A Message to Governor Parnell

by: Jeanette

Tue Mar 23, 2010 at 07:23:40 AM AKDT

"March 21, 2010, Juneau, Alaska - Governor Sean Parnell today expressed grave concern with the passage by Congress of national health care legislation, noting polls that show the vast majority of Americans opposing the government takeover of about one-sixth of the economy.

"This is public policy at its worst," Governor Parnell said. "I am very concerned with the impacts this bill will have on Alaska's seniors, families, small businesses, and physicians. For the many Alaskans currently unable to afford insurance, this legislation will do nothing but require that they purchase health insurance. This bill will increase insurance premiums and do very little to ensure that patients have access to needed health care professionals."

The governor shares the view of many Americans that forcing citizens into a health care plan they don't want, and one the nation can not afford, is unconstitutional.

http://gov.alaska.gov/parnell/...

In this recent statement posted on the Governor's website, Governor Parnell has indicated that he may join other Governor's in an attempt to block recent health insurance reform legislation.  Some of you may have followed the events of the weekend, and have felt the elation of knowing that the first steps in health care reform are underway.  Our Governor does not share our elation.  

If you support this bill, please take another few moments to write our governor at his email address, and express you support for H.R. 4278 and H.R. 3590 (soon to be signed by the President).  

Governor Parnell asserts that the vast majority of Alaskans stand against these two bills.  Let him know that it ain't so.  Do it for yourself, and for those still suffering.  Let us decide for ourselves if this will work.  How can we know unless we try.  Shoulda, woulda, coulda won't fix the problem, and despite what the radicals say, a bill done can be undone if it does not serve the will of the people.  Do not be afraid. Be bold. Be Progressive.  Above all, do not be silent.

http://murkowski.senate.gov/pu...
http://begich.senate.gov/public/

The Conflict Between Starr an Selkregg is the Rally Cry for the Next Elections

by: Jeanette

Wed Nov 04, 2009 at 21:06:11 PM AKST

http://www.ktuu.com/Global/sto...

This article was posted today on the KTUU Channel News Website.  

Last night the Anchorage Assembly met to discuss and adopt Mayor Sullivan's six year budget plan, a fifteen page plan drafted by the Mayor and his office outlining Anchorage's financial future.

The usage of the word socialism has frankly been worn out.  Those who use it seem not to truly grasp its meaning.  I had to comment on the article, and to reply to others who made comment.

Somebody please, in plain English, outline for me how our society has adopted socialism? As I understand the current usage of the term our churches engage in socialism. Churches regularly collect money from the members of their congregation, and redistribute the money to those it determines to be most in need. This is a basic principle of Christian faith and practice. Those of us who have been blessed with more give to those who have less or none. I have no problem extending this tenant of my faith in God to my state and nation. I render to Caesar what is Caesars as Jesus requested I do. I do so because it betters my society, and goes beyond what I or my congregation could do locally. Most of what I contribute goes to the upkeep of the infrastructure of my state and nation, and I am proud of that fact. If a portion is misused, well then that is but a portion, and those responsible can be brought to bare for their crimes. My faith tells me that their misdeeds will come around to trip them up eventually. I look around and see all that comprises my city, my district, my world, and I am grateful for it, and proud to have paid taxes to nurture it. I am blessed, and I can afford to pay a little extra to see to it that someone less fortunate than I has a better chance at life. My government isn't bad. It is run by humans, and there but for the grace of God go I.

Assemblyman Starr is a businessman.  He was elected to help run our city, to watch over its fiscal health and the physical well being of its occupants.  We pay his salary.  If we want a portion of our taxes to be redistributed to the poorest of our citizens, or to improve the commons (public places of commerce, government or recreation), then so be it.  If not to benefit our small portion of society, its commerce, trade, recreation, public health, etc., then for what do we pay taxes?

I have no doubt that Sheila Selkregg was acting on behalf of her constituency in District 19 of which I am a member.  She has done so consistently even when it has put her in direct conflict with other Assembly members and Mayor Sullivan.

District 19 has been extremely blessed to have elected three competent and able individuals to watch over our public welfare.   At the city level, we have Sheila Selkregg, who has an amazing head for business, and pragmatic approach to problem solving, yet consistently manages to apply both traits to the humanity of the people she was elected to serve.  Her steadfast defense of human rights during the long months of hearings on AO 64 (the sexual orientation ordinance) showed great character and fortitude.

To represent the needs of Muldoon in the state House, we have Pete Petersen.  http://www.petepetersen.net/.  Anyone who has taken the time to get on Representative Petersen's email list, will attest to the fact that information floweth freely from his office.  I will attest to the fact that its content is as accurate as I can validate through normal means of fact finding available to the citizen.  Representative Petersen has been  involved in and effective at researching and addressing such issues as Enstar's rate hikes, and the suspiciously high cost of fuel in Alaska.  By involved I mean he has been out gathering information, helping to draft legislation, and finally, to get the information gathered back out to his constituency.

Finally, serving ably in the Senate is Bill Wielechowski.  http://senate.legis.state.ak.u...  Senator Wielechowski has done a tremendous job for District J. His feedback to his constituency during the AGIA process was much appreciated.  So little was known about the process, and on several occasions, he or his immediate staff responded directly to my doubts and concerns.  Like Representative Petersen emails, the Senator's newsletters go beyond mere campaign bulletins, and the facts they provide have been invaluable to me in my personal attempt to keep up to date on public issues.  The young Senator has either drafted or help to draft key legislation to combat unfair prices hikes by utility companies, and high fuel price.

All of these individuals will have my vote next election so long as they continue to uphold their oaths of office.  Those votes do not come easily, and they cannot be bought.  They have earned them by meeting all of my criteria for what makes a solid servant of the public.  They have first done no harm, and secondly helped to safeguard against wrongdoing in both commerce and the public.  They have attended to the fiscal concerns of our district and of the state.  But above that they have been accessible to their constituency, to those who extended to them the privilege of serving in office.  They live in their district, and interact with those they serve.  I have seen no evidence of self seeking, and I have been vigilant.  Those who have read my blogs know that I love research.  They have demonstrated more than adequately, and in many instances outstandingly that they have the experience to do their jobs, and the fortitude to persevere when standing up for the public.  They have done even when it has placed them in opposition to the wishes of the business or the religious community.  They have shown no disdain for these institutions.  To the contrary, I believe their actions will ultimately protect them (though some may not think so).  Finally, I observe in them the humility to recognize that, should they swerve from the path of duty and service to the citizens of their state and the Constitution we all uphold, they will be replaced.

My purpose for this lengthy atta boy/girl for the public servants of Muldoon is a simple one.  Representative Petersen, and Senator Wielechowski are progressives, and Democrats.  The conservative Republicans have gathered candidates to run for those offices held by Representative Petersen and Senator Wielechowski.  They have this right.  I cherish their right to do so, but I worry that their reasons for seeking election may not be in the best tradition of public service.  By this I mean, I suspect they wish to run for reasons other than to better the health, welfare and economy of the public who may elect them to office.  If this is not the case, then they have only to prove themselves more worthy than the incumbent candidates.  Fair enough, but a warning to them:  our district has had enough of moral piety and empty campaign promises.  We have at our disposal two able bodied gentlemen who have proved their mettle in office.   What ever the opposition offers it had best meet the highest standards of office for they will be scrutinized, and their past actions carefully weighed for sincerity of merit.  Muldoon has just begun to see a spark of resurrection amidst economic disaster.  We have much to lose should we chose unwisely.  Our progression towards better neighborhoods, less crime, safer roads and better schools has been slow but it has been steady and meaningful.

The gathering of forces of the opposition to our incumbents in Muldoon will undoubtedly occur in other districts throughout the state.  As the next election draws near, we, the progressive citizens of all districts in Alaska must replay in our hearts and heads the words of our newly elected President one year ago.  We must remember that we the people must do our part to ensure that progress remains vital and alive.  Not simply the progress of commerce and trade of a nation (the big boys and girls will slug it out and eventually the tide will turn), but the progress of our small communities and the people who live and work in and for them.  We must take great pains and make necessary sacrifices of time, money and talent to ensure that those who have faithfully served us as they promised to serve us will be reelected.  We must give support to new faces who demonstrate to us a sincere desire and posses credible skills to serve their communities on behalf of the electorate who place them in office.  We must get out and vote.  We must help our neighbors get out and vote.  We must be willing to discuss the politics of our neighborhoods, and confront those would run for office with our concerns and questions.  If volunteers for the candidates we support call us for assistance, we must be willing to dig as deeply as we are able to answer that call.  If we lack money, we must contribute time.  If we lack time, we must contribute money when possible.  If we lack both resources, then we must lend to them the strength and the power of our voices.  We must explore the six degrees of space that separate us one from another.  If we respect our fellow man, we can find a way to discuss a subject that is important to our mutual welfare.  Yes, we will sometimes face hostility, but what is an instant of inconvenience compared to possibly years of it should someone unqualified to serve be elected?  To what lengths are we willing to go to see our children be welled schooled, our infrastructure in good service and repair, and our elders adequately cared for should they have no resources other than the public good will?  These will be the questions to ask ourselves in the next several months, as we recall the thrill of the last Presidential election, and as we listen attentively to the arguments on the Hill of our Capital as they decide the future of health care reform.  Democracy lives, breaths and we have the privilege of participating in it Day to Day.

HR 3200, Section 209 - 242: The House Version of When, Who and How to Deliver a Public Option

by: Jeanette

Sat Oct 31, 2009 at 21:58:14 PM AKDT

H.R.3200

America's Affordable Health Choices Act of 2009 (Reported in House)
SEC. 209. LIMITATION ON PREMIUM INCREASES UNDER EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS.

(a) In General- The annual increase in the premiums charged under any Exchange-participating health benefits plan may not exceed 150 percent of the annual percentage increase in medical inflation for the 12-month period ending in June of the prior year, unless the plan receives approval for a higher rate increase in accordance with subsection (b) or (c).
(b) Exception for Additional Required Benefits- If the Health Choices Commissioner requires Exchange-participating health benefits plans to provide additional benefits, the annual increase permitted under subsection (a) with respect to the first year to which such benefits are required shall be increased to take into account the costs of such additional benefits.
(c) Exception to Where Financial Viability Threatened- Subsection (a) shall not apply to any Exchange-participating health benefits plan for any year if such plan demonstrates to the Commissioner (or, if determined appropriate by the Commissioner, the insurance commissioner for the State in which the plan is offered) that complying with subsection (a) for such year would threaten its financial viability or its ability to provide timely benefits to plan participants.
(d) Non-preemption- Nothing in this section shall be construed as preempting existing State prior approval laws.
Subtitle B--Public Health Insurance Option

SEC. 221. ESTABLISHMENT AND ADMINISTRATION OF A PUBLIC HEALTH INSURANCE OPTION AS AN EXCHANGE-QUALIFIED HEALTH BENEFITS PLAN.

(a) Establishment- For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the `Secretary') shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the `public health insurance option') that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary's primary responsibility is to create a low-cost plan without compromising quality or access to care.
(b) Offering as an Exchange-participating Health Benefits Plan-
(1) EXCLUSIVE TO THE EXCHANGE- The public health insurance option shall only be made available through the Health Insurance Exchange.
(2) ENSURING A LEVEL PLAYING FIELD- Consistent with this subtitle, the public health insurance option shall comply with requirements that are applicable under this title to an Exchange-participating health benefits plan, including requirements related to benefits, benefit levels, provider networks, notices, consumer protections, and cost sharing.
(3) PROVISION OF BENEFIT LEVELS- The public health insurance option--
(A) shall offer basic, enhanced, and premium plans; and
(B) may offer premium-plus plans.
(c) Administrative Contracting- The Secretary may enter into contracts for the purpose of performing administrative functions (including functions described in subsection (a)(4) of section 1874A of the Social Security Act) with respect to the public health insurance option in the same manner as the Secretary may enter into contracts under subsection (a)(1) of such section. The Secretary has the same authority with respect to the public health insurance option as the Secretary has under subsections (a)(1) and (b) of section 1874A of the Social Security Act with respect to title XVIII of such Act. Contracts under this subsection shall not involve the transfer of insurance risk to such entity.
(d) Ombudsman- The Secretary shall establish an office of the ombudsman for the public health insurance option which shall have duties with respect to the public health insurance option similar to the duties of the Medicare Beneficiary Ombudsman under section 1808(c)(2) of the Social Security Act.
(e) Data Collection- The Secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle, including to improve quality and to reduce racial, ethnic, and other disparities in health and health care.
(f) Treatment of Public Health Insurance Option- With respect to the public health insurance option, the Secretary shall be treated as a QHBP offering entity offering an Exchange-participating health benefits plan.
(g) Access to Federal Courts- The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries.
SEC. 222. PREMIUMS AND FINANCING.

(a) Establishment of Premiums-
(1) IN GENERAL- The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner--
(A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and
(B) at a level sufficient to fully finance the costs of--
(i) health benefits provided by the public health insurance option; and
(ii) administrative costs related to operating the public health insurance option.
(2) CONTINGENCY MARGIN- In establishing premium rates under paragraph (1), the Secretary shall include an appropriate amount for a contingency margin (which shall be not less than 90 days of estimated claims). Before setting such appropriate amount for years starting with Y3, the Secretary shall solicit a recommendation on such amount from the American Academy of Actuaries.
(b) Account-
(1) ESTABLISHMENT- There is established in the Treasury of the United States an Account for the receipts and disbursements attributable to the operation of the public health insurance option, including the start-up funding under paragraph (2). Section 1854(g) of the Social Security Act shall apply to receipts described in the previous sentence in the same manner as such section applies to payments or premiums described in such section.
(2) START-UP FUNDING-
(A) IN GENERAL- In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. In order to provide for initial claims reserves before the collection of premiums, there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment.
(B) AMORTIZATION OF START-UP FUNDING- The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1.
(C) LIMITATION ON FUNDING- Nothing in this section shall be construed as authorizing any additional appropriations to the Account, other than such amounts as are otherwise provided with respect to other Exchange-participating health benefits plans.
(3) NO BAILOUTS- In no case shall the public health insurance option receive any Federal funds for purposes of insolvency in any manner similar to the manner in which entities receive Federal funding under the Troubled Assets Relief Program of the Secretary of the Treasury.
SEC. 223. NEGOTIATED PAYMENT RATES FOR ITEMS AND SERVICES.

(a) Negotiation of Payment Rates-
(1) IN GENERAL- The Secretary shall negotiate payment rates for the public health insurance option for services and health care providers consistent with this section and section 224.
(2) MANNER OF NEGOTIATION- The Secretary shall negotiate such rates in a manner that results in payment rates that are not lower, in the aggregate, than rates under title XVIII of the Social Security Act, and not higher, in the aggregate, than the average rates paid by other QHBP offering entities for services and health care providers.
(3) INNOVATIVE PAYMENT METHODS- Nothing in this subsection shall be construed as preventing the use of innovative payment methods such as those described in section 224 in connection with the negotiation of payment rates under this subsection.
(4) PRESCRIPTION DRUGS- Notwithstanding any other provision of law, the Secretary shall establish a particular formulary for prescription drugs under the public health insurance option.
(b) Establishment of a Provider Network-
(1) IN GENERAL- Health care providers (including physicians and hospitals) participating in Medicare are participating providers in the public health insurance option unless they opt out in a process established by the Secretary consistent with this subsection.
(2) REQUIREMENTS FOR OPT-OUT PROCESS- Under the process established under paragraph (1)--
(A) providers described in such subparagraph shall be provided at least a 1-year period prior to the first day of Y1 to opt out of participating in the public health insurance option;
(B) no provider shall be subject to a penalty for not participating in the public health insurance option;
(C) the Secretary shall include information on how providers participating in Medicare who chose to opt out of participating in the public health insurance option may opt back in; and
(D) there shall be an annual enrollment period in which providers may decide whether to participate in the public health insurance option.
(3) RULEMAKING- Not later than 18 months before the first day of Y1, the Secretary shall promulgate rules (pursuant to notice and comment) for the process described in paragraph (1).
(c) Limitations on Review- There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.
SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIVERY SYSTEM REFORM.

(a) In General- For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers.
(b) Requirements for Innovative Payments- The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that--
(1) seeks to--
(A) improve health outcomes;
(B) reduce health disparities (including racial, ethnic, and other disparities);
(C) provide efficient and affordable care;
(D) address geographic variation in the provision of health services; or
(E) prevent or manage chronic illness; and
(2) promotes care that is integrated, patient-centered, quality, and efficient.
(c) Encouraging the Use of High Value Services- To the extent allowed by the benefit standards applied to all Exchange-participating health benefits plans, the public health insurance option may modify cost sharing and payment rates to encourage the use of services that promote health and value.
(d) Promotion of Delivery System Reform- The Secretary shall monitor and evaluate the progress of payment and delivery system reforms under this section and shall seek to implement such reforms subject to the following:
(1) To the extent that the Secretary finds a payment and delivery system reform successful in improving quality and reducing costs, the Secretary shall implement such reform on as large a geographic scale as practical and economical.
(2) The Secretary may delay the implementation of such a reform in geographic areas in which such implementation would place the public health insurance option at a competitive disadvantage.
(3) The Secretary may prioritize implementation of such a reform in high cost geographic areas or otherwise in order to reduce total program costs or to promote high value care.
(e) Non-uniformity Permitted- Nothing in this subtitle shall prevent the Secretary from varying payments based on different payment structure models (such as accountable care organizations and medical homes) under the public health insurance option for different geographic areas.
SEC. 225. PROVIDER PARTICIPATION.

(a) In General- The Secretary shall establish conditions of participation for health care providers under the public health insurance option.
(b) Licensure or Certification- The Secretary shall not allow a health care provider to participate in the public health insurance option unless such provider is appropriately licensed or certified under State law.
(c) Payment Terms for Providers- The Secretary shall establish terms and conditions for the participation (on an annual or other basis specified by the Secretary) of physicians and other health care providers under the public health insurance option, for which payment may be made for services furnished during the year.
(d) Exclusion of Certain Providers- The Secretary shall exclude from participation under the public health insurance option a health care provider that is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act).
SEC. 226. APPLICATION OF FRAUD AND ABUSE PROVISIONS.

Provisions of law (other than criminal law provisions) identified by the Secretary by regulation, in consultation with the Inspector General of the Department of Health and Human Services, that impose sanctions with respect to waste, fraud, and abuse under Medicare, such as the False Claims Act (31 U.S.C. 3729 et seq.), shall also apply to the public health insurance option.
SEC. 227. APPLICATION OF HIPAA INSURANCE REQUIREMENTS.

The requirements of sections 2701 through 2792 of the Public Health Service Act shall apply to the public health insurance option in the same manner as they apply to health insurance coverage offered by a health insurance issuer in the individual market.
SEC. 228. APPLICATION OF HEALTH INFORMATION PRIVACY, SECURITY, AND ELECTRONIC TRANSACTION REQUIREMENTS.

Part C of title XI of the Social Security Act, relating to standards for protections against the wrongful disclosure of individually identifiable health information, health information security, and the electronic exchange of health care information, shall apply to the public health insurance option in the same manner as such part applies to other health plans (as defined in section 1171(5) of such Act).
SEC. 229. ENROLLMENT IN PUBLIC HEALTH INSURANCE OPTION IS VOLUNTARY.

Nothing in this division shall be construed as requiring anyone to enroll in the public health insurance option. Enrollment in such option is voluntary.
Subtitle C--Individual Affordability Credits

SEC. 241. AVAILABILITY THROUGH HEALTH INSURANCE EXCHANGE.

(a) In General- Subject to the succeeding provisions of this subtitle, in the case of an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan--
(1) the individual shall be eligible for, in accordance with this subtitle, affordability credits consisting of--
(A) an affordability premium credit under section 243 to be applied against the premium for the Exchange-participating health benefits plan in which the individual is enrolled; and
(B) an affordability cost-sharing credit under section 244 to be applied as a reduction of the cost-sharing otherwise applicable to such plan; and
(2) the Commissioner shall pay the QHBP offering entity that offers such plan from the Health Insurance Exchange Trust Fund the aggregate amount of affordability credits for all affordable credit eligible individuals enrolled in such plan.
(b) Application-
(1) IN GENERAL- An Exchange eligible individual may apply to the Commissioner through the Health Insurance Exchange or through another entity under an arrangement made with the Commissioner, in a form and manner specified by the Commissioner. The Commissioner through the Health Insurance Exchange or through another public entity under an arrangement made with the Commissioner shall make a determination as to eligibility of an individual for affordability credits under this subtitle. The Commissioner shall establish a process whereby, on the basis of information otherwise available, individuals may be deemed to be affordable credit eligible individuals. In carrying this subtitle, the Commissioner shall establish effective methods that ensure that individuals with limited English proficiency are able to apply for affordability credits.
(2) USE OF STATE MEDICAID AGENCIES- If the Commissioner determines that a State Medicaid agency has the capacity to make a determination of eligibility for affordability credits under this subtitle and under the same standards as used by the Commissioner, under the Medicaid memorandum of understanding (as defined in section 205(c)(4))--
(A) the State Medicaid agency is authorized to conduct such determinations for any Exchange-eligible individual who requests such a determination; and
(B) the Commissioner shall reimburse the State Medicaid agency for the costs of conducting such determinations.
(3) MEDICAID SCREEN AND ENROLL OBLIGATION- In the case of an application made under paragraph (1), there shall be a determination of whether the individual is a Medicaid-eligible individual. If the individual is determined to be so eligible, the Commissioner, through the Medicaid memorandum of understanding, shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding. In the case of such an enrollment, the State shall provide for the same periodic redetermination of eligibility under Medicaid as would otherwise apply if the individual had directly applied for medical assistance to the State Medicaid agency.
(c) Use of Affordability Credits-
(1) IN GENERAL- In Y1 and Y2 an affordable credit eligible individual may use an affordability credit only with respect to a basic plan.
(2) FLEXIBILITY IN PLAN ENROLLMENT AUTHORIZED- Beginning with Y3, the Commissioner shall establish a process to allow an affordability credit to be used for enrollees in enhanced or premium plans. In the case of an affordable credit eligible individual who enrolls in an enhanced or premium plan, the individual shall be responsible for any difference between the premium for such plan and the affordable credit amount otherwise applicable if the individual had enrolled in a basic plan.
(3) PROHIBITION OF USE OF PUBLIC FUNDS FOR ABORTION COVERAGE- An affordability credit may not be used for payment for services described in section 122(d)(4)(A).
(d) Access to Data- In carrying out this subtitle, the Commissioner shall request from the Secretary of the Treasury consistent with section 6103 of the Internal Revenue Code of 1986 such information as may be required to carry out this subtitle.
(e) No Cash Rebates- In no case shall an affordable credit eligible individual receive any cash payment as a result of the application of this subtitle.
SEC. 242. AFFORDABLE CREDIT ELIGIBLE INDIVIDUAL.

(a) Definition-
(1) IN GENERAL- For purposes of this division, the term `affordable credit eligible individual' means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)--
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).
(2) TREATMENT OF FAMILY- Except as the Commissioner may otherwise provide, members of the same family who are affordable credit eligible individuals shall be treated as a single affordable credit individual eligible for the applicable credit for such a family under this subtitle.
(3) EQUAL TREATMENT OF CERTAIN EMPLOYED INDIVIDUALS-
(A) IN GENERAL- For purposes of applying this section with respect to an individual who is an employee of an employer that has an annual payroll (for the preceding calendar year) which does not exceed $750,000 and that makes the contribution which would be required under section 313(a) if the table specified in subparagraph (B) were substituted for the table specified in section 313(b)(1) (and if, in applying section 313(b)(2), $750,000 were substituted for $400,000), such individual shall be treated in the same manner as an employee of an employer that makes the contribution described in section 313(a) (without regard to this paragraph).

Senate bills, S1679 (Senator Tom Harkin) and S1796 (Senator Max Baucus) also include provisions for a Public Option. I have provided the following links.  

http://hdl.loc.gov/loc.uscongr...

http://hdl.loc.gov/loc.uscongr...

S1679, Section 141 through Section 185 outlines provisions and language that authorize and regulate how states will implement a public option, who and how much will be paid by individuals and employers, and provision for expanding public health facilities.  

S1796, Section 1101 provides for the ESTABLISHMENT OF QUALIFIED HEALTH BENEFITS PLAN EXCHANGES. Another important read for this bill is SECTION  2226. WAIVER OF HEALTH INSURANCE REFORM REQUIREMENTS.

These are the three top bills highlighted on www.thomas.gov at this time, and the bills receiving the most scrutiny in Congress.  Of the three bills, HR 3200 is both the longest and the most straight forward.  Its content is well organized, and the sections easily cross referenced against the current laws it seeks to amend.  S1679 comes in second for these reasons.  S 1796, the Baucus bill, seems the least well organized and the most confusing of the three, and appears to provide the most wiggle room for states, insurance brokers and insurance companies.  In addition, S1796, like the house bill (discussed in an earlier blog) supported and cosponsored by Rep. Don Young, also seems to support the creation of independent "state brokers" responsible for the selection and distribution of the proposed public insurance exchanges.  

It will be very interesting to see how the House responds to and adapts the bills submitted by the Senate.  As many might remember, the Senate dealt heavy handedly with the House in September 2008 with the TARP bill.  The House has had ample time to formulate a strategy to handle the Senate and I for one am eagerly awaiting the outcome.  

The Need for Reform is No Myth

by: TruthAboutReform

Sat Oct 31, 2009 at 01:54:24 AM AKDT

If you're confused about health care reform, we don't blame you. With all that's being said on the news and on the internet, it's hard to decipher the real message, the real truth about what reform means to us as a country and as individuals. As we've noted in earlier posts, there are many myths circulating with the intention of dissuading Americans from believing that a change in our current health care system would be a positive one. Whatever the motivation, let's focus on what is happening now.

A Good Website for Home Owners With Mortgage Troubles

by: Jeanette

Fri Oct 30, 2009 at 19:10:50 PM AKDT

The following webpage casts more light on the crisis, and provides some very useful information to those affected by it. The language is plain and the summary straight forward.

http://homeownersconsumercente...

I encourage everyone to peruse the site, which covers far more than merely the lending crisis.  I stumbled upon the site some weeks ago while researching potential problems with sheet rock made in China.  

The damage done to our country's financial regulatory authority during the Bush Jr. years has yet to be fully understood.  Even the battle waged today over health care has at its core the villainous touch of those who bent Washington to the will in Wall Street.  The insurance crisis and the home lending crisis share basic roots in a system run riot with deregulation.  

The Myth of Health Care Rationing

by: TruthAboutReform

Mon Oct 19, 2009 at 11:42:09 AM AKDT

While rationing may be a popular topic - particularly among the conservative and right leaning blogosphere, it is, at its core, a health care myth. Unlike the health care debate in 1994, where Harry and Louise were lamenting government rationing on behalf of the insurance companies, rationing has no place in current health care reform bills.

According to the American Medical Association, "The health reform plans being debated in Congress ensure that health care decisions will be made by you and your doctor - no one else."  

I'm Just a Pothole...

by: Jeanette

Wed Oct 14, 2009 at 20:25:36 PM AKDT

This commercial tickles me senseless.  I just love to listen to the accent (I hail from the country), and speak "southernese" very well.  I found the youtube version, and played it several times.  

Somewhere around the third or fourth time, amidst the uncontrollable bouts of laughter, I realized that this video sums up the entire Republican strategy on health care.  

Picture this rewrite if you will:

"Oh no, your health care is all broke and junk. Did my party do that? Let me get out my policy on health care and find a solution...oh, no...I got no policy cause I'm a Republican...sooooo.....

The Republicans broke health care.  They have repeatedly approved and passed legislation (Gramm Leach Bliley Act of 1999) to empower health insurers.  They drove Medicare/Medicaid into the red in an attempt to destroy a system that was going to absorb the baby boomers as they moved into retirement, and would ultimately deprive the major health insurers of much depended upon profit.  They have answers and solutions, but they won't willingly share them with the general public. Why would they?  We don't pay them.  Oh, we do, but not nearly to the extend that the private lobbyist contribute.  

I haven't blogged much recently.  I have been watching and researching.  I am ready to make another comment.  

Two critical letters were disseminated in the past several years by two Congressmen whose ideologies could not be more different.  

In 2007, then Chairperson Representative Dingell released a letter to the Committee on Energy and Commerce.  

http://energycommerce.house.go...

This letter is a damning condemnation of Republican tactics towards health care as concerns Medicare and Medicaid.

In November 2008, Senator Baucus released his "white letter" on health care reform.  

http://finance.senate.gov/heal...

If you read both of these letters, you will determine for yourselves the character and intent of both of these men.  

It is rumored that Baucus is not even aware of the full content of his original letter.  Ironically, the existence of this letter was revealed to me by our own Representative Don Young.

Private health insurers can't help but want a piece of the profit to gained as the baby boomers move from private health insurance to Medicare.  I believe that Senator Baucus, who lit the fire for health care reform, sought/seeks to sponsor legislation to transfer power from Medicare back to Health Insurers.  I think that the House realized what he intended to do, and preempted his attempts with their own legislation, thereby throwing down the gauntlet to the Senate on Health Care Reform.  

The proof is revealed in the character of the two men.  

Fact:  the baby boomers have been the most reliable source of income for private health insurers.  As they reach the age of retirement, they will move from the realm of private health insurance to coverage under Medicare.  Health insurers will loose billions in this exchange. For profit health insurers either seek to destroy Medicare or to subvert the funding to their own coffers.  

What do we want as the paying public?  What will we demand?

Our system is not yet ready to transfer the burden to Medicare, but it can sustain a public option run efficiently.  Go to the Department of Health and Human Services and you will see the transformation that has occurred in this Department since Obama took office.  This Department can and will absorb the load placed upon it.  

The Stakes... What Do the Health Insurers Really Want?

by: Jeanette

Tue Oct 06, 2009 at 19:54:23 PM AKDT

The reality today is that the boomers are moving from the safety of for profit, health insurance to the murky realm of Medicare.  Who would blame them for being wary of the transition?  The Republicans have all but applied a proverbial nuclear warhead to the program, gutting it of its vital essence to the extent that today it limps along attempting to meet the needs of an every increasing elder population that has become accustomed to a "service now" program of medical treatment.  Medicare is so underfunded and understaffed that it cannot even defend itself  from the near constant attacks on its integrity.  

However, if you dig deep and do the research, you will find that Medicare has a good deal of credibility despite its lack of funding.  The AMA Health Insurers Report Card 2009 paints a remarkably positive picture of Medicare, including the area of reimbursement to medical providers.  Reimbursement is an issue often thrown up by the industry as a blemish on Medicare.

http://www.ama-assn.org/ama1/p...

So what does all of this mean to the current health reform debate?  If the boomers are transitioning to Medicare, then it stands to reason that the for profit insurance industry wants to follow the money.  I believe that the end game in this battle will be the privatizing of Medicare.  I am not certain at this point how they intend to reach that goal, but I have no doubt that they intend to do so.  

As the money from premiums slips away, insurance companies are shifting cost to whomever they can to cover lost profits.  I believe they target first those who can best afford it, and easy access to consumer credit information provides them with that information.  No rules exist to stop them.  Once again, Congress needs to revisit the financial regulations that govern the intertwining of financial institutions.  I doubt that insurance companies deny insurance based on credit ratings, but I suspect they set rates based on them.  

How does the pubic option interfere with the health insurers plans to privatize Medicare?  Well, for one, it would give government a chance to prove that they can indeed compete with private, for profit health insurers.  You see, private for profit health insurance has managed to insert themselves into Medicare over the past fifteen years.  If anyone doubts this, look into current efforts by health insurers to extend benefits under Medicare plan B, and to increase the funding for Medicare supplemental insurance policies.  As the Republicans cut funding to Medicare and hamstrung its ability to serve the over 65 population, private health insurers moved in to offer "supplemental programs" to elderly.  Such programs would not have been necessary had Medicare been properly funded in the first.  Republicans handed over business to health insurers by implementing the key strategy of "starve the beast."  A public option run by the government would allow the government to circumvent the intricate web of counter regulation and under funding that has allowed private health insurers to dominate health care.  Meanwhile, Congress will tighten up the regulations (HR 3200), and begin to impose stricter regulations on the private, for profit, health insurance industry.  

Keep a careful watch on all bills before Congress.  Read them for content.  Who do they benefit?   If it doesn't say the citizen, it doesn't deserve our support.  Read any of the finest legislation and you will be able to discern what separates bills "for, of and by the people" from those that support only the few.  

A Great Video on Health Care... Sit Back and Chuckle

by: Jeanette

Tue Sep 22, 2009 at 18:36:15 PM AKDT

Regardless of how the Senate health bill goes down, we the people, have faced the demons, and sent a clear message to our politicians that we live, breath and are aware of their every movement on the Hill, a Hill that heretofore has seemed impenetrable.  

Like bacteria responding to a good dose of antiseptic, the lobbyist must now lick their wounds, regroup and reposition.  The high ground belongs to us.  We have sussed the money behind the machine, and we have put the power brokers in Washington on notice.  The lobbyist are looking elsewhere for profits.  Insurance companies are already rewriting bi-laws in preparation for a new era of business, an era that frowns on wanton profits for the sake of the almighty shareholder.  Watch the investment portfolios and see how the asset share in health insurance change.

Stand Aside US Senate and Let the US House Reform Health Insurance and Health Care Now

by: Jeanette

Thu Sep 17, 2009 at 18:48:12 PM AKDT

The good Senator Baucus has shown America his hand at the table of Health Care reform, and progressive constituents are not impressed.  This bill offers no public option (a catch phrase whose complete meaning has yet to be fully evaluated), and it does nothing to regulate the for profit, private, multi-payer, health insurance industry.  

Here is a copy of the current text of the bill titled Chairman's Mark America's Healthy Future Act of 2009.  I was not able to pull a copy from the thomas.loc.gov.  

http://www.docstoc.com/docs/11...

Here is what the Insurance Journal thinks of this bill.  

http://www.insurancejournal.co...

I am very disturbed that the Insurance Journal describes the bill in these terms

Senate Finance Committee Chairman Max Baucus (D,Mont.)
today introduced the America's Healthy Future Act, landmark health care reform legislation to lower costs and provide quality, affordable health care coverage. The Chairman's Mark will make it easier for families and small businesses to buy health care coverage, ensure Americans can choose to keep the health care coverage they have if they like it and slow the growth of health care costs over time. It will bar insurance companies from discriminating against people based on health status, denying coverage because of preexisting conditions, or imposing annual caps or lifetime limits on coverage. The bill
would improve the way the health care system delivers care by improving efficiency, quality, and coordination. The $856 billion dollar package will not add to the federal deficit. The Finance Committee will meet to begin voting on the Chairman's Mark next week.

Point of fact:  this bill does not "bar insurance companies from discriminating against people based on health status, denying coverage because of preexisting conditions, or imposing annual caps or lifetime limits on coverage." As with most Senate bills introduced in advance of actual House legislation, it outlines in flowery terms the proposed wishes of the Senate.  

The House, and only the House, will get to the guts of the language and address reform in line by line legislative language.  I admire the late Senator Ted Kennedy, but even his legislation amounts to little more than a directive to the House as regards relevant legislation.  

At a mere two hundred and twenty-three pages, this bill does nothing to close the loop holes in current health insurance regulation - loop holes used by health insurers to hack and slash distribution of benefits to policy holders in such a way as to benefit top executives and the all mighty shareholder. As was the case with legislation co sponsored by Don Young, this legislation proposes to create "super brokers" offering insurance to those individuals whose insurance policies are 150% above the national average.  This does nothing to cover the person whose insurance rates rose less than that, or those having insurance policies with less than desirable coverage.  

H.R. 3200, long and verbose, was crafted to address, line by painful line, the loopholes in the federal tax codes, the social security act, and the Public Health Service Act.  We may crave the simpler version, but true relief lies in the mind numbing details of the more compplex House resolution.  

Senator Baucus' bill references HIPAA (Health Insurance Portability and Accountability Act of 1996), a bill, which in content and in spirit appears to protect the ability of health insurers to convolute the process of health care more than it protects the rights of the patient or claimant.  

http://www.cms.hhs.gov/HIPAAGe...

If asked, most health care professionals associate HIPAA with patient privacy as opposed to any meaningful regulation of health insurers.  In short, HIPAA is what we study in the heath care industry when we need to know what information is shared between what agencies in what capacity.

HIPAA and the Gramm Leach Bliley Act of 19 are very similar both in spirit and in content.

http://banking.senate.gov/conf/

Both Acts spend inordinate amounts of legal language to explain the rights of the average person to have their personal information guarded, yet do little to explain why that personal information needs to be guarded in the first place.  HIPAA, to my mind, was the precursor to Gramm Leach Bliley of 1999.  HIPAA was necessary to allow insurance agencies to access your credit information as a means to gauge how much they could charge you for your insurance premiums, even as Gramm Leach Bliley 1999 was needed to allow investors to blur the lines of banking so that they could issue loans to individuals based not on  ability to pay, but ability to sell or flip properties.  The two bills were orchestrated in the same cultural mindset, and the damage inflicted on the public by both has yet to be fully realized.  

As Americans, pondering the ramifications of health care reform, we must continue to focus on the dollar.  Health insurers want to continue to funnel profits from insurance premiums to either their direct shareholders or to the larger umbrella organizations.  We, as payers of premiums, must insist that our rights be held sacrosanct above those of the share holder and CEO.  

H.R. 3200 holds the greatest hope for meaningful health insurance reform.  Without this reform, a public option cannot hope to be truly effective in delivering affordable premiums and guaranteed coverage for essential medical procedures.  Every tactic thus employed by the conservative right has been to deflect our attention from this House bill.  This bill frightens them, and it is only the precursor to what they fear most - a single payer system.  H.R 3200 will seriously impact profits.  If profits fall, who will pay for the lobby to protest a single payer system?  Contact your state Senator and House of Representative and tell them to tell the US Senator and House of Representative that the citizens of Alaska want HEALTH INSURANCE REFORM.  Tell them why,in no uncertain terms, that their interest and action on your behalf amounts to a vote to keep them in office.  Contact Mr. Don Young and tell him that you do not support his alternative bills (H.R. 3218 and H.R. 2516,which he no longer officially claims to cosponsor), and want him to vote for HR 3200, and any other legislation that opts for significant health insurance regulation.  

Baucus to Push the Gang of Six to Support his No Public Option Bill Before President's Speech

by: Jeanette

Wed Sep 09, 2009 at 06:43:07 AM AKDT

KTUU news reported this morning that Senator Baucus will be rushing his gang of six to make concrete their support of his senate bill.  As you may know, Senator Baucus' bill does not contain a public option.  

H.R. 3200, as far as I can tell at this stage, still contains a public option.  

The President will address both the House and Senate tonight.  This could well be an historic speech.  

The push is on, and the stakes are high.  If you have not already contacted your state House and Senate representative, and our US Senators, Begich and Murkowski and our House Representative, Don Young, now would be an excellent time to make a phone call.  

Sarah Palin Attacks Hospice Care and Advnanced Care Planning Consultation Merely to Further Her Own

by: Jeanette

Wed Sep 02, 2009 at 16:17:54 PM AKDT

Unless I am mistaken, Mrs. Palin has no expertise in the field of Hospice counseling, nor has she claimed any direct connection to or experience with it? What lies behind her interest in Advanced Care Planning Consultation, and what has compelled her to refer to those who provide it to others as "death panels?" I do have personal experience with hospice and with end of life counseling. My experience was uplifting and life affirming, not life denying. I am dumbfounded that people such Mr. Huckabee, our former governor, and others have have chosen to diminish, and outright discredit the positive contributions these programs have made to society.

While no expert on the subject of medicine, I have professional experience reading and interpreting government regulations: federal and state workers' compensation, fisheries management, Occupational Health and Safety (OSHA), Code of Federal Regulations (CFR), Alaska Statutes (AS), and my personal favorite, the Uniform Code of Military Justice (UCMJ). I have read the section in H.R. 3200, and cannot see the connection between what has been provided for in section 1233, HR 3200 amending section 1861 of the Social Security Act and the establishment of "death panels."

Below is the full text of section 1233, page 424, of House Resolution 3200:

H.R.3200

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

`Advance Care Planning Consultation

The links that have been inserted into the language of the section of HR 3200 above are mine, and are not included in the original text of the legislation. I have done so to allow people to explore the definitions of certain terms, to provide links to examples of some of the organizations referred to in the section, or to other acts impacted by this section of proposed legislation. Because Mrs. Palin will be speaking in New York, the link for "health care proxy" is provided by New York's Department of Health. Similar definitions applicable to Alaskans can be found under the Department of Health.

Those in opposition to section 1233 of HR 3200 must not fully understand, or simply fail to acknowledge what is obvious in subsection (B).

Section 1233 of HR 3200 does not create provisions for the creation of death panels. It does not force doctors recommend to their elderly patients that they opt for euthansia. It does not force hospitals to pull plugs, shut off IVs or refuse other life sustaining treatments so long as it does not conflict with the wishes of the patient. Moreover, end of life counseling enables the patient to clearly set forth those wishes to his medical provider and family members in the form of a legally recognized living will which can be updated at any time as the health of the patient changes.

I have read the tweets, the letters to editors, watched the videos, heard the speeches of those in opposition to HR 3200. I have heard them make the outrageous accusation that section 1233 of HR 3200 is an attempt by Obama and the progressive Democrats to cut medicare spending by directing our elderly to end their lives prematurely. I denounce these people, and refute their claims based not only on my personal experience, but on the language of this bill and the Social Security Act it seeks to amend.

The sole purpose of these accusations is to derail any attempt by governemnt to impose long overdue regulations the practics of the for profit, health insurance industry. If Mrs. Palin has another reason for taking her position on this issue, she needs to quickly clarify those reasons. If she cannot, then I suggest she find another way to capitalize on her notoriety. If her intent is to use this issue for her personal gain, then progressive Alaskans must actively denounce her efforts. The issue of Advanced Care Consultation affects thousands of Americans every year in every city in every walk of life. Hospice has done so much good for so very many, and we owe it to those who provide such services, and even to those who choose to fight for life to the bitter end, to keep the cult of personality off the table, and politics for personal gain out of the discussion.

I encourage those with a personal stake or interest in this matter, to contact your state and federal Congressmen and women, local newspapers, local assembly persons and share your stories and your opinions. And, because our former governor has chosen to speak in New York, I would recomned contacting the NY Senate. I normally do advocate interfering in the legislative affairs of another state, but as goes Sarah so go her former constituents. Think of ourselves as character references not in favor of her character. We cannot let the voices of the one or the few outweigh the concerns and the needs of the many. "Start spreading the news."

Huckabee's Comments on Death Care

by: Jeanette

Sat Aug 29, 2009 at 19:26:31 PM AKDT

So far I have chosen not to directly address the repeated accusations of right wing, conservatives that President Obama and Progressive Democrats support death care, death panels, euthanasia or any number of other words and phrases meant to arouse fear in citizens.  

What comment by whom has finally drawn me out? Mr. Huckabee has chosen to join Sarah Palin and others in attacking "End of Life Counseling" and twisted it into some sick form of "death panels."  These accusations, ridiculous and without merit, threaten to place an undeserved black mark on a program that has provided comfort to and assuaged the fears of thousands of Americans who have had the misfortune of losing a loved one to a terminal illness.

The infamous page 425.  What does it mean?  What does it propose to do?  

First here is the link to H.R. 3200.  

http://energycommerce.house.go...

This is the house version of what has now been titled the "America's Affordable Health Choices Act of 2009."    A similar version of this bill has been introduced in the Senate.

http://help.senate.gov/BAI09A8...  

The section of H.R. 3200, much maligned by some right wingers, SEC. 1233., is Titled "ADVANCE CARE PLANNING CONSULTATION."  So much has been said by those who claim to understand what "end of life care" means, and all of it has little if any root in truth.  

I will give you my personal experience with "end of life counseling."  I hope it helps to clarify the importance of such counseling, and dispels the myths and fears surrounding this section of the bill.

My father was diagnosed with Esophageal cancer on October 14th.  For many months, my brothers and I hoped with all our might that my father would have the edge on this disease.  As many of you know, my partner and I joined my father in Lynchburg,and even as we celebrated the inauguration of our 44th President, we clung to the belief that my father would beat the cancer.  He was so strong, so viking, so seemingly indestructable.  

Cancer does not respect genealogy.  It cares not for the form and function of DNA and RNA as it was intended to exist at conception.  It invades the cell, manipulates the RNA, reorganizes the organic factory, and reforms it to serve its own needs.  Organs that were intended to live for decades, succumb to a lesser life span.  The affected cells grow and multiply destroying the delicate homeostatic balance of life.  

Chemotherapy, radiation, proper diet and other treatments are all attempts to counteract the growth of cancer, but sometimes, no matter how hard science tries to intervene, cancer wins, vital organs are crowded out.  The body tries to protect itself by accumulating fluid putting further pressure on the organs.  Eventually the body cannot maintain the balance of life.  The heart, the lungs, kidneys all begin to wear themselves out in an attempt to adjust.  

My father called me on a frosty day in early February.  I sat in my office as he told me that his doctor had informed him his cancer had gone terminal.  His body could not cope.  The chemo could no longer stop the cancer.  He was dying.
I collapsed in a heap, and I wept.  I allowed myself to grieve.  Then, as my father lived, so went I and every moment thereafter was dedicated to his wishes.

My father drew up a living will.  My step brother served as his executor.  All of his children were given copies of his will.   In this will he stated that he did not wish to be revived should his heart fail him.  He inserted in his will a DNR (do not resuscitate) clause. He did not want to be kept alive through artificial means after his brain had ceased to function.   Nor did he wish to have his body sustained artificially after it had lost its capacity for self sustenance:  no feeding tubes, no I.V. drips.  

Cancer is a nasty condition.  As it progresses, its growth begins to redirect precious resources away from normal body functions to feed the growth of the tumor(s).  As the cancer grew in my father's body, he grew thin.  What nutrients he was able to take in were immediately absorbed my the cancer. Because the tumor pressed against the other organs of the body, fluids began to collect around his vital organs in an effort to protect them from the pressure much as a blister forms on a foot to protect it from damage. I watched my father deteriorate.  For those who have witnessed this, I apologize with all my soul if I revive painful memories.  I do so only because I do not wish to see future generations deprived of end of life counseling.

End of life counseling for our family consisted of several key parts.

1st - My father paid a lawyer to draw up a will laying out specific instructions to his executor and designated "caregivers" as to his final wishes.  Having determined that his cancer was terminal, he did not wish to be resuscitated should his heart fail.  A copy of this directive was kept on his person at all times.   A copy was also registered at his hospital.  End of life counseling would give people access to such wills.  

2nd - My father elected to enroll in local Hospice care.  His wish was to die at home under the care of a hospice nurse.  Hospice provided him access to twenty four hour own call care, support for his caregivers, and would act as an intermediary with the funeral home at his death.  H.R. 3200 would afford people the option of participating his hospice care.  

3rd - My father arranged for his designated caregivers to participate in end of life counseling with hospice.  The counselling was intended to prepare his family for his death.    

End of life counseling.  This phrases can raise fear in the hearts of those who have no experience with it, and comfort in the hearts of those who have benefited from its care.  My father chose the care of hospice.  He wanted to die in his own home on his own terms.  It was his wish, and he had discussed his intentions with his family.  He was lucky enough to have the financial resources to draw up a living will, and a family willing and able to be with him as he prepared to die.  

It is one thing to say you are prepared to face the death of a loved one and quite another to face it.  End of life counselling helped to prepare me for what I was about to face.

During the first day of counseling, my brothers and I met our hospice counselor.  She explained to us the function of hospice, which was to provide the in home medical support my father would need to cope with the many symptoms and complications of end stage cancer.  She explained in detail the various stages that might be expected at the end of my father's battle with cancer.  We were given my father's emergency medications to be used only when his pain became unbearable.  We were instructed in pain management.  We were given a 24 hour number with which to reach on call nurses who would answer our questions.  We were given literature to read to help us transition as our father transitioned from life to death.  

Imagine if you will, a man capable of running 5 to 8 miles day, reduced to struggling for breath as he made his way to the bathroom.  Imagine your brother, all five foot ten of his massive frame, trying to help his father off the toilet without breaking ribs.  The literature we were given helped us overcome those obstacles.  Everyday presented a new set of obstacles.  Our counselor and nurses from hospice helped us through every step.  This is end of life counseling.  This is reality.  

No one told us to cut cords, disconnect respirators, refuse my father food.  When my father's body could no longer take food, the counseling helped us understand the biological mechanisms involved as his digestive system shut down.  When my father could no longer take fluids, they showed us how to prepare little sponges dipped in ice water to wet his lips.  The nurses  helped ease the awful fear in my chest that I was not trying hard enough to ease his pain.  When his pain became unbearable, they reassured us as we administered the painkillers, because there is no more nerve wracking worry than that you might give someone too much painkiller.  And, during those final hours, the counseling helped me recognize the signs that my father was letting go.  I understood the breathing patterns, the way my father appeared to speak with loved ones no longer with us, that he could hear us even if he could no longer respond outwardly to our words.  We read from the Bible, played Frank Sinatra, talked to our father, and told him he could let go.  Hospice volunteers called us frequently to ask if we needed help washing dishes, preparing a meal, all the little things you take for granted when all your time and attention is centered on your loved one.  

Please forgive any pain I may inadvertantly caused to those who have suffered the death of someone close from a terminal illness, but I feel compelled to talk about my experiences because the comments of Mr. Huckabee, Mrs. Palin and others who threaten the future of what I consider to be a very important program.  I cannot imagine facing my father's death without the help offered by hospice, and the end of life counseling it provided.  Because my father planned for his death, because he had the finances to do so, my brothers and I were able to be with my father in his final hours.  He enjoyed a peaceful passage from life to death on his terms, but I know that many in this country do not receive this gift.  I had the unbelievable privilege of holding my father's hand as he drew his final breath.  He was able to die in the house that he loved surrounded by the memories of his departed wife and the family he loved.  

I want people to have access to this program who do not have the financial resources my father enjoyed.  He would have wanted that for them.   That H.R. 3200 provides others access to end of life counseling is amazing.  That the political posturing surrounding this bill threatens to sour people's view of this program is appalling.

Emotions should compel us to rise above our stations in life to make life better for others.  They should not drive us to deprive others of better care, and access to a better quality of life or even death.  

Who Will Stand in the Lion's Place? We Will Stand Where the Lion Once Stood!

by: Jeanette

Thu Aug 27, 2009 at 17:15:02 PM AKDT

The lion of the Senate has passed.  Who will take his place?  Who will roar as passionately?  Who will take up the fight for the health and welfare of the pride?  Who will give up so much for so many?  Who will show their underbelly, and suffer the slings and arrows of the enemy?

We will stand for the lion!  We will continue his roar!  We were lost, but he never ceased his roar!  We followed the sound!  We have come home, and now we stand to protect the pride!  Our coats of many colors unite, and we honor the Lion's passion for humanity!

Stand fast!   Throw back your heads, and roar!  Beware, enemy, beware!  The pride has awakened!

Keith Olbermann Takes on United Health Group

by: Jeanette

Tue Aug 25, 2009 at 19:54:59 PM AKDT

http://www.msnbc.msn.com/id/30...

I have to share this piece aired today on Keith Olberman's, Countdown.  The many research tools and resources available to Mr. Olberman were leveled at United Health Group, one of the health insurers rated in the American Medical Association's, 2009 National Health Insurers Report Card.

http://www.ama-assn.org/ama1/p...

I sometimes feel so inadequate in my attempts to highlight what I think sits at the core of health care reform - a broken, oft times corrupt multi-payer, private, for profit health insurance system that has, through extensive lobbying efforts, been allowed to gain control of the American Health care system strong arming medical providers and policy holders alike.  The preponderance of evidence now points to the fact that some health insurers have been ripping off their clients for years.  Mr. Olberman's and his team of researchers and writers did a wonderful job with this piece.

I feel better knowing that the big guns have picked up the ball on exposing corrupt health insurers.  Now perhaps we can move forward and pass legislation that would close the loopholes in current health insurance regulation.  H.R. 3200 is long and complicated, but the laws that regulate private health insurers are long and complicated.  Changes will have to be made to the Public Health Service Act, the Social Security Codes and Federal tax codes among others.

Cleaning up health insurance regulations will protect those of us fortunate enough to have health insurance from being taken advantage of, but what about those who cannot afford health insurance?  It remains to be seen what will be the final language of H.R. 3200, which takes many steps to reintroduce much needed regulation on health insurance, but, in a revised form, may not adequately meet the needs of the uninsured who cannot afford it.  What are the alternatives?  Can those alternatives coexist alongside H.R. 3200?

We might do well to take a very close look at H.R. 676 (United States National Health Care Act or the Expanded and Improved Medicare for All Act)now currently in committee.  As Laz wrote in a blog last week, this is a straight forward bill to create a pubic health care system based on the current system of Medicare.  The bill is currently in committee, and has been since January 29,2009, but that doesn't mean it is dead.

What matters most in our efforts to achieve health care reform is that we remain steadfast when we say we want affordable health care.  At some point we simply have to resign ourselves to the fact that the legislators will have the final headache of drafting the correct language.  We are fearful of having a herd of sheep wool pulled over our collective eyes, but the final act of legislation belongs to Congress.  We elect them and pay them to know what they are doing.  If they do not, we vote them out.  The end product of health care reform will be the proof of their actions.  That is why the democratic process will always be ongoing, and there will never be a magic fix. I am deeply suspicious of anyone offering the quick fix.

The more immediate concern today is the spin factor.  There is already an attempt to spin proposed funding for health care reform into another scare tactic aimed at seniors.  President Obama explained that some of the funding for reform would come from cutting out the portions of Medicare that are wasteful and do not work.  The right has already begun disseminating information telling seniors that the President wants to cut funding to Medicare.  They of course fail to mention that conservatives themselves were the original arbitrators of deep cuts to Medicare under the Bush administration.  To illustrate this point I would like to share this Statement of Congressman John D. Dingell, Chairman
Committee on Energy and Commerce, dated February 28, 2008.  

http://energycommerce.house.go...

I attended and spoke at our district meeting in Muldoon yesterday.  It was a small but very knowledgeable group of people including our own Senator Bill Wielechowski.  I would like to share some of their comments.

Senator Wielechowski shared his views on what got his attention in an email.  He felt that personal, well stated arguments that demonstrated the persons passion for the subject as well as their knowledge were the most effective.  Of course, the elected official must demonstrate a  capacity to care about their constituents.  

One woman was born and raised in Germany.  Her family still lived there.  She fielded many questions about the quality and quantity of German health care.  She spoke of a niece who is receiving excellent treatment of Hodgkins Disease.  We discussed the fact that Germans passed insurance laws in the 1600's right around the same time as they passed their brewery laws (Germany is a wonderful country).  

A gentleman suggested that we encourage our state and US Congress folk to spend some time actually interviewing the health officials in countries with national health care programs.  First hand knowledge is the best.  We are all sick of the propagandizing of the right wing "think tanks," and the informative but sometimes agonizingly detailed (I hang my head) accounts from progressive sources can be confusing.  Having someone who operates the system explain it might be the best solution.  

If you haven't already done so, I highly encourage you to attend a house party on health care.  If no has hosted one, contact Organizing for America, the Alaska Democratic party, the Anchorage Democrats, or any affiliation of your choosing and offer to host one.  See if your district Representative or Senator will attend.  If they can't, have them recommend someone who might be able to speak on the subject of health care reform.  If they don't have anyone to recommend, ask them why they don't know anyone?  I am not trying to be mean, but this is a very economically important issue, and one would hope that they have at least given it some thought.  If they haven't, be the cattle prod.  Learn, learn,learn and share,share, share.

Updating Health Care Reform Bills... IMPORTANT!

by: lazarhat

Tue Aug 25, 2009 at 17:24:17 PM AKDT

But I do have some important news about links to several bills and some tips on how to find the bills on thomas.loc.gov and a newer legislative bill tracking tool... the links in THOMAS often go dead because they are temporary searches unless the bills are historical. Since we are dealing with active legislation we need another solution -- enter GovTrack.us

The rest of the "controversial" post on my blog is nothing less than a sincere call to action, a blaring alarm to help us all shift this debate from far-right craziness into a winning action for like minded progressives, moderates and centrists (you know, the big fat wide majority middle) once and for all.

I know Linda was kidding somewhat about me stirring up trouble over here but perhaps it is time for me to own it more on my blog and just post general updates over here. Not that there should be anything truly controversial about this blog post... still, probably safer for everyone involved. ;)

You'll find it at:

http://omfgalaska.blogspot.com...

And the reason it is IMPORTANT is because there are permanent links to these important bills that don't expire over time like the now broken links here because of the way THOMAS works.

-Laz

Committee Assignments: H.R. 3218 & H.R. 2516

by: Jeanette

Mon Aug 24, 2009 at 14:57:13 PM AKDT

http://divasblueoasis.com/diar...

For reasons previously discussed, I do not support either of these options.  I erred when I reported that H.R. 3218 had made it out of committee, and was active on the floor of the House.  Here is my correction to that statement, and an update to the current status of both bills.

Hi Freeper.

H.R. 3218 has indeed been referred to the House Ways and Means committee.  See quote below from:

http://thomas.loc.gov/cgi-bin/...

   H.R.3218
   Title: To provide a refundable tax credit for medical costs, to expand access to health insurance coverage through individual membership associations (IMAs), and to assist in the establishment of high risk pools.
   Sponsor: Rep Shadegg, John B. [AZ-3] (introduced 7/14/2009)      Cosponsors (25)
   Latest Major Action: 7/14/2009 Referred to House committee. Status: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

In addition, H.R. 2516 has also been referred the House Ways and Means committee.  

http://thomas.loc.gov/cgi-bin/...

   H.R.2516
   Title: To guarantee the rights of patients and doctors against Federal restrictions or delay in the provision of privately-funded health care.
   Sponsor: Rep Kirk, Mark Steven [IL-10] (introduced 5/20/2009)      Cosponsors (19)
   Latest Major Action: 5/20/2009 Referred to House committee. Status: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

I apologize for the confusion.  I took the inference that the bill was out of committee from the letter that Mr. Young sent me earlier in the month.  In addition, I had my cross reference notations for H.R. 3218 under "introduced into house."  I have spent part of the weekend when not painting my house, reorganizing my files.  

Senate Resolution 238...Proof that Private Health Insurers Fear Competition from a Gov't Option

by: Jeanette

Mon Aug 24, 2009 at 00:19:27 AM AKDT

http://thomas.loc.gov/cgi-bin/...

The summary of this resolution is as follows.

RESOLUTION

To provide for a point of order against any legislation that eliminates or reduces the ability of Americans to keep their health plan or their choice of doctor or that decreases the number of Americans enrolled in private health insurance, while increasing the number of Americans enrolled in government-managed health care.

The first two provisions seem reasonable enough, but the third, well, that is just a blatant attempt to block the introduction of any government-managed health care.  This resolution doesn't clarify what government sponsored programs health care would be included.  Does this preclude someone from moving from private insurance to Medicare upon retirement?  The language is vague.  Unlike some (take that you big oaf), I don't want to fan the flames of fear. I don't think exclusion from medicare upon retirement is Senator Demint's intent, but this resolution does not benefit Americans seeking health care reform.

This resolution demonstrates very clearly how much the private, for profit health insurers fear the introduction of a public option, single payer system, government sponsored/managed health care program, or any other option that would provide competition for premiums paid by policy holders.  The language in the resolution could have stopped at, "that decreases the number of Americans enrolled in private health insurance" and we might have assumed that it was protecting us from losing access to private insurance.  However, they went further by adding "while increasing the number of Americans enrolled in government-managed health care" thereby revealing the real intent of the resolution.  Of course increased enrollment in a government health care program will reduce the enrollment in private insurance as people gravitate from does not currently work to what will work.

The health insurers know deep in their profit driven souls that Americans will choose a government option over a private one once the benefits become apparent, and the irrational fears espoused by a few have been put to rest.  This industry has responded to the threat of a public option by attempting to forbid its establishment.  This resolution is senseless, and nothing more than an outright attempt to block a government option.  

The underlying purpose of this resolution mirrors that of H.R. 2516, co-sponsored by Representative Don Young, which also seeks to limit/halt government intervention in the private health insurance industry.  Other than a tax credit for those who pay premiums, and the elevation of insurance brokers to the level of IMAs (H.R. 3218), I cannot find any positive input from the Republican side of the the Congress on the issue of health care reform.  

Senator Murkowski's Opinion of Health Care Reform Remains Unchanged

by: Jeanette

Fri Aug 21, 2009 at 10:03:32 AM AKDT

I was very disappointed yesterday when at four o'clock p.m., I realized the window installers had a made a mistake that would need to be corrected immediately.  I had to wait for them to come and fix the problem.

A good friend of mine, "B, attended the meeting, and has kindly agreed to share with me her notes.  In addition to "B"s notes, I also read several news accounts of the Town Hall meeting including this from KTUU, Channel 2.  

http://www.ktuu.com/Global/sto...

From what I learned, it doesn't appear that Senator Murkowski's views on health care reform have changed at all since her last town hall in Fairbanks, or from what is published on her website.  

http://murkowski.senate.gov/pu...

Senator Murkowski still thinks the "bill" (note the singular form of the word) before Congress is "to costly and ineffective."  My friend, who shall be called "B" told me that the Senator did not chose to discuss in any great detail how and why she believes the health care plan is too costly and ineffective.  Costly and ineffective compared to what:  the current situation with multi-payer, for profit, health insurers who have a 35% (AETNA) and 65% (Blue Cross) control of the health insurance market in Alaska? What is the comparison between the 1 billion spent in Alaska on Medicaid to the $200 billion wasted by the health insurers through "ineffective" administrative costs (AMA 2009 National Health Insurers Report Card).  How many years does it take for $200 billion to add up to one trillion?    

Apparently, at one point during the meeting, a young woman of high school age, stood up and commented that people didn't seem as inclined to protest the cost of the Iraq war, and no one seems to want to discuss how the debt from the war will impact future generations.  And, yet, she noted, people all over the country keep talking about the trillion dollar cost of health care reform and the burden it will place on the youth of America.  "B" said the audience gave the young lady a nice round of applause after she finished speaking.  

The Senator did remark that "she agrees changes do need to be made" to the current system of health care, but had nothing much to say about the Republicans plan to make those changes. "B" reported that members of the audience made comments both in favor of and against Medicare and Medicaid.  Murkowski reiterated her belief that both of these programs are inadequate to meet health care needs of Alaskans.  The Senator did not discuss the chronic lack of funding for these programs, and its impact on the ability of the programs to retain the services of medical providers.

Contrast this with the Chamber of Commerce meeting on August 10th.  Senator handed out several very well organized fliers at his meeting.  They were ripe with facts and figures, as well as credible sources to back them up.  Those very same facts, figures and links to helpful informational sites can be found on his website.  Senator Murkowski's site contains roughly the same information she presented at the town hall meeting last night and earlier in Fairbanks.

KTUU reported that:

"The forum was pretty tame compared to last week's held by Sen. Mark Begich where a large crowd turned out to shout down the plan. On hand Thursday were people on both sides of the debate."

This does not surprise me in the least.  Progressive Alaskans came to hear what the Republicans have to offer the people of America.  To effectively listen one must remain quiet.  In addition, "B" mentioned that the members of her group chose to spread out in the audience so that they could discuss their opinions with folks who were open to doing so.  Contrast this approach with the tactics of "teabaggers" who push to the front of audiences to make their numbers appear larger.  Take that you "big oaf."  

I truly apologize for not having attended.  Despite my criticism of our senior Senator, I refuse to develop a political callous on my liberal heart, and discount the possibility that our presence and voice might not yet convince her to rethink her position.  My belief in the power of rational discussion is what compelled me to remain after the press conference earlier this month, and attempt to talk with protesters.

Here is my response to a news article on the Channel 2 website (link provided above), which sums up my feelings about what Senator Murkowski had to say at the Town Hall meeting:

Bottom line - the goal of health care reform is to make health care more available and affordable to the public. Health insurance is merely a means by which we pay our medical debt. For those of us who can afford it, we purchase a health insurance policy that will pay the most toward that debt. We expect insurers to honor their contractual obligations. Mounting evidence says that this is not always the case. Policies have become overly complicated, riddled with exclusions, and patients and medical providers alike are fed up. The primary culprit in the current mess surrounding health care is the multi-payer, for profit, health insurance system. According to the American Medical Association (AMA), "The inefficient and inconsistent claims process adds as much as $200 billion annually to the health-care system." The following link will take you to the AMA website where one can read the all the details of the 2009 National Health Insurers Report Card from which I took the above quote. http://www.ama-assn.org/ama/pu...  Private health insurers must either bow to stricter regulation and place the needs of the premium holder above those of the shareholder, or move over and let the government find a solution. If the definition of socialism is the unequal redistribution of wealth, than having the profits from my premiums divvied up at the end of the year for redistribution to shareholders of the company qualifies my private insurer as a socialist institution. I invite anyone who doubts that statement to take a look at the year end financial statements for their health insurance company.

I concur with Linda's comment in her earlier blog that republicans have nothing to add to meaningful health care reform. Indeed, they appear to be in the midst of developing new strategies to further delay reform.  The basic Republican message is, "Let them eat 0g transfat, low carb, no preservative, organic, low sodium cake!"  

To illustrate this final comment, I present this link from last night's Rachael Maddow show.  This is just too good.

http://www.msnbc.msn.com/id/26...

 

Senator Begich's Comments on Health Care Reform Monday at the Dena'ina Center in Anchorage

by: Jeanette

Fri Aug 14, 2009 at 14:54:12 PM AKDT

Someone once described Senator Begich as a wonker:  someone who gets very engrossed in the details of a subject.  That may not be the technical definition, but it works for me.  That was the first time I had heard that term use, but being something of a wonker myself, I appreciate this trait in both my President and Senator Begich, especially when it helps to dispel the myths surrounding health care reform.  In true form, Alaska's junior Senator passed out several informational flyers to attendees before his speech Monday at the Dena'ina Center.  I thought I would share a couple of them.  

The first flyer, outlines the Senators case for health insurance reform and includes specific figures related to the cost of current and future health care in Alaska.  It is of no small significance that the title of the flyers is Time for Action: The Case For Health Insurance Reform as opposed to simply Health Care Reform. The latter cannot happen without the former.

http://farm3.static.flickr.com...

These numbers speak volumes, and I need not add further comment save to say that figures similar to these have been posted and discussed (civilly when possible) in town halls and Chamber of Commerce meetings throughout the United States.

The second flyer lists the benefits to be had with Health Insurance Reform. How much more clearly can a Senator state their case?

http://farm3.static.flickr.com...

All over the country people have come forward to testify to the widespread prevalence of the practices of health insurers listed in this flyer. With these examples in mind, one can sit down and review one's health insurance policy, and perhaps identify potential problems with future coverage.  Many of us have actually dealt with some or all of the problems listed in this flyer at some point in our lives.  Senator Begich's figures seem to indicate that, in Alaska at least, this is the case.

I have heard the argument stating Americans are already protected by provisions in Title XXVII (Requirements Relating to Health Insurance Coverage) of the Public Health Service Act (TXXVII PHSA). However, the evidence of both personal experience and heard during testimonials from thousands of people across the United States seems to conflict with that argument.

For instance, in the matter of discrimination of pre-existing conditions, TXXVII, PHSA states only that an insurer offering group coverage cannot deny an individual within that group a policy because of a pre-existing condition. It does not, however, prevent that insurance company from denying coverage for a pre-existing condition within that policy.

On the matter of gender discrimination, yesterday, Randy Rhodes had a quest on her show, a former CEO with Cigna Health Insurance, who spoke of the practice of health insurers whereby they required companies to disclose how many of their employees were female, then adjusted the premiums up or down based on those numbers. As of today, I have not been able to locate a provision in the PHSA that prohibits gender discrimination as it occurs in the above example. If it does exist, it has not been properly enforced. Either way, the problem needs to be addressed in some version Health Care reform.

Senator Begich addressed an assemblage that included some of the top business leaders in Alaska. His point was clear that Health Insurance Reform would directly benefit small businesses in Alaska. Medical practices comprise a portion of those small businesses. Here is a link to a document released by the America Medical Association regarding benefits of reform to medical practitioners:

http://www.ama-assn.org/ama1/p...

I apologize if the images may be to small to read.  They can be read if they are printed.  I believe that copies of these flyers can be obtained on Senator Begich's website.

http://begich.senate.gov/public/

Although the end of the Congressional recess is drawing closer, there is still ample time to contact Representative Dong Young, http://donyoung.house.gov/, and Senator Lisa Murkowski, http://murkowski.senate.gov/pu... and learn more about their views on Health Care reform.  Although the outcome of their decisions may already have been decided, we should not count them out.  Mr. Young did not win by a landslide, and we may still be able to capitalize on those numbers.  Senator Murkowski also may be vulnerable at the polls in the next election.  For your vote to count at the polls, you must exercise your first amendments rights today, and we need to be clear when we say, "Reform Health Care now or we will find Congressfolk who will!"

Tomorrow we will explore the percentages of net assets for the various sectors of the health care industry.  Stock up on your coco folks, and pull out those woolly slippers.