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Cover the Uninsured Week
highlights need for solutions in Detroit, Wayne County
A diverse coalition of more than 400 organizations and
faith leaders last month launched Cover the Uninsured Week at
a news conference featuring Michigan Surgeon General Kimberlydawn
Wisdom, MD, Detroit Mayor Kwame Kilpatrick, Gail Warden, Wayne
County Executive Michael A. Ficano, Oakland County Executive
L. Brooks Patterson, Macomb County Commissioner Nancy White,
and DeFannie Davis, spokesperson for the uninsured.
In a study released May 10 the Kaiser Commission on Medicaid and the
Uninsured estimated that the United States will spend $41 billion for
uncompensated care for the uninsured in 2004. Federal, state and local
governments will incur as much as 85 percent of these costs, according
to the study, which notes that even with uncompensated care, people who
are uninsured for the entire year "can expect to receive about half
as much care as people who are fully insured." This study comes
on the heels of new research from The Robert Wood Johnson Foundation,
the national sponsor of Cover the Uninsured Week, which found that 20
million working adults in the US are uninsured, including 500,000 in
Michigan. Both reports have been released to coincide with Cover the
Uninsured Week, the largest national educational effort on the issue
of health coverage and the uninsured.
"What this report tells us is that while we spend significantly on health
care in this country millions of Americans still don't get the health care they
need because they are uninsured. Many of them live here in Michigan," said
Gail Warden, President Emeritus, Henry Ford Health System and trustee of The
Robert Wood Johnson Foundation. "This should be a wake-up call for all of
us. Solving this problem will not only mean better health care access for those
who are currently uninsured, but also economic benefits for our entire country.
From a practical perspective and a moral perspective, we need to solve this problem
once and for all."
More than 400 organizations, including United Way, Blue Cross Blue Shield
of Michigan, all major health systems, the Detroit Regional Chamber,
Greater Detroit Area Health Council, AFL-CIO, and more as well as more
than 100 area faith leaders from all denominations were involved in organizing
Cover the Uninsured Week in southeast Michigan. More than 1,700 activities
took place nationwide during the Week, with more than 25 events
throughout Wayne, Oakland and Macomb counties.
During the kick-off event held at University of Detroit-Mercy, Michigan
Surgeon General Dr. Kimberlydawn Wisdom presented a proclamation signed
by Gov. Jennifer Granholm proclaiming Cover The Uninsured Week in Michigan.
Detroit's Mayor Kwame Kilpatrick also presented a proclamation declaring
Cover The Uninsured Week in Detroit. They also heard from Defannie Davis,
an uninsured mother and sole caregiver for her chronically ill husband,
who described how living without health insurance has affected her life.
Speakers at the news conference in addition to those already mentioned
included: David Morse, Vice President, Communications, The Robert
Wood Johnson Foundation; Spencer Johnson, President, Michigan Health & Hospital
Association; and, Cynthia Holste Pepper, Chairperson, Small Business
Association of Michigan.
"Being uninsured means living with fear every day," said DeFannie Davis. "I
fear getting sick and not being able to work, I fear an injury that will leave
me with bills I am unable to pay and I fear getting a regular check-up that results
in finding something that needs further treatment. I am here today, because I
fear this problem will not be solved unless more people speak out, tell their
stories and demand this issue receive the attention it deserves."
The May 10 event followed the national launch of Cover the Uninsured
Week on May 5, which featured US Senate Majority Leader Bill Frist (R-TN),
US Senator Jay Rockefeller (D-WV), and Noah Wyle, star of television's "ER," who
serves as the campaign's national spokesperson. Cover the Uninsured Week
is the largest mobilization in history on behalf of uninsured men, women
and children in America. Former presidents Gerald Ford and Jimmy Carter
are the honorary co-chairs.
According to the most recent information from the Census Bureau, there
are nearly 44 million Americans living without health coverage-including
8.5 million children. In 2002, the number of people without health care
coverage increased by more than 2 million, the largest one-year increase
in a decade. In Michigan, 1.2 million are estimated to be uninsured.
"This issue is about all of us and that is why so many of us are here representing
diverse organizations that are calling for the same thing - health care coverage
for every man, woman and child in America," said Warden.
Cover the Uninsured Week, working with Families USA, a national health
care consumer advocacy organization, developed a resource guide in English
and Spanish that details what help may be available to residents of Michigan
who do not have health coverage. The guide contains information on free
or low-cost health insurance programs, community health centers, free
clinics and pharmaceutical assistance programs. The guide will be available
at the health and enrollment fairs taking place as part of Cover the
Uninsured Week, and at www.CoverTheUninsuredWeek.org.
In addition, the guide can be obtained by calling a toll-free telephone
number (888) 538-4371. The toll-free number is funded in part by Pfizer
Inc, and offers help in both English and Spanish.
Cover the Uninsured Week in Detroit is funded in part by The Robert Wood
Johnson Foundation, the nation's largest philanthropy dedicated exclusively
to improving the health and health care of all Americans. The California
Endowment and the W.K. Kellogg Foundation also are providing significant
funds for events throughout the nation.
To view the research reports released as part of Cover the Uninsured
Week log on to www.CoverTheUninsuredWeek.org.
Letter: WCMS urges city, county to approve health authority
The following is a letter dated May 4 from WCMS
President Edward Jankowski, MD, and Executive Director Adam Jablonowski
to the Detroit City Council and the Wayne County Commission
We are writing this letter to
urge you to approve the Detroit City Wayne County Health Authority
(DWCHA).
The health status of Detroit and Wayne County’s citizens already ranks
among the worst in the nation and things are not going to get better
left on their own. The status quo will only lead to worsening health
status, further fragmentation of the delivery system, and loss of services
in the community. We have already seen so many doors close and resources
dry up.
In light of this burgeoning health crisis, Gov. Jennifer Granholm challenged
us to find workable solutions. Since then, we, a group of 80 or more
volunteers, have devoted hundreds of hours of our time, expertise and
resources to put forth our best recommendations. It has been an honor
and pleasure for us to weave these ideas together into the development
of the Detroit Wayne County Health Authority (DWCHA).
It is clear that no single organization or unit of government, health
care system, physician or clinic, provider or advocate has the resources
to get the job done.
With our combined experience and expertise, we have designed and recommended
an integrated model of health care services that will provide or arrange
for a safe, effective, timely, efficient, equitable, and patient-centered
continuum of care, which includes preventive health, disease management,
primary care services and a care management medical home for all enrollees.
An estimated 695,000 Detroit and Wayne County citizens will be eligible
to benefit from DWCHA services.
We have been able to identify $50 million additional federal Medicaid
dollars for the region. Moreover, we have been able to secure a $500,000
Congressional earmark and more than $1 million in grants to begin DWCHA
operations.
No new county or city funds are required. There are no new obligations
to the city or county. No authority oversight is relinquished by any
governmental unit.
The DWCHA is not a political entity. Nor is it another level of bureacracy.
Rather, the DWCHA will serve as a focal point of expertise that can maximize
current state, federal and local resources that cannot be obtained individually.
The DWCHA will work collaboratively with existing organizations so that
the safety net of health care services can be restored for the community.
You control the final steps: ratification of the Interlocal Agreement (ILA),
the legal document that provides the foundation for the DWCHA, by the
Detroit City Council and Wayne County Commission. Without the ratification
of this document most of these efforts will be lost. Without the DWCHA
it will be harder for the community to maximize its federal reimbursement.
The grants and congressional earmark will be lost. The individual organizations
will be left to face a snowballing health crisis on their own and continue
to struggle as they have in the past. The uninsured and under-insured
individuals and families of Detroit and Wayne County will continue to
get piecemeal services, if any. The status quo may be preserved - if
we’re lucky enough to hold on to what’s left.
As volunteers who came together willingly for the greater good of our
community, we ask you to act NOW. We have other jobs and responsibilities,
and so, we will move on. Unfortunately, Detroit and Wayne County will
not.
Detroit is recognized nationally for its serious health care predicament.
We have tried to help. Now it is your turn. Please don’t lose this opportunity
to make a difference. Again, we urge the Detroit City Council and the
Wayne County Commission to move forward and ratify the ILA.
Editorial: Network And Need
By JOSEPH WEISS, MD
Editor
Richard Smith, MD, was inaugurated May 15 at the Detroit
Institute of Art as the next president of the WCMS. Guests enjoyed
dinner in the Great Hall, the world famous mural by Diego Rivera
surrounded and encompassed us. The setting was not lost on Dr.
Smith, whose inaugural remarks made reference to the congruence
between art in the DIA and the "art" of medicine.
However, the setting provided more than an elegant ambiance. The importance
of the evening came from the guests. They included MaryAnn Mahaffey,
President of the Detroit City Council, Congresswoman Carolyn Cheeks Kilpratick,
representatives from Congressman John Conyers’ office, leaders of the
ministry in Detroit, and Marc Shulman (R) Chair of the Appropriations
Committee in the Michigan House of Representatives. More Democratic party
noteables would have been present except the evening was also the date
of the the state Democratic Jefferson-Jackson Day dinner.
Representatives from the Michgan State Medical Society were in attendance
including President Elect Alan Mindlin, MD. Staff and chiefs from
Ford hospital and the DMC were represented. The guests, numbering more
than 175, were not just at the DIA to honor the office of WCMS President;
these people knew Dr. Smith personally.
Among the guests, there was sufficient political power and finesse to
take the Gordian Knot that is now the Wayne County Detroit Authority
and untie it.
Dr. Smith brings an extensive political network begun by chance in childhood
but woven by him with skill as an adult. At the same time, we have before
us the need for those skills: The task is to resolve the political dilemma
now upon the Wayne County Detroit Health Authority. This problem threatens
not only the Authority's implementation but its existence.
Of course, the WCMS cannot broker a compromise that would give the Health
Authority the legal recognition vital to it now. But with Dr. Smith,
the WCMS has the contact to nurture that resolution.
The May 15 inaugural revealed the potential that the WCMS brings to the
medical community. This year provides an opportunity to turn this possible
energy into real gain.
Special communication from Thomas Simmer, MD, BCBSM Chief
Medical Officer
You've heard a lot about the new health benefits that
are being implemented for hourly auto workers following the collective
bargaining agreements last fall. The changes to the benefit
programs are complex and vary from one manufacturer to another. I
will briefly summarize the information that is most important
to physicians. There are three major changes:
· Transfer from the Traditional network and fees to the TRUST network and fees
· Mandate of mail order pharmacies for maintenance medications
· Coverage for office visits at 100 percent co-payment by the patient
Under the new collectively bargained benefit plan, patients must seek
services from physicians contracted with the TRUST network or pay an
out-of-network sanction. For hourly workers at Daimler-Chrysler, this
was implemented on April 1, 2004. Ford hourly will begin on July
1, and the date for General Motors has not yet been established. Most
physician fees are five percent lower under the TRUST contract than they
are under Traditional.
When prescribed medications for long-term use, patients may fill the
initial three months through retail pharmacies and then must switch to
mail order pharmacies for continued coverage. Physicians are often
asked by patients to write two sets of prescriptions, one for each type
of pharmacy.
Office visits have never been covered for auto workers enrolled in the
Traditional program. Under the new agreements, such visits are
described as "covered benefits" with a 100 percent member co-payment. For
Daimler-Chrysler a catastrophic deductible of $5,000 applies to office
visits. Under the TRUST agreement, physicians are limited to collecting
the established fee screen for covered services. Physicians may
demand payment in full from the patient at the time of service.
The agreement also directs BCBSM to examine ways to improve the performance
and cost-effectiveness of the Blue Preferred Plus network, which serves
about 160,000 members in Michigan. This may include a reduction
in the number of facility and professional providers in the network. The
impact of this directive has not yet been determined.
Governor signs pesticide notification law for schools,
day care centers
Gov. Jennifer Granholm recenlty signed into law Public
Act 24 of 2004, legislation strengthening parental notification
requirements prior to the application of pesticides in schools
and day care settings.
"Encouraging parents and others to limit childhood exposure to harmful environmental
toxins represents one of the top public policy priorities of the Michigan Junior
Leagues," says Linda Kingston, Chair, of the State Public Affairs Committee
of the Michigan State Council of Junior Leagues. "This new law will increase
parents awareness of the dangers pesticides pose to their child's healthy development,
and promote the use of less toxic alternatives around young children."
House Bill 5154, sponsored by Rep. Ed Gaffney (R-Grosse Pointe), provides
for universal notification of all parents prior to the application of
pesticides, except in emergency situations, in schools and day care settings. The
bill also encourages alternative control techniques to minimize pesticide
use.
While current Michigan law requires schools to notify parents at the
beginning of the school year that they have the right to be notified
prior to the application of a pesticide in the school, Junior League
members found that not all parents were aware of this requirement and
not all schools were in compliance.
This final action culminates years of study, planning and collaboration
by Junior League members with other concerned child health organizations
such Local Motion and the Michigan Environmental Council. Junior League
leaders credit this collaborative effort with the unanimous support the
bill received in both the House of Representatives and the Senate, and
the support of the governor.
Children are especially vulnerable to toxic substances. Pound for pound,
they eat more food, drink more water, and breathe more air than adults,
all of which dramatically increases their exposure to chemicals. There
is growing evidence that chemicals in the environment, including some
pesticides, may be contributing to some illnesses. For example:
-Over just the past 20 years, children's brain cancer has increased 35
percent, cancers of the testicles are up by 66 percent and certain lymphomas
in teenagers have doubled;
-Asthma too, has more than doubled over the past 20 years and is the
leading cause of school absenteeism;
-Children living in homes where the yards are treated with pesticides
have four times the risk of soft-tissue sarcoma; and
-Children exposed to pesticides used in the home and garden are three
to six times more likely to develop leukemia than children who are not
exposed.
Although improved detection may figure in, environmental causes may account
for more than half of all cancers, says the American Cancer Society.
"The vast majority of all pesticides registered for use by the US Environmental
Protection Agency (EPA) have never been fully tested for the full range of potential
human health effects." Over the last two years, the Junior Leagues of Michigan
have been educating their members and other parents about the dangers of environmental
toxins in the home and suggesting healthy alternatives.
The Junior Leagues represent women from across the state dedicated to
promoting voluntarism, developing the potential of women, and improving
communities through the effective action and the leadership of trained
volunteers.
HOD Resolutions
RESOLUTION 79-04A
Title: Reappointments to
the Medical Staff. Approved.
Introduced by: Robert J. Jackson, MD, for the Organized Medical
Staff Section
Supported by the Wayne County Delegation
Original Author: Narinder K. Sherma, MD
RESOLVED: That the
Michigan Delegation to the AMA ask the AMA to work with the
Joint Commission on Accreditation of Healthcare Organizations
to change the requirement for reappointments to medical staffs
to every four years.
RESOLUTION 86-04A
Title: Limit Availability
of Soda Pop in Schools. Referred to the Board for Study.
Introduced by: Ronald M. Davis, MD, Wayne County
Original Author: David A. Share, MD
RESOLVED: That MSMS support
legislation that seeks to limit the availability of soda pop
in schools by prohibiting the sale of soft drinks to students
on school premises while school is in session.
RATIONALE: Although the
Reference Committee unanimously agreed with the importance
of a healthy diet and with the high caloric content of sugared
soda pop, it felt that the resolution oversimplified the causes
and solutions of obesity and did not take into account other
beverages that include high fructose corn syrup - including
some fruit drinks. The Committee also is aware that many
school districts rely on soda pop sales for additional funding.
RESOLUTION 87-04A
Title: Michigan Pharmaceutical
Produce List. Substitute Resolution (in lieu of Resolutions
29-04A and 87-04A). See Resolution 29-04A.
Introduced by: Edward G. Jankowski, MD, for the Wayne County Delegation
Original Author: George J. Murakawa, MD
RESOLUTION 88-04A
Title: Bargaining With Managed
Care: Putting Quality of Care Where it
Belongs. Approved.
Introduced by: Narinder K. Sherma, MD, for the Wayne County Delegation
RESOLVED: That MSMS study
state action doctrine legislation as passed in other states
and consider preparing such legislation for introduction in
the Michigan legislature.
RESOLUTION 89-04A
Title: Targeting Obesity. Adopted
as Amended.
Introduced by: Federico G. Mariona, MD, for the Wayne County Delegation
RESOLVED: That MSMS join
with health care organizations, academic centers, community
agencies, local health departments and the state of Michigan
to aggressively promote effective interventions to deal with
obesity as an increasing and pervasive public health concern;
and be it further
RESOLVED: That MSMS join
with health care organizations, academic centers, community
agencies, local health departments and the state of Michigan
to promote preventive health educational programs based on
making better dietary choices, increasing physical activity,
informing medical practitioners about practical and effective
ways to counsel patients on the dangers of excessive body mass,
and informing the public about ways and means to help themselves
become thinner and healthier.
RATIONALE: The Michigan
Department of Community Health, led by the State Surgeon General,
is developing a coalition of health care organizations, academic
centers, community agencies and local health departments to
address this issue. The Committee wanted to include the
state of Michigan in this initiative to reflect their interest
and commitment to public health.
RESOLUTION 90-04A
Title: Fees for Copies of
Records. Referred to the Board for Study.
Introduced by: Narinder K. Sherma, MD, for the Wayne County Delegation
RESOLVED: The MSMS seek
clear legislation allowing physician charges for copies of
medical records and materials and that these fees be annually
adjusted for inflation.
RATIONALE: There are current
legislative efforts that potentially address many of the concerns
expressed in this resolution. Further study is necessary
to adequately address the intent of this resolution.
RESOLUTION 91-04A
Title: Alternative/Complementary
Medicine. Disapproved.
Introduced by: Martin H. Daitch, MD, for the Wayne County Delegation
RESOLVED: That the
Michigan Delegation to the AMA ask the AMA to work with appropriate
organizations to require that information regarding alternative
or complementary medicines, including drug interactions similar
to that found in the PDR, be available with the cost borne
by manufacturers.
RATIONALE: The Committee
recommends disapproval of the resolution because no significant
testimony was provided to clarify the intent of the resolution. The
manner of how the information is to be collected and which
alternative medicines should be included was not specified.
RESOLUTION 92-04A
Title: Physician Representation
on Hospital Boards of Trustees. Referred to the Board
for Study.
Introduced by: Narinder K. Sherma, MD, for the Wayne County Delegation
RESOLVED: That MSMS seek
legislation to mandate an adequate number of actively practicing
physicians (elected by medical staffs) on hospital boards of
trustees.
RATIONALE: The Committee
did not believe that this resolution would accomplish the author's
intent to provide greater physician input in disputes between
the hospital administration and medical staffs. Hospital
board members are fiduciaries of the institution and not necessarily
able to advocate for the interests of their colleagues. Additionally,
the resolution asks that MSMS seek legislation to mandate an
adequate number of actively practicing physicians on the hospital
board. Hospital boards are not uniformly sized and the
term "adequate" is not defined, and would therefore
be difficult to implement in legislation.
RESOLUTION 93-04A
Title: Increasing State Tobacco
Taxes. Substitute Resolution (in lieu of Resolutions
34-04A and 93-04A) See Resolution 34-04A.
Introduced by: Ronald M. Davis, MD, for the Wayne County Delegation
RESOLUTION 34-04A
Title: Increasing State Tobacco
Taxes. Adopted as Amended. Substitute Resolution
(in lieu of Resolutions 34-04A and 94-04A)
Introduced by: Rajesh B. Makim, MD, for the St. Clair County Delegation
RESOLVED: That MSMS strongly support an increase of a minimum of 75 cents
per pack in Michigan's cigarette excise tax increase (and comparable increases
in taxes on other tobacco products); and be it further
RESOLVED: That MSMS
support the Governor's proposal to allocate all of the revenue
generated from this tax increase to health care and public
health programs, with the first $30 million being dedicated
to public health programs including tobacco prevention and
cessation, chronic disease prevention and control, and maternal
and child health, and with the remainder being dedicated to
Medicaid services.
RATIONALE: The Committee recognizes the importance of MSMS supporting
the tobacco tax legislation. The Committee would like to commend
the bipartisan efforts of Governor Jennifer Granholm and Representative
Larry Julian to give proper support to the Michigan Medicaid program
and for sending a strong message to the People of Michigan on the effects
of tobacco use. If physicians want more information, please visit www.mitobaccotax.org and
support House Bill 5632.
RESOLUTION 94-04A
Title: Billing the Uninsured
for Hospital Services. Adopted as Amended.
Introduced by: Edward G. Jankowski, MD, for the Wayne County Delegation
Supported by the Organized Medical Staff Section
RESOLVED: That MSMS
support federal and state regulatory reforms that do not preclude
hospitals from billing uninsured patients on a means-tested
sliding scale: and be it further
RESOLVED: That the Michigan Delegation to the AMA ask the AMA to
support federal and state regulatory reforms that do not preclude hospitals from
billing uninsured patients on a means-tested sliding scale.
RATIONALE: The Committee
agrees that the current regulatory environment has created
a situation that adversely affects low-income patients without
insurance. However, the Committee did not wish to further
jeopardize the already narrow financial margins of hospitals
by mandating billing and collection procedures. Therefore,
the Committee recommends adopting a resolution that provides
adequate flexibility for hospitals to accommodate lower income
patients without fear of violating any state or federal regulations.
RESOLUTION 95-04A
Title: Affordable Health
Insurance Coverage for All. No Action.
Introduced by: Edward G. Jankowski, MD, for the Wayne County Delegation
Original Author: H. Richard Henderson, MD
RESOLVED: That the Michigan
Delegation to the AMA ask the AMA in 2004 and for as long as
necessary make as its number one priority affordable health
insurance coverage for all Americans; and be it further
RESOLVED: That the Michigan
Delegation to the AMA ask the AMA to allocate the financial
resources equivalent to that allocated to physician advocacy
issues to addressing the issue of affordable health insurance
for all Americans.
RATIONALE: The AMA delegation
advisors indicated that the content of this resolution is already
policy of the AMA and that work on this issue continues.
RESOLUTION 96-04A
Title: Blue Cross Blue Shield
of Michigan Reform. Approved.
Introduced by: Federico G. Mariona, MD, for the Wayne County Delegation
RESOLVED: That MSMS vigorously
pursue any and all remedies (legislative, judicial) at any
and all levels (state, federal) to ensure that Blue Cross Blue
Shield of Michigan reimburse physicians with both timely payment
and timely notice of any changes in coding.
RESOLUTION 97-04A
Title: Clean Up Physician
Health Plan Contracting. Disapproved.
Introduced by: Edward G. Jankowski, MD, for the Wayne County Delegation
RESOLVED: That MSMS
seek legislation that would cause all health plans to deliver
to physicians, on request and within 30 days, a copy of their
current contract with all changes highlighted and dated since
the original contract was signed.
RATIONALE: There was no testimony
in support of this resolution at the Committee. Furthermore,
it was the sentiment of the Committee that this issue should
be addressed in the contract with the health plan as opposed
to creating legislation.
RESOLUTION 98-04A
Title: Prescription Refill
Cycle. Adopted as Amended.
Introduced by: Martin H. Daitch, MD, for the Wayne County Delegation
RESOLVED: That MSMS
work with the appropriate Michigan government entities and
pharmaceutical benefit managers to change the coverage rules
to allow prescriptions for chronic illnesses and non-narcotic
drugs written and filled for up to a 90-day supply so that
patients will avoid additional co-pays.
RATIONALE: The Committee amended
the resolution in order to adequately address the full scope
of this problem for patients and physicians. The Committee
agrees with the intent of the resolution to provide greater
access, convenience, and lower costs for patients.
RESOLUTION 99-04A
Title: State Audit of Mental
and Physical Health Funds to Counties. Adopted as Amended.
Introduced by: Edward G. Jankowski, MD, for the Wayne County Delegation
RESOLVED: That MSMS encourage
the state to require an annual independent statute audit, reported
by county, of Medicaid and other state and federal funds provided
through the state for mental and physical health services;
and be it further;
RESOLVED: That an
annual independent state audit, reported by county, of Medicaid
and other state and federal funds provided through the state
for mental and physical health services be made widely available
to all citizens of Michigan.
RATIONALE: The Committee amended
the resolution in order to provide a greater number of options
in obtaining the information that is requested by the author. This
could include legislation, but could also be accomplished by
a request to the Department of Community Health, and FOIA request,
or other means. The Committee was aware of the perceived
lack of financial accountability and the inability of patients
to access care within the mental health system in Michigan,
and was supportive of the intent of this resolution.
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