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18 March 2010

California Edition

March 29
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Insured Are Rapidly Losing Toehold
Millions Have Lost Coverage or Bear Soaring Costs
inability of public programs such as It’s officially Covered the Uninsured Week, Medi-Cal and Healthy Families to meet but three new studies indicate it will be huge surges in demand. years, if not decades, before such a goal is “For millions of people, losing their attained by Californians. jobs also meant losing their health The data – from the UCLA Center for insurance. The data shone a bright Health Policy Research, the Robert Wood spotlight on all of the Johnson Foundation and Hewitt Associates Health Insurance Coverage in 2009 among places in which our Californians up to Age 64. Source: UCLA health insurance – paint an system based on jobenvironment where based coverage failed,” said the ranks of the uninsured Shana Alex Lavarreda, the 4% have been bloated 16% UCLA Center’s direct of health dramatically due to the Great 24% insurance studies and coRecession. Meanwhile, those author of the study. 5% who have held onto their Lavarreda noted that COBRA insurance are being squeezed premiums are often out of mightily by their employers reach for those workers and insurers to bear more without a job. “Even with a 50% costs. COBRA subsidy in place, the The UCLA study expense of even a concluded that the Uninsured Employer-Based ranks of the Individual Coverage Medi-Cal/Healthy Families reduced premium Other under a group plan uninsured in was unaffordable California have for many,” she said. “The data helps us to swelled by 28% between 2007 and 2009, see that middle-class people need more from 6.4 million to 8.2 million. That’s 24% help to keep their insurance.” of the state’s entire population of 36 The UCLA report predicts that the million. percentage of employment-based UCLA researchers linked most of the losses to the huge spike in unemployment in California – which more than doubled Continued on Next Page between 2007 and last year – and the

April 9-11
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April 14-16
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Insured (Continued from Page One)
insurance coverage will not increase “in the near future.” Such a large percentage of uninsured places the Golden State within reach of Texas, whose uninsured rate of 27% leads the nation, and squarely in the ranks of Mississippi and New Mexico, the nation’s two poorest states. Meanwhile, those who have held onto their coverage are paying far more out of their pockets to maintain it. According to the Robert Wood Johnson Foundation, the amount Californians contributed to their healthcare premiums increased 83% between 2000 and 2008, even though their income was stagnant during that period. At the same time, premiums to cover the typical family in California rose nearly 65%, about 16% higher than the nationwide average increase of 56%. “Employers must choose between either passing on costs to workers who cannot afford the increase and therefore

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In Brief
Amnesty International Ranks California 35th In Infant Mortality
Human rights group Amnesty International ranked California 35th among the 50 states in rates of infant mortality, claiming the state’s Medi-Cal program does not do enough to provide maternal services to low-income expectant mothers. Altogether, California’s infant death rate is 11.3 per 100,000 births in 2007, up from 8.1 in 2004. The national rate is 13.1 per 1,000 births in 2007, up from 7.7 deaths per 1,000 in 2004. The National Women’s Law Center supplied the data for the study. According to Amnesty International, 13% of California’s women receive delayed prenatal care, or no prenatal care at all. That rate climbs to 14.5% among ethnic minorities. The report also found that 49% of California’s women live in medically underserved areas. “The government should accept its duty and its moral obligation to address this inexcusable crisis by developing a comprehensive plan to ensure quality healthcare for all pregnant women,” said Jared Feuer, Amnesty International’s acting western regional director.

drop coverage, or paying more for their employees’ coverage at the cost of creating and preserving jobs,” said RWJF Chief Executive Officer Risa Lavizzo-Mourey, M.D. The report noted that not only have Californians been slammed by the current recession, but the 2001 recession also contributed to the erosion in employerbased coverage. The squeeze is only expected to get tighter. According to the Hewitt report, 47% of large employers say they plan to impose penalties of higher premiums and other costs on employees who do not participate in health-related programs, such as disease management or biometric screening. “The economy and continued escalation of healthcare costs have driven many employers to be a little more bold and demanding of their employees, making disincentives an increasingly attractive option,” said Hewitt principal Cathy Tripp.

Second Opinions As Business Model
L.A. Firm Seeks Treatment Alternatives – For a Price
Patients once diagnosed with a serious acute Michelson, an Ivy League-educated or chronic illness usually listened to what attorney, served for years as the head of the they were told, immediately embarking on a Prostate Cancer Foundation. Prior to that, he treatment regimen designed by their enjoyed success founding companies that physician and allied specialists. focused on disease management and Today, that may no longer be the case, streamlining product development for the thanks in part to a Los Angelespharmaceutical and biotech based rm called Private Health industries. Management (PHM). Michelson would not For annual fee ranging from disclose how many clients the $5,000 to $40,000, PHM will rm has, but he said it has consult with its network of more assisted in “hundreds” of cases than 150 medical specialists, since its 2007 founding. About conduct deep research into half of its clients reside in available therapies, and set up California. The remainder are consultations with some of the divided between out of state leading experts in specic elds residents and foreign nationals. Private Health Management of care. As opposed to boutique founder Leslie Michelson “Our focus is getting people believes there’s a niche in practices or patient advocacy obtaining second opinions the very best healthcare in the rms, PHM does not treat for patients. world. What we have done is patients directly or confront created our own fundamental insurers. Rather, the rm will architecture in order to do so,” review medical records – up to said PHM Chief Executive Ofcer Leslie D. Michelson. Continued on Next Page

U.S. Chamber Releases Highly Selective Poll on Healthcare Reform
The U.S. Chamber of Commerce released a poll of carefully selected Congressional districts this week suggesting that American voters

Continued on Page 3


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Second Opinions (Continued from Page Two)
and including tissue biopsies – and seek treatmnt alternatives. One example: a 60-year-old client given months to live after being diagnosed with a metastatic melanoma. PHM helped enroll her in clinical trial. She’s currently in remission. Another patient faced with the amputation of her leg below the knee saved the limb. Industry observers say a signicant gap has been created in coordinating specialty care that leads to such dilemmas – in part because physicians have segregated themselves into specialties and do not communicate well as a result. “You have a lot of specialists who provide primary care, and they are not always the best providers of primary care,” said Howard P. Greenwald, a professor of management and policy at the University of Southern California who has authored two books on surviving cancer. As a result, there is a niche to be served by helping patients become treatment

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In Brief
overwhelmingly oppose healthcare reform. However, the poll of voters in 10 Congressional districts taken last week contained large blocs of independents who have vociferously opposed government spending of any sort. Most of the districts traditionally support Republicans, although several elected a Democratic candidate during the 2008 election. Fewer than a third of the voters in Congressional districts in Texas, Arizona, North Carolina, upstate New York, Ohio, Pennsylvania, Virginia and Florida say they supported the current healthcare reform plan. However, in three of the districts, the number of voters who supported it or were unsure of their position reached 50%. About 70% of those polled say the plan will increase the deficit. Fewer than 20% of those polled say that the U.S. should focus on covering its 47 million uninsured citizens. “There should be absolutely no question in anyone's mind how Americans view this healthcare bill,” said Bruce Josten, the chamber’s executive vice president of government affairs. “This legislation is among the most unpopular proposals in recent memory and Members of Congress would be well advised to listen to their constituents' concerns.” The Chamber, which spends more than any other group on lobbying in Washington on an annual basis, has developed a deeply conservative agenda in recent years that includes support for offshore oil drilling, opposition against raising the minimum wage, and opposes the scientific evidence in support of global warming.

contrarians. “In oncology, in particular, (protocols) are not completely rigid, and there is a lot of trying of new treatments,” said Paul Campbell, managing director of the consulting rm Manatt Health Solutions in Washington, D.C. PHM has a deep bench of medical talent to draw from: its 22-member physician advisory board includes department heads from Memorial Sloan-Kettering Cancer Center, Johns Hopkins University Medical Center and King’s College in London. They often help in setting up virtual or in-person consultations with leading specialists, according to Michelson. Campbell noted that a service like PHM might have difculty branching out into serving clients who are struggling with healthcare issues and do not have the deep pockets to pay its fees. But Greenwald believes that may be beside the point. “If you’re ghting for your life, money is usually no object,” he said.

UCLA: Age Bias In Chemotherapy
Elderly Receive Less Aggressive Colon Cancer Care
A new study by UCLA and the RAND Corp. concludes that older patients with colon cancer are often steered away from the most aggressive treatments, even if it could save their lives. The study, which focused on 675 patients with stage III colon cancer (the second mostserious stage, wherein the cancer has spread to the lymph nodes), concluded that fewer than half of the 202 patients over the age of 75 received chemotherapy following surgery to remove tumors, even though it is the most effective form of treatment. Moreover, only 14% of those older patients who underwent chemotherapy received it in the strongest dosages, which are recommended by the outcomes of clinical trials. Researchers suggested that clinicians may be treating older patients more gingerly because of their age, but dismissed this is as unnecessary. “Among treated patients, older patients did not experience more adverse outcomes in the year following the cancer diagnosis than younger patients, even after accounting for the additional illnesses that older patients are more likely to have,” said Katherine L. Kahn, M.D., an internist at the David Geffen School of Medicine at UCLA.

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Are Options For Obesity Too Slender?
Far More Can be Done to Battle a Huge Epidemic
Are we doing enough to combat obesity in often known and trusted in the area. America? • Advocate for Policy Change Advocate for California’s data helps answer that local, state and federal policies that will question: 48% of its women are improve community health outcomes. A considered overweight or obese. lack of grocery stores, healthy school These women are wives, mothers, lunches and safe places to walk and play in sisters, working professionals, community many communities contribute to an leaders, and our members and patients. overweight society. One recent example of Often, women are also the primary a policy change in California is the addition healthcare decision makers for their of calorie content on restaurant menus. families, so their decisions are often much How many of us choose other more far-reaching than just options or take home a part of their own health. our meal now that we know how They rely on us, their many calories we’re consuming? ! healthcare providers and health • Support a Healthy Work insurers, to give them Environment This one may recommendations, advice, surprise you, but it’s not only encouragement, and education your members or patients who regarding their health. need help making healthy But a nationwide survey choices. It’s also your shows that doctors mention a employees. As an employer, patient’s weight only 12% of establish policies that encourage the time if they are overweight, By healthy food and lifestyle choices. Give and 34% of the time if they’re obese. Doctors seem to have a collective Elaine incentives to employees who bike or walk to work, or consider starting a uneasiness about bringing up the “O” Batchlor, walking club. Make sure healthy food word to patients, especially women. M.D. options are available to your staff and Also at issue are the ongoing racial visitors. disparities in healthcare. A 2010 Los Angeles County Department of Public Do you need another reason to combat Health survey shows that 40% of women obesity in women? By helping our mothers, are at risk for heart disease, but for wives and sisters take control of their weight, African- American women, the number we’re also helping our children. Michelle jumps to 52%. Obama’s new “Let's Move” campaign is With heart disease being the leading focused on children, but who is the most cause of death in women, and stroke the important role model in a young child’s life?! third highest cause of death, isn’t it time Most often, it is the child’s mother.! more is done? So, are we doing enough to combat the Here are a few simple steps both health epidemic of overweight and obesity in care insurers and health care professionals America? The answer is no. However, we can should undertake: move forward on the right path, right now. •Track Body Mass Index (BMI) Doctors should make it a practice to track patient Elaine Batchlor, M.D., is the chief medical BMI. Health insurers should track BMI as officer for L.A. Care Health Plan. She is a a quality measure. member of the Payers & Providers editorial •!Train and Partner with Promotoras board. Community health workers, or promotoras, are volunteers who receive Op-ed submissions of up to 575 words are special training to communicate about welcomed. Please e-mail proposals to important health issues in their own, or call communities. Promotoras live and work (877) 248-2360, ext. 3. in the communities they serve, so they are

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