Advocates: Disabled take huge hit under GOP health reform

Advocates for the disabled say the House Republican plan to replace the Affordable Care Act seriously threatens some of the most vulnerable Americans.

The website DisabilityScoop reports that advocates say the bill threatens home- and community-based services and other supports that people with developmental disabilities rely upon.

Photo: Joshua Zader/Creative Commons

“The American Health Care Act shows callous and dangerous disregard for the well-being of people with disabilities and their families and erases decades of progress,” said Peter Berns, CEO of The Arc, an organization that service people with intellectual and physical disabilities.

The House passed the bill 217 to 213, allowing President Donald Trump and Republicans to do a victory lap that they had finally succeeded in destroying Obamacare. The measure though was roundly criticized by doctors, hospital and senior groups. It must still pass the U.S. Senate, which gave it a lukewarm response and promised to address its more draconian measures.

While the disabled take a hit, the most wealthiest Americans are big winners with the new legislation as it delivers a big tax cut the would redistribute billions of dollars to the upper tier.

 

How does it hurt the disabled? The many groups who represent them say the bill would institute a per capita cap for Medicaid. This means the federal government would offer a fixed amount of money for each beneficiary.

“These huge cuts and caps will likely put pressure on states to cut home- and community-based waiver services, especially those that are ‘optional,’ like personal care services and therapies,” said Kim Musheno, chair of the Consortium for Citizens with Disabilities, a coalition of disability advocacy groups.

Schools also would be affected by the Medicaid shift because they are currently able to seek reimbursement for a variety of services provided to disabled children to a tune of $4 billion annually. That means money to reimburse schools for speech and occupational therapy, specialized playground equipment, and even wheelchairs is now in jeopardy.

Advocates for the disabled say House Republicans would allow states to no longer consider schools as eligible Medicaid providers.

To read all of the story by DisabilityScoop click here.

 

Health care refugees: Couple flees Florida after Medicaid nightmare

A Boynton Beach couple said they left Florida – a state they loved – because they could not get adequate health care for their ailing 5-year-old daughter through Medicaid.
CNN’s series on health care refugees started this week with Kim and Richard Muszynski. The couple in September packed their bags and took their ailing 5-year-old daughter, Abby, to Colorado.
Abby was born with a missing a piece of her brain and is subject to violent seizures.
Like Abby, nearly early half of all children in Florida get their health care through the state-run health insurance Medicaid. Abby ended up on Medicaid when Kim Muszynski left her job – and lost the health insurance that came with it – to care for her daughter full-time.
Abby ended up on Medicaid when Kim Muszynski left her job – and lost the health insurance that came with it — to care for her daughter full-time.
Florida Medicaid refused to pay for lifesaving medicines and initially denied payment for a wheelchair. CNN reported. Sometimes Medicaid took so long to pay some of her health care providers that they refused to treat Abby, CNN reported.
Sometimes Medicaid took so long to pay some of her health care providers that they refused to treat Abby, according to the cable news network.
The Agency for Health Care Administration, which runs Medicaid for Florida, disagreed with the CNN report. “The state has done everything in its power to support this family,” said Mallory McManus,  spokeswoman for the agency.
A federal judge ruled in a civil suit that 2015 that Florida had violated the law by underpaying doctors. The state later reached a settlement.
“Florida’s Medicaid program is currently operating at the highest level of quality in its history,” McManus said.
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State Sen. Joseph Abruzzo
AHCA and CNN also have clashed in the past.
AHCA criticized the cable news network for its story on the pediatric heart surgery program at St. Mary’s Medical Center.
AHCA characterized the June 2015 story as “sensationalized reporting.”
St. Mary’s program closed down shortly after the story ran.
The network is currently being sued for defamation by the surgeon who established the program.
Now CNN is back in South Florida reporting on the Muszynskis.
In February, the family got word she was being kicked off Medicaid by the state of Florida until state Sen. Joseph Abruzzo interceded, CNN reported.
The couple was told by the state Abby was dropped because of a computer glitch but still the family had trouble getting coverage for her. So, they decided it was time to leave Florida.
To read the whole CNN story on the Muszynskis click here.

Marketing over common sense? May be better to wait on flu shot

The marketing of the flu vaccine has become an almost year-round effort as drug store chains urge their customers to get a shot earlier and earlier.

But a story by CNN says that may not be the wisest thing to do to combat the flu.

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When should you get a flu shot? It may be better to wait despite retailers’ claims.

Some experts say marketing may be overtaking medical wisdom since it’s unclear how long the immunity imparted by the vaccine lasts, particularly in seniors.

An early flu shot is better than no flu shot at all, but the science is uncertain how long your immunity will last if you get the shot in late summer as opposed to early fall. Flu season generally peaks in mid-winter or beyond.

“If you’re over 65, don’t get the flu vaccine in September. Or August. It’s a marketing scheme,” said Laura Haynes, an immunologist at the University of Connecticut Center on Aging.

Tom Charland, founder and CEO of Merchant Medicine, said medical services on demand appeals to millennials but when it comes to late summer flu shots, “It’s a way to get people into the store to buy other things.”

Read the whole debate on the issue at CNN by clicking here.

Epi-Pen crisis sends Boynton Beach mom to Canada

A Boynton Beach mother says she hopes to buy EpiPens in Canada for her 8-year-old son after the price of the life-saving product for allergies skyrocketed in the U.S. by 400 percent.

Anna Pickman’s son, Zander, has a severe food allergy that her doctor says could be fatal. “The allergy is so bad he can’t even touch anything containing milk. Just from touching it, he breaks out in hives,” she said.

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Families of children with allergies s who need EpiPens have been hit with a 400 percent increase in the product.

Every school year she buys EpiPens for home and for school. This year when she went to CVS to buy them and was told that the medicine would cost $575 for one package of two (the dose is often two shots),

She thought it was $5.75.

Then when she said she needed another and the pharmacist said it would cost her total of $1,100.

“Then my jaw dropped. I don’t have $1,100 in my pocket,” Pickman said.

Pickman said in past years she has paid $100 and even nothing with a coupon and insurance. This August, her insurance said the cost was not covered because she had not met her deductible.

Heather Bresch – the CEO of Mylan, the company that makes EpiPens – has come under intense fire   surrounding the recent 400-percent increase in her company’s allergy injector that is used for peanut, milk and other food allergies, as well as for those allegeric to bee stings.

Mylan’s profits from selling EpiPens hit $1.2 billion in 2015. The drug in EpiPens is actually generic but Bloomberg reports that the epinephrine-delivery system by Mylan represented 40 percent of the company’s operating profits.

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Anna Pickman with her son, Zander, says she would have had to pay nearly $1,100 for EpiPens for her sons’ milk allergy.

In response to the backlash, Mylan is offering a generic EpiPen for half the price, or about $300 for a pack of two. It also has said it would increase financial assistance for uninsured patients. But the company has refused to reduce the price, meaning that either insurance or the patient ends up picking up the tab.

Pickman said she found it interesting that Bresch has received an increase in her CEO pay and that company has aggressively marketed the product.

She says there is only word to describe the EpiPen price gouging: greed.

Pickman’s husband, Sarge, will soon travel to Canada and she has done research and found that the product is far less expensive north of the border where drug costs are regulated. She hopes with prescription in hand she can get the much-needed life-saving medication for her son there.

In the meantime, she has a few EpiPens that have not expired and will rely on those until her husband heads to Canada with fingers crossed.

Local mom fought for kids in Medicaid lawsuit

More than a decade ago, Rita Gorenflo of Palm Beach Gardens signed on as a plaintiff in the class-action lawsuit against the state of Florida on behalf of nearly two million poor and disabled children on Medicaid.

Through a lengthy Miami trial and the appeal of the judge’s scathing findings against the state, Gorenflo lost a son, while she raised six other adopted disabled children to adulthood.

Last week, the state and plaintiffs settled the class-action case with Florida agreeing to increase enrollment efforts that have left children off of Medicaid.

“It is, at least, an admission from the state that issues exist and need to be dealt with,” said Gorenflo, her son Thomas’ care becoming a prime example of the state failing disabled children.

One of the biggest victories in the multifaceted settlement is that the state agreed to increase reimbursement rates for doctors and pediatricians – one of the lowest in the country. The aim is that more doctors will now participate in the Medicaid program, increasing care and cutting travel times for families.

“It’s been 30 years since physicians were able to increase their reimbursement,” Gorenflo said. “You want to know why pediatricians were reluctant to take Medicaid patients? It was way beyond pathetic. Hopefully, it will be better.”

Gorenflo’s son, Thomas, died of his birth defects in 2011 at age 12. He became emblematic of the lawsuit. Despite his lungs being crushed by the curvature of his spine due to progressive scoliosis, the child had to wait 18 months for vital surgery while Gorenflo battled the state.

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Les and Rita Gorenflo of Palm Beach Gardens adopted Thomas, 2, in 2001. Thomas’ care became emblematic of the lawsuit against the state of Florida claiming it failed children on Medicaid. He died in 2011. (Photo by Jennifer Podis)

The registered nurse praised the lead attorney Stuart Singer and his firm Boies, Schiller & Flexner, which handled the case pro-bono. The case was settled after a federal judge ruled for the plaintiffs in December 2014, finding the state was low-balling doctors. Florida, however, appealed the decision.

Singer said there is a belief the state agency that administers Medicaid — the Agency for Health Care Administration — will act in good faith. “There is also the ability to go to court and seek injunctive relief if the agreement is materially breached and that is not remedied,” he told The Post.

Dr. Tommy Shechtman, president of the Florida Chapter of the American Academy of Pediatrics, noted that there is still work to be done as there are approximately 377,000 uninsured children in Florida — more than 28,600 living in Palm Beach County.

“We have the unfortunate distinction of being one of the nation’s top 20 counties for having the highest number children without health insurance,” Schechtman said. “This is alarming. However, I remain encouraged that through FCAAP’s collaboration with the state we can and will strive for significant improvement.”

Tallahassee pediatric cardiologist Louis St. Petery, who was highly involved in the lawsuit, said the effects of the settlement will take some time to implement.

“I don’t see any change in access tomorrow compared to today just because the settlement agreement is in place,” he said. “The settlement agreement meters this out over one year, two years, three years, depending on which category of physicians and dentists you’re talking about.”