Freddie Lempe Slated To Die Due To North Carolina's Slack, Stingy Medicaid System (NC DSS & Health Care Reform Needed)

Medicaid approved for Smithfield teen in a coma

A Smithfield father fighting a Raleigh hospital to keep legal guardianship of his son has been able to secure Medicaid benefits to cover the teen's treatment for a traumatic brain injury.

Freddie Lempe, 18, has been in a coma at WakeMed since a car wreck in March 2011.

His father, Fred Lempe, says Medicaid coverage for his son was dropped in December when he turned 18.

The hospital has said that the teen was denied coverage because his father failed to file the paperwork.

It wants the court to appoint a guardian for Freddie who would be legally authorized to make all medical decisions.

Fred Lempe has said he's gotten conflicting information from the Johnston County Department of Social Services about what was required.

Calls and emails to WakeMed were not immediately returned Friday afternoon, and it's unclear whether the hospital will pursue its request in the court system.

A hearing is scheduled for July 25.


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Sources: WRAL, Google Maps

Blair Watch: Bi-Partisan Summit Or Partisan Health Care Showdown?

The Big Bi-Partisan Lie


If President Barack Obama really wanted to show he’s serious about winning over Republicans on health care reform, he could offer up some key concessions at Thursday’s summit, like caps on malpractice awards or allowing insurers to sell across state lines.

And if Republicans wanted to reciprocate, they could at least acknowledge the congressional scorekeepers are right – the Democratic plans cut the deficit in the long term and rein in health care costs.

But that would assume either side is willing to do this.

Heading into Thursday’s summit, there’s been a lot of talk on both sides about how they’re the reasonable ones, willing to meet in the middle – and it’s the other side that’s to blame.

But the reality is, both sides have been responding to the overwhelming incentives to play to the home team, and to tailor their positions to seek partisan advantage and political gain.

So in the end, the health care summit seems most likely to clarify what has been an obvious reality lurking just below the surface at almost every turn in this episode, which is that neither side is really on the level when they say they were committed to bipartisanship.

Nor do they really want to split the difference – to do something in six hours at Blair House that they wouldn’t do all year.

The parties have become so entrenched in their positions that Republicans say they will never accept the Democratic comprehensive reform bill, and Democrats say they will never start over and adopt the GOP’s scaled-back, market-driven approach.

But the opportunities will be there, to be sure. Republicans will push a six-step plan for enacting health care reform, which includes many ideas that have already been embraced to a lesser degree in the Democratic bills.

And a central element of the Democratic strategy – hashed out on a conference call with President Barack Obama himself Wednesday — will involve pointing that out at every turn, to essentially shame the GOP to get on board.

Yet neither side showed any sign of cooling off ahead of the summit.

"If they are coming in and saying start over, there is nothing to talk about,” said Sen. Chris Dodd (D-Conn.)

Sen. John McCain (R-Ariz.) shot back: "Why not start over? The overwhelming majority of the American people want us to start over."

The tit-for-tat continued until hours before the summit convened. House Minority Leader John Boehner (R-Ohio) pushed to expand the invite list to include governors, but the White House denied the request.

So Boehner offered a spot to Rep. Bart Stupak, a Democrat from Michigan who crafted an anti-abortion provision in the House bill that infuriated liberals. But Stupak later said the minority leader never consulted him.

The White House, on the other hand, extended a last-minute invite to Sen. Olympia Snowe, the moderate Maine Republican who negotiated for months with Democrats but was left off Senate Minority Leader Mitch McConnell’s list. She declined.

While Republicans huddled among themselves, Obama dialed into a meeting of top Democrats in House Speaker Nancy Pelosi’s office to map out a strategy. Democrats view the summit as a confidence-building exercise – it will be a success if Obama shows up the Republicans and, in turn, gives Democrats the political will to take the next step of reconciliation, a senior congressional aide said.

It took a year to get to this point.

Democrats believe congressional Republican leaders were determined, almost from Day One, to kill health care reform at any cost – and McConnell (R-Ky.) acknowledged as much during a POLITICO interview in November.

He said he embarked on a “very systematic and persistent” campaign since Memorial Day -- well before the House or Senate bills were even released -- to undermine support for the president’s reform push.

“For the public to understand there was a genuine debate about policy here, it was important for it not to become ‘bipartisan,’” McConnell said. “On the merits, this was a proposal that didn’t deserve, in my view, bipartisan support.”

“It deserved bipartisan defeat,” McConnell said.

In response, Republicans argue that Obama should have reworked his approach, knowing their objections. Instead, Obama embraced a strategy of limited engagement. He targeted Snowe and met with her repeatedly, once for more than 90 minutes in the Oval Office, hoping to put bipartisan sheen on the bill and provide some wiggle room in the Senate.

“Their attitude towards bipartisanship has been kind of like a shooting gallery, we can pick off two or three Republicans to pass the bill,” Sen. Lamar Alexander (R-Tenn.) said. “That is not the way it is done. The way we do bipartisanship is we sit down at the beginning and agree with each other on how to move forward.”

In fact, Senate Finance Committee Chairman Max Baucus (D-Mont.) tried the bipartisan route. He spent almost nine months trying to bring a handful of Republicans onto the bill, and had the support of Obama and Majority Leader Harry Reid (D-Nev.) in doing it – to an extent. The theory was that if Baucus could convince Sen. Chuck Grassley (R-Iowa) to come on board, other Republicans in both chambers would follow.

Until July, the approach looked promising. But a cascade of decisions threw it off course.

Sen. Jim DeMint (R-S.C.) told conservative activists that they needed to make health care Obama’s Waterloo, infuriating Democrats who saw the remarks as the first public sign that Republicans had no plans to support the bill.

It was around this time that Baucus faced increased pressure from Reid and the White House to wrap up the Gang of Six negotiations, angering Republicans who didn’t want to be rushed.

Yet the Republicans involved in talks – Snowe, Grassley and Sen. Mike Enzi of Wyoming – were also being squeezed. When it appeared that the group was nearing a compromise, McConnell reined them in, extracting guarantees from Grassley and Enzi that they would not sign off on a deal without consent from the caucus, according to congressional aides.

Along the way, Republicans grew more frustrated with Democrats. Obama would say at public events that he would sit down with any lawmaker, only to ignore repeated requests from conservatives. He told the American Medical Association that he was open to reducing medical malpractice costs, on ly to never make a serious push for the reforms that Republicans cared about. Democrats portrayed the Senate Health committee bill as bipartisan because 160 Republican amendments were accepted, only to have their staff later write some of them out of the measure, Republicans have said.

Grassley went to the White House in early August and asked Obama to drop the public insurance option in a bid for bipartisan support. Obama refused, Grassley has said. Democrats, who no longer trusted Republicans, understood the president’s strategy – if he had disavowed the public option, Republicans would have targeted the next major element of the bill.

That was their last interaction before the tumultuous August recess, when Grassley returned home to Iowa and pushed some of the most extreme charges leveled against Democratic health care plan.

By early September, top Democrats were convinced bipartisanship would never happen. And in October, Reid made a decision to cut the cord – initially against the advice of the White House, which was still wooing Snowe – by introducing a Senate bill with a public option that allowed states to opt-out, rather than Snowe’s public option “trigger.”

Snowe, who has said Reid assured her in September that he would go with the trigger, was lost for good. So was any hope of bi-partisanship.


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Sources: CNN, Politico, Google Maps

Feds Order North Carolina DHHS To Repay $300 Mill For Overbilling Medicaid...HC Reform Can't Wait!

Charlotte Observer, MSNBC-----

RALEIGH - North Carolina will repay about $300 million to the Federal government because of a Medicaid billing error, but it will affect neither the state budget nor patient treatment, NC Health and Human Services Secretary Lanier Cansler said Friday.

The accounting mistake began last November when annual changes were made to the share the federal government pays for Medicaid, Cansler said. The error caused more public hospital payments to be billed to the Centers for Medicare and Medicaid Services and less to the state's account.

Most of the money will be paid back by the end of the month.

"The safeguards that were in place to prevent this type of error were inadequate," Cansler said in a prepared statement. "There were breakdowns in communication and oversight, and corrective actions will be taken quickly."

Gov. Beverly Perdue said late Friday she had told the department to alert the state budget office in the future when federal- or state-funded payments exceed 2 percent of projections and to submit a report giving a reason. Such a process would have caught the problem sooner, she said.

"The circumstances under which it was made and perpetuated are simply unacceptable," Perdue said. "I am moving quickly to get to the bottom of this situation and am taking steps to fix it."

Cansler said he was alerted to the mistake last week and worked out an agreement Wednesday with Centers for Medicare and Medicaid Services to pay back $200 million by July 31 and the rest in payments through the fiscal year.

Most of the state money was available immediately, so it won't worsen the state's already weak fiscal situation, Cansler said.

"We were unknowingly borrowing the money from the federal government," Cansler said in an interview.

Medicaid, the government health insurance program for low-income children, older adults and the disabled, received $7.5 billion from the federal government this past year for Medicaid. The state is slated to spend more than $2 billion this year on the agency that operated Medicaid.

When asked if remedial actions would include personnel changes, Cansler said any changes would be decided upon in the next few days.

The overpayment is the latest in a series of fiscal errors or overspending Medicaid in North Carolina this decade.

In 2006, the state agreed to reimburse the Federal government $151 million for Medicaid over payments made in error to hospitals as part of a program for poor and uninsured patients.

Earlier this month, a legislative watchdog agency determined North Carolina could have saved itself up to $226 million — up to $635 million when the federal portion is counted — by containing costs sooner in a Medicaid program that provides non-medical care for mental health patients living at home.



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Sources: Charlotte Observer, MSNBC, Google Maps

Pres. Obama Releases Statement On Agreement to Bring Down Drug Prices For America's Seniors

Whitehouse.gov---

Statement from the President Obama on Agreement to Bring Down Drug Prices for Americans Seniors:

"I am pleased to announce that an agreement has been reached between Senator Max Baucus and the nation's pharmaceutical companies that will bring down health care costs and reduce the price of prescription drugs for millions of America's seniors. As part of the health reform legislation that I expect Congress to enact this year, pharmaceutical companies will extend discounts on prescription drugs to millions of seniors who currently are subjected to crushing out-of-pocket expenses when the yearly amounts they pay for medication fall within the doughnut hole any payments by seniors not covered by Medicare that fall between $2700 and $6153.75 per year. The existence of this gap in coverage has been a continuing injustice that has placed a great burden on many seniors. This deal will provide significant relief from that burden for millions of American seniors".

"The agreement by pharmaceutical companies to contribute to the health reform effort comes on the heels of the landmark pledge many health industry leaders made to me last month, when they offered to do their part to reduce health spending $2 trillion over the next decade. We are at a turning point in America's journey toward health care reform. Key sectors of the health care industry acknowledge what American families and businesses already know - that the status quo is no longer sustainable. The agreement reached today to lower prescription drug costs for seniors will be an important part of the legislation I expect to sign into law in October. I want to commend House chairmen Henry Waxman, George Miller and Charles Rangel for addressing this issue in the health reform legislation they unveiled this week. This is a tangible example of the type of reform that will lower costs while assuring quality health care for every American".


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Sources: Whitehouse.gov, Flickr, Twitter, Google Maps

Medical Bills Underlying Cause of Most Bankruptcies (Health Care Reform)

Reuters----

WASHINGTON - Medical bills are involved in more than 60 percent of U.S. personal bankruptcies, an increase of 50 percent in just six years, U.S. researchers reported on Thursday.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

"Using a conservative definition, 62.1 percent of all bankruptcies in 2007 were medical; 92 percent of these medical debtors had medical debts over $5,000, or 10 percent of pretax family income," the researchers wrote.

"Most medical debtors were well-educated, owned homes and had middle-class occupations."

The researchers, whose work was paid for by the Robert Wood Johnson Foundation, said the share of bankruptcies that could be blamed on medical problems rose by 50 percent from 2001 to 2007.

"Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy," Harvard's Dr. David Himmelstein, an advocate for a single-payer health insurance program for the United States, said in a statement.

"For middle-class Americans, health insurance offers little protection," he added.

The United States is embarking on an overhaul of its healthcare system, which is now a patchwork of public programs such as Medicare and employer-sponsored health insurance that leaves 15 percent of the population -- 46 million people -- with no coverage.

About 170 million people get health insurance through an employer but President Barack Obama says soaring healthcare costs are hurting the economy and forcing businesses to drop medical insurance for their workers.

CANCELED COVERAGE

"Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year," the report reads.

Obama told Congress on Wednesday he was open to making mandatory health insurance part of the overhaul but only with exemptions for the poor and for small businesses.

Neither Congress nor Obama are considering the kind of single-payer plan advocated by Himmelstein and his colleague Dr. Steffie Woolhandler.

"We need to rethink health reform," Woolhandler said. "Covering the uninsured isn't enough.

"Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy."

The researchers surveyed 2,134 random families who filed for bankruptcy between January and April in 2007, before the current recession began.

They used public bankruptcy court records and survey 1,032 respondents by telephone.

While only 29 percent directly blamed medical bills for their bankruptcy, 62 percent had medical bills that totaled more than 10 percent of family income, said an illness was responsible, had lost income due to illness or some other medical factor.

"Among common diagnoses, nonstroke neurologic illnesses such as multiple sclerosis were associated with the highest out-of-pocket expenditures (mean $34,167), followed by diabetes ($26,971), injuries ($25,096), stroke ($23,380), mental illnesses ($23,178), and heart disease ($21,955)," the researchers wrote.

Sources: Huffington Post, Reuters, Day Life