have decided to go along. (New Jersey’s Governor Chris Christie announced yesterday that he would be the 24th.)

But the question remains: will more individuals covered by Medicaid result in more individuals actually receiving medical care?

It is estimated that the Medicaid expansion could provide coverage for up to 15.1 million people who are currently uninsured. While this effort will help achieve the goal of reducing the number of uninsured individuals in the United States, it is unclear how the medical community will accommodate the increased number of patients seeking treatment.

POSTED: Sunday, February 24, 2013, 6:00 AM
Filed Under: Robert I. Field

Seven Republican governors have broken ranks and declared their support for expanding Medicaid in their states under Obamacare. The latest is Florida’s Rick Scott, who made his surprise announcement this week.

To hear some of them explain their decisions, you might think they had undergone ideological conversions. Rick Scott declared, “I cannot, in good conscience, deny the uninsured access to care.” Gov. John Kasich of Ohio, citing the Bible, called expanding Medicaid a “moral imperative.” New Mexico’s Susana Martinez noted an obligation to provide care “for those most in need in our state.”

But there’s a deeper force at work – money. And the draw is not just money to help the poorest citizens gain access to health care. It is support for the providers that serve those citizens, primarily hospitals. Expanding Medicaid is a financial bonanza for many facilities and a financial lifeline for others.

POSTED: Thursday, February 21, 2013, 7:00 AM
Filed Under: Erica Cohen

I was at my annual check-up and my physician asked me, “Do you exercise regularly?” I looked down sheepishly and said, “Well, uhh, law school doesn’t give me much free time. So I don’t exercise as much as I probably should. But I bike everywhere in the city, at least two miles a day, five days a week.”

My doctor looked at me through narrowed eyes and scoffed, “There is no excuse for lack of regular exercise. Biking throughout the city does not count. Weight-bearing exercise is especially important for petite women. You need to get yourself to the gym.”

I was so humiliated by this interaction that I left the appointment telling myself that in the future, I will just tell her that I exercise four times a week, both weight-lifting and running, whether or not it’s true. But should I have to lie to feel comfortable talking to my physician?

POSTED: Sunday, February 17, 2013, 5:00 AM
Filed Under: Robert I. Field

Has your doctor ever said you need a medical procedure? If so, you were probably told what hospital or clinic to use, which specialist or surgeon to select and numerous other key details. But did the doctor say what it would cost? Did you even think to ask?

If you had thought to ask, would your doctor have known? Probably not.

The cost of medical care in the United States is as transparent as the fog at Philadelphia Airport. It probably never occurred to you to ask about price because your insurance plan will pay the bill. The doctor doesn’t know because he or she won’t have to pay it, either.

POSTED: Thursday, February 14, 2013, 6:00 AM
Filed Under: Erica Cohen
Just because a surgeon is only operating on your toe does not mean that your overall mental state is irrelevant. (iStockphoto)

“Treating the whole person includes mental health care.” That statement was the title of a commentary written by the American Medical Association president, Jeremy A. Lazarus. Dr. Lazarus recognized that physicians can best treat their patients if they integrate mental health and mental illness into overall medical care.

A recent Johns Hopkins University study indicated that this integration is far from complete. The study, which surveyed the US News and World Report top 18 hospitals nationwide in 2007, found that only 44% maintained most or all of their psychiatric records electronically, only 28% made psychiatric records accessible to non-psychiatric physicians, and only 22% did both.

The study also showed that mental health record integration has promise – of the 18 hospitals surveyed, those that shared mental health records with non-psychiatrist physicians had significantly lower readmission rates for 2,000 psychiatric patients.

POSTED: Monday, February 11, 2013, 11:21 AM
Filed Under: Robert I. Field
President Obama (AP Photo/Jason Reed, pool)

Could Obamacare cause you to lose paid work time?

The law requires employers to offer health coverage to all full-time workers. They can avoid the rule by reducing an employee’s hours to fewer than 30 a week, which is the cut-off for part-time status. Some companies have already said they plan to do so for some workers.

If you are cut back to part-time status, you could find yourself in a bind. Your employer doesn’t have to offer coverage, but the law’s mandate still requires you to have it. Fewer hours could also mean less money with which to buy a policy on your own.

POSTED: Friday, February 8, 2013, 5:30 AM
Filed Under: Erica Cohen

Did you know that an item discarded as medical waste after your baby is born could save someone’s life? Cord blood from the placenta and your baby’s umbilical cord is filled with blood-forming cells that can be used in transplants for patients with leukemia, lymphoma, and many other life-threatening diseases. Thousands of people worldwide are searching for a lifesaving marrow or cord blood donor each and every day. Just by donating your baby’s cord blood after birth, you could save a person’s life.

While some patients in need of a transplant are eligible for an autologous transplant in which the patient receives his or her own stem cells that were collected before transplant, many patients require an allogenic transplant from another individual. Some patients are fortunate to find a match in a relative, often a sibling; however, seven out of ten patients look to an unrelated donor, usually a perfect stranger, to save their lives. And currently, six out of ten patients never find a matching donor. But, you could help change those odds.

It is up to the patient’s physician to determine whether cord blood, peripheral blood, or bone marrow is the best type of transplant for the patient’s condition. Cord blood is especially useful for minority patients because it is more difficult to find a bone marrow match for patients with diverse racial or ethnic backgrounds.

POSTED: Wednesday, February 6, 2013, 12:09 PM
Filed Under: Drew Harris

The Field Clinic is pleased to welcome two new guest bloggers who will be contributing on a regular basis, Dr. Drew Harris and Dr. David Nash of the Jefferson School of Population Health. Both are renowned experts on health policy and the American health care system. This is Dr. Harris’s inaugural entry.

Governor Christie must soon decide whether New Jersey will expand its Medicaid program under the provisions of the Affordable Care Act (“Obamacare”). Now that Governor Corbett has moved to turn it down in Pennsylvania, at least for now, the pressure is on him to act.  Will he follow Corbett’s lead or chart a separate course?

Expansion is a good deal for the state. At first, the federal government will pay all of the additional costs, with the state’s share rising to 10% after three years. For some of the estimated 177,000 uninsured citizens who will receive health coverage, this could mean the difference between life and death.

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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