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Dec 20, 2010 Written By: Kristen Pavle

Health & Medicine Policy Analyst Kristen Pavle Provides Testimony @ Illinois Governor's Conference on Aging: December, 2010

Illinois Transitional Care Consortium (ITCC) testimony

Wednesday, December 8, 2010

The Illinois Long Term Care Council and the Illinois Coalition on Mental Health & Aging public forum on “The Transformation and Continuum of Long Term Care in Illinois” at the Governor’s Conference on Aging

 Good Afternoon, my name is Kristen Pavle and I work at Health & Medicine Policy Research Group, a health policy think tank. I am here today to represent the Illinois Transitional Care Consortium (ITCC). ITCC is a diverse group of community-based organizations, hospitals, a university based researcher and a policy/advocacy organization.   Our consortium members represent a geographically diverse group of state-wide populations: down-state rural Illinois, the city of Chicago, and suburban Chicago.  The elderly population we serve includes Hispanic and African American Illinoisans, the medically underserved, and older adults of all socio-economic groups.

 ITCC came together as a coalition over 2 years ago to develop and implement a service model designed to break down the fragmented silos of medical and social service care.  More specifically, the ITCC was formed to more effectively address needs of older adults transitioning from the hospital to the community by linking hospital based services with the post-discharge care environment, including community physicians, home health agencies and the aging network. 

 We are entering an era of an increasingly aged population, longer life-spans and improved medical technology, giving individuals with chronic conditions of all ages greater functionality.   People are now living longer but often living sicker, and at least 65 million older adults experience multiple chronic conditions [Boult, Karm & Groves, 2008].   The implications for health care costs are significant.  Currently, older adults with more than four chronic conditions, 25% of the Medicare population, are responsible for at least 80% of Medicare spending [Boult et al., 2008]. 

 Widespread consensus exists that our country’s health care system is fragmented and care is not coordinated across the many care settings used by individuals.  Transitional and coordinated care is a way to mitigate fragmentation and reduce service duplication and costs as patients move through a variety of care settings and interact with numerous health care professionals. Transitional and coordinated care is essential as vulnerable individuals, often with multiple chronic illnesses, navigate an increasingly complex health care system.

 Rehospitalization is one outcome of poor transitions between acute care settings and the home and community, and is a great concern to health care providers and the patients for whom they provide care.  Older adults experience more than 13 million transitions from hospital to home every year [Summary Proceedings: Transitional Care Leadership Summit, 2006]. Rehospitalization is common, expensive and associated with detrimental health care outcomes after discharge from the hospital [Jencks, Williams & Coleman, 2009]. The cost of rehospitalization places an enormous strain on our health care system.  Approximately 1 in 5 Medicare patients return to the hospital within 30 days of discharge, accounting for more than $17 billion in annual Medicare spending [Jencks et al., 2009].   Other serious consequences of poor transitions and uncoordinated care for older adults include: unnecessary nursing home admissions, caregiver stress and poor health, deteriorating health status, medication errors, redundant diagnostic testing, compliance and continuity of care problems, and increased health care costs. [Naylor et al., 1999; Coleman, Parry, Chalmers & Min, 2006; Summary Proceedings, 2006].  Please note that these figures I cite are Medicare-specific, but what we also know is that the dual eligible population, those utilizing both Medicaid and Medicare, are the most complex and medically needy. Many of these Medicare patients are also covered by Medicaid for health care coverage.

 To return to the ITCC: ITCC focuses on the coordination of care during transitions in order to connect the varied silos of post-discharge care, streamline services for the patient and their family, reduce the burden of care on the patient’s family and caregivers, and to improve the health outcomes of our older adults thereby lowering hospital readmissions and diverting form nursing home usage.  We also recognize that effective care coordination presents an opportunity to reduce overall health care costs. 

 In response to the statistics cited above, ITCC decided to focus on a specific point in a client’s health and social services usage: the discharge home from an inpatient hospital stay.  When an older person enters a hospital, it is often a time of crisis and uncertainty for the person and their family.  There is a strong body of evidence supporting the use of care coordination, administered early in a hospitalization, to impact whether the older person can safely return home.  Once home, it has been demonstrated that care coordination and follow-up can significantly reduce the rate of re-hospitalization, improve health outcomes and reduce caregiver stress. 

 We have developed a model of transitional care called the Bridge model.  The Bridge model relies on the leadership of experienced social workers called Bridge Care Coordinators.  Bridge Care Coordinators may be employed through a hospital and  partnering with a local case coordination unit (CCU); or Bridge Care Coordinators may be employed by a community based organization – a case coordination unit (CCU) – with a dedicated Aging Resource Center space within the hospital intended to improve access community resources and provide a client meeting space.  In each Bridge Model implementation, therefore, there is a community-hospital partnership.  Within the health care field, it is widely recognized that when hospitalized, people are most receptive—health care professionals are presented with an optimal teachable moment. Our model capitalizes on this opportunity to engage patients and their families in the hospital, assess what their unique needs are prior to discharge, follow up with patients post-discharge to ensure a smooth transition back to the community, and assure that their needs have been adequately addressed.

 The existing literature and current research on transitional and coordinated care are dominated by medical models of care primarily staffed by nurses.  These evidence-based models of care include: the Care Transitions Intervention (Eric Coleman, M.D.), Transitional Care Model (Mary Naylor, Ph.D.), the Geriatric Resources for Assessment and Care of Elders (GRACE) model (Steven R. Counsell, M.D.), and the Guided Care Model (Chad Boult, M.D.).  Such models have shown cost savings through success in either decreasing hospital readmission rates [Naylor et al., 1999; Coleman et al., 2006; Counsell, Callahan, Tu, Stump & Arling, 2009] or lowering the number of days patients stayed in the hospital or nursing home [Leff et al., 2009].

 However, studies suggest that 40% to 50% of hospital readmissions are linked to psychosocial problems and lack of community resources [Proctor, Morrow-Howell, Li & Dore, 2000].  While social work-based models addressing these issues have not been extensively studied [Proctor et al., 2000], the limited research available suggests positive outcomes: A randomized control trial using social workers as case managers in a transitional care intervention for Medicare managed care recipients showed promising results [Alkema, Wilber, Shannon, & Allen, 2007].  Another randomized control trial, of the Enhanced Discharge Planning Program (EDPP) at Rush University Medical Center, provides preliminary evidence for the success of a transitional care model that uses social workers to address the psychosocial needs of individuals in addition to their medical needs [Altfeld et al., 2009].  Further research beyond the medical, physician and nursing models of transitional care is imperative to further explore the best ways to mitigate the myriad factors that lead to rehospitalization, negative patient outcomes and high health care costs. 

  The Patient Protection and Affordable Care Act (PPACA) – the federal health care reform bill enacted on March 23rd 2010 – has created many opportunities to improve care for people with chronic conditions who often fall between the cracks of institutional-based care and community- and home-based services.  The opportunities presented through PPACA funding of demonstration projects allow states to become innovators in testing transitional and coordinated care models in a variety of settings and with various populations. 

  Through the Affordable Care Act, the Administration on Aging announced the opportunity to apply for grant funding through an Aging and Disability Resource Center (ADRC) project.  The Aging and Disability Resource Center model focuses on streamlining access, resources and referral to aging and disability services through a single point of entry.  One of the funding announcements focused specifically on transitions in care.  ITCC worked closely with the Illinois Department on Aging and the suburban cook county Area Agency on Aging — AgeOptions — to apply for this grant.  Illinois was one of only 16 states to be awarded an ADRC Care Transitions grant, and the only one to use social workers to lead the care coordination role.  This funding enables Illinois to expand the ITCC’s Bridge Program to the planning and service area of suburban Chicago and to individuals with disabilities within this service area.

 I am here today to share this triumph for Illinois, the securing of federal dollars through the Affordable Care Act to better serve our older adults and persons with disabilities. I am also here to emphasize the importance of care coordination, especially as people transition from one setting to another.  We need to develop models that can operate across settings, address the barriers that impede successful transitions and identify the services that enable people in the community to survive and thrive.  In addition, we need to develop models of coordinated and transitional care the bend the cost curve, slowing down the rate of increasing health care costs.  With the state addressing court mandates to deinstitutionalize people, effective care coordination models will become increasingly necessary as people transition out of institutions. 

 The Affordable Care Act has several other provisions that address care coordination and transitions in care.  These include the Community Based Care Transitions Program, a grant funded project that rewards hospitals and community partners for using transitional care programs when individuals leave a hospital setting.  There are also demonstration projects requiring an episode of care to be bundled into one payment: from just prior to hospitalization through the hospital experience and subsequent discharge.  All of these initiatives require interdisciplinary team work, a patient-centered approach, and ultimately an underlying focus on coordinating the care for the patient’s sake.  The ultimate goal is to improve quality of care, and also to contain costs. 

 If we are to succeed in enabling people to live in the community for as long as possible, a critical piece to the puzzle is the effective coordination of care that can work across systems.  The Illinois Transitional Care Consortium is committed to working with the state to capitalize on opportunities within the Affordable Care Act in order to enhance the ability of the Aging Network to develop and provide effective transitional and coordinated care. We recognize that states need guidance to translate federal policy into state/community-level applications, and are already active on this front.  Current and future activities include collaboration with aging, disabilities and mental health advocates, medical and health establishments, state agencies, and Illinois citizens.  We strongly believe that Illinois can be a leader in the field of transitional and coordinated, and look forward to working with all of you here today.

 Thank you.


For a pdf version of the testimony (with an extended reference list), please see the link below:

Download 12_8_10_ITCC_LTC_PublicForum_Testimony_FINAL

 Please Contact Kristen Pavle,, for more information on ITCC or any of the related points made in this testimony.

Dec 17, 2010 Written By: Kristen Pavle

HMPRG Founder Dr. Quentin Young: "A Judge's Assist to Single Payer?"

"A Judge's Assist to Single Payer?" By Quentin D. Young

December 15, 2010

Perhaps unwittingly, U.S. District Judge Henry Hudson of Richmond, Va., has enhanced the prospects for single-payer health reform. He did so Monday by ruling the individual mandate provision of the Obama administration's health law to be unconstitutional.

Hudson ruled that the so-called linchpin of the law -- the requirement that most Americans obtain insurance -- exceeds the authority granted to Congress under the Commerce Clause. While his decision has no immediate effect, and while this is certainly not the last word on the subject, it does cast a cloud over the law's prospects and adds another element of doubt over the law's ability to fix our broken health care system.

Judge Hudson and the American people should be aware that this kind of problem wouldn't come up under a single-payer national health insurance plan, an improved Medicare for all. Unlike the administration's law, which requires that people carry or buy health insurance -- generally from a private health insurance company -- or face a penalty, a single-payer plan would automatically cover everyone and be financed by taxes and federal appropriations, much like Medicare is financed today (but on an stronger foundation). Much of the funding would come from recovering about $400 billion presently squandered on private-insurance-generated administrative waste.

As my colleague Dr. Don McCanne, senior health policy fellow for Physicians for a National Health Program, has remarked: "Nobody is going to argue that Medicare is unconstitutional. We should fix it so it works better and then provide it to everyone."

Find "A Judge's Assist to Single Payer" by Quentin D. Young on the Huffington Post by clicking here.

Dec 17, 2010 Written By: Kristen Pavle

Comments RE “Health Insurance Reform and the Option of Establishing an Insurance Exchange in Illinois.”

Health & Medicine Policy Research Group

December 9, 2010

Health & Medicine Policy Research Group believes that the PPACA offers opportunities to build a healthcare infrastructure that aligns health systems, including Medicaid, Medicare, the new health insurance exchanges, and the employer-based insurance market.  Health & Medicine’s comments focus on creating a seamless health care system with an emphasis on quality and comprehensive coverage. 

 Functions of a Health Benefit Exchange

Health & Medicine believes that Illinois should operate its own Exchange (as long as it has the capacity to do so) so that the State can tailor the exchange the meet the needs of IL residents.  Illinois can lead the country with a progressive and innovative exchange in a way that the Federal HHS would not.  However, close attention should be paid to the rules and regulations developed by HHS in mid 2011 regarding the Exchange to ensure the IL Exchange operates at the highest possible level according to law.

 From an insurance market perspective, the most desirable outcomes of a State Exchange would be an increase in benefits covered, increase in quality, and decreases in premiums/costs.  The Exchange should include mandated reporting requirements on key health indicators (defined by the Department of Public Health) by participating insurers and should provide incentives for insurers who focus on care coordination and innovative delivery reforms that improve quality and decrease cost.  The State should act as an active purchaser through the Exchange in order to ensure the highest quality health insurance for the widest range of IL residents possible.

 Beyond the minimum functions, the IL exchange should set a minimum quality standard for plans participating in the exchange, but should remain as open as possible to an “any willing provider” structure as long as those quality standards are met.   The IL exchange should negotiate with insurers to gain the best benefits and premiums for Illinoisans and should reward insurers for the adoption of new tools such as electronic health records (i.e.: Insurers could have a reduced “participation” fee for adopting these new tools). 

 The IL Exchange should require additional reporting from insurers, including aggregated claims data and outcome data.  The IL Exchange should elicit consumer feedback regarding Exchange products to help ensure barriers are removed from accessing the products and health care.  If the State has the capacity, it should also provide additional administrative functions on behalf of payers or employers, including collecting, aggregating and passing through premium payments, coordination of electronic health reforms for patients moving from one insurance plan to another, etc..  If the State does not have the capacity for these administrative functions, the State should ensure this functionality by contracting with a non-profit agency that does have the capacity, to ensure the most seamless system as people move from one insurance plan to another.

 While allowing “any willing provider” to participate in the Exchange would increase the risk and diversity of the insurance pool, we want to urge the State to monitor the quality of the plans included in the Exchange.  Health & Medicine encourages a wide participation in the Exchange as long as minimum quality standards are met in order to prevent adverse selection.

 Structure and Governance

Health & Medicine believes that the best way to structure the State Exchange is through a quasi-governmental Board, much like the current Illinois Health Facilities and Services Planning Board.  This structure would limit the resources needed from the State to govern the Exchange but would hold the Exchange accountable to the public and to an Executive Branch Agency.  A Board would also be protected from political changes over time, ensuring the voice of the stakeholders rather than interest and political groups. 

 We urge the Board to be staffed by the Department of Insurance and have representation from, at least, a consumer advocate, a quality improvement professional, two providers (at least one non-physician), a hospital administrator, a health policy professional, a consumer, and a representative each from the Departments of Public Health, Health and Family Services, and Aging.  Board members should have 4 year terms with the option of renewal. 

 The External Market and Addressing Adverse Selection

Optimally, Health & Medicine would like to see a single market Exchange, so as to limit the administrative needs of running the Exchange and monitoring the market.  However, there will be many people left out of the Exchange and Federal subsidies for the Exchange, so it is important that the market outside of the Exchange also be monitored.  Given two markets, the State should require the same rules for plans sold inside and outside of the Exchange so that those finding coverage outside the Exchange are not subject to sub-par, expensive coverage plans that don’t truly meet their needs.

 Structure of the Exchange Marketplace

Illinois should operate separate exchanges for individuals and small employers in order to protect the premiums for small employers from unnecessary rate increases.  Experts predict that by combining the individual market with the small-business market, the small business plan premiums will increase while only bringing down the individual market premiums minimally.  This would be detrimental to small businesses, who already often struggle with providing coverage for their employees.  Also, while citizenship verification is required in the individual exchange, this administrative task is eliminated in the small employer exchange because the ACA assumes the employer has already verified citizenship status for its employees.  This would eliminate an administrative burden of the State Exchange for a significant portion of the population receiving insurance through an exchange.

 Illinois should limit the restrictions placed on employers to participate in the Exchange so as to make it as easy as possible to participate.  Increased participation is key to increasing the risk pool, a key element of controlling costs.

 Illinois should have one State individual exchange and should avoid the creation of multiple regional exchanges.  Multiple Exchanges would create added bureaucracy and oversight and could possibility create disparities in coverage and costs across the State. 

 Self-Sustaining Financing for the Exchange

Health & Medicine believes that the financing option presented in the Federal law is the best way to ensure financing of the Exchange after Federal funding is eliminated.  Illinois should charge a participation fee to insurance providers to cover the costs of the exchange.  Many thousands of IL residents will be mandated to purchase insurance products and the insurance providers should pay in to be part of the Exchange (where most people will go to look for coverage).  State funds should not be used. Employers and individuals should not be assessed fees as this would limit the affordability of insurance plans, having a disproportionate impact on low-income populations. 

 The State should consider a separate funding source for maintaining state benefit mandates and one option for this funding would be minimal premium surcharges on those added benefits. 

 Eligibility Determination

While there are many complexities to how individual eligibility will be determined, Health & Medicine recommends the development of a seamless point of entry into the health insurance system, including a single enrollment form and process for Medicaid, the State Insurance Exchange, CHIP, and other public programs (i.e. TANF and food stamps) as an easy way of moving between the programs as categorical and income eligibility change.  The system established should be highly sensitized to guiding people with respect to their benefit coverage, payment obligations and provider choice as they move into private health insurance options within the exchange or elect care through their employers. 

 The system should meet the cultural and linguistic needs of IL residents, and should be available electronically and via a paper application and phone line (requirements of ACA).  We recommend that State examine the Tri-Agency Letter, “Policy Guidance regarding Inquiries into Citizenship, Immigration Status and Social Security Numbers in State Applications for Medicaid, State Children's Health Insurance Program (SCHIP), Temporary Assistance for Needy Families (TANF), and Food Stamp Benefits.”  This letter establishes the minimally necessary questions needed when developing an application for the stated public programs, and we believe IL should work to create a streamlined application using this guidance (the guidance can be found at

 Depending on the rules and regulations developed regarding the State-based Exchanges and the “benchmarked benefits” covered by plans in the Exchange, IL should consider developing the ACA optional “Basic Health Plan.”  The Basic Health Plan would function much like Medicaid for those between 133% and 200% of the Federal Poverty Level (and would not have a five year bar for immigrants like Medicaid).  If the benchmark benefits package in the Exchange is deemed at least comparable to the coverage provided in Medicaid, IL should not develop the Basic Health Plan and should shift all residents above 133% of the FPL to the Exchange.  However, if the benchmark benefits plan does not cover as comprehensive a package as Medicaid, IL should operate a Basic Health Plan for those between 133%-200% of FPL, to assure that the vulnerable populations currently covered by Medicaid who would otherwise be switched to the Exchange (i.e. pregnant women between 133-200% of FPL, etc.) receive continued, seamless coverage. 

 With or without a Basic Health Plan, Illinois might consider a Medicaid/Family Supplemental Policy, offering additional, subsidized benefits to higher risk population groups above 133% FPL with graduated payment contributions as families and individuals raise their income.  And, Illinois should offer a state-based supplemental product for purchase by all families to ensure comprehensive coverage.  These state and sliding-scale premium-funded programs would help fill gaps in coverage presented by plans in the Exchange.  For example, a “bronze plan” in the Exchange is only required to cover 60% of the costs, so IL should have a supplemental plan to help cover the remaining 40% of costs (paid primarily through premiums using minimal state dollars).

 In order to truly coordinate the acceptance of public and private insurance by provider teams and medical homes, Medicaid and plans in the Exchange should all meet a minimum standard for reimbursement rates, and Medicaid reimbursement rates should be increased (with the help of increased Federal funding for the first 2 years).  Also, the State should work with providers to increase the willingness of providers to accept payment from any of the payers (Medicaid, Medicare, private insurance, CHIP) so that residents can remain with their provider of choice no matter if their coverage status shifts over time.

 Thank you for your consideration of these comments.

Dec 15, 2010 Written By: Kristen Pavle

HMPRG founder Quentin D. Young quoted in article on December 11, 2010 about Cook County Health System

"Staffs Worry About Shifts In County Health System"


As Tia Speat strode through the quiet halls of Oak Forest Hospital last week passing out fliers about the nurses union’s contract negotiations with Cook County officials, angry nurses accosted her with questions and complaints about proposed cuts in service and staff.

As the county health system shifts strategy to deliver care with leaner resources, many who provide medical services say they are approaching a breaking point. An analysis by the nurses union predicted that the county health system’s 2011 budget would cut about 1,000 jobs, including 114 nurses and 19 doctors, to help close a $487 million countywide budget gap.

After the Cook County Board of Commissioners approved staff reductions and closed eight clinics in 2007, an independent board was appointed to oversee the health system. Toni Preckwinkle, the newly elected County Board president, said “the system was hacked with an ax” during that round of cuts, and she has been an outspoken supporter of the independent board, which recently submitted its budget to her.

The budget is based on a plan called Vision 2015, which the independent board adopted last summer. The plan is designed to shape budgets and operations over the next five years, shifting the focus of the health system to primary-care service from in8patient care. Because the new plan sets out an overall strategy, Ms. Preckwinkle has said, the pending staff reductions will be more in line with long-range goals and less painful.

Lucio Guerrero, a spokesman for the Cook County Health and Hospitals System, said: “We’re cutting superexpensive services that are underutilized and adding services that are needed in the communities. This isn’t just an exercise in the bottom line; this is a medical model that makes sense for the next five years.”

“I don’t blame people for not really trusting us,” Mr. Guerrero added. “Maybe in the past they didn’t have a reason to. With the independent board, it’s a different day.”

Under Vision 2015, emergency and inpatient services at Oak Forest Hospital will be eliminated, and at Provident Hospital in Bronzeville inpatient care will be greatly scaled back, meaning that many of the sickest patients from the South Side and south suburbs will have to travel to John H. Stroger Jr. Hospital of Cook County on the West Side. The cuts would be offset by increases in primary care and outpatient services at Oak Forest, Provident and Stroger and county clinics.

Many nurses are not convinced that the plan is workable. The layoffs will most likely be heaviest at Oak Forest, where nurses said staffing levels had been winnowed to bare-bones levels. They are already hard-pressed to give adequate attention to patients, the nurses said.

If county officials are going to close inpatient units, “they should just do it, instead of expecting us to work miracles in a horrible situation,” said Kathy McKinney, a registered nurse. “I’m just tired. I still love my career, but I dread coming to work at this place.”

The County Board’s finance committee will begin deliberations on the budget Tuesday.

The health system, like all county departments, was ordered to trim 21 percent from last year’s budget, even as federal aid was being reduced. Doctors and nurses say the budget squeeze could not come at a worse time, with rising unemployment producing an influx of newly uninsured patients.

On Dec. 22, the National Nurses Organizing Committee, which represents 1,300 registered nurses in the county health system, will tally the results of a mail-in vote that would authorize union leaders to call a strike to protest the staffing cuts and other concerns. Administrators at Stroger Hospital, the largest institution in the health system, have prepared a contingency plan that would include early release or transfer of patients to other hospitals, cancellation of elective surgery, mandatory 12-hour shifts and other measures.

The Service Employees International Union’s Doctors Council, which represents 500 county doctors, is also in the midst of contract negotiations. In a recent report, it described the county system as “cut to the bone.”

Despite bureaucratic obstacles and long emergency room waits for patients — some reportedly as long as 14 hours at Stroger — the county’s health care system has long been known for its top-notch specialists and services. “You’ll die waiting at county, but then they’ll bring you back to life,” goes a popular saying.

Quentin Young, chairman of Cook County’s Department of Medicine from 1972 to 1981, called Stroger “a spectacular place that has provided care for millions.” Now, Mr. Young and other experts say, the system’s challenge is to cut costs while maintaining a high standard of care.

Mr. Young supports the independent board’s plan to cut emergency and inpatient services in favor of expanded primary and outpatient care. “Any kind of cut is painful,” he said. “They’re trying to choose between the lesser of two evils.”

Doctors and nurses say they fear that the sickest, most vulnerable South Side and suburban patients who had relied on Provident and Oak Forest will fall through the cracks in an efficiency-driven corporate model. They say they are being pressured to increase the numbers of patients they see, which gives them less time to spend with each one.

“There is a business mentality that exists on the board now,” said Dr. Fred Martin, a family medicine residency supervisor. “They don’t have a good feel for what’s happening on the front lines. The only measure of productivity that we have is numbers of patients seen. The consultants have not been taking into consideration that a doctor might see a 62-year-old diabetic with thyroid disease, hypertension — and, oh, his back hurts, also. We need to spend time with people like that. He’s not just a number.”

At Stroger Hospital, nurses say they worry about the expected increase in seriously ill patients after changes in inpatient and emergency services at Provident and Oak Forest. Dennis Kosuth, an emergency room nurse at Stroger, said administrators had demanded that nurses provide better customer service, even though they were taking care of up to nine patients at a time — 18 when their partners are on breaks.

“The best customer service attitude in the world doesn’t help when you just have too many patients,” Mr. Kosuth said. “We give the best care we can with the resources we have, but an overcrowded emergency room where people are waiting 12 hours is a disaster waiting to happen.”

An analysis by David Goldberg, a Stroger doctor and president of the executive medical staff, said previous cuts in service had been financially self-defeating. With each dollar of services cut in 2007, the study showed, revenue — from fewer potential patients — dropped by $1.62 in 2008. Dr. Goldberg said many patients might have given up on the county system after the 2007 cuts and gone without care or found other options, causing a drop in reimbursement from Medicaid and health insurers.

County officials and taxpayers should be willing to spend more on the health system, he said.

“We’re doing our part to support the work force and the residents of Cook County by caring for all these people,” Dr. Goldberg said. “We need a county who stands behind us. If everyone’s going to walk away from us, that’s not a society I’m proud of.”

You can also read the full story here: "Staffs Worry About Shifts In County Health System" , with pictures, from the Chicago New Cooperative.

Dec 02, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)


The Chicago Tribune is beginning a series of web chats on issues of concerns to seniors, hosted by Tribune Health Reporter Judy Graham.

These chats will give readers/listeners a good opportunity to interact with experts on a variety of important topics.

The first webchat is planned for Tuesday, Dec. 7, at Noon CST (Chats will be held every other week on Tuesdays at Noon CST)

Topic:  The ABCs of Medicare:  What Baby Boomers need to know as they get ready to enroll in this program.

The experts answering questions for this chat will come from the Medicare Rights Center in New York.

Readers  are invited to send questions to Judy at

View the Tribune information about this series


Nov 20, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Health & Medicine's Letter to CMS Re: Public Comment on Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

November 15, 2010
From: Health & Medicine Policy Research Group
Re: Public Comment on Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

To Whom It May Concern:

Health & Medicine Policy Research Group is a 29 year old independent policy center that conducts research, educates and collaborates with other groups to advocate policies and impact health systems to improve the health status of all people.  Our mission is to promote social justice and challenge inequities in health and health care, with a vision of a society free of social inequities, with a healthy population accessing high quality health care, delivered in comprehensive health systems by culturally competent providers.

Health & Medicine has undertaken analysis of the health reform law and its potential impact on the State of Illinois and the Chicago region.  In response to the proposed rules for the review and approval process for Section 1115 Demonstrations, Health & Medicine has the following comments:

  • We applaud CMS’s efforts to increase transparency and public engagement in the Section 1115 review and approval processThe proposed rules are sensitive to the potential challenges resulting from demonstration projects and we agree that public input will help deter these problems
  • The proposed rules indicate that a State must provide public notice of a demonstration in either the State’s Administrative Record or in the newspaper with widest circulation in each city or county.  Health & Medicine would encourage CMS to require that public notice be included in BOTH the State record and widely circulated newspapers as to assure public input from those who do not regularly read the State Administrative Record.
  • The proposed rules require States to host at least two public hearings regarding the demonstration application at least 20 days prior to the application’s submission.  Health & Medicine encourages CMS to consider if 20 days is enough time for states to properly analyze the results of public hearings and incorporate the results into the application. 
  • We applaud the proposed rule that CMS may request application modifications and may, at its discretion, direct an additional 30 day public comment period.  Further clarification on when “discretion” would be used would be helpful for advocates and the public.
  • We encourage the requirement of financial data for both new and extension demonstrations.  Projects should also be required to determine per capita cost per value received by the demonstration project and should estimate how the demonstration changes the total costs and revenues for Medicaid.
  • We applaud the rule’s requirement of publishing the status of demonstrations on the CMS website. 
  • Regarding evaluation of demonstration projects, we are concerned the six months may not be enough time to see the impact and outcomes of a demonstration project.  We encourage CMS to consider changing the requirement for public forums after implementation of a demonstration from 6 months to 12 months, as to allow for intended changes to occur. 
  • Overall, the need for greater transparency is recognized in these rules and is appreciated by health policy and advocacy professionals.  Health & Medicine would encourage CMS to set similar transparency standards for State Medicaid Plans so that the plans are available electronically (via the State website) and made available to the public in a variety of means.

Thank you for your consideration of these comments.


Margie Schaps, MPH, Executive Director               

Janna Stansell, MPH, Policy Analyst

Nov 20, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

HMPRG Testimony on Options in Medicaid and Systems Delivery Reforms in Illinois

Download HMPRG_Nov_16_2010_Testimony

State Options in Medicaid and System Delivery Reforms
Health & Medicine Policy Research Group
For State Public Hearing, Nov. 16, 2010

Health & Medicine Policy Research Group believes that the PPACA offers opportunities to build
a healthcare infrastructure that aligns health systems, including Medicaid, Medicare, the new
health insurance exchanges, and the employer-based insurance market. The State of Illinois
should proceed diligently in implementing provisions of Federal reform, especially around
Medicaid, to ensure the most seamless, effective, and affordable health system for all residents in
the state..

Medicaid reform in Illinois should employ the following principles. State policy leaders should
ensure that the new system is patient-centered, seamless, equitable and transparent. The health
system should provide coordinated care, optimal benefits, interdisciplinary provider teams,
opportunities for statewide research and evaluation, and overall system cost-savings. These
principles are supported by evidence revealing their effectiveness in improving the quality of
care and providing cost-savings.

  • The patient should be the focus of all reforms in IL and primary care in patient-centered medical homes is one model that can be used successfully to improve quality and reduce costs.
  • When there is flexibility, the State should implement options that create the most seamless and efficient system
  • The eligibility criteria for the new Medicaid expansion category differs from the traditional categories, but IL should create one common eligibility and enrollment form for Medicaid, the state health exchange, and other public programs to ensure a single point of entry into the system (while internally dealing with the complexities of having multiple standards for eligibility)
  • States have options in determining the Medicaid “benchmark benefits.” While these benefits must include “essential health services” as defined by HHS and meet other Medicaid benefits standards, States will be able to voluntarily provide additional services. Illinois should provide maximal benefits and implement costsavings reforms so that these benefits can be provided.
  • All reforms must consider the needs of all residents, especially the most vulnerable, so that an equitable health system can be established.
  • If possible, IL should include plans for undocumented immigrants when implementing reform (even though they are explicitly left out of Federal reform,  should include a plan for alternative avenues of coverage and care)
  •  IL needs to ensure the viability of safety net institutions that will continue to serve the remaining uninsured
  • IL should work to increase its Medicaid reimbursement rates to be more like Medicare rates (cost-saving reforms can be used to off-set this increased reimbursement)
  • IL must find innovative ways of attracting a diverse and culturally competent workforce
    • State could expand the scope of practice for non-physician primary care providers
    • State should be sure to apply for all Federal grants for workforce training programs, etc.
  • Illinois must remain transparent as it implements reform
  • Illinois should promote care coordination and the use of interdisciplinary provider teams in Medicaid and the State exchanges. Care coordination and provider teams reduce costs (by reducing duplication of services, for example) and improve care quality. Perhaps the state should participate in ACOs, and other delivery system and payment reform options under health reform.
  • IL should develop a state-wide research, evaluation, and innovation center to monitor IL’s progress and the outcomes of other Federal innovation and evaluation entities. Pooling academic and state resources to create a coordinated innovation, research, and evaluation agenda that is aligned with the Federal agenda in those areas will improve the effectiveness and efficiency of health reform implementation in Illinois and help the public and professionals monitor its progress.
  • The state must consider ways of sustaining Medicaid after the increase in Federal funding for the program declines. The state should consider innovative ways of financing the system, including in Long Term Care, as well as innovative delivery system reforms that can produce cost savings while maintaining and improving quality outcomes. The state should develop a Medicaid financial advisory committee to inform this transformation over time.

Beyond our recommended general principles above, we have the following specific recommendations:

IL should fully explore the Medicaid state option to create health homes for persons with
chronic health conditions (section 2703 of the Affordable Care Act). This state option
emphasizes health care service delivery that promotes care coordination, transitional care
services, referral to community and social support services, and care management. This service
delivery focus supports the long-term care shift from institutional to home and community based
service provision. Further, this state option is accompanied by a 90% increased FMAP for the
first 2 years of operation, further incentivizing the necessity of coordinating care. There are also
planning grants available to states beginning in 2011 for this Medicaid state plan option.

IL should fully explore the Demonstration Project on Integrated Care Around Hospitalization (section 2704) and subsequent application to participate in the demonstration.
This provision focuses on bundled payments around an episode of care for Medicaid
beneficiaries. Per the legislation, the demonstration project may target specific Medicaid
beneficiaries, and it is worth exploring if IL could target Medicaid beneficiaries in the IL
Medicaid 1915 (c) waiver program: Community Care Program. The majority of these individuals
are dual eligibles as CCP serves persons 60 years and older. This presents an opportunity to
focus on a particularly vulnerable, high-cost, high-need population.

IL should formally evaluate the State Balancing Incentives Program, a Medicaid grant funded
project to incentivize the spending of Medicaid dollars in a home and community based setting
(HCBS). IL’s Older Adult Services Advisory Committee recently submitted a formal Plan for
Long-Term Care Reform to the Governor and included under the primary goal of “improving
funding for HCBS programs” the following recommendation: “Evaluate the impact of the state
balancing incentive program and prepare an application which will be submitted to CMS.” This
opportunity fits in with Illinois’ existing focus to balance long-term care services between
institutional and HCBS, and offers a funding mechanism to support on-going efforts to balance
long-term care. IL should work closely with stakeholders when addressing the requirements of
this provision: establishing a single-point of entry system for long-term services and supports,
adopting conflict free case management, and application of standardized assessment instruments
for determining eligibility.

IL should explore the idea of using a portion of the enhanced FMAP funding received through
the Money Follows the Person program to promote quality housing options for individuals in
the community. If IL is promoting HCBS through MFP, it is a necessity to provide access to
affordable housing.

Nov 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Linda Rae Murray Quoted in Article on Dental Services in Cook County

HMPRG's Immediate Past President (and current APHA President) Linda Rae Murray, MD, MPH, was quoted in today's Chicago tribune feature on public dental  clinics in Cook County.

download from Tribune Online

County to assess state of oral care

Closing of public dental clinics has led to a health crisis

Ed Finkel, Special to the Tribune

Lorraine Tatum rarely had a problem scheduling dental appointments when her older children were in school, but the mother of seven said she struggles to get her three remaining school-age children into the dental clinic in her Englewood neighborhood.

"We could use more than one clinic. You have to be standing outside in line," said Tatum, noting that the weather is turning cold. "It's ridiculous."

The private Reymar Dental Clinic at 6202 S. Halsted St. takes 15 appointments on the weekends on a first-come, first-served basis for people on public aid.

Cook County has just four public dental clinics — in Ford Heights, Maywood, Bridgeview and Rolling Meadows — along with the main county dental office at Stroger Hospital to serve the more than 1.4 million residents registered for government health care. The result is an oral health care crisis, with thousands of residents going without dental treatment or forced to wait months for routine treatment, according to a consortium of health organizations.

Acknowledging the crisis, the Cook County Board recently passed a resolution supporting the coalition's Bridge to Healthy Smiles campaign and directing the county health department to take a complete inventory of dental services. The department is to report back within 45 days on clinic locations, hours of operation, staff at each location, numbers of patients served, wait times and procedures performed, as well as a list of clinics closed in the last decade.

In 2007, the Cook County closed four of its eight satellite dental clinics — in Markham, Robbins, Skokie and South Holland. That was on top of the city shuttering its three clinics last year. The Chicago Department of Public Health refers people to dental schools and other providers of low-cost or free care, said spokesman Tim Hadac.

But the total volume of services has not dropped as drastically as it might seem, said Linda Murray, chief medical officer for the Cook County Department of Public Health. She said the county never had more than six full-time dentists, who used to split time between locations. Still, Murray readily agrees there remains great unmet need.

"We do not value oral health appropriately," Murray said. "All of my colleagues believe we should be offering more dental services. The question is, what is the Board of Commissioners willing to pay for? …

When we talk about rolling back the 1/2 percent (sales) tax, I'm going to tell you right now that means more cuts. The citizens of Cook County have to understand: Is this a basic human service, or is this a luxury?"

County Commissioner Peter Silvestri, who sponsored the board's resolution, said he will wait to hear the department's report before coming to a conclusion but agreed that adding more resources is a possibility — but that could mean cuts in other public health areas that seem less vital.

"If that means realigning existing resources, that's what we need to do," Silvestri said. "If that's not possible because of budget cuts, we will come to that determination." He said the resolution asks for information and is not intended as criticism of the department or its dental services.

"For lack of a better term, it's not a punch in the teeth to anybody," he said.

The consortium of about 30 public health-related organizations and agencies is advocating for reinvestment of public resources to bridge the current gap, which it estimates affects 1 million people in Cook County.

The campaign cites statistics showing that 27 percent of third-graders have untreated cavities, including 36 percent of those in Chicago, and the average wait time for an appointment is two months for general care and a year for specialty care. It also cites a surgeon general's report that links oral disease with ear and sinus infections, weakened immune systems, diabetes, and heart and lung disease, among other conditions.

Murray said that measuring the wait times at public health clinics will not even measure the full extent of the need because the county does not cover anyone who has dental insurance — no matter how flimsy that insurance might be.

"Dental services are one of the things in this country that distinguishes working people and poor people from the upper middle class," she said. "You can frankly tell by looking at (the teeth of) a teenager or young adult how much money their family has."

Resources at the clinics are limited; each has one full-time dentist and no dental hygienist. Stroger, which handles oral surgery, sees only 35 patients per day and the line, which opens at 8 a.m., is usually filled by 8:15, according to the county's Web site and voice mail.

"There's pro bono, a lot of those, but it will never be able to take care of this much need," said Michael Stablein, president of the Chicago Dental Society. "If it's a child, we don't want them to miss school. If it's an adult, we want them to go back to work. If you're missing teeth, it's hard to be able to get certain types of jobs. We're asking for relief of pain and infection. We're asking for a routine appointment within seven to eight weeks."

Dental care is often one of the first things cut when budgets get tight, said Anne Clancy, project director at Chicago Community Oral Health Forum, a project of the Heartland Alliance and a Bridge to Healthy Smiles member group.

"The overhead's extremely high," she said. "When there's issues in county budgets and state budgets and so forth, they look at programs that cost a lot of money and don't necessarily bring a lot of money in."



Nov 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Steve Rothschild on the Robert Wood Johnson Foundation Report, "A New Way to Talk about the Social Determinants of Health"

Steve Rothschild, MD is a Health & Medicine Board member and co-author of a chapter in Urban Health:  Combating Disparities with Local Data; Steven Whitman, Ami Shah and Maureen Benjamins, eds.; recently relased by Oxford University Press.


Whenever discussing health disparities, it is important to avoid using the following words and phrases:  “injustice”, “immoral”, “unconscionable”, “outrage”, or any variation of “equal”, “equality”, or “equalizing”.                                                                                                                                                      
So says a recently issued Robert Wood Johnson Foundation report, A New Way to Talk about the Social Determinants of Health.  Foundation staff felt that the phrase “social determinants” had little resonance with their grant recipients and with lay people, and set out to find a simple, tidy proxy that would be more meaningful to the general public.   They commissioned researchers, focus groups, and communications specialists to find messages about the root causes of health disparities that would be clearer and more acceptable across the political spectrum.    The resulting report makes for reading that is both interesting and highly disturbing.                                                                            

The authors are, of course, right about “social determinants of health” – it IS a sterile, academic phrase that fails to capture the issue.   Explaining health disparities can be difficult; many of us, after giving a well-documented presentation describing excess deaths from cancer, diabetes, or heart disease among blacks and Latinos have found ourselves repeatedly being asked if the problems aren’t really the result of bad genes or high risk individual behaviors.  So we try, yet again, to explain the concepts of food deserts, and the impact of high chronic stress and discrimination, and environmental racism and pollution, and the rapidly disappearing health care safety net.   We try to infuse a sense of urgency into our presentations through vivid illustrations; for example, in the city of Chicago alone, three black women die from breast cancer every day, who would not die if their mortality rate were the same as white women.   For some audiences, our words are persuasive, but many more seem to tune them out.                                                                               

In this context, the Foundation’s report is a welcome addition to our armamentarium.   Words matter, and the report explains the benefits of tested phrases such as “All Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education, or ethnic background” or “Your neighborhood or job shouldn’t be hazardous to your health.”    I will certainly plan to incorporate many of the report’s suggestions into my own presentations.                                                                                                                                                                                     

At the same time, the recommendations that we stay away from speaking of outrage and injustice seem facile.   Shouldn’t everyone be outraged by the current situation?   Aren’t these injustices?    When did inequality become an acceptable American core value?    Hearing about the recommended phrases, my wife said the language sounded more appropriate for Sesame Street than a serious policy discussion; a colleague at Health and Medicine rejected them as Orwellian.  At the very least, they seem to soft sell the needless death and disability of thousands of Americans every year.  Reading the report, I found myself building up self-righteous indignation over the idea that I should avoid speaking of “leveling the playing field” lest I prompt a negative reaction from people who prefer Sarah Palin, and Glenn Beck, and the other propagandists at Fox News.  Why should I even care what conservatives think?  Do they worry what I think about their daily attacks on gays, immigrants, Moslems, and the poor?

OK, so that rant makes me feel better for a moment… but if we are to achieve an equitable health care system, millions of our fellow citizens must come to recognize health inequities as inconsistent with their personal understanding of what it means to be American.   This will require speaking in language that they can hear and relate to.   If it is easier for them to accept that “Health begins where we live, learn, work, and play” (another one of the report’s tested and approved phrases), then perhaps we should put aside our indignation for a few moments and use these more measured approaches.

And yet… I can’t help but think of the powerful language used by a highly persuasive speaker who once said “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”   Wow – both “shocking” AND “inhumane”.   I wonder what the consultants who wrote the Foundation’s report would think about Dr. King’s choice of words?

Nov 07, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Sinai Urban Health Institute Study Featured in NY Times

The November 4, 2010 NY Times featured an article focusing on “Urban Health: Combating Disparities with Local Data,” the study and book conducted by HMPRG Board member Ami Shah; our friend and HMPRG Award-winner Steve Whitman;  and Maureen Benjamins from the Sinai Urban Health Institute. The article also discusses the Block By Block program, Northwestern University Feinberg School of Medicine and Illinois Maternal and Child Health Coalition.

Download the article from NY Times Online

After a Study, Healthy Changes Block by Block


Seven years ago, Leony Calderón felt much older than her 30 years. “My joints hurt so much, it was hard to go up stairs,” Ms. Calderón said last week at her office at the Greater Humboldt Park Community Diabetes Empowerment Center. Dangerously overweight, she stopped menstruating, had high cholesterol and was pre-diabetic. She knew something had to be done.

Humboldt Park, where Ms. Calderón lives and works, is the heart of Puerto Rican life in Chicago. It is also, as researchers from the Sinai Urban Health Institute discovered, the site of a full-blown diabetes epidemic. A survey conducted by Sinai and local community leaders from 2000 to 2006 showed that 21 percent of Puerto Ricans in Humboldt Park were diabetic, compared with 4 percent of Mexicans living in the same neighborhood and 11 percent of Puerto Ricans in New York City.

The alarming findings could have easily faded from public view. But this information was hardly academic. It was the product of a 500-question survey written in consultation with community leaders, conducted by local residents and intended to promote a healthier lifestyle. Those factors, said Steve Whitman, director of the institute, set the survey apart from other urban-health initiatives.

The results resonated within the community, Ms. Calderón said, in part because people trusted their interviewers. “It’s always easier to talk to a friend or a neighbor about something personal like health,” she said.

Mr. Whitman said that because the community felt ownership of the data, residents were more compelled to act on it.

“We showed up at a meeting after the results came out, and we thought maybe there would be 50 people there,” he said. “Instead, 700 people showed up.”

That enthusiasm has inspired an array of community health initiatives, including improved produce selection and availability at local markets and free diabetes screenings at a local health center.

“People have been talking about racial and socioeconomic inequities in health forever,” said Ami Shah, a senior epidemiologist at the institute. “But having these numbers that are personal, relevant, local — people start to react and respond in a new way.”

Knowing that a problem exists, of course, is only one step. The challenge for underserved communities like Humboldt Park is to keep it from getting worse.

“You can get a patient the exams they need for their diabetes, but in order to bring things under control, they have to exercise and eat the right food,” said Romana Hasnain-Wynia, director of the Center for Healthcare Equity at Northwestern University Feinberg School of Medicine. “They need to feel safe walking outside, and they need grocery stores where they can buy fruits and vegetables.”

Those are a few of the issues Humboldt Park activists hope to address with a new program called Block by Block. Part health-education campaign, part epidemiological survey, Block by Block encompasses the 72 blocks of Humboldt Park and offers residents free cooking instruction, support groups and exercise classes.

Ms. Shah, along with Mr. Whitman and Maureen Benjamins, is co-editor of “Urban Health: Combating Disparities with Local Data.” Clunky title notwithstanding, the book, which was published in October by Oxford University Press, is engaging, detailing the key public health findings from eight years of individual interviews in eight diverse Chicago communities.

As the Sinai data have shown over the past few years, Humboldt Park is not the only neighborhood in the Chicago area facing serious public health problems. Researchers found that 40 percent of adults in North Lawndale smoke, compared with 20 percent nationwide and citywide. And though 25 percent of children in the United States are obese or overweight, two-thirds of the children in the survey communities fell into those categories. Obesity is a particular challenge, investigators discovered, in the Orthodox Jewish community of West Rogers Park.

The specifics of the Sinai approach — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.

“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.

This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.

That sounded right to Ms. Calderón, who sees the impact of those results first-hand, every day. Now 50 pounds lighter, Ms. Calderón is the physical activities coordinator for Muévete (Movement), a component of Block by Block. She teaches an overflowing slate of weekly fitness classes at the Humboldt Park Field House and at the Diabetes Empowerment Center, including three dance-aerobics classes and two yoga sessions.

Because of her weight and her family history, Ms. Calderón is still pre-diabetic, but is healthier in nearly every way measured by the Sinai health survey.

This is precisely the kind of result Mr. Whitman said he and his colleagues had hoped for — and the reason for the Sinai approach to public health research.

“Lots of people analyze and demonstrate health disparities,” he said. “The point is to fix them.”





Nov 04, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Info About The Next Health Care Reform Implementation Council Meeting in Illinois. Your Testimony Is More Important Than Ever!

As we reflect on the election that just happened and look toward the new year with the new House of Representatives vowing to dismantle the health reform legislation, it is important that our state leadership hear from those of us who are committed to implementing the most comprehensive, robust health system possible in Illinois.

See the info below for the date, time and location of the next meeting of the Health Care Reform Implementation Council. The topic to that will be discussed at this meeting will be how the state should reform the Medicaid service structures and enrollment systems.  There is also an option to submit testimony online.

November 16, 2010
3:30 PM - 6:00 PM
Howlett Building, Auditorium
501 S. 2nd St.
Springfield, IL 62756
**you must have a photo ID to enter the building**

If you or your organization is interested in providing testimony regarding this topic, please contact Amy Lulich at: or 312-814-8266 by Friday, Nov. 12th. 

You may also submit written testimony to:

Please take the time to develop thoughtful comments that can help our state realize our vision of health care for all.

Nov 04, 2010 Written By: Kristen Pavle

Economic Security for All: Support the Paycheck Fairness Act, Now!

Please join Health & Medicine and Wider Opportunities for Women (WOW) in urging the Senate to vote in support of the Paycheck Fairness Act (Senate Bill 182).

Please note, one of the Senators that is critical to passing this bill is Illinois' Senator-elect Mark Kirk. Call today to urge Representative Kirk to support the Paycheck Fairness Act: (202) 225-4835.

A message from WOW:

"Join WOW and a coalition of national organizations for nationwide call-in days this week in support of the Paycheck Fairness Act (S. 182). The bill is up for a vote in the Senate on November 17, so now is the time to make your voice known! We encourage you to target your outreach to Sen. Olympia Snowe (R-ME), Sen. Susan Collins (R-ME), Sen. Scott Brown (R-MA) and senator-elects Joe Manchin (D-WV) and Mark Kirk (R-IL), who will be seated for next week's post-election session.

Sen. Snowe's Office: (202) 224-5344

Sen. Collins' Office: (202) 224-2523

Sen. Brown's Office: (202) 224-4543

Gov. Joe Manchin's Office: (304) 558-2000

Rep. Mark Kirk's Office: (202) 225-4835

As you know, women make less money than men for equal work, making 77 cents for every dollar a man earns. The Paycheck Fairness Act builds on the Equal Pay Act of 1963 by ensuring women receive equal pay for equal work by:

  • Prohibiting employers from retaliating against employees who disclose or discuss salaries;
  • Improving wage data collection;
  • Putting remedies for gender-based wage discrimination on an equal footing with those for discrimination based on race or ethnicity.

So call today and urge these senators to support the Paycheck Fairness Act."

Nov 02, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Congratulations, to HMPRG Board member and APHA President-elect, Linda Rae Murray, MD, MPH

Congratulations to Health & Medicine (HMPRG) Board member  (and past President) and APHA President-elect, Linda Rae Murray, MD, MPH; who is being honored by National Medical Fellowships (NMF) with their 2010 Champion of Public Health Award. Awards will be presented  on November 16th at the 2010 Chicago Champions of Health Awards at The Mid-America Club in Chicago.

This year NMF will also honor Ellis D. Johnson, MD, Psychiatrist & Pioneer, with the NMF Lifetime Achievement Award; Terry Mason, MD, FACS, Chief Medical Officer, Cook County Health & Hospitals System with the NMF Distinguished Alumni Award; Martha Daviglus, MD, PhD, Professor of Preventive Medicine at the Feinberg School of Medicine, Northwestern University with the NMF Champion of Community Health Award ; Bob Love, Director of Community Affairs, Chicago Bulls with the NMF Corporate Champions of Health Award.

For more information about the award or the awards event, please contact or call 212-483-8880 ext. 307.

Nov 02, 2010 Written By: Kristen Pavle

"Women Underestimate Importance of Long-Term Care Planning"

Health & Medicine's Center for Long-Term Care Reform will be regularly updating the blog with original articles and with links to other articles outside of Health & Medicine in recognition of:

Long-Term Care Awareness Month.

Please check out this article: "Women Underestimate Importance of Long-Term Care Planning" originally posted on PR Newswire.

"November is designated as national Long-Term Care Awareness Month to build awareness for the type of care needed by individuals who have a chronic illness or disability.  By 2020, some 12 million older Americans will require long-term care services according to the American Association for Long-Term Care Insurance (AALTCI). Many women assume that government programs like Medicare or Medicaid will completely cover the cost of all long-term care needs.

"We are proud to be working in partnership with AALTCI to help women better understand and plan for their golden years. We are hopeful this month will serve as a catalyst for women to start separating facts from myths, and seek solutions most appropriate for them and their loved ones," states Lisa Wendt, president and CEO of LifeSecure Insurance Company.

Women, especially, bear the burden of long-term care costs for three reasons:  women live longer than men; they require care longer, and because women more often assume the responsibility for their family's welfare, they often become the primary caregivers for elderly family members or their partner.  

"Long-term care is a critically important issue for women," explains Jesse Slome, executive director of AALTCI, a national trade group. "The vast majority of women who are age 50 or older considerably underestimate the risk and have no plan in place."

According to the Association's publication, A Woman's Guide to Long-Term Care Insurance Planning, women are far more likely to reach an age when they will be the recipients of long-term care.  Some 980,000 women over the age of 65 are currently nursing home residents compared to only 337,000 men.  Nearly three-fourths (73.6%) of assisted living residents are women.  Twice as many women age 65-plus are being cared for in a home setting than men (3.27 million versus 1.68 million).

"It's time to talk about this significant women's issue. I encourage every woman to have a real conversation with their loved ones about their future long term care options", continued Wendt.  "For guidance, review your situation with a financial planner or insurance agent, familiar with long-term care planning, to learn about the latest resources and insurance products available to plan for your future needs. "

When it comes to long-term care insurance, women currently account for nearly two-thirds of the $6.0 billion in annual benefit dollars paid according to AALTCI.  Experts advise women begin investigating long-term care insurance in their early to mid-fifties.  "At this age you are far more likely to qualify for good-health discounts that you don't lose even if your health changes in future years," Slome concludes.

For more information, visit the American Association's for Long-Term Care Insurance's Consumer Information Center: ( where you can read the organization's free guide describing ways to save on this protection."

Oct 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

October 23 NYTimes Editorial Debunks Pre-Election Myths Circulating About Health Care Reform

Download the editorial from NY Times online

New York Times Editorial
Published October 23, 2010

Health Care and the Campaign

Republican candidates and deep-pocketed special interests are spreading so many distortions and outright lies about health care reform that it is little wonder if voters are anxious and confused.

Here are a few basic facts that Americans need to keep in mind before they go to the polls, and afterward. First, most aspects of the reform do not go into effect until 2014. Second, things are indeed bad out there: The costs of medical care and insurance premiums are (still) rising, and some employers are (still) dropping coverage. But for that, you should blame the long-standing health care crisis and the current bad economy. Health reform is supposed to help with these problems.

Here is a look at the claims being made on the campaign trail — and the distortions they contain:

PURE NONSENSE: John Raese, the Republican candidate for the Senate in West Virginia, is claiming that the law will require patients to go through a bureaucrat or panel to reach a doctor. That is flat out untrue. You will still choose your own doctor or insurance plan without interference. Nor, despite other claims, will the law provide subsidized insurance to illegal immigrants. They are precluded from using even their own money to buy policies on new exchanges.

The Obama administration will not be compiling a federal health record on all citizens, including each individual’s body mass index, as Ann Marie Buerkle, a Republican running for a House seat in upstate New York, has claimed on her Web site. The administration is offering incentives to doctors to record various vital statistics in electronic medical records and report the data in the aggregate, to help understand national health trends.

WE CALL THAT CAPITALISM: Republican politicians never tire of denouncing health care reform as a “government takeover” — or socialism. What is true is that the law relies heavily on private insurers and employers to provide coverage. It also strengthens regulation of those insurers and provides government subsidies to help low- and middle-income people buy private insurance on the exchanges.

Those exchanges will promote greater competition among insurers and a better deal for consumers, which last time we checked was a fundamental of capitalism.

WHAT ABOUT MCDONALD’S? Conservative commentators pounced after the fast food chain and several other large employers that provide skimpy, low-cost policies to their workers warned that they might drop their health plans entirely if forced to comply with the new law. They particularly objected to a requirement that they begin raising the low annual limits on what their plans are willing to pay for health care.

In response, the administration has granted some 30 waivers for one year (Rush Limbaugh promptly accused the administration of allowing these employers to “break the law”) and has signaled willingness to smooth out other bumps on the road toward full reform. In 2014, all plans will have to meet minimal standards and large employers will have to provide coverage or pay a stiff fine.

WHAT ABOUT MY PREMIUMS? Some Republicans are also claiming that health reform is driving up premiums. There have been sharp increases in some states, primarily in response to soaring medical costs. Some insurers may also be trying to increase their profits before the reform law holds them in check. A few very welcome provisions that take effect early, like requiring insurers to cover preventive care without cost-sharing, will play a minor role in premium increases for next year.

Reform has also energized federal officials and many state regulators to challenge and force down big increases sought by insurers. The Justice Department just filed suit against Blue Cross and Blue Shield of Michigan for allegedly using its market power to drive up costs for its competitors and its own subscribers.

MEDICARE SCARE TACTICS: Republican candidates routinely and cynically charge that the reform law will “cut” $500 billion from Medicare — leaving the clear implication that benefits will be reduced. In reality, the law will slow the rate of increase in payments to health care providers over the next decade, and benefits for most beneficiaries will be as good or better than they are now.

The only beneficiaries apt to see a change are those enrolled in private Medicare Advantage plans that will lose their unjustified subsides. Many of these beneficiaries, roughly a quarter of the Medicare population, may have to pay more for their plans or may lose the extra benefits, like gym memberships or dental care, that the subsidies pay for. Some inefficient plans will die out, but the efficient private plans will compete successfully with traditional Medicare — on an even playing field.

MEDICAID SCARE TACTICS: Republican governors are complaining bitterly that reform will force them to expand their Medicaid programs. What they are not saying is that the federal government will pick up the vast bulk of the added expense to cover millions of vulnerable Americans. States that do not want this largess will be shortchanging the health of their poorest citizens, who will continue to use costly — to the state and the taxpayers — emergency rooms for routine health care.

WHAT THEY’RE NOT SAYING: Health care reform has already brought substantial benefits, mostly starting in late September. Insurers are now barred from dropping coverage after a beneficiary becomes sick. Dependents can stay on their parents’ policies until age 26. Insurers must cover preventive services and annual checkups without cost-sharing. Lifetime limits on how much insurance plans will pay for treatment are gone.

The major benefits start in 2014, when tens of millions of the uninsured will gain coverage through Medicaid or by buying private coverage — with government help for low- and middle-income Americans — on the new competitive exchanges. If you lose your job, you will no longer lose access to insurance. And with government help the coverage should be affordable.

Far too few Democrats are explaining this on the campaign trail. The barrage of attack ads are hard to push back against. But the voters need to know that health care reform will give all Americans real security.


Oct 15, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

It Takes a Community: Aging Well in the 21st Century - Keynote Speech delivered by Martha Holstein, PhD, at Aging Care Connections Annual Luncheon.

Below is an excerpt from the thought-provoking and powerful keynote speech delivered by Martha Holstein, PhD, Co-Director of HMPRG's Center for Long-Term Care Reform, at Aging Care Connections’ annual luncheon held Thursday, October 14, 2010. To read the speech in its entirety, use the link below.

Download Holstein_Aging Care Connections_Keynote_10_14_10


A few weeks ago, I was talking about Social Security to a neighbor, a smart,?self-confident, politically savvy young woman. I did this because I feared, like? many others, that the now-familiar lines—it won’t be there when I need it-- will? erode political support for this essential program. So I described the program? to Erin and observed that the future of Social Security is primarily a political? and not a financial problem. To solve the financial problems is relatively easy;? to address the political problems is not. So I explained to Erin why I thought? this program was so vital and what might be done to secure its future. Among ?my arguments was this one—Social Security represents the most visible? example of a tacit compact between generations, reflecting the important but ?often submerged American value that there is something that we may call the? common good, a belief that there is not only an “I” but a “we.” A belief in the? common good is so central to how I see the world that I was startled when Erin? said, “when you used the phrase ‘common good’ I shuddered.

Task for Today

That’s what I want to talk about today--why we have lost this connection to? what unites us, and why it is so important to restore the notion of the common? good and the intergenerational solidarity that it reflects. I also want to make a? strong claim—that the human condition is more about vulnerability,?dependency, and human connectedness than it is about independence and? strength. Thus, community is essential for all of us. I will propose that a? commitment to the common good, exemplified by your aging well efforts, and? the recognition that we are all dependent are fundamental to making aging well? a more universal possibility. I will conclude with some broad ideas for how to? move toward a society where aging well is built on a firm foundation.

Use the link below to read the entire keynote speech...

Download Holstein_Aging Care Connections_Keynote_10_14_10


Oct 14, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Rockford Register Star Op-Ed on Long-Term Care Rebalancing

Health & Medicine’s Center for Long-Term Care Reform is part of an advocacy group: the Alliance for Home and Community Care — a coalition of long-term-care and community-based senior service providers.  The Rockford Register Star recently published an op-ed written by The Alliance, on the need for the state to rebalance long-term care expenditures, to fund more home and community based services. In light of the current budget crisis, we must continue to fund these home and community based providers, if we don’t we risk more people needing care in institutional settings, which costs more.

Read the op-ed 

Oct 12, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Save the Date! HMPRG Hosting a Forum on Non-Profit Hospital Charity Care in Illinois on Friday, November 5, 2010.

Even with the passage of the Affordable Care Act, many Illinoisans will be uninsured or underinsured, making charity care an important component of the health care safety net. 

The new Affordable Care Act requirements for non-profit hospitals and the IL Supreme Court’s Provena decision, make now the right time to set standards for charity care in Illinois.

 The forum will examine the history of charity care in IL, the recent IL Supreme Court decision in the Provena case and possible ways to set a clear standard for charity care in Illinois. 

Speakers include:

  • Dave Buysse, Senior Assistant Attorney General, Office of the Illinois Attorney General
  • Ralph Martire, Executive Director, Center for Tax & Budget Accountability
  • Margie Schaps, Executive Director, Health & Medicine Policy Research Group
  • Additional Speakers TBA

The forum will take place on November 5, 2010 from 8:30am-12:30pm (Location TBD).  To RSVP, please email Janna

Read the Center for Tax and Budget Accountability’s report on Charity Care

Sep 28, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Announcing the release of an exciting new book addressing solutions to health disparities!

...from our friends at Sinai Urban Health Institute

Urban Health: Combating Disparities with Local Data

The 1980s opened a discussion of the varying nature of health in different segments of the United States. Falling under the rubric of "health disparities," a great deal of research has been published demonstrating the substantial differences in health status within a population. The causes of health disparities are varied and not always clear but most researchers agree that disparities are a reflection of social and economic inequities and political injustice. One of the obstacles to addressing disparities is the lack of meaningful health data especially for vulnerable populations, which is often nonexistent despite being a critical factor for informing health programs and policies at the local level.  

Urban Health: Combating Disparities with Local Data provides a model for combating health disparities by describing how the authors gathered local health information, engaged the community at every step of the process, and created movement toward evidence-based sustainable change.  It explains how a landmark health survey in Chicago generated dramatic data that are allowing investigators throughout the city to move from data to action and from observation to intervention. In detailing how the community-focused collection and analysis of health data can serve as an impetus for improved well-being, Urban Health is an invaluable resource for researchers, community groups, students and professionals.

The book is available for order at Oxford website and Amazon

Steven Whitman, PhD: Director, Sinai Urban Health Institute, Chicago, IL

Ami M. Shah, MPH: Senior Epidemiologist, Sinai Urban Health Institute, Chicago, IL

Maureen Benjamins, PhD: Senior Epidemiologist, Sinai Urban Health Institute, Chicago, IL

Sep 27, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

NYTimes article on the rising use of midwives in Illinois and the impending changes in State law...

Great article...

Download the article from the NY Times website

September 23, 2010

Use of Midwives Rises, Challenging the State to Respond


After three “really traumatic” hospital births, Alyssa Ruben was determined to have her fourth child at home. She hired a midwife, and eight months later, Ms. Ruben delivered a healthy baby girl at her home in Geneva.

“It was amazing,” she said.

It also was illegal. Under state law, the only legal home births are those attended by a physician or a nurse midwife, an advanced-practice nurse with a secondary degree in midwifery. Kimberly McCarty, who attended Ms. Ruben, is a direct-entry midwife, an unlicensed practitioner who lacks a nursing degree. Ms. McCarty completed a three-year, informal apprenticeship with another direct-entry midwife.

Haunted by a fear of felony charges and jail time, Ms. McCarty moved to Wisconsin, one of 27 states where direct-entry midwives can practice legally. Ms. Ruben, who is expecting her fifth child in October and plans to become a midwife herself, soon followed with her family.

“My husband got a new job in Wisconsin,” she said, “but we knew we wanted to move there because of the midwifery laws, and also because Kim is there.”

While Ms. Ruben’s devotion to her midwife is exceptional, her decision to forgo a hospital delivery is not. After decades of decline, home births are on the rise in the United States, up 5 percent from 2004 to 2005, and remain steady at 25,000 in 2006 — the last year for which figures are available — according to the National Center for Health Statistics.

Reasons for choosing home births vary. Some women cite religious beliefs. Christian Scientists, for example, categorically refuse medical interventions, while some ultra-orthodox Jewish views on female modesty rule out a hospital birth. Other women opt for home births to avoid Caesarean sections, which are also increasing.

Each year, 700 to 1,000 babies are born at home in Illinois, many of them in rural locations, according to the Illinois Department of Vital Health Statistics. Licensed home-birth practitioners work in just 7 of the state’s 102 counties, and most are concentrated in Lake and Cook Counties, leaving the majority of Illinois home births unattended, or attended illegally by someone whose education and licensing are unregulated.

That could change as early as November. After 30 years of trying to get the legislature to license direct-entry midwives, Illinois’s midwifery organizations are guardedly optimistic. In May, the State Senate passed the Home Birth Safety Act. A House vote is pending.

The bill’s supporters say it toughens standards and protects pregnant women and fetuses from untrained practitioners, while allowing qualified midwives to practice openly and to transport emergency cases to hospitals without fear of reprisal or arrest. (Women often register home births as “unassisted” to protect their midwives.)

State Representative Robyn Gabel, Democrat of Evanston, is the bill’s chief sponsor. “It’s an uphill battle in the House,” Ms. Gabel said.

That the bill has made it this far is testament to the midwifery community’s newfound political acumen and its first lobbyist, hired by the Coalition for Illinois Midwifery in 2006.

The bill’s opponents, including the American College of Obstetrics and Gynecology, the Illinois State Medical Society and the American Medical Association, argue that home births are inherently more dangerous than births in medically supervised settings. Also resisting the bill, though more quietly, are members of rural midwifery groups that have operated under the radar and off the grid for years, and would prefer to remain that way.

“We just don’t think home is a safe environment for delivery,” said Dr. Jacques Abramowicz, co-director of the Fetal and Neonatal Medicine Center at Rush University Medical Center and a Fellow of the American College of Obstetrics and Gynecology. “Childbirth is very dynamic, and it can be a very dangerous process. In the vast majority of cases, nothing happens. However, if an emergency occurs, it happens very fast — in two, three, four minutes.”

Rachel Dolan Wickersham, president of the Coalition for Illinois Midwifery and the vice president of the Illinois Council of Certified Professional Midwives, is the midwife groups’ lobbyist. She said she was frustrated by the bill’s opponents in the medical community.

“There’s just no room for negotiation,” Ms. Wickersham said. “It’s a turf battle. It’s about power and control. These women are going to have babies at home. There’s no question about that. Why would anyone want to keep the situation so that the person attending them has no regulated training or is afraid to transport them to a hospital in an emergency?”

Whether home births are riskier has not been definitively shown. There is evidence to support both physicians’ and midwives’ positions.

But in 2008, Childbirth Connection, a nonprofit, maternal health research organization, co-authored a report based on hundreds of studies of maternity care in the United States. It said medical interventions, even in low-risk pregnancy and labor, had increased substantially in the past two decades. The number of induced labors, for example, doubled from 1990 to 2005, while Caesarean sections accounted for a record-high 40 percent of United States hospital births — versus 4.5 percent in 1965.

Meanwhile, according to the federal Centers for Disease Control and Prevention, maternal mortality in the United States is on the rise. Midwifery advocates say these figures support their contention that the majority of Caesarean sections are unnecessary and potentially dangerous.

After three hospital births, Jamie Stoltzfus of Decatur knew she hated the way epidurals made her feel, and thought a water birth, in which the baby is born into a pool or bathtub, might be a good alternative for her fourth delivery.

Her doctor was unenthusiastic. “She said something like, ‘Oh, honey, hospitals don’t really do that,” Ms. Stoltzfus said. “It’s too messy to clean up afterward.’ ”

Now expecting her seventh child — her fourth home birth — Ms. Stoltzfus said she had no qualms about using a direct-entry midwife. “I know my midwife’s qualifications are as good or better than some of the doctors I’ve used in the past,” she said.

Kristina Stevens graduated from nursing school at the University of Illinois at Chicago in May and began a three-year course to become a legal nurse midwife. She supports the Home Birth Safety Act.

“There’s a trend of more women having home births,” Ms. Stevens said, “and they need trained practitioners.”

Obstetricians are not practicing in the southern part of the state, she said, because liability costs are so high. “They need to make room for people who will do that work,” Ms. Stevens said, “and there has to be legislation to support those people.”

Dr. Abramowicz conceded that poor women in some areas do not have anyone to attend their deliveries. “But the solution is not to allow very untrained people to become licensed,” he said. Instead, he said, the government should give incentives, including school-loan forgiveness programs, to rural obstetricians.

While economics and geography certainly inform the midwifery debate, one question cuts to its core: What is the extent of a pregnant woman’s autonomy? Midwifery advocates say women are often patronized or ignored when medical decisions are made during hospital deliveries.

Cassandre Creswell of Chicago, whose first child was born in a hospital, had her second at home to avoid the “combative experience” of defending a natural-birth plan in a delivery room.

Dr. Abramowicz conceded the point, saying, “To tell you we are ecstatic when a woman comes in with a birth plan would not be the truth.”

But, he added, hospital births can be a collaborative experience between patient and doctor. “We’re not telling women what to do,” he said. “We’re telling women what we think is best.”

That is unlikely to sway women like Alyssa Ruben.

If she developed risk factors, Ms. Ruben said, “I would obviously go to the hospital.” But, she added, she vastly prefers the care from her direct-entry midwife.

“It’s very woman-centered, totally different than what happens in the hospital,” she said. “I’m in charge of my labor and my pregnancy, not taking a back seat the way doctors want you to do.”

This article has been revised to reflect the following correction:

Correction: September 24, 2010

A previous version of this article had the incorrect given name for a nursing school graduate who is starting a three-year course to become a legal nurse midwife. It is Kristina, not Chirstina.



Sep 23, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

HMPRG Testimony before the Illinois Health Reform Implementation Council

Download HMPRG Testimony-September 2010

Testimony before the Illinois Health Reform Implementation Council
September 22, 2010

Thank you very much for the opportunity to testify today on the critical issue of how best to implement the Affordable Care Act in Illinois.  My name is Margie Schaps and I am the Executive Director of the Health and Medicine Policy Research Group, a 29 year old research, policy and advocacy organization with a mission focused on the health of the poor and underserved.

The provisions of the Affordable Care Act have the potential to improve the public’s health through insurance accessibility, workforce development and new service delivery model development with a focus on prevention, quality and outcomes.  This Act provides Illinois the opportunity to be a leader, to take advantage of the flexibility of the Act in developing innovative programs that have the potential to improve the public’s health and reduce healthcare expenditures. More critically, the Act requires Illinois to establish state-based capacity that will meet the needs and expectations of Illinois residents for better and more cost-effective health care. As the state contemplates these exciting tasks, we have several recommendations and will have more at the other public hearings.

First, with regard to health insurance reforms, we would support the development of legislation that will enhance the authority and oversight capability of the Department of Insurance. We recommend the Department increase collection of and transparency of health plan data including premium increases and how insurance company profits and expenditures are balanced with the use of premium dollars for services. Specifically, the law requires that reporting on health insurance company medical loss ratios must be provided to HHS- we recommend transparency of this information through making it available to the public through the website of the Illinois Department of Insurance. Furthermore, as the law allows, Illinois should be at the forefront of evaluating whether we can institute a higher medical loss ratio than is federally required as well as evaluating what is included in the MLR. We recommend that Illinois institute a ban on pre-existing conditions and that we eliminate gender rating as soon as 2012 and certainly before 2014 when the law requires. 

The federal law allows for much innovation in Medicaid through delivery system improvements and coordination of care to contain spending and improve outcomes—The State should take advantage of these opportunities. We must utilize existing evidenced based quality measures and outcomes benchmarks from AHRQ and the National Quality Forum and ensure strong consumer protections as we choose new modes of care to make sure that they truly improve access for consumers. Illinois’ experience with primary case management and other Medicaid financial incentives should be used to transition providers into patient-centered medical home models of practice. We should develop a program based on successful models in other states like Vermont so that we can more quickly expand capacity, increase patient satisfaction, improve patient outcomes and reduce waste in the system. In working with the provider community, the State should both shape and align initiatives with our large institutional systems in response to both private sector and Medicare demonstrations in an effort to leverage state investment efficiently with the resources of others.  HMPRG recommends that the state form a commission made up of stakeholders from payer, provider, purchasers and patient groups that will articulate the vision of what we want to see under a reformed health system in Illinois.  Direct and regular input from stakeholders will help ensure that the fundamental principles of transforming the system are vetted, tested and broadly evaluated.

Based on the research of our Center for Long Term Care Reform we believe that global payment systems, bundled payment systems, and coordinated care through transitional care programs that utilize a variety of providers and settings all have the opportunity to maximize provider efficiency, improve quality and reduce waste in the system.
HMPRG has long been an advocate of broadening the delivery system settings and providers to make it easier to access services, improve quality and reduce costs. We should increase the availability of freestanding birth centers, school-based health centers, hospice, retail clinics and connect these alternatives to ongoing, continuous primary care medical homes—and expand the clinical authority and practice collaborative models using nurses, nurse practitioners, social workers, pharmacists, community health workers and other health care providers to help address the workforce shortages we will be facing. One successful model of this is the Fairview Health Services in Minneapolis-St.Paul

With regard to the development of the exchange in Illinois, we recommend that there be significant representation of consumers and advocates on the group that is put together to define the exchange. Second we would urge you to use community based organizations, FQHCs and others based in communities as the Navigators to assist in enrollment.  Ensuring basic consumer protections can be facilitated by using the Massachusetts Connector Board experience—this Board oversees decisions on available health plans, determines subsidy levels and governance issues with one third of its members being consumers and leaders of advocacy organizations and labor.

 We would implore you to put in place a mechanism whereby you know about every upcoming deadline for potential grant money from the federal government related to the implementation of this Act. So many of the upcoming grant opportunities represent the greatest chance for health reform to be successful in bending the curve of spiraling health care costs.  In addition to the ones mentioned above, the opportunities for grants to expand the healthcare workforce will be essential for Illinois as we face serious shortages in the number of personal and home care aides for the elderly and disabled, direct care workers in nursing facilities, assisted living and home and community based settings for example. 

To facilitate the best implementation of the Act, we believe it is essential for the State to restructure the way it organizes health services and programs at the state level.  We believe the restructuring that took place in the mid-1990s has not led to an integration of services and population-based health initiatives and has not served the people of Illinois very well.  The reforms which led to the separation of maternal and child health programs from other public health and primary care initiatives has not reduced costs and impedes our ability to ensure quality, evaluation, care coordination and data sharing, all essential under health reform.  HMPRG recommends that the Maternal and Child health programs should be reunited under the Department of Public Health as they are in most states in the country, and that there should be a central point responsible for overseeing quality improvements and indicators of health programs developed under the new law.

HMPRG recommends conducting a baseline analysis and a series of benchmarks depicting where the state is now in terms of spending, innovation, programs and services, population-based measures and system-based measures-- so that we can put in place a monitoring system to track both intended and unintended consequences of health reform. 

Health and Medicine stands ready to help develop a collaboration of stakeholders to work with the state as they design accountability measures for successful implementation of the ACA.

All of the recommendations that we and others make must recognize that there will remain a strong need for safety net providers in our state for those roughly half million people who will not have health insurance but also those who the private sector traditionally has not served; the homeless, those with severe mental illness, migrant farm workers and those with HIV.

Thank you for the opportunity to provide this testimony.

Sep 21, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Quentin Young Papers part of Northwestern University Library Exhibit

A portion of the papers of Dr. Quentin Young, which were recently donated to the Northwestern University Archives, are on display as part of a larger exhibit at the Northwestern University library, titled: "Global Health: Access and Information."

The lynchpin of the exhibit, Tracy Kidder's Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, is being used to leverage a broader conversation with students and visitors about global health.

The exhibit, which runs from September 7 through October 22, 2010,  includes:

          o The papers of  Quentin Young, a Northwestern Medical School Alumnus ,  national leader on public health policy and social justice issues, and founder and chairman of Health & Medicine Policy Research Group (HMPRG)

          o Rare materials dating back to the eighteenth century documenting efforts to alleviate poverty and disease among the global poor

          o Books on global health initiatives in Africa, and

          o Books, reports and journals describing emergency transportation and evacuation in the wake of natural disasters

Link to the library information and bibliography for the exhibit

The library is located at 1970 Campus Drive   Evanston, IL 60208-2300  

Evanston: 847.491.7658

Mountains Beyond Mountains—and Beyond!

Submitted by Editor on Mon, 08/30/2010 - 17:11

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The Library wants to help you join the campus conversation on this year's One Book, One Northwestern selection, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World.  Our new exhibit "Global Health: Access and Information" (September 7 through October 22, 2010) takes you beyond Tracy Kidder's fascinating look at a doctor who's dedicated his life to serving some of the world's poorest populations.  We're featuring a selection of Dr. Farmer's own books; previous books by Pulitzer Prize-winning author Kidder; and items that highlight the diversity of the Northwestern University Library research collections, including

    • The papers of Dr. Quentin Young, a Northwestern Medical School Alumnus and national leader on public health policy and social justice issues
    • Rare materials dating back to the eighteenth century documenting efforts to alleviate poverty and disease among the global poor
    • Books on global health initiatives in Africa, and
    • Books, reports and journals describing emergency transportation and evacuation in the wake of natural disasters
Sep 20, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)



As a supporter of Health & Medicine we know you share our commitment to making Freestanding Birth Centers a reality in Illinois…that’s why we need your help now to make a change in the Rules as published.

As you know, following the enactment of Public Act 095-0445 we’ve been working with the Illinois Department of Public Health for the past 3 years to develop rules and regulations governing the establishment of birth centers in Illinois.

While the Illinois Birth Center Task Force has reviewed these PROPOSED RULES and agrees with them in the most part, we still have concerns about several burdensome and unnecessary requirements.   We have prepared a list of recommended changes categorized by those proposed rules that we believe are most critical ("Highest Priority) to amend or delete, and those that are of lower priority.  Read our recommendations here. 

The proposed rules for the Birth Center Demonstration Project have been posted on the Illinois Register and are now available for public comment. You can view them at:   Illinois Register.BirthCenters (go to page 12012). or cut and paste

The public still has a brief opportunity to add additional comments and suggestions.  IT IS VERY IMPORTANT that you use this opportunity to have an impact on the viability of establishing Birth Centers in Illinois.  Even if you live in another state, your comments will be useful – particularly if you have experience with existing birth centers or with a birth center review process!

After you read our recommendations, we urge you to use them in part or in whole to develop your response.

Finally, because the next step  is for IDPH to submit their final responses to body called the Joint Committee on Administrative Rules (JCAR), it would be helpful if you would talk with your legislator if he or she is on JCAR. The list can be found at:

Please send your comments to the following address.  They most be postmarked by October 1, 2010!

Susan Meister

Illinois Department of Public Health

535 West Jefferson St., 5th Floor

Springfield, Illinois 62761





Sep 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Public Illinois Hearings on The Affordable Care Act

Below is the list of Public Hearings on The Affordable Care Act, to be held by Governor Quinn’s Health Reform Implementation Council.

The topic of the first meeting is “establishment of a health insurance exchange and related consumer protection reforms.” The Council will be interested in hearing from consumers and business owners about the challenges they have experienced in securing affordable health insurance. Future meetings we will discuss workforce, Medicaid reform and improvements to enrollment systems, and incentivized delivery systems to assure high quality health care and outcomes.  We will keep you posted as we receive more information.

September 22, 2010
3:30 PM - 6:00 PM
James R. Thompson Center
100 W. Randolph, Concourse Auditorium
Chicago, IL 60601
**you must have a photo ID to enter the building**

October 5, 2010
3:30 PM - 6:00 PM
Illinois Central College
Arbor Hall Auditorium
5407 N. University St.
Peoria, IL 61614

Another October Date TBD  (we'll post once we know)

November 16, 2010
4:00 PM - 6:00 PM
Howlett Building, Auditorium
501 S. 2nd St.
Springfield, IL 62756
**you must have a photo ID to enter the building**

Sep 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Press Release from PNHP, RE: Skyrocketing Number of Uninsured...

From our Friends at Physicians for a National Health Program (PNHP)

Number ofuninsured skyrockets 4.3 million to record 50.7 million in2009

Big leappoints to urgency of enacting single-payer Medicare for all: national doctors'group

Sept. 16, 2010


Quentin Young, M.D.

OlveenCarrasquillo, M.D.

Margaret Flowers, M.D.

Mark Almberg,PNHP, (312) 782-6006,
Local physicians in almost all 50 statesavailable for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureaushowing a dramatic spike of 4.3 million in the number of Americans withouthealth insurance in 2009 - to a record 50.7 million - underscore the urgency ofgoing beyond the Obama administration's new health law and swiftly implementinga single-payer, improved Medicare-for-all program, according to Physicians for aNational Health Program, a 17,000-member physician group.

The Census Bureau reported that 16.7percent of the population lacked health insurance coverage in 2009, up from 15.4percent in 2008, when 46.3 million were uninsured.

Lack of health insurance is known to havedeadly consequences. Last year researchers at Harvard Medical School showed that45,000 deaths annually can be linked to lack of coverage.

"Tragically, we know that the new figuresof uninsured mean a preventable annual death toll of about 51,000 people -that's about one death every 11 minutes," said Dr. Quentin Young, nationalcoordinator of PNHP. Young is a Chicago-based retired physician whose privatemedical practice once counted President Obama among its patients.

Young said that even if theadministration's new health law works as planned, the Congressional BudgetOffice has projected about 50 million people will be uninsured for the nextthree years and about 23 million people will remain uninsured in 2019.

"Today's report suggests those projectionsare likely too low," he said.

The jump of 4.3 million uninsured is thelargest one-year increase on record and would have been much higher - over 10million - had there not been a huge expansion of public coverage, primarilyMedicaid, to an additional 5.8 million people.

The rise in the number of uninsured wasalmost entirely due to a sharp decline in the number of people withemployer-based coverage by 6.6 million. In 2009, 55.8 percent of the populationhad such coverage, having declined for the ninth consecutive year from 64.2percent in 2000.

The record-breaking number of uninsured -exceeding 50 million for the first time since the Census Bureau started keepingrecords - includes 10 million children.

The biggest jumps in the percentage ofuninsured were in Alabama, Oklahoma, Ohio, Missouri, Georgia, Delaware, NorthCarolina and Florida. In terms of absolute numbers, the biggest increases werein California, Florida, Texas, Ohio, Georgia, North Carolina, Illinois, Alabama,Michigan and Pennsylvania. In Massachusetts, 295,000 people remain uninsureddespite that state's 2006 reform. (See link below for historical tables of theuninsured by state.)

"The only way to solve this problem is toinsure everyone," Young said. "And the only way to insure everyone at areasonable cost is to enact single-payer national health insurance, an improvedMedicare for all. Single payer would streamline bureaucracy, saving $400 billiona year on administrative overhead, enough to pay for all the uninsured and toupgrade everyone else's coverage."

Dr. Olveen Carrasquillo, a PNHP boardmember and chief of general internal medicine at the University of Miami'sMiller School of Medicine, noted that the Census Bureau was once again silent onthe pervasive problem of "underinsurance."

"Not having health insurance, or havingpoor quality insurance that doesn't protect you from financial hardship in theface of medical need, is a source of mounting stress and poor medical outcomesfor people across our country," Carrasquillo said.  New researchhas found that about 14.1 million children and 25 million non-elderly adultswere underinsured in 2007, a figure that is likely much higher today.

"The government subsidies under the newhealth law will not be sufficient to provide quality and affordable coverage tothe vast majority of Americans," he said. "Tens of millions will remainuninsured, underinsured and without access to care. We need more fundamentalreform to a single-payer national health insurance program."

State-by-state data on theuninsured from 2006-2009 can be found here:

Physicians for a National Health Program( is anorganization of more than 17,000 doctors who support single-payer nationalhealth insurance. To speak with a physician/spokesperson in your area, or call(312) 782-6006.

Sep 14, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

HMPRG Board Member, Geeta Maker-Clark MD, Featured In Chicago Tribune Article on Healthy Food Options

Download the article from The Chicago Tribune

Geeta Maker-Clark and her husband Todd prepare dinner and next-daylunches for their kids, from left, Devika, 2, Sachin, 5, and Sahaara,7, in their Evanston home on Tuesday.(Phil Velasquez, Chicago Tribune / August 30, 2010)

What's in the bag?

Parents, kids, manufacturers rethink lunch

By Emily Bryson York, Tribune reporter

10:39 PM CDT, September 12, 2010

With back-to-school season in full swing, busy parents aretrying to find convenient yet nutritious ways to hand their kids ahealthy lunch. And that has the attention of food manufacturers.

Kraft Foods Inc., General Mills Inc., Campbell's Soup Co. and ConAgraFoods Inc. are some of the food companies trying to show that packagedfood can deliver on price, convenience, taste and health. From Kraft'sLunchables to ConAgra's Chef Boyardee, food manufacturers arereformulating their products in an effort to lure more parents.

Some parents, with memories of what packaged foods looked like in theirchildhoods, need more convincing. Nutritionists are more skeptical, andsome doctors say that substitutes and fillers in reduced-calorie foodscan be worse for kids than full-fat versions.

Still, the demand for convenient packaged food that can count towarddaily fruit or vegetable requirements is increasing. Experts say that'sdriven not just by moms and dads but by kids. The major packaged-food companies have launched products with reduced fat, calories or sodium for fall.

Darin Dugan, senior director of marketing for Kraft's Lunchables, saidthat while kids will opt for tastier options just like everyone else,they've also got an eye on what's good for them.

"Moms and kids are looking for fresher, more wholesome, less-processedlunch options," he said. "While kids aren't as nutritionally aware asmoms, kids will tell you they know foods that are good for them and notso good for them."

Lunchables recently underwent sweeping changes to packaging andadvertising, which came on the heels of product reformulations that cutcalories, fat and sodium and also removed high fructose corn syrup frommost of the line. The result has been dramatic sales gains that thecompany describes as about 10 percent. According to grocery scanner datafrom SymphonyIRI Group, a Chicago-based market research firm,Lunchables sales increased 6 percent over the 52 weeks ended August 8,to $578 million. IRI data doesn't include Wal-Mart or club stores.

Lunchables is just one example. While Gen Y parents may have had baloneyon white bread, chips, a juice box and a snack cake, for instance,their kids may be more likely to have sandwich on wheat bread, fruit,pretzels or yogurt, and maybe a piece of candy.

For fall, in response to the shifting mandate, ConAgra's Chef Boyardeebrand is promoting whole-grain pastas, while General Mills' Yoplait isadvertising Go-Gurt,a yogurt that can go into a lunchbox frozen and bethawed by lunch time.

Campbell's is pushing its fruit-and-vegetable drinks, V8 V-Fusion, whichoffer a full serving each of fruits and vegetables. The idea is tosneak vegetable nutrients into children's diets with a sweet-tastingbeverage.

Some doctors and nutritionists argue that this strategy misses thepoint. The foods are, in short, side-stepping opportunities to eat wholefoods that have fewer calories and more fiber, they say.

Geeta Maker-Clark, a family physician with NorthShore UniversityHealthSystem, said she sometimes views the processed-food industry as"the enemy" of her work.

"They market in such a way as to make the food seem irresistible andimpossibly convenient for parents, and they really sort of create asituation in which it's easier and cheaper for parents to choose whatthey're offering versus something that's clearly going to benefit theirchildren," she said.

Highly processed food, she added, can be particularly dangerous forchildren with inflammatory conditions like asthma. "(It) can worsentheir problems," she said. "And I don't think most people know that."

Better-for-you updates of classic processed food are generally focusedon reducing fat, calories and sodium, and sometimes removing suchingredients as high fructose corn syrup. Products that meet establishedcriteria may be promoted within grocery stores as a "better for you"option.

In the absence of universal guidelines, the packaged-food industrycreated a "Smart Choices" labeling system, in an effort to denotehealthier foods. The FDA shut down that program last fall and is in theprocess of establishing a federally-regulated standard.

From a business perspective, however, healthier makeovers often seem toboost sales. For instance, Lunchables discontinued its Maxxed Out line,which had larger portions and higher calories. Lunchables also launched asub-segment dubbed "Lunchables with water," which features white-meatchicken and turkey, crackers with whole grain, mandarin oranges,unsweetened applesauce or sugar-free Jell-O, and, of course, water.

Northfield-based Kraft has also revisited packaging and advertising.Kraft ditched movie tie-ins on packaging, and nutritional information ismore prominent. Most Lunchables trays are now clear, because moms saidthey wanted to be able to see the food inside. Because the plastictrays aren't recyclable, Kraft moved to avoid "green" criticism bypartnering with TerraCycle to convert used Lunchables containers intolunch boxes and pencil cases.

New ads focus on kids' potential, and an updated logo stacks the words"Lunch" and "ables." One advertisement, depicting a young boy doing achalk drawing, says, "Even da Vinci started somewhere." The ad ispromoting a cheese-pizza lunch, with a side of mandarin oranges.

Katie Nahrwold, a mother of four who lives in Kenilworth, said she seeslots of Lunchables boxes when she volunteers in the school lunchroom.She added that some parents get it for their children as a Friday treat.

"I think it's easy for working parents just to grab and go," she said.She buys the meals occasionally when in the grocery store with her kidsat lunchtime, but they often eat the treat and leave the rest. "Itreminds me of those old TV dinners," she said.

Juliet Berger-White, of Evanston, said she doesn't buy Lunchablesbecause her daughter wouldn't like everything in the container. It'seasier for her to assemble a lunch piecemeal. For the first day ofkindergarten, she packed a turkey sandwich on wheat bread, pretzels,organic baby carrots, a plum, water and an organic juice box. Most days,Berger-White adds a small treat, like a piece of chocolate.

"I think it's fair to say we have to strengthen our relationship withmoms and with kids," said Lunchables' Dugan. He added that changes tothe products are altering parents' perceptions in Kraft focus groups. Ofthe families tracked over the last year, 68 percent said Lunchablesquality has improved , and 89 percent like the new package.

"Moms told us they really wanted to see the food," Dugan said, addingthat "kids like what we're doing, and they understand that the move tofresher, less-processed foods is the right thing to do."

Nutritionists are still skeptical. "I always applaud when companiesreduce calories, sodium and fat," said Toby Smithson, a registereddietician and spokeswoman for the American Dietetic Association. Sheadded, however, that Lunchables' sodium levels "still tend to be high,"and while improvements are a good thing, "we're not quite there yet."

For some families, home-made lunches are the only way to go. Maker-Clarksaid that for her children, ages 7 and 5, she has a handful of lunchoptions that create variety and make her kids feel good about eatinghealthy. One day may feature a whole-wheat pita with almond butter,banana and unsweetened coconut flakes, celery with peanut butter andraisins, or cheese and crackers with grapes and a hard-boiled egg. Sidesmay include berries or Stonyfield Farm's YoBaby yogurt.

"School lunch is a great opportunity," Maker-Clark said of getting kidsto eat healthy. "If they're having a great lunch, and (other) kids seeit, they have a sense of pride around what they're eating. That's workedfor my kids. They take pride in their great lunches, and so they tellother kids about them."

Sep 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Congratulations to the Winners of the 2010 HMPRG Awards!

In 2006, Health and Medicine Policy Research Group (HMPRG)established an awards program, to commemorate the 25th anniversary of theorganization’s founding.  The purpose ofthe awards was to recognize public health vision and leadership in the areas ofHealth, Medicine, Policy, and Research; along with a fifth award which waspresented to a Group for its focus on the determinants of health and its impactbeyond the scope of its programs.. The awards were presented that year andagain in 2009 when we added two new award categories for an Emerging HealthLeader and a Young Health Activist.  

We are very pleased to announce the 2010 HMPRG Award Winners:

  • Health - Jose Lopez; Executive Director of the Puerto Rican Cultural Center
  • Medicine - Ghassan Souri, DDS; Vice President of Oral Health Services,  Erie Family Health Center
  • Policy - Julie Hamos; Director of the Illinois Department of Healthcare and Family Services & Patrick Lenihan; Executive Director of the Northern Illinois Public Health Consortium
  • Research - Richard Warnecke, PhD; UIC Institute for Health Research and Policy
  • Group - Chicago Women's Health Center
  • Emerging Health Leader - Abby Hymen; Director of Youth Programs, Hyde Park Neighborhood Club

Please join us on October 7th at "Honoring Leaders in Our Midst," as we celebrate these public health leaders!  Get information about the event and order tickets

Don't forget to enter "The 'i's' Have It" Raffle for a Chance to Win Great Apple Prizes Worth $1000+ (All proceeds go to Health & Medicine) (Winners Need Not Be Present at the Event to Win)

Download RaffleFlyer

Download AwardsFlyer-91310

Aug 25, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

HMPRG's Martha Holstein's New York Times Letter-to-the-Editor on Social Security

Is It Fair to Raise the Retirement Age?

To the Editor:

Re “Attacking Social Security,” by Paul Krugman (column, Aug. 16):

The importance of Social Security generally and the retirement age specifically is closely linked to race, class and gender.

Viewed from the perspective of privilege (most legislators and theco-chairmen of the National Commission on Fiscal Responsibility andReform, consciously or otherwise, see the world through that lens), itis easy to say that we are living longer and can work longer. But thegeneralization breaks down once we start paying attention to the workhistories, health status and other limiting conditions that affect vastnumbers of older people — mostly women and people of color.

There are many ways of “fixing” Social Security that will not undulypenalize those who cannot work until 70 or beyond because there are nojobs, or because they are simply too tired or worn down. Unlike peopleof privilege, they cannot retire without full benefits.

No policy should be considered just that further harms the already disadvantaged.

Martha Holstein
Chicago, Aug. 16, 2010

The writer is co-director of the Center for Long-Term Care Reform.

Aug 25, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

HMPRG's Public comment on the Illinois Health Information Exchange operational plan

This is the letter was submitted by HMPRG to the State on August 19, 2010

Health and Medicine Policy Research Group is an independentnon-profit policy center that conducts research, educates, and collaborateswith others to advocate for policies and impact health systems to improve thehealth status of all people.  In 2006,Health & Medicine began an initiative that convened a broad group of healthcare safety net stakeholders in northern Illinois (those institutions thatprovide health services to uninsured, Medicaid, and other vulnerablepopulations) to determine priorities and recommendations for strengthening thesafety net. 

One priority that was identified was the necessity for allhealth care institutions to use electronic health records and be connectedthrough a health information exchange.  Itwas also determined that connecting medical data to public health data and datafor the social determinants of health (such as education, social services, housingand employment status) would play a critically important role in the publichealth community’s ability to improve the health status of all.

We are pleased that the IL HIE Strategic and OperationalPlan includes a strong emphasis on public health and that a Public HealthAdvisory Committee will continue to meet as HIE planning ends andimplementation begins.  Health &Medicine hosted a forum in early 2010 calling for the inclusion of broad publichealth data elements in the HIE plan, as well as data for behavioral health,case management, and nursing services. While we laud your efforts to include the public health community, wewant to ensure that the public health data elements, including the socialdeterminants of health, are linked to the medical data through the HIE.  For example, asthma and lead poisoning ratescould be linked to housing data, which would help public health professionalsmore effectively target prevention and treatment initiatives. 

We look forward to the inclusion of public health in IL’sHIE. We encourage the State to remember that the health status of our residentsis determined by more than their medical services, and that in order for us tocomprehensively improve our health status, we must have current, timelyinformation on the factors that most affect our health on a day to daybasis. 


Margie Schaps, Executive Director                               

JannaStansell, PolicyAnalyst

Quentin D. Young, Chairman

Aug 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Report from The Illinois Department of Healthcare and Family Services on Efficiencies and Improvements in the Illinois Medicaid Program

Aug 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Interesting Opinion Piece About Quentin Young's Health Care Vision from The Capital Times, Madison, Wisconsin

Download the article from The Capital Times

President Obama should heed his doctor’s advice

John Nichols | Capital Times associate editor | Posted: Sunday, August 15, 2010 5:15 am

Dr. Quentin Young, the longtime leader of the national campaignfor real reform of our broken health care system, is a familiarfigure to many Wisconsinites. He has appeared frequently inMadison, often at the side of his fellow activists on behalf of“Medicare for all,” Dr. Eugene Farley and his late wife, Dr. LindaFarley.

Still active at 87, Young is a remarkable figure whosecontributions as medical researcher, clinical professor and policyanalyst led to his selection as president of the American PublicHealth Association and a member of the American College ofPhysicians’ Health and Public Policy Committee.

But Young has also been a working physician, maintaining apractice in Chicago’s Hyde Park neighborhood where he served as thepersonal physician to the Rev. Martin Luther King Jr., formerChicago Mayor Harold Washington and a young lawyer named BarackObama.

When Young celebrated his 80th birthday in 2003, Obama helpedlead the celebration. That was back when Obama was an outspokenadvocate for real reform along “Medicare for all” lines. Indeed,Obama said back then: “I happen to be a proponent of a single-payeruniversal health care program. I see no reason why the UnitedStates of America, the wealthiest country in the history of theworld, spending 14 percent of its gross national product on healthcare, cannot provide basic health insurance to everybody. Andthat’s what (activists are) talking about when (they say)‘everybody in, nobody out’: a single-payer health care plan, auniversal health care plan. And that’s what I’d like to see. But asall of you know, we may not get there immediately. Because first wehave to take back the White House, we have to take back the Senate,and we have to take back the House.”

After the scenario Obama sketched came to pass, he compromised,delivering far less than “Medicare for all.” And old friends suchas Young have expressed their concerns.

But what is strange and troubling is that the Obama White Houseis now deriding activists like Young, with press secretary RobertGibbs grumbling: “That’s not reality.”

Well, didn’t Barack Obama once think it was “reality”?

And isn’t Gibbs engaging in a creepy form of demagoguery? That’swhat Young suggests in a letter to the press secretary: “When Ifirst read your interview, my reaction was incredulity. The quotesyou offered reflected the worst tea party disinformation. I andmany others strongly believe these intemperate and mendaciousattacks on progressives dissatisfied with some of theadministration’s incredible concessions to the militant right-wingRepublicans are extremely destructive.”

Young warned that the press secretary’s remarks run the risk of“(driving off) those of us who supported the president’s campaignand have anguished over the fruitless lurches to the right thathave characterized the first half of the president’s firstterm.”

Obama would be wise to consider what his former physician says.Even as they differ, Young remains a far wiser and better friend tothe president than Gibbs.

John Nichols is associate editor of The Capital

Aug 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

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All proceeds go to Health & Medicine Policy Research Group (HMPRG).

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Raffle drawing to be held on October 7, 2010 at The 2010 HMPRG Awards. Winners need not be present – but it’sa great event to attend!

Aug 05, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Quentin Young on the individual mandate, Missouri and more...

Quentin Young on the individual mandate, Missouri, and a rebuttal of the RNCC's MichaelSteele

Read the article on Medpage Today

MissouriVotes Against Healthcare Reform Mandate

By Joyce Frieden, News Editor, MedPageToday
Published: August 04, 2010

Missouri residents have voted for a measure exempting residents of the statefrom the "individual mandate" provision of the new healthcare reform law.

The mandate, part of the Patient Protection and Affordable Care Act signedby President Obama on March 23, requires all individuals to purchase healthinsurance or pay a penalty beginning in 2014.

The vote in Tuesday's statewide election was 71% to 29% in favor ofProposition C, which asked "Shall the Missouri Statutes be amended to:

  • Deny the government authority to penalize citizens for refusing to purchaseprivate health insurance or infringe upon the right to offer or accept directpayment for lawful healthcare services?
  • Modify laws regarding the liquidation of certain domestic insurancecompanies?"

The ballot went on to explain that "it is estimated this proposal will haveno immediate costs or savings to state or local governmental entities. However,because of the uncertain interaction of the proposal with implementation of thefederal Patient Protection and Affordable Care Act, future costs to stategovernmental entities are unknown."

Although the vote of 667,680 to 271,102 was considered a "landslide" by themeasure's supporters, only about 20% of registered voters weighed in on thequestion.

That's only slightly higher than the typical turnout in August specialelections, according to Missouri newspapers. Voters were also asked to decideprimary races for the Senate and the House of Representatives.

There is also a question about whether the Proposition C vote is enforceable,since federal law usually preempts state law.

Legal issues aside, Republican officials were elated by the victory.

"By rejecting ObamaCare with nearly three-quarters of the vote in a criticalswing state, Missouri sent a clear message to Democrats and the Obamaadministration that government-run healthcare is a gross over-reach of thefederal government that needs to be repealed and replaced," Republican NationalCommittee chairman Michael Steele said in a statement.

"Last night's decisive vote against a key provision of ObamaCare, arguablythe cornerstone of the Obama presidency, shows how completely detached theDemocrat agenda is from the American electorate," Steele said.

But other groups heard a different message.

"The vote in Missouri ... shows that people do not want to have their healthbenefits linked to penalties and fines, but would much prefer a rational systemof finance that covers everybody in a comprehensive way, as Medicare alreadydoes for persons over 65," Quentin Young, MD, national coordinator of Physiciansfor a National Health Program, which favors a single-payer system, said in ane-mail to MedPage Today.

"It's possible to oppose the newly enacted mandate to purchase private healthinsurance while retaining some of the desirable reforms embedded in thelegislation, [such as] no exclusions for preexisting conditions, no rescissions,and no lifetime caps on claims," Young wrote. "However, serious reform of ourdesperately troubled health system is contingent on the enactment ofsingle-payer, an improved Medicare for all."

Measures similar to Proposition C will be on the ballot in Arizona andOklahoma in November. A proposal scheduled to appear on Florida's ballot wasnixed by a circuit court judge in that state because a proposed ballot summarycontained misleading information.

Aug 05, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Quentin Young's Comments in The Chicago Tribune on Medicare's 45th Birthday

Quentin's recent article on the Anniversary of Medicare was printed in theChicago Tribune

Read the article at

Rx for Medicare's birthday: Expand it


By Quentin Young

6:37 PM CDT, August 4, 2010

Medicare, one of our nation's most cherished social programs, turned 45 lastweek.

I was in active medical practice on July 30, 1965, when Medicare was signedinto law by President Lyndon B. Johnson. Its impact on older Americans and theirfamilies was swift and spectacular. I saw the results with my own eyes.

Almost overnight, millions of Americans age 65 and older had the doors tohealth care opened to them that had hitherto been closed. They streamed into ourdoctors' offices seeking long-deferred and sometimes urgently needed medicalattention.

Simultaneously, the specter of crushing medical debt was lifted from theshoulders of tens of millions of America's seniors and their children. You couldalmost hear a collective sigh of relief.

That was only the beginning. Through the years, Medicare dramatically reducedpoverty among the elderly. It added new benefits like preventive care. Itreduced racial and income-based disparities. It extended its coverage to theseverely disabled. It laid the basis for nationwide, comparative health studiesthat have improved the quality of care for everyone.

In short, Medicare, a government-sponsored program that now covers over 45million Americans, has been a triumphant success.

However, instead of celebrating, Medicare is facing ominous rumblings fromPresident Obama's debt commission and not-so-veiled threats from otherquarters.

"Medicare's going broke," its market-obsessed critics say. "It's draggingdown the economy."

Such alarms have been sounded about every six or seven years since Medicarebegan, but in real life it continues to thrive. Either the economy prospers,yielding greater tax revenues, or Congress tweaks the payroll tax by a tinyfraction of a percentage point, and immediately the projected shortfalldisappears. (The last adjustment was in 1985, when the rate was increased to1.45 percent from 1.30 percent.)

While it's true aging baby boomers will make bigger demands on Medicare,again, modest adjustments today will assure its financial solvency tomorrow.

In fact, Medicare stands like a rock in a troubled sea of waste, inefficiencyand disarray in the rest of our health care system, dominated as it is by big,corporate insurers whose paramount goal is to maximize profits, often byenrolling the healthy, avoiding the sick, raising premiums and denyingclaims.

Medicare is not without its problems, of course. Its benefits package couldbe richer. It lacks authority to negotiate lower prices with drug companies. Thereimbursement rate to physicians could be enhanced and stabilized, instead ofdepending on an annual cat-and-mouse game with Congress (the "doc fix") over aflawed accounting formula that only erodes physician confidence in theprogram.

But the best way to remedy these problems — and to bring down skyrocketinghealth care costs at the same time — is to improve the program and, mostimportant, to expand it to cover every person in the United States.

That's right: Extend Medicare to everyone. By replacing our crazy-quilt,inefficient system of private health insurers with a streamlined, publiclyfinanced single-payer program, we would reap enormous savings.

First, we would save about $400 billion annually that is presently wasted onunnecessary paperwork and bureaucracy. That's enough money to cover everyone whois currently uninsured and to upgrade everyone else's coverage withoutincreasing overall U.S. health spending by a single penny.

Patients could go to the doctor and hospital of their choice. They'd becovered for all medically necessary services and medications, with no co-pays ordeductibles.

Second, we'd acquire powerful cost-control tools like the ability to purchasemedications in bulk, negotiate fees, develop global budgets for hospitals andcoordinate capital investments. Such tools would rein in costs and help assurethe program's sustainability over the long haul.

Conventional wisdom suggests we should wait and see how the new health lawplays out. But we've seen how comparable reforms have fared on the state level:They've invariably failed after only a few years, chiefly because they can'tcontrol costs. Meanwhile more millions suffer.

It's never too late to do the right thing. So when naysayers urge cuts toMedicare, don't buy it. Tell them to ask Congress to enhance Medicare and toextend it to all.

Aug 05, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Interesting Commentary: Massachusetts' first for-profit health plan has physician access problems

Read the article at Healthcare Payer News

Massachusetts' first for-profit health plan has physician access problems

Massachusetts' first for-profit health plan has physicianaccess problems

Jul 29, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)


Press Release from The Independent Television Service (ITVS)


Sundays, August 15 and 22 at the Chicago Cultural Center

Film Series Shines a Light on Women and Girls Working to Create Social Change Around the World
Post Screening Panel Discussions Bring a Local Perspective to International Issues
Such As Youth Empowerment, Labor, Human Rights, among others

Chicago, IL -The Independent Television Service (ITVS), which brings independently-produced, public broadcast and new media programs to local, national and international audiences, announces a film screenings series highlighting stories of women and girls in the United States and around the world who are making real change on critical social issues in their communities. Two films will be presented on Sunday, August 15, and another two films on Sunday, August 22, at the Chicago Cultural Center, 78 E.
Washington Street, in partnership with the Chicago Foundation for Women<>and the Chicago Department of Cultural Affairs<>.
 Each screening will be followed by a post screening panel discussion organized by local Chicago organizations engaged in the issues explored in the film. Admission is free, and seating is on a first-come, first-seated basis.

The screening series is one of several taking place in a dozen cities across the country during the month of August. More than 15 documentary films from ITVS's award-winning catalogue will be shown in cities, including Los Angeles, Seattle, San Francisco, Philadelphia, Washington, D.C., Nashville, Louisville, Rochester, New York, St. Louis, and Denver.  View the complete line up and locations
Jul 27, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

NYT Letter to the Editor on Cuts in Home Care

Pat Volland is the co-founder and co-chair of the National Coalition of Care Coordination with Health & Medicine Board member Robyn Golden. The issue Ms. Volland raises in her New York Times letter to the editor regards the “quick” fix of cutting home care services and the resulting long-term cost increases; which is a budget concern for all long-term care systems throughout the country.  In her letter, and the NYT article she cites, Volland reiterate the necessity for our country to “reorganize and refocus” our health care system.  The passage of the Patient Protection and Affordable Care Act is only the beginning. We must do all we can  to find better long-term solutions for complex issues like these that place elderly and disabled Americans at risk.

July 26, 2010

Cuts in Home Care

To the Editor:

Re “Cutting Home Care Now, Paying for It Later? (news article, July 21):

The recent cuts to home care services may prove devastating for those who rely on them, especially low-income older adults with multiple chronic conditions who want to age in place in their homes. Cutting programs to save money in the short term will likely backfire, as it leads many of these isolated older adults to require hospitalization and costly long-term care.

America’s health care system needs to be reorganized and refocused to successfully meet the needs of older adults, especially the 25 percent of Medicare recipients who account for 85 percent of Medicare spending. Additionally, the distribution of federal Medicare money to states should rely not only on their provision of nursing home care, but also on their development of cost-effective home care and community-based programs.

Helping older adults avoid institutionalization and remain in their homes should be a top priority. It’s the right path not only for our nation’s budget but also for our communities.

Patricia J. Volland
Senior Vice President
New York Academy of Medicine
New York, July 23, 2010

Jul 15, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Health & Medicine Hosts Forum on Effects of Federal Health Reform on Illinois’ Health Care Safety Net

Health & Medicine hosted a forum on July 9, 2010 to examine how federal health reform legislation will potentially impact the health care safety net in Illinois. The term ‘health care safety net’ means the institutions that care for the uninsured, Medicaid, and other vulnerable populations. 

The forum explored the impacts of reform on:

•    community health centers,
•    safety net hospitals,
•    the healthcare workforce, and
•    vulnerable populations such as undocumented immigrants. 

While there are many provisions in health reform that help people gain health insurance, including Medicaid, access to care may remain difficult because of the lack of an adequate and well-trained health workforce.

Speaker Dr. Linda Rae Murray addresses problems in health workforce. During the forum, Linda Rae Murray, MD, MPH, the Chief Medical Officer at the Cook County Department of Public Health and President-Elect of the American Public Health Association, presented data showing the lack of diversity amongst the health workforce as well as the imbalance of specialty care versus primary care professionals in the United States (about 70% of our physicians are in specialty care with only 30% in primary care, compared to most other developed countries having about 50-60% in primary care). 

Dr. Murray also pointed out that it takes years (entire generations), for educational pipeline programs to change the make-up of the health workforce.  We must invest deeply in our workforce, developing incentives and training opportunities to get underrepresented students to go into the health professions, primary care, and to work in underserved areas if we ever hope to have a well-trained, diverse, and adequate health workforce.

U.S. Department of Health and Human Services allotted $96 million for educational health profession programs. Apropos to this discussion, on July 13th the Washington Post published an article about education grants aimed at increasing diversity in health profession programs at colleges and universities.  The federal grant funding, while not sufficient to address the entire shortage or diversity of professionals, will help stimulate programs for underrepresented students by off-setting some of the financial barriers to entering into health professions programs. 

Health & Medicine will continue to be a source of information on the impact of federal health reform in Illinois. Health & Medicine will continue our analysis of health reform and provide opportunities for providers, researchers, advocates, and systems leaders to come together to learn about reform, help shape the vision for reform in Illinois, and educate the public on the real impact of reform in their lives.  We also have fact sheets on the impact of federal health reform in Illinois posted on our website.

Please contact Janna Stansell, Policy Analyst at Health & Medicine, for more information on the upcoming forum or our on-going work on health reform.  

Presentations from this and other Health & Medicine forums can be found at

Jul 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Quentin Young in the July 13, 2010 Chicago Sun Times, On the Cook County Health System's Reorganization

County health plan focuses on outpatientcare

July 13, 2010

Cook County's health system is looking at a dramatic overhaul,shifting away from costly inpatient care at two hospitals in favor ofmore extensive outpatient services.

While the move is being praised by health experts, a new strategicplan that lays out the overhaul is likely to face strong opposition whenit's introduced to the full Cook County Board this week, particularlyahead of November's elections.

Under the five-year plan, Oak Forest Hospital would discontinue allinpatient care and become a regional outpatient center that wouldprovide a wide range of primary care services.

Inpatient services would also be scaled back at Provident Hospital,but the emergency room and a few short-stay beds would stay open.

Provident could retain more of its existing services, though, if apartnership is brokered with the University of Chicago Medical Center.

Inpatient care reductions are expected to generate $72 million insavings, which would be used to beef up primary and specialty servicesand compensate community hospitals for treating displaced patients fromOak Forest and Provident.

The hospital system would also spend $202 million on capitalimprovements.

More outpatient centers should translate to shorter waits formammograms, colonoscopies and other routine exams, hospital system CEOWilliam Foley said.

"We feel strongly that we're expanding services, not taking servicesaway," he said. "We're placing our services where our patient populationis to make it more accessible."

The plan, the culmination of a year-long $950,000 study withChicago-based Integrated Clinical Solutions Inc., was unanimouslyapproved last month by the independent Cook County Health and HospitalsSystem Board. Today, it is scheduled to be introduced to countycommissioners, who will have the final say on whether the plan advances.

Dr. Quentin Young, a longtime health care reform advocate and formerchief medical officer of Stroger Hospital, called the plannedreorganization "very forward-looking" and said the emphasis onpreventive medicine is the right one.

"Obviously, you want to have a skilled hospital when that needarises, but the real solution to the county's care of the population itserves is properly placed outpatient clinics," Young said.

He added that it's critical for the county hospital system to formsolid partnerships with private hospitals that would be able to treatpatients who would be displaced from Oak Forest and Provident.

County Commissioner John Daley (D-Chicago) said the key to thisplan's suc cess is changing some patient attitudes, including seeing adoctor for regular checkups instead of waiting until they're gravely illto go to the emergency room.

That was the goal of expanding the county's clinic system over theyears, Daley said, "but we still have a lot of people who wait to thelast minute."

Commissioner William Beavers (D-Chicago) said Provident needs tocontinue offering obstetric and gynecological services, not cut them asthe plan calls for, and Oak Forest needs a true emergency room, not justa walk-in ER. His district is sandwiched between the 113-bed Providentand 115-bed Oak Forest.

"If these were full-service hospitals, they would pay forthemselves," Beavers said.

Jul 12, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

Heather O'Donnell's July 12th Chicago Tribune Letter to the Editor on Medicaid Managed Care

Letter to the editor in The Chicago Tribune, July 12, 2010, fromHMPRG Board member, Heather O'Donnell, policy director forHealth Care and HumanServices, Center for Tax and Budget Accountability, Chicago

Download the letter from The Chicago Tribune site

Medicaid Managed Care

Unfortunately your July 5 editorial "Mending Medicaid" makes thefalse assumption that enrollment and spending for Illinois' Medicaidprogram, the primary federal-state health care program for the poor, isout of control.

The primary reason for growth in Illinois'Medicaid program is that the private sector has failed to provideaffordable health insurance for poor and low-income families.

Healthcare costs have far outstripped wage growth over the past severaldecades.

Between 1999 and 2008, the cumulative cost growth inaverage premiums for private family health coverage increased 119percent. This is more than four times cumulative inflation and more thanthree times cumulative wage growth over the same period.

Forthese reasons public health care programs like Medicaid have becomeincreasingly important in ensuring access to basic health care for thosestruggling to make ends meet.

Enrollment in Illinois' Medicaidprogram also grew over the last 10 years in response to a nationaleffort to provide health coverage to poor, uninsured children. Between1999 and 2001, as Illinois implemented the federally enacted StateChildren's Health Insurance Program, the state saw a spike inenrollment. Today more than 1.5 million poor Illinois children havehealth coverage through Medicaid/SCHIP. Most of these children would beuninsured but for the program.

Countless studies show thatchildren with medical coverage are healthier and do better in schoolthan uninsured kids.

The most recent surge in Medicaid enrollmentis due to the recession. As workers lose their jobs, they also losetheir employer-sponsored health insurance.

The loss of income andcoverage forces many people to turn to Medicaid.

As Illinoisfaces a $13 billion budget deficit, many have touted managed care as apanacea to controlling the state's Medicaid costs. However, managed careis no magic bullet that will close the state's budget gap. Certainly ifmanaged care is implemented in a responsible manner, it has thepotential to improve access to primary care and, as a result, willreduce emergency-room use and hospitalizations, curbing unnecessarycosts.

On the flip side, however, if care is better coordinated — aprincipal goal of a well-run managed-care program — specialty-carecosts are bound to increase as individuals battling long-term diseasegain improved access to diagnostic and specialty services.

Medicaidmanaged care should be pursued carefully and thoughtfully as a way tobetter serve the medical needs of those who become ill or get injuredwhile marginalized by poverty, not as a budget-cutting mechanism.

Heather O'Donnell, policy director for Health Care and HumanServices, Center for Tax and Budget Accountability, Chicago

Jul 08, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

20-30 Year Olds In Chicago - Help Ensure Social Security's Robust Survival!


Posted by Kristen Pavle,  Policy Analyst, Center for Long-TermCare Reform

Social Security Will Be Around When You Retire… If YouWant It To Be!

There seems to be a growing opinion among 20 and 30 yearolds about the United States Social Security program:  that it will not exist upon our retirement, sowhy should we care?  Perhaps I am missingsomething here, but the mere fact that we are paying into the Social Securityprogram NOW, for others’ benefits, is reason enough to care!  I want this program to exist in my retirement,too.  But even this is only a minorreason to becomemore involved in the discussion surrounding Social Security as a younger person. 

As of 2006, the Social Securityprogram has provided more than $541.6 Billion dollars in benefits to over 49million individuals.  Social Securityallows citizens of this country to retire with the earned privilege—anenforceable right—of an income after a lifetime of work.  Social Security retirement income, withbenefits also paid to spouses, widows (or widowers), minor children, and peoplewith disabilities represents a fundamental cornerstone of our society.  Because of Social Security, older Americansare no longer the poorest demographic in the country.  It is the most visible symbol ofintergenerational connectedness and the last remaining leg of the three-leggedstool (savings, pensions, and Social Security) that its foundersenvisioned.  Today it is the bedrock of economicsecurity, particularly in old age, for thousands of people, especially olderwomen.  Not only do I urge you to careabout Social Security, but I want to start the discussion on WHY we should allcare about the concept of “social security” as manifested by the SocialSecurity program.   

What Does the DataSay About Social Security in the Long-Term?

Didyour parents ever tell you not to worry about Social Security, because the programwould not be around for you would not enjoy its benefits?  Well, they were not exactly right.  According to the “2009 Annual Report of theBoard of Trustees of the Federal Old-Age and Survivors Insurance and theDisability Insurance Trust Funds” (read: Annual Report on the Social SecurityProgram), intermediate (neither conservative nor liberal) projections forthe solvency of the Social Security program are as follows:

  • By2016 the benefits program will be paying out more than it will be gainingin revenues, thus beginning to deplete the trust fund.
  • By2024 the Social Security pot of money, the trust fund, will no longer begrowing. 
  • By2037 the Social Security trust fund will be exhausted, empty, no moneyleft. But income will still be coming into the system from payroll taxesso benefits will be paid but at a reduced amount.

Maybe your parents were right…?  But, these figures about financing SocialSecurity in the long-term function under a rather large assumption:  that there will be no structural changes inhow the Program operates.  However, lasttime I checked we live in a democratic nation.  As citizens, we have a choice to demonstrateour commitment to Social Security so that benefits can be available IN FULLwhen we retire.

Advocates for Social Security are equipped with many ideasfor how we can change the structure by which the Program operates, giving it fullfinancial sustainability beyond 2037, when WE retire.  Social Security’s problems are political, notfinancial.  Contrary to popular opinionit is not in crises; it does not contribute a single penny to the deficit.  In fact, it is in surplus.

A Call for YourVoice to be Heard: Focus Group

  • Areyou in your 20’s or 30’s?
  • Do youhave an opinion on Social Security?
  • Do youhave questions about Social Security or an interest to learn more?

In an attempt at brevity, I will close this blog articlewith an invitation to continue the discussion. Health & Medicine Policy ResearchGroup (HMPRG) wants to talk with you.  On Wednesday, July 28thfrom 6-8pm, HMPRG will host a focus group for individuals in their 20s and 30s on SocialSecurity.  We look to you to help usbuild a campaign to get all younger people committed to Social Security’srobust survival.  Quite honestly, we wantto turn you into an informed advocate for a strong Social Security program, onethat will be there for each succeeding generation.  Remember, it is the only source of income thatyou cannot outlive.

    Please contact Kristen Pavlefor details and to RSVP.  


    Jul 08, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young's Chicago Sun Times Letter to the Editor, Advocating "Medicare for All"

    Download the letter from the Sun Times website

    Medicare for all is best system

    July 8, 2010

    Your article about the new restrictions on access tothe free clinics at NorthShore Evanston Hospital ["Free clinics tightenboundaries," July 6] is a chilling harbinger of the accelerated declineof our broken health-care system.

    These are clinics "of last resort," standing between health care andtotal neglect. To see them shrink in this way shows how heartless anduntenable our present arrangements are. The resultant suffering -- andeven death -- that will ensue is unacceptable in a country ascompassionate and wealthy as ours.

    Tragically, this kind of diminished access to care will not beseriously ameliorated by the new health law. We will continue to face anacute shortage of primary care physicians. The private insuranceindustry will continue to erect barriers to care with high premiums,co-pays and deductibles. The drug companies will continue to chargeastronomical prices, putting needed medications out of reach formillions.

    The solution, favored by a solid majority of the American people andphysicians, is an improved Medicare for all -- single-payer nationalhealth insurance. Such a program would cover everyone, withoutexception, and give us the cost-control tools we need to deliverhigh-quality care over the long haul.

    Given the power and resources of the multimillion-dollar privatehealth industry, it will take a mass movement -- much like the women'ssuffrage or civil rights movements -- to achieve this goal. The alarmingnews about Evanston's curtailed clinics should spur us on to build thismovement without delay.

    Quentin D. Young, M.D.,

    Hyde Park

    Jun 30, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    HMPRG Participates in America Speaks: A Town Hall Meeting

     Democracypixels_pete fletch

    Martha Holstein

    On Saturday, June 26, 3,500 people gathered at 19 locations across the United States in town hall meetings sponsored by AmericaSpeaks. I attended the event at Navy Pier in Chicago, Illinois. We spent the entire day in a carefully-facilitated discussion, that is, with an aim at neutrality, about spending cuts and tax changes. The background materials were detailed although several important options, in my mind, were simply omitted like structural changes to the health care system.  All the health related options, for example, involved cuts to existing programs—by 5%, 10%, or 15%— rather than identifying other means to rein in medical care costs, such as expanding primary care or reducing the use of high technology medicine or, perhaps most importantly, introducing a single payer system so that no dollars meant for health care go to profit and revenue enhancing activities. 

    The day’s goal was to identify ways to reduce the deficit by 1.5 trillion by 2025.  The event was well-organized and was not, as we had feared, taken over by a right-wing agenda. In Chicago, the “tea party” folks were certainly represented but so were large numbers of people identifying themselves as liberals.  In fact, 26% of the participants identified themselves as liberals while only 20% identified as conservatives; the remainder identified as moderates. The three funders were the Peter Peterson Foundation, the Kellogg Foundation, and the MacArthur Foundation. The wrap-up speaker was the highly-regarded Alice Rivlin. 

    The Scene at the Navy Pier Town Meeting
    Let me describe the scene at Navy Pier. As usual, on a hot and humid day, many people were leisurely strolling down the pier. Since I had arrived intent upon joining a rally that Older Women’s League (OWL) had called, along with and a broad coalition called Social Security Works, I tried to distribute leaflets to people strolling along the pier (we had designated spots, marked by masking tape, in which to stand) but most of the people going to the rally must have entered the room directly from the garage because we saw very few people who even seemed to know about the Town Hall.  When I entered Festival Hall A, it was filled with large round tables, each with a laptop computer and a facilitator, large screens to capture the scene in other cities and the lead facilitators, who were in Philadelphia. Coffee, tea, and cookies were available all day.  Lunch was brought to each table so that we could continue working while eating. The latest in computer technology brought instant results for the areas in which votes were taken.  We were able to see the tallies for Chicago set against the national results.
    The first hint of tea party involvement came in the opening round of discussions.  At my table of 10, the theme very quickly became “I want the old America back where it was safe, people were ‘hard’ and we were more competitive.”  Luckily for me, I was the last speaker at the table.  I simply said that I did not want the country that once was, where women couldn’t own property and were effectively closed out of many jobs and educational programs like law or medicine, and people of color faced discrimination wherever they went. My refrain throughout the day was that whatever decisions we made had to be judged by how they would affect the least advantaged.  I actually think people heard that message.  Other signs of tea party sentiment emerged at different times during the day—even when the facilitator couldn’t restrain inserting his ideas like the time one person criticized executive salaries, second homes, yachts, and so on.  The facilitator responded by saying that second homes, etc. created jobs.  But that claim was relatively easy to rebut by suggesting that universal pre-school or adequate special education or any number of critically needed infrastructure improvements would create not only jobs but socially useful ones.  In this way, it was good to meet face-to-face with people I would never otherwise meet.

    Social Security & Economic Security at the Town Meeting
    Going in to the Town Hall meeting, Social Security was our biggest concern.  Given the major sponsorship of the Petersen Foundation, known to be a strong advocate of Social Security privatization, progressive advocacy groups expected a strong push in that direction.  Nationwide only 27% supported that option and even fewer in Chicago. 

    Here is a capsule summary of the voting results:
    •    52% supported raising the age for full benefits to 69;
    •    85% supported raising the limits on taxable earning so that it covers 90% of total earnings in America;
    •    42% supported increasing the payroll tax to 14.4% (from 12.4%) by 2025; 
    •    23% supported no change;
    •    30% supported limiting increases in starting benefits for all but the lowest wage earners;
    •    32% supported changing the formula for raising benefits each year to reflect a lower rate of inflation.

    These issues are critically important for current and future generations.  We will address each one in future posts and in a major Social Security Public Forum that we will convene in the fall in conjunction with the Elder Economic Security Initiative (EESI). In the meanwhile, we welcome your comments.

    FYI—AmericaSpeaks is a national organization involved in numerous activities characterized as “direct democracy.” It convened and managed this Town Hall meeting but will report to the National Commission on Fiscal Responsibility and Reform, otherwise known as the Deficit Reduction Commission. I just signed up to be on their mailing list.  I think it would be a good idea for many people with progressive ideas to do so.  While AmericaSpeaks describes itself as a neutral organization, the results of deliberations at the meetings it sponsors will clearly be influenced by who knows about them and who attends. 

    Thank you to Pete Fletch on for the image.
    Jun 30, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Deficit Reduction and Old Age Policy

     “Martha Holstein,HMPRG’s co-director of the Center for Long-Term Care Reform, shares herperspective on the federal government’s response to the national budgetdeficit.”

    Deficit Reduction and Old Age Policy

    A few months ago, Health & Medicine (HMPRG), along with 60 other organizations and individuals, signed a petition opposing the appointment of a Congressional deficit reduction commission.  We did so because whatever decisions the commission made were to be subject to a “fast track” up or down vote in Congress.  We feared (and still fear) that the deficit reduction would go where the money was—Social Security and Medicare—without opportunities for amendment. It failed to garner the votes to pass.  In its stead the President has established the National Commission on Fiscal Responsibility and Reform by executive order. It will report to Congress in December 2010.  We regret that the President appointed as co-chairs two critics of Social Security—former Senator Alan Simpson and Erskine Bowles, former chief of staff in the Clinton administration. This post raises our concerns; we invite your commentary.

    First, about deficit reduction—we accept the arguments of Nobel prize-winning economists like Paul Krugman and Joseph Stiglitz that it is bad policy to cut spending in order to reduce the deficit while trying to revive the economy.  More stimulus spending rather than less is needed at this time. A Gallup poll report on June 17, 2010 shows that 60% of Americans favor more spending to address unemployment.  We accept, however, that over the longer-term—if and when the economy gains further strength—the deficit will have to be addressed.  We thus regret that the President, whether for political, pragmatic, or other reasons, has decided to support deficit reduction at this time.

    Second, and more to the point, we worry that in an atmosphere of crises poor decisions are often made. Entitlement programs, long the nemesis of the right, will be on the negotiating table. Calls to raise the social security retirement age, reduce future benefits, and privatize social security are already being voiced. Many also point to the high costs of Medicare with subtle blame directed at older people, thus re-igniting the intergenerational debate of the 1980s.

    Fact: While older people are no longer the poorest group in America, in part because of Social Security, many have not risen far above the antiquated poverty line, as our work on the Elder Economic Security Initiative clearly shows.  In every county in Illinois, including those with the lowest cost of living, there is a gap between what people have in the way of income and what they need to make ends meet. For these people Social Security is the bulwark of their income. 95% of African-Americans, 85% of Hispanics, and 80% of whites report that Social Security is or will be an important part of their retirement income (National Academy of Social Insurance (NASI), February 2010).  These individuals want social security strengthened even if that means higher taxes on workers, which includes them. Nearly half of all Americans say that they would not be able to cover basic necessities without Social Security (NASI, Reno and Lavery, 2009). Social Security also benefits families not only because of joint survivor benefits or aid to the disabled but for this simple reason—if older family members did not have Social Security or if it were reduced substantially, responsibility to support aging parents can fall to their adult children who are often already struggling to make ends meet.  With pension formation falling and the market deeply uncertain, social security’s importance escalates.

    Thus, we contend that Social Security should be “off the table” much as health care reform strategies took single payer “off the table.”  We fear that the new commission, not made up of Social Security experts, will look immediately to that program because that’s where the money is. Today, social security is not in deficit.  If the goal is to make Social Security more sustainable further into the future then strategies to do so should be in the hands of an independent group specifically charged with that goal.  The 1983 Social Security Commission led to modest system-wide reforms. These reforms have kept social security in the black for 27 years.  There is no urgent need to cut Social Security at this time. 

    We thus call for the appointment of a similar expert commission to examine what will need to be done to protect Social Security for the next 25+ years.  It should not be seen in the context of deficit-reduction.  Rather it must be viewed as the centerpiece of America’s commitment to its elders.  How we frame the issue of Social Security—it’s busting the budget or it’s an essential program that requires some changes to assure its solvency for another two generations and beyond—makes a big difference in the questions that are asked and the facts that are gathered. Putting Social Security’s future into a context of deficit reduction changes the nature of the debate from how this program can be protected to how it can be reduced to lower the deficit.  This is unacceptable. It has not contributed one cent to the deficit, which has been caused by two wars, by Part D of Medicare, by tax cuts for the wealthiest Americans, and by lowered tax revenue because of the recession.

    This new proposed Social Security Commission should have as its single purpose developing plans for Social Security’s stability into the future. Its first goal should be to examine ways to generate additional income for the program rather than reduce benefits or raise the retirement age in any major way. The National Academy of Social Insurance (NASI), for example, proposed a variety of ways to generate such revenue.  Analysts that do not have an ideological bias against Social Security believe that several relatively modest changes can assure the program’s financial stability well into the future.

    HMPRG believes that any changes to Social Security must protect the least advantaged.  That is why we oppose any significant increase in retirement age unless there is some non-intrusive way of protecting low wage workers who have few or no other assets and income.  They would be forced to work longer often at physically difficult jobs while more affluent white collar workers who are more likely to have other income are able to retire.  To protect the least advantaged, any changes in Social Security payroll taxes should also protect lower wage workers. This can be done by introducing modest progressivity into the tax structure. The survival of Social Security is a political, not a financial problem.  We must not get caught up in the rhetoric that implies it will not be there in the future.  It will be there if we all have the will to make the modest changes that are necessary to assure an income floor for all who contributed to the program throughout their working lives.

    We plan a series of forums on Social Security in the next several months as part of our work on the Elder Economic Security InitiativeWe invite you to participate in the discussion and to let us know what kind of programs would interest you.

    Jun 25, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Health & Medicine ED, Margie Schaps Quoted in Tribune Article on Strategic Planning at the Cook County Health & Hospitals System

    Download the story from the Chicago Tribune website

    Plan to overhaul Cook County health system set for vote
    Independent board to vote Friday on new strategic plan

    By Judith Graham, Tribune reporter
    8:34 PM CDT, June 24, 2010

    Put more medical services in needy communities. Emphasize care that keeps people healthy or minimizes illness. Develop partnerships with other clinics and hospitals. Become more customer-friendly.

    Those are the pillars of a new strategic plan for the Cook County Health & Hospitals System to be voted on Friday by its independent governing board. The blueprint then goes before county commissioners in July.

    While complete details aren't available yet, the plan is the most important effort in years to address the public health network's long-standing problems, among them inefficient operations, long waits for care, abysmal financial management and a poor record of improving the community's health.

    "We know we need to redesign in a major way the way we provide our services," said Bill Foley, the system's chief executive.

    The plan emphasizes serving more patients in outpatient clinics in city neighborhoods while reducing Cook County's historical reliance on expensive inpatient hospital care, a shift that drew praise from health experts.

    "This is a very necessary, progressive and positive set of moves, and it's long overdue," said Dr. Kevin Weiss, a professor at Northwestern University's Feinberg School of Medicine who authored a highly critical 2006 report on the county's health system.

    "They're emphasizing access to care, which I think is right" given the extent of need in Cook County, said John Bouman, president of the Sargent Shriver National Center on Poverty Law, based in Chicago.

    The county health system is the medical provider of last resort for almost 800,000 county residents who don't have health insurance, providing nearly $500 million in free care every year.

    Under the plan, the county would begin offering specialty services — such as consultations with orthopedists, endocrinologists and urologists — at county clinics in Cicero and Cottage Grove and at a new clinic in Arlington Heights or Des Plaines.

    Similar arrangements may also be reached with dozens of private clinics in Chicago and its nearby suburbs. "We could provide the specialty care while they provide the primary care," Foley said, describing potential partnerships.

    Donna Thompson, president of Access Community Health Network, the largest chain of health centers serving low-income patients in the region, said her organization was interested in this kind of relationship.

    "Real people are waiting in real lines for service," she said, noting a significant shortage in specialty medical care for people without insurance or financial resources.

    More than 4,000 patients are waiting for colonoscopies and gastrointestinal consultations at county facilities, while nearly 3,000 women are in line for gynecological checkups and almost 2,000 are on hold for CT scans, MRIs and X-rays.

    Joyce Johnsonsmith, 67, has been trying to get an eye exam through the health system for more than two years. Every time she makes an appointment, she said, the doctor is too busy to see her. After experiencing physical trauma in 2008, she had to wait a year to get a CT scan of her head.

    "I was so frustrated, so scared," said Johnsonsmith, a retired county worker who lives on a small fixed income.

    Most controversial in the new strategic plan is a proposal to convert Provident Hospital and Oak Forest Hospital into large outpatient centers, a move that could endanger jobs at the two underused medical centers and that has drawn strong union opposition.

    "Our concern is that people won't have access" to needed hospital care, said Christine Boardman, president of Service Employees International Union Local 73, which represents 1,500 workers in the health system.

    The situation surrounding Provident Hospital — a pioneering African-American hospital with deep roots on the South Side — is especially complex. If negotiations under way over a possible relationship with the University of Chicago Medical Center are successful, the institution would remain largely intact.

    But those talks have been rocky. If they fail, the proposed strategic plan would significantly scale back services at Provident, which would keep its ER open and retain a few dozen hospital beds for patients who need to stay overnight.

    The county began the process of closing Oak Forest's long-term care unit several years ago. The fewer than two dozen patients who remain would be placed in nursing homes and rehabilitation facilities under the plan; the facility's ER and hospital beds would close.

    "That concerns us because this is an area where medical needs are growing," said William McNary, co-director of Citizen Action/Illinois.

    Foley acknowledged that to take care of county patients, "we would really need to build relationships with other hospital providers" on the Far South Side.

    Also controversial, given the county's precarious finances, is a proposal to spend $143 million over the next five years on capital improvements for the health system: renovating facilities, strengthening services at Stroger Hospital, rebuilding the Fantus Health Center and building a new clinic in the northern suburbs. The sum would come from county coffers.

    Another $310 million is slated to overhaul health system operations between 2011 and 2015, an expenditure expected to be offset by savings at Provident and Oak Forest hospitals. Whether those savings will materialize remains an open question.

    "There will be considerably greater convenience for most patients," said David Dranove, professor of health industry management at Northwestern's Kellogg School of Management. But costs don't necessarily plummet when a hospital is converted to outpatient care, he said.

    The county health system's 11-member independent board was appointed two years ago to govern the network, freeing it from political meddling that made it a patronage haven and hampered effective management. Earlier this month, Cook County commissioners voted to make the independent board a permanent body.

    If the board approves the strategic plan as expected, it will go before county commissioners, who are responsible for authorizing funds for the system. Commissioners may vote on the blueprint next month or defer a vote until after a new board president is elected later this year.

    Timing is important because the medical landscape is set to change dramatically with the rollout of national health reforms. Hundreds of thousands of poor, uninsured adults — the county health system's core clients — will gain insurance cards and the ability to choose medical providers for the first time in 2014.

    If large numbers of people elect to leave the county health system, that could prove devastating. "We've got to improve our services and improve our infrastructure or we'll lose a large part of our patient base," Foley said.

    Currently, many people chafe at the kind of experience Lynn Crenshaw said she had when she was hospitalized this year for rectal cancer and encountered nurses who wouldn't respond to her requests for help. "I was born at Cook County Hospital, I've been going here for 41 years, I love the doctors, but some of the staff, they're rude beyond belief," she said.

    The county health system will be moving "in the right direction" if it adopts the new strategy that has been proposed, said Terry Conway, a former official at the system and current managing principal at Health Management Associates.

    If the plan passes, the concern is whether the county has the commitment and the resources to pull off implementation. "It's a great long-term vision, but getting there is going to be really hard," said Margie Schaps, executive director of Chicago's Health and Medicine Policy Research Group.

    Jun 24, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    America Speaks Holding National Town Meetings


    On Saturday June 26th, 2010, Americans willgather in town meetings across the country to discuss our country’s fiscalfuture and share strategies to ensure a strong economic recovery. This nationalevent is organized through America Speaks, a non-profit organization dedicatedto reinvigorate American democracy. Health & Medicine (HMPRG) supportssafety-net programs like Medicare and Social Security; these topics will ariseduring the Town Meetings.

    “AmericaSpeaks:Our Budget, Our Economy.”

    Town Meeting—This Saturday June 26th!

    On the UnitedStates Budget & Economy


    This TownMeeting is different than others you may have attended.  Sites across the country (in cities like Chicago, Dallas, Detroit, Los Angeles, Philadelphia) will belinked through technology, and able to participate in the conversationtogether, across the country.


    The goals of the Town Meeting are to identify values andpolicy priorities. These priorities will be shared with theNational Commission on Fiscal Responsibility and Reform, and theBi-Partisan Policy Center’s Debt Reduction Task Force.


    In advocacy of preserving Social Security, the group “Social Security Works” will also behosting rallies outside of the Town Hall meetings.


    For more information on the Chicago Town Meeting, and toregister, please visit the ChicagoTown Meeting: Our Budget, Our Economy website.  Across Illinois,in the cities of Alton and Barrington, other Town Meetings will be heldas well.


    Please visit the America Speaks: Our BudgetOur Economy Town Meeting About page for more information.

    Photocourtesy of jcolmanon
    Jun 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)


    Back in 2006, Health & Medicine Policy Research Group(HMPRG) inaugurated the HMPRG Awards to ensure that visionary public healthand health justice leaders receive the recognition they deserve.  Sincethen, the awards have been presented twice.  The winners become members of ourAdvisory Council, where they have had an opportunity to guide and enrich ourwork and, most recently, were asked to provide input to help Quentin Young shapethe role of the Illinois Public Health Advocate. 

    We invite your nominations for the 2010HMPRG Awards; which will be presented at a cocktail party and celebration onOctober 7, 2010. (Save the date!)

    Below are the comprehensive criteria for each of the 5 HMPRG awardscategories; representing individual achievements in Health, Medicine,Policy, and Research, and a Groupaward. (Criteria are also listed on the nomination form.)   Only one Award winner will be selected for each category. Nominators of selected award recipients will receive a complementaryticket to the celebration. Current and past Schweitzer Fellows are also invitedto nominate an Emerging Health Leader from agencies where theyhave done their placements.  And we will honor a Young HealthActivist (aged 16-20) who has shown a commitment to social justice andactivism. (To enlarge the criteria below, click on the image to open in a new window)


    In submitting your nominations, please consider whether your nominee has:

    • demonstrated outstanding leadership to a project or organization; madesignificant contributions in their field;
    • furthered our understanding of an issue affecting the public’s health;creatively and effectively promoted system or institutional change;
    • exhibited steadfast commitment and dedication to underserved anddisadvantaged populations (in the spirit of Albert Schweitzer);
    • or distinguished themselves as a mentor or role model to others.

    Download your Nomination Form Here

    We need to receive your forms by July15, 2010. (Forms can be returned by mail, fax oremail.) If you have any questions, please  email HMPRG DevelopmentOfficer, Karin Pritikin.

    We look forward to seeing your nominations and trust that you havesome inspired – and interesting – choices for people or organizations you wouldlike to honor. 

    View list of past winners

    Jun 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Great Health Reform Analaysis Resources from NHeLP


    Below are thelinks to NHeLP’s analysis of the PPACA and Reconciliation health care reformlaws.  They have concentrated their analysis on areas of the law most related toNHeLP’s focus areas – Medicaid and CHIP, civil rights, reproductive health andjustice, and empowering low-income beneficiaries and their advocates.

    Each partof the analysis includes introductory information and a Table of Contents thatidentifies which specific sections of the laws are analyzed.  Because theanalysis is rather lengthy, they've broken it into threeparts:

          Part I includes an analysis of the private insurance reformsand state-based exchanges;

    ·        Part II includes an analysis of changes to the Medicaidprogram; and

    ·        Part III analyzes selected provisions from other titles of thePPACA and Reconciliation law.

    NHelp anticipates focusing on some issues for an even more concentrated analysis overthe coming months.  We'll post what they send to us here and in the Health Reform section of the HMPRG website.

    Jun 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    In Chicago? Our Friends at Center for Tax and Budget Accountability Are Hosting a Benefit/Fundraiser


    Our friends at The Center for Tax and Budget Accountability (a 10 year-old non-profit, bi-partisan research and advocacy think tankcommitted to ensuring that tax, spending and economic policiesare fair and just, and promote opportunities for everyone,regardless of economic or social status) are hosting a benefit: Crossing the Color Line: From Rhythm-n-Blues to Rock-n-Roll; featuring Julian Bond, founder of the Student Nonviolent CoordinatingCommittee and former Chairman of the NAACP.

    Bond will present a history ofAmerican music, tracing the melding of jazz, blues, country music andpop into rock & roll, examining the influences of race,demographics, war, immigration and technology in this transformation. His presentation recognizes the interplay of race andpublic policy and will be accompanied by music and photos describinghow black and white Americans, immigrants and their music, andentrepreneurial efforts came together to create a new type of music.

    Ticket and sponsor information

    Jun 14, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young Quoted in Crain's Chicago Business Article on CCHHS Overhaul

    Crain's Chicago Business, June 10, 2010

    Cook County prescribes 5-year health system overhaul

    By: Mike Colias

    (Crain's) — Cook County health officials are prepping a new long-range plan to improve access to medical care for the needy while curbing massive financial losses.

    The proposal calls for scaling back expensive inpatient care in favor of expanding the county’s network of clinics and specialty-care sites. It forecasts that visits to county outpatient facilities will increase more than 60% by 2015 — to 1 million patient visits from about 600,000 last year.

    Two of the county’s three hospitals, both lightly used money-losers, would be converted to treat patients on an outpatient basis, helping ease current months-long waits for colonoscopies, surgeries and other treatments.

    And the savings from ending those in-patient services — more than $70 million a year — would be plowed back into expanding tough-to-find specialties and primary care countywide.

    Implementing the proposal would cost $142 million for new and overhauled facilities.

    The five-year plan, in the works since Cook County Health and Hospitals System CEO Bill Foley was installed a year ago to turn around the cash-strapped system, is an effort to stretch its $880-million annual budget to reach more patients.

    “We think we can provide more services, actually expand services, by moving away from very expensive inpatient care,” Mr. Foley said in an interview Friday.

    It’s also a big test for the 11-member independent health board formed two years ago when county commissioners bowed to political pressure, ceding control of the health system. Mr. Foley’s strategic plan is a road map for how the new panel will overhaul a health system still plagued by decades of patronage and mismanagement.

    “I think it’s a really important step in the right direction,” says Quentin Young, a physician and health advocate who led calls for independent governance of the hospital system. “The question is whether they can repair the county health system’s reputation for graft and corruption and sweetheart contracts.”

    No big changes are prescribed for Stroger Hospital on the Near West Side, the nerve center of Cook County’s health system.

    But Provident Hospital on the South Side, long derided by critics as a font of patronage jobs, would be converted into a large outpatient facility, offering specialty and diagnostic services that are in short supply for the county’s poor.

    Provident’s busy emergency room would stay open and about 20 beds, out of a 220-bed capacity, would remain, Mr. Foley said.

    South suburban Oak Forest Hospital, which now cares for a relatively small number of very sick patients who require lengthy hospital stays, would shut down its 137 licensed hospital beds and be converted into a large outpatient center.

    Those moves are likely to lead to an even bigger reduction of the county’s roughly 6,200 health-care staffers; about 1,000 positions have been eliminated over the past year.

    Mr. Foley acknowledges that Oak Forest and Provident will need far fewer workers after the changes that the combined 1,500 they now employ. He says it’s too early to predict how many jobs would go and that many staffers would be redeployed elsewhere in the system.

    The county’s independent health board will vote on the proposal by the end of June. It would be unveiled July 13 to the Cook County Board of Commissioners, which must approve the plan.

    Large outpatient centers also are slated for suburbs that have seen an increase in the number of low-income residents, who often lack health insurance. Facilities are slated for Cicero, near south suburban Chicago Heights, and in either Des Plaines or Arlington Heights.

    The emphasis on preventive outpatient care, rather than hospital services, makes sense because it’s less expensive and puts the care closer to where patients live, helping them get treatment before they become sicker and require hospitalization, says Terry Conway, managing principal at Health Management Associates, a Chicago-based consultancy.

    “It’s a much more pro-active approach than the county has ever taken,”
    Mr. Conway says.
    Download the article from Crain's
    Jun 10, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young in The Huffington Post, June 10, 2010


    Posted in The Huffington Post, June 10, 2010

    Health care drama at America's crossroads

    The movement for single-payer health reform - an improved Medicarefor All - is hopping in Indianapolis, "the Crossroads of America."

    I can personally vouch for this, having taken part in two events there on May 18 sponsored by Hoosiers for a Commonsense Health Plan and several other groups committed to health care justice.

    The occasion? The annual shareholders meeting of WellPoint, the giant for-profit health insurance company.

    For the fourth year in a row, a small group of energetic andprincipled shareholders led by Dr. Rob Stone of Bloomington, Ind.,attended the annual meeting with the aim of speaking truth to power.They sought to direct shareholders' and the media's attention to someof WellPoint's most egregious practices, including (as Dr. Stoneeloquently describes here)its astronomical premium hikes on individuals and businesses, itsnotorious algorithm for canceling insurance policies of womenpredisposed to breast cancer, and - in an evasion of parts of the newhealth law - its relabeling of administrative expenses as "medicalcare."

    This year, in their latest bid to move WellPoint away from itscorporate-greed and service-denial posture, Dr. Stone and otherssuccessfully introduced a shareholder resolutioncalling upon the company to demutualize - i.e. to return to itsoriginal, nonprofit status. (WellPoint was once a nonprofit, charitableBlue Cross company.)

    The subtext was clear: WellPoint should concern itself with maximizing health care rather than profits.

    It was this shareholder resolution calling on WellPoint to besocially responsible that prompted local organizers to invite me toparticipate in two related activities in Indianapolis that day - anafternoon health reform rally ("Health reform - we're still for it!")and a subsequent strategy session with regional activists - for I hadplayed a modest role in pushing a precedent-setting, similarshareholder resolution some four decades ago.

    In 1968, the Medical Committee for Human Rights (where I was thenchairman), was given 10 shares of stock in the Dow Chemical Company.Dow was the leading manufacturer of napalm, a jellied gasoline, whichwas being used widely by the U.S. military in the war in Vietnam,including on its civilian population.

    MCHR's leadership developed a shareholder resolution calling onDow's board to stipulate "that napalm shall not be sold to any buyerunless that buyer gives reasonable assurances that the substance willnot be used on or against human beings."

    To make a long storyshort, after being rebuffed by Dow's board, the Securities and ExchangeCommission, and various courts, the legitimacy of our resolution waseventually upheld and the measure was ultimately voted upon. While itgot less than 3 percent of the shareholders' votes, the effort helpedto pave the way for many other "socially responsible" shareholderresolutions in subsequent years - including this year's WellPointresolution.

    I must admit that I experienced a certain sense of satisfaction isseeing MCHR's human concerns of four decades ago finding strongexpression in today's context.

    Dr. Stone briefly presented his resolution in the morning and then,a bit later in the meeting, his colleagues (and other shareholders)readied themselves to participate in the question and answer session.

    But then an interesting, unanticipated event gave drama and anunexpected twist to the meeting. A member of WellPoint's board, William"Bucky" Bush (brother of George H.W. and uncle to George W.), fainted.The immediate first aid came from Dr. Stone, a seasoned ER doc, and Mr.Bush proceeded to recover promptly.

    Nonetheless, WellPoint CEO Angela Braly (whose annual compensationwas recently boosted to $13.1 million), who was chairing the meeting,seized on this incident to abruptly adjourn the session, therebyshort-circuiting the discussion period. This was bad, but certainly notthe worst conduct of the WellPoint organization.

    Even so, consider this: a subsequent tally showed that Dr. Stone'sresolution calling for WellPoint to return to nonprofit status received9.4 percent of the shareholder votes, representing over 30 million shares!

    This extraordinary development, and the well-attended rallyand activists' meeting that followed the shareholders meeting, aresymptomatic of persistent national unrest with the present financing ofour health care system, based as it is on private health insurers. Thepassage of the new health law has not addressed that unrest.

    Physicians for a National Health Programargues forcefully that the central problem in our current health systemis embodied in corporate giants like WellPoint. PNHP, sadly, feels thatthe new health law on balance actually increases the stranglehold ofthese corporate interests on our health system, with dire results incost, quality and access.

    For this reason, all of our endeavors seek to establish single-payer national health insurance, an improved Medicare for All: "Everybody in, nobody out."

    The Indianapolis events demonstrate the continuing vigor and commitment of single-payer health advocates nationwide.

    We must continue to strive to join the rest of the world'sdemocratic, industrialized nations in achieving a truly universal,comprehensive health care system. Such an achievement will not onlyenhance the health status of our people but arguably will rescue ourfailing economy as well.

    Jun 08, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Philadeplphia Inquirer Obituary: Walter J. Lear

    See obituary below for ourfriend and colleague Walter Lear that appeared in today's Philadelphia Inquirer. He will be missed.

    Postedon Mon, Jun. 7, 2010
    Walter J. Lear, health official, activist

    Philadelphia Daily News

    WALTER J. LEAR was an activist whose causes ranged fromhealth reform to support of revolutionaries in ElSalvador and nearly every cause inbetween. As a writer once put it, Lear "made a lifetime of noise in thename of the poor and the persecuted, the sick and the scorned. "Thefact that Lear was probably the first openly gay person to hold publicoffices in the city and state usually dominated discussion of his career,but he was an advocate for nearly anything he thought would make lifebetter for Americans.

    Walter Lear, a physician who served as deputyPhiladelphiahealth commissioner in the '60s and later regional health commissioner forthe Pennsylvania Department of Health, died May 29 of multiple myeloma. Hewas 87 and lived in Powelton Village.

    It was while serving inthe state Health Department that Lear decided to come out of the "closet."In January 1976, the first edition of the Philadelphia Gay News reportedthat Lear, then 52, had revealed himself to be homosexual. Hispurpose, the newspaper reported, was "to emphasize the need for bettermedical treatment for gays."

    In fact, he was a strong advocate forbetter health care for everybody, and was an early advocate of a publichealth system that would guarantee health-insurance coverage for allAmericans.He authored books on health-care reform in which he urged theyounger generation of health activists to end "this bureaucratic nonsense"and create a national health system."It's tragic and immoral thatthis, the richest country in the world, has decided to make profit-makingthe central value of the health field," he said.

    Lear was appointeddeputy city health commissioner by Mayor James H.J. Tate in 1964, and in1971, Gov. Milton J. Shapp named him state regional health commissioner.Tate later appointed him executive director of the old Philadelphia GeneralHospital. Of course,Lear was also active in gay and lesbian organizations and battled for betterunderstanding of the AIDS scourge and support for its sufferers.

    Hehelped found the Gay and LesbianCommunity Center, now the William Way Center, and the Philadelphia AIDS TaskForce, as well as the Maternity Care Coalition of GreaterPhiladelphia.He convened the first national conference on AIDS in the1980s.

    Lear was born in Brooklyn, N.Y., and received a bachelor's degree fromHarvard in 1943. He received his medical degree in 1948 from Long IslandCollege of Medicine, and a master's in hospital administration fromColumbiaUniversity in1948.

    He came to Philadelphia fromNew York toaccept the city Health Department job. He said he was convinced that Tatewould never have appointed him if he had been openly gay in 1964.Asit was, Shapp was inundated with complaints when Lear announced his sexualorientation while serving as regional health commissioner.However, theuproar died down and Lear always said that the people he worked with had noproblem accepting him.He received strong support from fellow physicians."He showed me that physicians can do good things," said Dr. Lawrence"Bopper" Deyton, who ran the AIDS Service program of the U.S. Department ofVeterans Affairs.

    Lear was a competitive swimmer. In April 1998, he toldthe Daily News' Leon Taylor that he was about to leave for Amsterdam to particate inthe 75-80 age bracket in swimming at the Gay Olympics."I'm going forthe gold," he said. And he made it. He got his gold medal in the200-meter freestyle.

    Lear is survived by his longtime partner, James F.Payne; his former wife, Evelyn Lear; a son, Jon Stewart, and a daughter,Bonnie Stewart.

    Jun 07, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young Quoted in Article on Response to National Plan for Improving Health Literacy

    Download this post from Medill Reports, Chicago

    Local health leaders react to national plan for improving health literacy

    by Dayna Dion
    June 02, 2010

    Localhealth leaders say thefederal government’s call for more understandable health informationsignals an important shift away from the idea that consumers areresponsiblefor interpreting the health information they receive.

    “I think that it’s somewhat groundbreaking in that it’schanging the thinking from ‘it’s your responsibility to figure it outas apatient’...and putting the onus on the health care system,” said ElissaBassler,CEO of the Illinois Public Health Institute, a nonprofit organizationthat works to "maximize health and quality of life for the people ofIllinois."

    The Action Plan for Improving Health Literacy, issuedThursday by the U.S. Department of Health and Human Services, calls for theelimination of complex, jargon-filled health information, given that even themost well-educated Americans have difficulty understanding it.

    In fact, “nearly nine out of ten adults have difficulty usingthe everyday health information that is routinely available in our health carefacilities,” according to the U.S. Department of Education.

    To change that, health service providers will need tocoordinate efforts, Bassler said.

    And that’s exactly what local public health organizations,like Building a Healthier Chicago, are doing. BHC is a partnershipamong the Chicago Department of Public Health, American MedicalAssociation and Regional Office of the U.S. Department of Health andHuman Services.  

    “One major priority for BHC is to develop a better networkof communication and collaboration among the health, business and socialservice organizations throughout Chicago,” said Elizabeth Jarvis, from the BHC.

    Ultimately, BHC hopes increased coordination among themultitude of organizations delivering health services in Chicago will allow formore consistent messaging about health, Jarvis added.

    Also, the Illinois Public Health Institute partnered with the Illinois Department of Public Health on the 2010 StateHealth Improvement Plan. TheSHIP, issued once every four years, calls for improving health literacy throughcommunity engagement and education.

    “Community health systems and resources should be leveragedto produce information that can increase understanding,” according to the plan.

    One vitally important, yet often underestimated, communityresource is the library system, said Jacqueline Leskovec, Outreach andEvaluation Coordinator for the Greater Midwest Region of the National Network ofLibraries of Medicine.

    “[Librarians’] role is very significant because we can bethe bridge between information and the people, improving access toinformation,” Leskovec said.

    Why visit a library when you can just log on to the Internetat home?

    “Librarians can train consumers on how to go and find goodhealth information,” Leskovec said. “They can go in and evaluate Web sites...and health information on theInternet.”

    While increased coordination among health organizations willhelp improve consumers’ health literacy, the buck stops with physicians, saidDr. Quentin Young, Illinois’ Public Health Advocate and national coordinatorfor Physicians for a National Health Program.

    “There’s no question in my book that it’s the doctor’sresponsibility,” Young said. "[The doctor] has all the special knowledge andshould be absolutely certain that the patient leaves with, at a minimum, afull understanding of what the issues are.”

    But doctors haven’t always accepted that responsibility, Young added. In fact, in many cases, they have used the mystique of medicine to theiradvantage.

    “I think doctors like to have control of information and useit to stimulate patient loyalty,” Young said. “But I think that’s diminishing.There’s a very strong movement to lift some of the mystique of medicine."

    Jun 07, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    National Council on Aging (NCoA) to Sponsor Town Hall Meeting on Health Reform

    On Tuesday June 8th, 2010, the NationalCouncil on Aging (NCOA) co-sponsors a Town Hall meeting on Health Reform withPresident Barack Obama and also features Health and Human Services SecretaryKathleen Sebelius.  The town hall meeting set-up is interactive and televisedvia satellite at locations across the country; many of the host locations aresenior centers.  The televised broad cast will take place tomorrow, June8th, from 10:15-11:45am (CST), and will air on C-SPAN.  It will alsobe streamed live at: and

    NCOA is actively involved in educating seniors about howhealth care reform affects them through their campaign, StraightTalk for Seniors on Health Reform.

    The White House has also been involved with senioreducation regarding health reform, with documents like “TheAffordable Care Act Gives America’s Seniors Greater Control Over Their OwnHealth Care.”


    May 27, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    CMS Actively Promotes the Community Living Initiative, Offers Assistance for State Long-Term Care Reform

    We'd like to share a letter from Cindy Mann, Directorof Centers for Medicare & Medicaid (CMS), to State Medicaid Directorspromotes the Community Living Initiative, and offers assistance to states tobalance the long-term care system to reflect more home and community basedoptions for older adults and persons withdisabilities.

    In Ms. Mann’s letter to StateMedicaid Directors, she outlines “Opportunities and Partnership –Tools forCommunity Living”.  CMS offers, among othersupports:

    ·        technical assistance,

    ·        waiver programs,

    ·        information on managed care modelsfor long-term care,

    ·        information on affordable housingoptions,

    ·        support for infrastructure reforms,

    ·        financial support for demonstrationprojects,

    ·        guidance in dischargeplanning.

    We commend CMS for continuing topromote the Community Living Initiative, and for assisting the states in ourefforts to balance the long-term care system to reflect more home and communitybased options for older adults and persons with disabilities.  This letter is agreat opportunity for education and advocacy to ensure that Illinois takes advantageof the support and guidance CMS is offering.  Please visit this link to read theletter in full:

    May 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    In the Chicago Area? Save the Dates for Upcoming Safety Net Forums!

    Save the Date! June 14, 2010, 1pm-5pm

    A forum, “The State’s Fiscal Crisis: Changing our CollectiveResponse,” will be held on Monday, June 14th, 2010 at the UICStudent Center West (828 S. Wolcott Ave, Chicago) from 1pm-5pm.  Theforum will be a conversation about the impact of the state budget cutson health and human services in Illinois and how we can change the waywe collectively respond to these cuts.

    Speakers include:

    • Jack Kaplan, Director of Public Policy and Advocacy at the UnitedWay of Metropolitan Chicago and United Way of Illinois
    • Linda Rae Murray, MD, MPH, President-Elect of the American PublicHealth Association and Chief Medical Officer for the Cook CountyDepartment of Public Health
    • Ralph Martire, Executive Director of the Center for Tax and BudgetAccountability
    • Representatives from mental health, HIV/AIDS, substance abuse,aging, disability services, and education (invited)

    To RSVP for this forum, send an email to and put “RSVP-June 14 Forum”in the subject line

    Save the Date! July 9, 2010, 8:30am-1pm

    A forum, “Health Reform and the Health Safety Net: Challengesand Opportunities,” will be held on Friday, July 9, 2010 atthe UIC School of Public Health Auditorium (1603 W. Taylor St, Chicago,1st floor) from 8:30am-1pm.  The forum will examine the potential impactof the health reform legislation on the health safety net, elicitingchallenges and opportunities for providers and health systems inIllinois.  We will look specifically at the impacts on community healthcenters, safety net hospitals, the health workforce, and vulnerablepopulations.  The forum will ask us to consider if reform will help usmore effectively and appropriately use the trillions of dollars in ourhealth system and what structures need to be in place to provide qualityhealth services to all.

    Speakers include:

    • Philippe Largent, Vice President for Government Affairs, IllinoisPrimary Health Care Association
    • Bill Foley, CEO, Cook County Health & Hospitals System
    • Representative from the Cambridge Health Alliance

    To RSVP for this forum, send an email to and put “RSVP-July 9 Forum”in the subject line

    Additional details for both forums will be posted soon on ourwebsite, here on our blog and Facebook.

    May 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    What You Think About the Budget Matters! Let Your Voice Be Heard!

    Wider Opportunities for Women (WOW) is hosting its second annual Blog Day, Wednesday May 26th, 2010: “America’s Budget Matters, So Does Yours.” The posts on HMPRG's about the impact of both the federal and state budget deficits and their impact on the aging community are only the beginning to an ongoing discussion of elder economic security, and we want to hear from you:

    •    Do you have anything to contribute to this conversation about the federal deficit?
    •    About Illinois’ budget deficit?
    •    About cuts to social service programs in Illinois?
    •    About preserving Social Security?
    •    How do potential budget cuts affect you?

    Please leave your comments below.  HMPRG is working with WOW to make sure that your voice is heard, that the Federal Commission and the Illinois state government knows that their decisions affect you.  Our country, and our state of Illinois, is in difficult times. Now is not a time to be quiet, but a time to advocate for your right to remain economically secure in your homes and communities as you age.
    May 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Amidst Federal and State Budget Crises, are Elderly Safety-Net Programs, Social Security, Safe?

    Photo from Organize for America- Barack Obama -  on flickr

    National Commission on Fiscal Responsibility and Reform, and Social Security

    On February 18, 2010, President Barack Obama issued an Executive Order to establish the National Commission on Fiscal Responsibility and Reform (Commission).  The Commission aims to provide recommendations on balancing the federal government’s budget by 2015.  Further, the Commission will recommend action to improve the fiscal outlook of the country in the long-term.  A lot of discussion about the country’s long-term fiscal outlook has centered on entitlement programs, specifically where money coming in to fund programs has fallen below program expenditures.  There has been quite a bit of conversation about the Social Security entitlement program as a possible way to help reign in spending and balance the budget.

    The Social Security entitlement program in the United States has a long history; President Franklin D. Roosevelt signed it into law in 1935, passing Congress as part of the New Deal.  Social Security is a social insurance program for retired persons, disabled individuals, and individuals who depended on a family worker who has died.  Social Security is a safety net for many Americans, and specifically many older adults. With more than 47 million Americans depending on Social Security income, and over two-thirds of retirees relying on Social Security for the majority of their income, it is imperative we protect and strengthen the Social Security program.  As the National Commission on Fiscal Responsibility and Reform continues to meet, behind closed doors, advocacy to preserve Social Security must be a priority.

    The True Cost of Living for Older Adults, Illinois Perspective

    Wider Opportunities for Women (WOW), a non-profit based out ofWashington D.C., created the Elder Economic Security Initiative (EESI)several years ago.  EESI approaches building economic security throughadvocacy, organizing, and research.  A key part of EESI is the ElderEconomic Security Standard™ Index, calculating the cost of living for anolder adult.  The Illinois state partner for EESI is Health &Medicine Policy Research Group (HMPRG) and detailedinformation about EESI can be found on the HMPRG website.  InIllinois, and across the country, EESI is revealing that frequentlyolder adults cannot make ends meet based on their income and the cost ofliving. 

    According to the policy brief, “EldersLiving on the Edge: When Meeting Basic Needs Exceeds Available Income inIllinois”  inIllinois 1 out of 5 older adults relies solely on Social Security. Unfortunately, the average Social Security payment for a single, retiredIllinoisan does not cover the cost of living.  Using EESI as a tool,specifically the data of the Elder Economic Security Standard™ Index,Illinoisans can advocate in many ways to protect the economic securityof its older adult population.  One way is to advocate for thestrengthening and preservation of the Social Security program.  With somany older adults in Illinois relying on Social Security and currentlyunable to afford the cost of living in the community, any disruption ofSocial Security benefits would be tragic.

    Fiscal Budget & Illinois State Budget, How Does This Affect YOU?

    As Washington D.C. tackles the federal budget, states have the task of managing their own budgets.  Illinois is in a budget crisis, with a deficit of $13 billion, almost half of the state’s general fund revenue.  Attempting to come up with a solution to this deficit has not been easy—state employee pension plans, social service agencies, health care agencies, and the education system have all been threatened by budget cuts.  Illinois' budget deficit threatens important health and social programs, and is already affecting social service agencies throughout the state.  Particularly concerning to the aging community is the delay in paying social service agencies that provide care for the elderly. 

    Without providing payment to state-funded social service agencies, many older adults will not be able to access the services they need to remain healthy and viable in their communities.  As the Federal Commission researches ways to balance the federal budget and talk of changing Social Security continues, the economic well-being of older adults has never been a more pertinent issue.

    May 19, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Elder Economic Security—Update

    The U.S. Census Bureau recently announced the creation of a supplemental measure to the federal poverty level. It’s about time! It’s been 50 years since the original poverty level was developed and its methodology has yet to be updated. This antiquated measure fails to capture the true number of Illinois elders and families struggling to meet their basic needs.

    Elders in Illinois are having a tough time making ends meet with one out of five living on Social Security alone. The average Social Security payment for Illinois’s elders is $12,996. This payment barely surpasses the original federal poverty line, and is not enough for these elders to be economically secure. According to the Illinois Elder Economic Security Standard™ Index (Elder Index), a geographically-based measure of what elders need to age in place created by Wider Opportunities for Women and the Gerontology Institute at the University of Massachusetts-Boston,  a single elder renter needs $19,810 a year.

    The proposed supplemental poverty measure is a good first step, because it will improve on how poverty is currently measured by providing new data including the cost components of food, housing, and clothing. But, the supplemental poverty measure alone is not enough.

    Decision makers need tools that accurately reflect the real cost of aging in place. For instance, the Elder Index demonstrates that seniors have high health costs, which may affect their ability to pay for other basic needs. In Illinois an elder in fair health pays $357 a month for health care while an elder in poor health pays $387. And if long-term care services are needed, these costs can double or even triple what an elder needs to make ends meet. 

    Additional data is necessary to better capture elders’ real costs and to determine the best way policy makers, administrators and service providers can utilize funds and target strategies to promote economic security.

    The supplemental measure is sure to spur continuous and much needed discussion as we grapple with how best to define economic security in our state and in our country.  We’ve already waited too long. Too many elders and their families live without enough to meet their basic needs. Now is the time to move past simply measuring what it means to be deprived to what it means to be secure.

    Please see, “Elders Living on the Edge: When Meeting Basic Needs Exceeds Available Income in Illinois” for more information, and check out Health & Medicine’s involvement with the Elder Economic Security Initiative
    May 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Boston Globe Editorial on Obama's Choice of Berwick to Run Medicare

    Our friends at NHeLP shared this editorial fromthe Boston Globe, which has additional information on the pending nomination ofDonald Berwick to head CMS.  


    In Berwick, Obama chooses innovativeleader for Medicare

    SENATEREPUBLICANS haven’t even waited for the confirmation hearing for PresidentObama’s candidate to run Medicare and Medicaid — Dr. Donald Berwick, a Harvardpediatrician — to begin using him as a tool to renew the debate over the recenthealth reform law. It’s within their rights to question the worthiness ofObama’s nominee, but they’re picking the wrongtarget.

    Berwick,who has run the Cambridge-based Institute for Healthcare Improvement for thepast 19 years, has been a leader in promoting innovative ways to improve thequality of care, thereby cutting the costs of medicine. He is well-qualified tomake the many crucial decisions surrounding Medicare and Medicaid, and could endup being one of the most significant appointees in theadministration.

    YetRepublicans such as Senate minority leader Mitch McConnell are painting Berwickas a proponent of rationing health care, because the nominee supports, forinstance, a payment system that reimburses hospitals based on what it shouldcost to treat a patient successfully, rather than on the sheer numbers of testsand procedures being run. McConnell takes Berwick especially to task for oncepraising the British health system, which coverseveryone.

    Never mindthat Berwick has already won endorsements from AARP and the American MedicalAssociation, neither of which advocates rationing. Republicans hope to createthe impression that Obama’s efforts to cut health care costs are sending thenation down a slippery slope toward rationing ofservices.

    Berwick’sconfirmation hearing, which has not yet been scheduled, will provide him with aforum to remind senators — and the public — about the upside of the recentreform law, including immediate benefits such as including children on theirparents’ policies until they are 26 and granting tax credits to help smallbusinesses manage their insurance costs.

    Beyondthat, Berwick could describe some of the work his institute has done to reducemedication errors and hospital-acquired infections. Other reforms he haschampioned include such measures as keeping hospitalized patients propped up toprevent pneumonia and extending hospital visiting hours so that friends andfamily members can help monitor patients’ care. Though basic, such simplereforms can make a big difference in curingpatients.

    Under thereform law, Washington must find $400 billion in Medicaresavings over 10 years. Improved care that stops patients from returning tohospitals with infections or pneumonia is one good way to achieve that goal. Letthe health care debate begin — again. 


    May 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Interesting website...

    As you can see,  the right hand column of  our blog contains links to RSS feeds from other blogs we follow. There is also a blog subpage listing urls for organizations without feeds whose work we track. We're adding this interesting website aimed at students, educators and the general public that explores social determinants of health and the basic principles of health justice.

    The site is run by Martin Donohoe, MD, FACP, Adjunct Associate Professor in theDepartment of Community Health at Portland State University and ahospitalist at Kaiser Permanente Sunnyside Hospital. Donohoe - who has publishedarticles and frequently lectures on public health and social justice,activism, and the medical humanities - serves on theBoard of Advisors of Oregon Physicians for Social Responsibility (PSR)and is Chief Scientific Advisor to Oregon PSR’s Campaign for Safe Foods. He received his BS and MD from UCLA, completed internship andresidency at Brigham and Women’s Hospital / Harvard Medical School, andwas a Robert Wood Johnson Clinical Scholar at Stanford University. Hiscareer has included clinical practice in academic medical centers,community hospitals, and clinics for homeless and un/underinsuredpatients.

    May 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Tom Wilson, Disability Activist/Advocate (and HMPRG Board Member) on Why He Opposes Managed Care...

    ...fromLead On: DisabilityRights & Empowerment Chronicling the work and issues of AccessLiving of Metropolitan Chicago

    Why I oppose managed care

    By Lead On: Chronicling the work of Access Living ofMetropolitan Chicago

    Tom Wilson is a Community Development Organizer for Health Care atAccess Living

    Theauthor of this post is Tom Wilson, a community development organizerand health care advocate

    As an organizer supporting home and community services and highquality affordable health care with equal access for all at AccessLiving for many years, I have seen advances and setbacks for people withdisabilities in Illinois based on state policy decisions related toMedicaid. In the current Illinois budget crisis (which is partially dueto many years of financial mismanagement and a structural deficitpredating the economic crash) Illinois is in the midst of the worstfinancial circumstances for state government since the GreatDepression.  Because of this crisis, Illinois has proposed cuts in stateservices.

    People with disabilities who are on Medicaid, now confront thiscrisis through various cuts in services.  Medicaid Managed Care is oneform of these cuts.  The state is proposing to put 38-40,000 people insix counties into its new Medicaid Managed Care program.  This proposalwould hand most of the current taxpayer money spent on the healthcarefor people with disabilities over to two insurance companies (known asManaged-Care Organizations).

    Read the full post

    May 09, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Sunday Chicago Tribune Cover Story on New Bill to Improve Nursing Home Safety

    Bill aims to overhaul nursing home rules

    Tribune investigations lead to proposed changes

    By Gary Marx and David Jackson, TRIBUNE REPORTERS

    May 8, 2010

    After years of frustration, authorities and advocatesbelieved this spring represented their last and best opportunity toreform Illinois's troubled nursing homes.

    Still, it took tense negotiations and an eleventh-hour deal to strike ahistoric bill that aims to undo a half-century of failed policies andend a legacy of violence in which nursing home residents were raped,assaulted and murdered.

    Both sides had come so far that only moments after the 159-page billsailed over its first hurdle and passed the House with a 118-to-0 votelate Thursday night, Gov. Pat Quinn's top health care advisor, MichaelGelder, was hugged by both the industry's top lobbyist and one of theindustry's toughest critics.

    The reform bill's overwhelming support in the General Assembly "reflectsa change of direction for the state," said an exhausted Gelder, whohelped shepherd the negotiations. "It sends a very clear message thatnursing homes are going to provide high-quality care, and they're notgoing to be dominated by individuals who have put profit ahead of thecare and needs of their residents."

    The overhaul effort was sparked by a series of Tribune investigationslast year exposing chronic violence inside a subset of facilities thathouse younger psychiatric patients and convicted felons alongsidegeriatric residents.

    The bill, which passed the Senate Friday and now goes to Quinn's desk,contains an array of measures to stem the brutality inside thosefacilities.

    It would tighten existing criminal background checks and psychologicalscreenings of incoming nursing home residents, and place the relativelysmall number of dangerous patients into separate, secure therapeuticwards.

    It also would require nursing homes to significantly increase staffinglevels and to meet more stringent safety and treatment standards as acondition of admitting any resident who has a serious mental illness orwho presents a danger to others.

    The most ambitious measures are designed to divert thousands of mentallydisabled people from nursing homes and into an array of smaller,residential programs that provide intensive therapy and supervision forthose who require it, but greater independence for those who don't.

    While celebrating the bill's passage, Gelder and lawmakers said it willbe a huge task to implement its many provisions, and that much difficultwork remains. "It is a watershed day," said Chicago Democratic Rep.Sara Feigenholtz. But, she added, "I see this as a first step."

    Even at a time when the state is nearly broke, officials and lawmakerssay they are confident they can find a cost-neutral method to roughlydouble the number of state safety inspectors to more than 350 over thenext three years, significantly increase staffing at the homes andexpand Illinois' community mental health programs.

    One way they plan on doing it is by redirecting state funds away fromnursing homes and into community-based care programs. Officials alsoplan on raising tens of millions of new dollars annually by raising feesfrom nursing home providers and matching that money with federalMedicaid payments.

    A significant portion of that money would then be returned to thefacilities to pay for the additional staffing and other needs. Stateofficials would use the rest to hire the new inspectors and to fundcommunity-based mental health programs, according to participants in thetalks.

    The details of that funding plan must be hammered out by governmentauthorities, the industry and advocates, and be submitted to the GeneralAssembly no later than Nov. 1, the bill says.

    "It's in everybody's interest to get it passed," said Chicago Democraticstate Sen. Heather Steans, who sponsored the bill in the Senate. "Ireally think this is a great victory for residents of nursing homes andultimately for folks who want a route out."

    Illinois' nursing home problems reach back to the 1960s, when the statejoined a nationwide deinstitutionalization movement and began to emptygovernment-run psychiatric hospitals that once housed more than 50,000patients but now hold about 1,500.

    With few alternatives, many of the discharged psychiatric patientscycled from the streets to jail cells and emergency rooms. Thousandslanded in a subset of nursing homes that were eager to fill their bedswith indigent Medicaid recipients, even if those people had violentcriminal records and were decades younger than their geriatrichousemates.

    Although mentally ill people are no more likely than others to bedangerous or to commit crimes if given proper treatment, many facilitiesprovided substandard care and monitoring, the Tribune found.

    The violent cases chronicled by the newspaper included the rape lastyear of a 69-year-old woman by a 21-year-old mentally ill felon atElgin's Maplewood Care. Attacker Christopher Shelton's backgroundscreening had been improperly handled by the nursing home, and thefacility failed to act adequately on warnings of his behavior, recordsshow.

    Though the state offers an array of community mental health programs,including congregate homes that offer 24/7 clinical supervision, thesystem is stretched to its limits. It could take several years to expandservices and housing enough to handle the thousands of new clientsenvisioned in the bill.

    "Most of these [programs] are at full capacity at this point, and we'regoing into a budget crisis," said Ed Stellon of the Heartland Alliance."It is doable, but it will take some time."

    Gelder said state authorities are already redrawing budget lines toprovide the needed resources without increasing payments from theGeneral Revenue Fund. "We don't want to empty our nursing homes andleave people on the streets," he said.

    Among the bill's other key provisions is a mandate that nursing homesadmitting people with serious mental illness obtain a new certificationdemonstrating that they can effectively monitor and treat thoseresidents.

    The new standards for those homes, which must be written in the nexteight months, would require the homes to have sufficient staff,including psychiatric professionals, on a 24-hour basis; training ofstaff on "managing aggression and crisis prevention"; and substanceabuse programs.

    People with serious mental illness must be re-evaluated periodically byindependent experts to assess whether they need to remain in thesenursing homes.

    Those who present "a high risk of aggression" would be housed andtreated in separate, "self-contained units within existing nursinghomes," according to the bill.

    The legislation does not specify how the "behavioral management units"would be secured. But state authorities would be required by January2011 to draft specific rules on staffing levels and training,"strategies to avoid physical harm" and use of "containment techniques."

    Periodic independent re-evaluations also must be conducted for thoseplaced in these units to ensure that only those who require intensivesupervision are housed in them.

    The bill also would establish a database that would track violentincidents inside the homes. It would add safeguards to ensure theinformed consent of residents administered psychotropic drugs. And itwould expand the state's ability to deny operators permits to open newhomes if they run facilities that have repeatedly violated safetystandards.

    At the last minute, nursing homes agreed to increase nursing stafflevels in the next four years to 3.8 hours of daily nursing care foreach resident who needs skilled care, up from the current minimum of 2.5hours. Quinn's task force had recommended 4.1 hours.

    Terry Sullivan, regulatory director of the Health Care Council ofIllinois, the state's largest nursing home trade association, said thelegislation would create a tougher regulatory and financial environmentfor the industry, but he welcomed what he called "sweeping ... genuinereform."

    Tribune reporter Monique Garcia contributed to this report.

    May 04, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Margie Schaps HMPRG Testimony to the Cook County Health and Hospital Systems Board, on CareLink and Co-Pays


    Testimony before the CCHHS Board of Directors

    April 30, 2010


    Good Morning, my name is Margie Schaps and I am the Executive Director of the Health and Medicine Policy Research Group, a nearly 30 year old independent health policy research and advocacy organization committed to improving health systems and health status in our region.  As most of you know, Health and Medicine has been committed to strengthening the public sector health system with a particular focus on the Cook County system during our entire 3 decades of work. We have been part of every major task force and committee charged with planning systems, creating the independent board, nominating members for the board, planning the new hospital, informing new County leadership on health system issues, and more.


    I am here today to comment in general on the strategic plan and vision you are here to discuss today and on the proposed CareLink plan to charge co-pays for clinical services and Pharmacy services to system users, requiring retroactive payment, and turning away patients who do not comply with billing requirements. 


    First, I want to say that Health and Medicine feels that this board has done an outstanding job in extraordinarily difficult times, even for the County health system. The problems you have faced and will continue to face run deep throughout the system and they will not be solved in a year or two or by a couple of years of balanced budgets.  Vision of how we can help lead the transformation of the practice of medicine, continued commitment to the communities you serve, and the courage to fight for what is right is what the people of our county need from the leadership of the system.


    The board must be forward looking, not backwards directed.  No longer should inpatient hospitals determine the character of County Health Services.  We suggest organizing around two operating divisions, one for hospital based services that would include inpatient and specialty outpatient personal health services and a second for community/public health services which would include a network of primary care centers, Cermak and public health. 


    We must be prepared for the reality that our area, like the nation as a whole, does not have the primary care capacity to meet the needs of  increased populations with insurance under the new health care legislation.  Significant fiscal challenges at the State level in addition to the fact that there will still be tens of millions of Americans (likely 3-400,000 in our region) without health insurance, the county system is likely to be further stressed in the next decade, not relieved by passage of the federal health reform legislation.


    As you define your strategic plan direction, we urge you to have a clear vision of a world class comprehensive and fully integrated health system based in communities encompassing personal and population health.  These services must be available to all regardless of ability to pay or legal status.  The services must be delivered in a linguistically specific and culturally appropriate manner with dignity and respect by a workforce and leadership that reflect the communities served by the system.  We believe the system must be based on community centered primary care and reviving the ACHN network as a network of Federally qualified health centers.  We believe that the public system must be partnered with the private sector depending on the needs of the system, the most critical partners are other parts of the traditional safety net, particularly the FQHCs and the safety net hospitals.


    Furthermore, we urge you to examine the possibility of fully merging the City of Chicago and the County health services under a countywide health system with taxing authority, independent of political control thereby creating the foundation for important regional alliances and cooperation in the future.


    While we are aware of and sympathetic to the need of the system to raise additional revenue, we have concerns about the universal co-pay system now being contemplated as the right approach to raising needed financial support for the system. The revenue generated by this plan will likely be insignificant and may have more significant negative consequences.


    •  With regard to co-pays for medications, a 2004 study funded by the federal Agency for Health Care Research and Quality found that increasing patients’ co-payments for prescription medications led to decreases in their use of eight classes of therapeutic drugs. A study in the Journal of Occupational and Environmental medicine in 2007 found that increasing co-payments after the patient has started on a medication was a predictor of early termination of the medication. And finally a study reported on in Health Affairs in January 2010 found that reducing co-payments on medications increased the chances that employees with chronic illnesses will take preventive medications.
    • Second, With regard to co-pays for outpatient services, a study published in the New England Journal of Medicine in January 2010 comparing longitudinal changes in the use of outpatient and inpatient care between enrollees in Medicare plans that increased copayments for ambulatory care and enrollees in matched control plans and concluded that “raising cost sharing for ambulatory care among elderly patients may have adverse health consequences and may increase total spending on health care”.  This was in a system, Medicare, with people of all income levels and where people we accustomed to paying co-pays already.
    • Finally, as you contemplate this decision to implement a co-payment program, I would caution you about the impact this may have on the long term loyalty of your patients. As health reform unfolds and more people are eligible for Medicaid coverage, the County risks losing some of these newly insured people to other providers.  A goal of the system over the next couple of years must be to create an environment that patients are committed to, whether they have insurance or not. I fear that instituting universal co-pays will provide another reason for people to leave the system when they are able.


    Thank you for the opportunity to testify.

    Apr 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Margie Schaps' Testimony on the Takeover of West Suburban Medical Center and Westlake Hospital

    Testimony delivered this morning by HMPRG Executive Director Margie Schaps, at a public hearing of the Illinois Health Facilities and Services Review Board on the takeover of West Suburban Medical Center and Westlake Hospital by the for-profit corporation Vanguard.

    Health and Medicine Policy Research Group

    Testimony before the Illinois Health Facilities and Services Review Board


    Re: Vanguard Health Systems applications to acquire West Suburban Medical Center (10-014) and Westlake Hospital (10-013)

    My name is Margie Schaps.  I am the Executive Director of the Health and Medicine Policy Research Group. I also was a member of the state task force that met throughout 2008 to revise and recreate the Illinois Health Facilities and Services Review Board (formerly the Illinois Health Facilities Planning Board).


    Our organization has a number of serious concerns regarding the applications for change of ownership.  We urge the Board to set as a condition of the permit a requirement that Vanguard Health Systems maintain and operate Westlake Hospital and West Suburban Medical Center for a minimum of ten years.  While this condition would not mitigate all of our concerns, it would address the most serious: ensuring continued provision of medical services to residents in the services areas, particularly residents with very limited alternatives for care.


    For almost 30 years, Health and Medicine has operated as an independent, non-profit center driven by a singular mission: formulating health policy, advocacy and health systems to enhance the health of the public.  The reason for our focus is obvious.  America’s vast dysfunctional health care system has lurched from crisis to crisis.  Demand for services is growing as a result of our aging population while spending on public sector health care services has declined. 


    In the last several years, the Cook County Bureau of Health Services has suffered unprecedented budget cuts, causing clinic closures, significant reduction of services and long waits for prescriptions and appointments for non-urgent procedures.  At the same time, the health care safety net across the Chicago region is deteriorating as fewer hospitals struggle to serve an ever-increasing number of people in need. As the federal health reform unfolds over the next several years, the need for community-based health services that people can count on, will be even greater.



    In this context, Resurrection Health Care’s plan to sell Westlake and West Suburban hospitals to for-profit Vanguard Health Systems raises several serious questions.


    If West Suburban and Westlake hospitals do not generate sufficient profits, will Vanguard close the hospitals or certain services such as the maternity or emergency departments? 

    Some years ago Vanguard purchased Phoenix Memorial Hospital, which served several low-income communities.  Residents were assured that the “mission and heritage” of Phoenix Memorial would continue under new management.  Within a year, Vanguard attempted to close the hospital’s emergency room.  In response, two elected officials in Phoenix pressed Vanguard Health Systems to help defray the projected $1.5 million it would have cost the three urgent-care clinics run by Maricopa County if they had to expand their hours to try to make up for the loss of the emergency department.  


    Vanguard halted its plans for closing the ER but several years later closed the hospital entirely and leased out the space.  During that same period, Vanguard was investing significantly in its hospital located Paradise Valley, an affluent suburb of Phoenix.


    Similarly, after acquiring Louis A. Weiss Memorial Hospital located here in Chicago in partnership with the University of Chicago, Vanguard closed the OB/GYN department.  Not surprisingly, these cases have added to the concerns of residents in the West Suburban and Westlake hospitals’ service areas.


    Unfortunately, Vanguard has not chosen to address those concerns by providing a long-term commitment to maintain and operate the hospitals.  While Vanguard has recently announced that it would keep Detroit Medical Center hospitals open for at least ten years, the corporation has only committed to operating Westlake and West Suburban for two years – less than the three years stipulated in the Board rules regarding change of ownership.


    Has Resurrection Health Care behaved responsibly to the communities that rely on West Suburban and Westlake hospitals?

    In the applications to the Board for change of ownership there is no indication that Resurrection actively pursued a nonprofit purchaser for these hospitals.  The purchase agreement references consideration of several alternatives but apparently the Resurrection Board chose not contact any of the financially viable health care networks here in Chicago or nationally. 



    Also of note in these applications is the very modest sale price for the two hospitals – less than half the value set for the hospitals when they were purchased by Resurrection.  Given the very low price negotiated, it would seem that Resurrection could have at least secured a serious commitment to the future operation of Westlake and West Suburban.



    How would closure or change in services at these two hospitals impact residents in the service areas?

    This question cannot be answered until there is consensus and clarity on a health plan for the region.  A central feature of the revised Illinois Health Facilities Planning Act is the creation of the Center for Comprehensive Health Planning, empowered to create such a plan over the next several years.  The Board is required to make decisions consistent with the findings of the Comprehensive Health Plan.  By requiring Vanguard to commit to maintaining services at West Suburban and Westlake hospitals for ten years, the Board will be taking a responsible step to ensure that the hospital does not close prior to a comprehensive evaluation of the health care needs in the area.


    Thank you for your consideration.

    Apr 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    New Report from the Budget & Tax Policy Initiative at Voices for Illinois Children on the Impact of the State Budget Deficit

    Download the new report from the Budget & Tax Policy Initiative at Voices for Illinois Children:  
    “Confronting the Fiscal Firestorm: An Update on the State Budget Deficit for FY 2011”

    Apr 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Update on Illinois' Money Follows the Person (MFP) Program

    Health& Medicine’s Center for Long-Term Care Reform has supported the supported the Money Followsthe Person (MFP) program in Illinois since 2007, when the demonstrationproject began in the state. MFPis a federal demonstration grant to assist individuals living in nursinghomes for 6 months or longer to transition back into a home and community basedsetting.  Through MFP, Illinois was awarded $55.7 million in theform of enhanced Medicaid reimbursements for a 5 year program, 2007-2011.

    Although Illinoishad set the highest goal for number of people to transition from nursing hometo home and community, the state has been slow in getting started in helpingpeople make their transitions.  Illinois is not alone,however, and most states are finding it difficult to meet their transitiongoals. 

    As a result of the passage of the Health CareReform legislation, the MFP grant has been extended through 2016 withadditional federal funds allocated to the program.  The eligibility requirements have also beenchanged, including the length of stay in the nursing facility; individuals whohave been in a nursing facility under Medicaid payment for at least 3 monthsare now eligible for MFP transitional services.

    As Illinoiscontinues to reform its long-term care system and works to promote quality homeand community based service options, MFP is an important demonstration projectfor the state.  Although Illinois hasbeen transitioning people out of nursing facilities into the community at aslower pace than originally planned, the Health Care Reform legislation givesthe state the opportunity to make some adjustments in the project and worktowards increasing transitions.

    Check out this Kaiser Family Foundation article for moreinformation on the Money Follows the Person grant:

    Questions? Contact Kristen Pavle, Policy Analyst, Center for Long-Term Care Reform 
    Apr 26, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Notice: Chicago Premiere of Film About Art Therapy and Alzheimer's

    This film about art therapy and it's effect on a woman with Alzheimer's was made by friends and is premiering May 3, in Chicago:

    "I Remember Better When I Paint"
    A documentary film about art and Alzheimer's
    A film by Eric Ellena and Berna Huebner (2009, 54 minutes)
    Narrated by Olivia de Havilland

    Chicago Premiere, May 3, 6:00 PM
    Gene Siskel Film Center
    164 N. State Street
    $10/General Admission  $7 Students (with ID) $5/Film Center members
    Discounted parking at the InterPark Self-Park, 20 E. Randolph

    Download Film Flyer

    Apr 22, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    From the Common Good Network: It's time to pass medical pot law in Illinois House

    From our friends at Protestants for the Common Good, a column by the their Executive Director, Reverend Al Sharp, on newlegislationpertaining to medical marijuana that appeared in their bi-weekly newsletter, The CommonGoodNetwork and also ran in the Chicago Sun Times, April 16, 2010.

    It's time to passmedical pot law in Illinois House

    April16, 2010


    Two years ago, ifyou had asked whether legalizing medical marijuana should be a highpriorityfor religious people, I would have smiled politely and said "no."

    Things change.Last Saturday, I participated in a press conference on behalf ofProtestantsfor the Common Good to support the passage of the "Compassionate Use ofMedical Cannabis Pilot Program Act," Senate Bill 1381. This bill wasapproved in the Illinois Senate last spring and is pending in the House.

    Why is this billso important? The first reason is simple. Passing this legislation wouldbe anact of compassion and mercy. Victims of cancer, multiple sclerosis,epilepsyand other serious health problems have given compelling testimony thatcannabis(the technical term for marijuana) provides relief from pain andsuffering.This relief often can come in no other way.

    The number ofpeople who use marijuana for this purpose is small, but if you are oneof them,or have a family member who is, the issue of legalization suddenlybecomesurgent.

    The second reasonthis bill matters is that passing it would send the message that it's OKtospeak honestly and intelligently about drug policy in Illinois. That isvery difficult right now.

    State Rep. LouLang (D-Skokie) says he has approached all 118 members of the IllinoisHouse.He reports that 92 say privately to him, "This is a good bill. I hopeyoucan pass it."

    But of this group,only 52 are prepared to vote "yes." They fear "spinpolitics" that will label them as "soft on drugs."

    They're afraid todo what they know is right.

    In reality, thearguments against this bill don't hold up. The biggest fear is thatlegalizingmedical marijuana use will encourage recreational marijuana use,especiallyamong the young. But similar bills have been passed in 14 other states,and inthe 11 states where follow-up analysis has been done, the evidencesuggests nosuch effect.

    Others claim thebill is unnecessary because Marinol, a pill that contains marijuana,alreadyhas Federal Drug Administration approval. But this drug has only one ofthe 85ingredients contained in cannabis; consequently, it does not providerelief foreveryone. Besides, taking a pill is hardly helpful when one is nauseatedandvomiting.

    To be sure, thereare some horror stories out of California,where a medical marijuana bill was passed without adequate safeguardsand seemsto have led to some recreational use.

    But thelegislation being considered in Illinoisincludes extensive regulations concerning access, quantity and physicianoversight. It's also a pilot project requiring legislative approval tocontinueafter three years -- providing ample time to assess whether the sky hasfallen.

    As for thepolitical downsides? My guess is that lawmakers' fears of a voterbacklash fordoing the right thing are greatly exaggerated. A recent Pew ResearchCenter poll shows that awhopping 73 percent of Americans support the use of marijuana asmedicine.

    Still, Langdeserves plaudits for leading this effort, as does Bill Haine (D-Alton)in theSenate. Their bill is one of compassion and, indeed, sanity -- twoqualitiesthat are all too often absent from the political process in Springfield.

    Dr. Quentin Young,Illinois'public health advocate, said at Saturday's press conference that he willurgeGov. Quinn to sign the bill when it appears on his desk. It is time fortheIllinois General Assembly to put it there.

    Apr 20, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Fellows for Life "Leadership By Example" Lecture Series to Start With Look at Chicago's Underground Populations

    If you're in Chicago on Tuesday, May 4,  join us for the the first 2010 Fellows for Life "Leadership by Example" Lecture with guest speaker, Dr. Greg Scott, a sociology professor at DePaul University who has conducted extensive ethnographic fieldwork on drug-dealing street gangs.

    Since 2005, Scott's nonprofit multi-media company, Sawbuck Productions, has produced educational and political materials concerning the well-being of illicit drug users. The documentaries have been shown at film festivals around the world and have appeared on the National Geographic Network, BET Network and MSNBC.  His film “Begging for Grace,” which documents the daily life of a panhandling homeless heroin addict named Freeway, was an official selection of the International Documentary Challenge at the 2007 HotDocs Film Festival in Toronto, Canada, and was recently acquired for commercial distribution.

    In 2008 Dr. Scott began working as a freelance audio documentarian for Chicago Public Radio’s WBEZ where he produces and directs 8-12-minute stories about street life within Chicago’s “undergrounds.” Topics have included prostitution, heroin overdose and drug selling. His radio series “The Brickyard” relates stories about outlaw communities of heroin addicts, crack smokers, prostitutes, thieves, drug dealers and others living on Chicago’s west side.

    The event is open to the public and will be held Tuesday, May 4, 2010 beginning at 6:00pm at Northwestern University’s Chicago medical campus in Baldwin Auditorium, 303 E. Superior Street, 1st Floor, Chicago.

    It is free of charge, and open to the public, but reservations are strongly recommended.  RSVP by email or call 312 372-4292 extension 24

    Download the flyer to share with colleagues and friends

    Now in its third year, the lectureseries is organized by Fellows for Life (alumni of the Chicago AreaSchweitzer Fellows Program).  Speakers in the series have been selectedto talk about their exemplary lives of public service, with a specialemphasis on individuals who focus on the well being of underservedpopulations.

    Apr 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Make Your Voice Heard at the "Save Our State" Rally!

    The Responsible Budget Coalition will hold a “Save Our State” rallyon Wednesday, April 21 at the State Capitol in Springfield to demand asensible budget for Illinois. Join advocates from around the state totell legislators that WE CAN’T WAIT for a responsiblebudget that includes revenue reform. Speak out to ensure a bright futurefor children and families!
    For more information and to downloadrally fliers in English and Spanish go to

    Apr 15, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Attention Public Health Partners: Upcoming May Hearings on the Illinois State Health Improvement Plan (SHIP)

    Download a copy of this hearing notification to share with colleagues and friends

    From Damon Arnold, MD, MPH,  Director, IL Dept. of Public Health Co-Chair,SHIP Team;  and Robert Kieckhefer, Co-Chair,SHIP Team

    Under Public Act 94-0975, the Illinois Department of PublicHealth, in conjunction with the Illinois State Board of Health, must produce aState Health Improvement Plan approximately every four years.

    For the past seven months a thoughtful and expert Team representingpublic health system partners has worked together to craft the 2010 IllinoisState Health Improvement Plan.

    The Plan envisions optimal physical, mental and socialwell-being for all people in Illinois through a high-functioning public healthsystem comprised of active public, private and voluntary partners and describesoutcomes for five Public Health System strategic issues: 1) Improve Access toHealth Services; 2) Enhance Data and Health Information Technology; 3) AddressHealth Disparities and Social Determinants of Health; 4) Measure, Manage,Improve and Sustain the Public Health System; and 5) Assure a SufficientWorkforce and Human Resources. There are also eight Priority Health Concernsaddressed in the SHIP. These are listed, without rank ordering, as: 1) Alcoholand Tobacco; 2) Use of Illegal Drugs/Misuse of Legal Drugs; 3) Mental Health;4) Natural and Built Environment; 5) Obesity: Nutrition and Physical Activity;6) Oral Health; 7) Unintentional Injury and Patient Safety; and 8) Violence.

    We are now at the stage of gathering input and reaction tothe draft plan. We need the support, engagement and participation of thebroader public health community and public health partners to improve the planand make it a reality. We hope that the many sectors of the Illinois public health system, includingbusiness, health care providers, local public health departments, communitygroups, universities and state agencies will provide feedback over the nextthree to four weeks for the Team to consider.

    The State Board of Health invites you to attend and makecomments at one of three public hearings in early May.

    Chicago,IL, May 7, 2010 - 10am-1pm, JamesR. Thompson Ctr., 100 W. Randolph, Rm 2-025

    Springfield, IL, May 10, 2010 - 10am – 1pm, Ill. Dept. of Natural Resources, One NaturalResources Way, Lake Level A, B & C

    Carbondale, IL,May 13, 2010 – 2pm -4pm, Civic Center, 200 S. Illinois,Rm 111/112

    The draft Plan can be found at

    • Oraltestimony at the hearings will be strictly limited to three minutes.
    • Pleasealso provide two (2) copies of written testimony to accompany your oraltestimony.
    • If youare unable to attend one of the hearings in person, you may submit writtentestimony to Please note “2010 SHIP Testimony” inthe subject line. The deadline for submitting written testimony is May 13,2010.

    The Planning Team and the State Board of Health are lookingforward to rich and thoughtful public comment and input to help us craft thebest State Health Improvement Plan possible.

    Apr 15, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young in Huffington Post (April 14, 2010) - No Time to 'Wait and See' On Health Law

    No Time to 'Wait and See' on Health Law

    Building the Single-Payer Movement

    Having just gone through a grueling, frequently raucous debate onhealth reform, capped by the narrowest of votes to pass the Obamaadministration's bill, many activists are now tempted to adopt a "waitand see" attitude on how the new law plays out.

    A few others are putting their emphasis on helping the administrationimplement the law, in some cases enthusiastically trumpeting their strange-bedfellow partnership withthe profit-hungry health insurers and Big Pharma.

    Still others - the hostile, noisy Know-Nothings associated with theRepublicans and Tea Party crowd - continue to rail against PresidentObama's "socialized medicine" plan (a misnomer if there ever was one),and pledge to obstruct or overturn it. Conservatives vow to makepolitical hay out of the law in the run-up to the midterm elections.

    Wall Street, on the other hand, is very comfortable with the newlegislation. Mutual fund analysts now say it's increasingly clear thatthe law is beneficial for health industry stocks,particularly for pharmaceutical and medical equipment companies, becausethere are no "onerous cost controls" in the law. And health insurancecompany stocks continue to a yearlong trend upward, and the industry's CEO salaries continue to be astronomical.

    After all, the health insurers wrote the bill. Sen. Max Baucus wasrecently caught on tape heaping effusive praise on his aideElizabeth Fowler for her pivotal role in crafting the legislation.Fowler is a former vice president of WellPoint, the giant healthinsurer.

    Baucus himself, a key actor in this bad movie, was surrounded byhealth industry lobbyists from the very beginning, and has received over$2.8 million in campaign contributions from these toxic sources overthe past few years. That he earned his payoff was demonstrated whenKaren Ignagni, the president of America's Health Insurance Plans,congratulated him (during this week's episode of "Frontline") on his handling of the single-payer nonviolent disruption of his SenateFinance Committee hearing after single-payer advocates like Dr. MargaretFlowers were excluded from giving testimony.

    Supporters of single-payer national health insurance face severalchallenges, the chief of which is how to transform the various effortsof single-payer Medicare-for-All activists into a movement for politicaland legislative success. Among the key tasks are these:

    * Educating candidates for political office (and currentofficeholders) from all political parties about the merits of thesingle-payer proposal, and offering to advise them on health policymatters.

    * Ensuring the reintroduction and largest possible legislativesponsorship for national single-payer bills like Rep. John Conyers' H.R. 676 and Sen. Bernie Sanders' S. 703.

    * Supporting efforts (including a change in the new law) to permitstates to experiment with their own, independent single-payer models ofreform right away.

    * Defending Medicare from harmful budget cuts and educating Medicarebeneficiaries about their self-interest in improving and expanding theprogram to cover everyone, i.e. embracing the slogan, "Everybody in,nobody out."

    * Continuing our educational work about the merits - nay, thenecessity - of adopting a single-payer system. The sooner we initiate atruly universal, egalitarian, humane and efficient system, the soonerthe American people will enjoy the high-quality health care our nationand our health professionals are capable of providing.

    A major burden the enactment of the new law imposes on single-payeradvocates is its timeline. Specifically, major elements in thelegislation do not kick in for two, four or even eight years' time.

    But "wait and see" is not an option for us. The legislation justpassed is completely inadequate to the task at hand.

    Under the new law, the suffering and financial hardship imposed onAmericans by our private-insurance-based system will largely continueunabated for four more years, and only then be subject to very modestregulation. (Loopholes in the law abound.) Over 50 million people willremain uninsured each year until 2014, which translates into 50,000 preventable deathsannually. A comparable number will remain underinsured, with manyvulnerable to medical bankruptcy when serious illness strikes,even after 2014.

    Even if the new law works as planned, at least 23 million people willremain uninsured at 2019. So "universal health care" remains a dreamdeferred.

    That spells human misery. This week a new Harvard-based study showed that people withmigraine who lack health insurance, or who are on Medicaid,disproportionately suffer from their condition because they can't getaccess to the standard medications they need to reduce their pain andother symptoms. And that's just one example of the unnecessary sufferingthat lies in wait.

    Meanwhile costs, including for health insurance premiums, will continue to escalate.

    The unrelenting advocacy of single payer by Physicians for a NationalHealth Program also stems from a careful study of repeatedlyunsuccessful experiments with state-based reforms based on private insurance,including the Massachusetts plan (upon which the new law ismodeled). The evidence is clear: incremental reforms of this type -based on the private-insurance model - will not work. They invariablysuccumb to skyrocketing costs.

    Single-payer Medicare for All is the reform that's required. Just likealmost all other major areas of progress in American life, fundamentalhealth reform requires a movement based on equity, justice, prudence andscience that is free of market greed. That movement today is singlepayer.
    Apr 15, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    HMPRG Board Member to Present at Conference on Fathering Urban Youth: The Role of Fathers in Adolescent Well-Being

    HMPRG Board member Camille R. Quinn (Diversifying Faculty in Illinois Fellow, 2009-2010
    and Doctoral Student, Jane Addams College of Social Work) and Qiana Cryer will be presenting  "Exploring Adolescent Well-being and Father Involvement" at Fathering Urban Youth: The Role of Fathers in Adolescent Well-Being, Thursday, May 6, 2010, 8:30am–4pm, at International House Assembly Hall, The University of Chicago, 1414 East 59th Street, Chicago 60637 (Open to the public)

    Download the flyer with RSVP information

    Apr 14, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)


    From our friends at Citizen Action - please share this with others you think might be interested:

    FIRST THE PARKING METERS , NOW OUR WATER SYSTEM??? Attend the upcoming community forum on Chicago Privatization to learn what it could mean for Chicago's Publicly-owned water system. The educational forum will be held on Monday, April 19th, 7 - 9 pm at the Chopin Theater (1543 West Division) and is being sponsored by Illinois PIRG and Food and Water Watch.

    There will be a good mix of speakers with expertise on the impact privatization has on taxpayers and the public, the experience other cities have had and what can be done to prevent any bad privatization deals. This is particularly timely - last year the city parking meter deal resulted in poor service, skyrocketing meter rates, and the loss of as much as $1 billion in taxpayer revenue. Now that the funds from that sale are dwindling, Mayor Daley has indicated that "all options are on the table". It's important that citizens be involved to make sure their voice is heard if the city decided to lease another taxpayer-owned asset like our water system.

    Speakers include:  Alderman Scott Waguespack, 32nd Ward, Jon Keesecker, Food and Water Watch and Phineas Baxandall, U.S. PIRG The Community

    For more information, call Emily Carroll Chicago Organizer, Food and Water Watch  at 773-318-3823 or email her at:
    Apr 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Reminder - HMPRG Hosting 2 Training Sessions for Direct Service Workers Who Work With Girls and Women

    Health & Medicine is hosting  two importantupcoming facilitator training sessions by Girls Circle

    May19th/20th - Girls Circle Facilitator Training (Learn Skillsto Lead Engaging Support Groups for Girls)

    May 21st -Mother-Daughter Circle Training(Promote Healthy Bonds betweenMothers & Daughters)                                                                           

    Training Location: MentalHealth America of Illinois 70 E. Lake Street, Ste. 900, Chicago, IL60601

    Download the flyer to learn how you canbecome a Girls Circle facilitator and bring this evidenced-based programinto your girl-serving agencies and organizations to improve theresilience of girls and young women

    Questions? Email Sarah Schriber,Senior Policy Consultant
    Health & Medicine Policy Research Group
    Apr 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Could Physician Shortage Translate to Expanded Role for Nurse Practitioners?

    Interesting AP medical article from Yahoo News

    Doctor shortage? 28 states may expand nurses' role

    Apr 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Two Tribune Posts, Re: The Illinois Hospital Report Card

    Illinois adds patient safety information to online hospital report card

    April 13, 2010

    SPRINGFIELD, Ill. (AP) — An online tool that Illinois consumers canuse to compare hospitals and surgical centers has added new information.

    The Illinois Hospital Report Card launched in November. It now includes red,yellow and green icons on numerous safety measures.

    Red means the hospital's performance was worse than the state or nationalaverage. Green means better. Yellow means no better or worse than average.

    For instance, consumers can see whether their local hospitals are significantlybetter or worse than the state average on injuries to babies during birth.Patients can see how many times a foreign object such as a surgical sponge wasleft inside a patient's body during a procedure.

    Data were updated through June 2009. The site will be routinely updated withthe most recent data available.

    Illinois hospital death rates published by state
    Death rates for adults in Illinois hospitals now up on the Internet

    April12, 2010|By Judith Graham, Tribune reporter

    Patients die ofcommon medical conditions more often at some of the area's best-known hospitalsthan at other institutions with less sterling reputations, according to a newstate report published Monday.

    Medical centers immediately challenged the information, saying it didn'taccurately reflect differences in the kinds of patients institutions attractand how seriously ill they are.

    The data, including death rates for stroke, pneumonia, hip fractures andcongestive heart failure, are posted on the Internet at

    Critics faulted a methodology used to adjust the information for patientcharacteristics. It's "not as sensitive as it should be," said Dr.Bruce Minsky, chief quality officer at the University of Chicago MedicalCenter.

    Mary Driscoll, head of patient safety at the Illinois Department of PublicHealth, said the so-called risk adjustment methodology was developed by the federalAgency for Health Care Research and Quality, where it underwent significanttesting and evaluation.

    This is the first time Illinoishas published mortality data for hospitals. Statistics, which cover all adults,come from information hospitals compile when patients are discharged. Notablefindings include:

    • Death rates for patients with congestive heart failure were higher at the U. of C.Medical Center than at other hospitals. Thestate's average mortality rate for people hospitalized with congestive heartfailure is 3.88 percent; at the U.of C., it was 4.86percent.

    Minsky said those figures are misleading. The U. of not out of line with other academic medical centers when a morecomprehensive way of adjusting for patients' risk of death is employed, hesaid.

    The U. of C. also reported more deaths amongpatients who underwent coronary artery bypass surgeries (4.94 percent versus astate average of 2.87 percent).

    • Death rates for stroke patients were higher at the Universityof Illinois at Chicago MedicalCenter (10.67 percent)than at other hospitals in the state (an average of 9.10 percent).

    UIC is a major referral center for strokes and sees many difficult patientswith attacks that cause significant bleeding in their brains, said spokeswomanSherri McGinnis Gonzalez. These hemorrhagic strokes are more often fatal, butthe state's data don't take that into account, she said.

    Apr 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Some Additional Health Care Reform Resources

    Apr 13, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    The Use of Chemical Restraints in Illinois Nursing Homes

    Author: Nadia Chivers, Policy Intern, Health & Medicine Policy Research Group

    Editor: Kristen Policy, Policy Analyst, Center for Long-Term Care Reform, Health & Medicine Policy Research Group

    The Outlawing of Physical and ChemicalRestraints

    Since October 1990, nursing homes across the country havehad to comply with a federal mandate, The Omnibus Budget ReconciliationAct of 1987, that restricts the use of inappropriate physical and chemical restraintson nursing home residents unless the restraint is necessary to treat theirmedical symptoms.

    Physical restraints restrict a person’s movement and mayinclude leg and arm restraints, hand mitts, vests, ties, and trays/tables/barsthat cannot be removed from a chair or bed and limit the person’s mobility.

    While the use of physical restraints in nursing homes servessome legitimate purpose, unnecessaryuse has drastically reduced in the past 20 years.  The same cannot be said for the use ofchemical restraints.  While psychotropicdrugs are often an essential form of treatment in nursing homes, they becomechemical restraints when they are used to control a resident’s behavior ratherthan administered for medical purposes.

    The misuse and overuse of psychotropic drugs on nursing homeresidents has been well documented and is nowconsidered by some experts to be the newest form of nursing home abuse.  It is estimated that 1 in 4 patients in the U.S. receiveanti-psychotic drugs and 15,000 nursing home patients are killed each year dueto unnecessary anti-psychotics.  

    As a response to the inappropriate use of psychotropic drugsin Illinois nursing homes, theIllinois Nursing Home Safety Task Force (The Task Force) has included inits FinalReport a recommendation that a policy be developed to assure these drugsare used properly. 

    Danger of Chemical Restraints and Lack ofRegulation

    The dangers associated with chemical restraint are just assevere as those associated with physical restraint.  Misuseand overuse of psychotropic drugs may result in overdose, malnutrition anddehydration, the inability to feel pain, brain injury, bed sores and other skinconditions, chemical dependence, choking, and death.

    The lack of regulation surrounding the use of psychotropicdrugs in nursing homes is one reason why these drugs are so frequently misused.  Currently, there is no policy prohibiting doctorsfrom practicingoff-label use of drugs.  Forinstance, an anti-psychotic drug to treat mental illness may also be prescribedfor non-mentally ill patients, even though the FDA may not have approved thedrug for such conditions.  The Task Forcereceived complaints about inappropriate use of drugs – including that“psychotropic drugs were repeatedly used for unapproved indications,” (see Recommendation28 and Highlights of Public Testimony in the Task Force Final Report).  There is also no oversight as to the doctorswriting the prescriptions or the actual administration of the drugs.  The Task Force found that only a fewphysicians prescribe the majority of psychotropic drugs for people with mentalillness, frequently doing so without even seeing the resident.  This could be a result of thepractice of drug-makers paying doctors to promote their drug.

    Additionally, the Task Force found that nursing home staffcould administer the drugs “as needed” without first consulting a doctor.  As long as there is a valid prescriptionsigned by an Illinois-licensed physician, the nursing home cannot be cited forimproper use of the drugs. 

    Lastly, Illinoisdoes not require nursing homes to receive residents’ consent for eachpsychotropic drug administered.  Accordingto a December 20, 2009 Chicago Tribune report, since 2001 hundreds ofnursing home residents in Illinoishave been given psychotropic drugs without their permission. 

    IllinoisNursing Home Safety Task Force Recommendations on Use of Chemical Restraints

    In its Final Report, the Task Force includes Recommendation28 to “Develop a policy to assure proper use of psychotropic drugs for peoplewith serious mental illness and dementia” as a result of the many complaints itreceived regarding inappropriate use of psychotropic drugs.

    To achieve this, the Task Force offered “Next Steps,” whichinclude implementation of policy changes that consist of standards for theappropriate use of psychotropic medications being developed in consultationwith the Illinois State Medical Society, Illinois Psychiatric Society,University of Illinois College of Medicine, and other potential clinical andacademic partners.  A workgroup devotedto this issue has convened and is currently preparing a rulemaking report forstate agencies which is scheduled to be completed on April 23, 2010.  

    While the use of physical restraints in nursing homes is nolonger a widespread problem, the use of chemical restraints is.  With the deadline of the workgroup reportnearing, we should all stay-tuned to see how it plans to address the inappropriateand dangerous use of psychotropic drugs in Illinois nursing homes. 

    If you want to become more involved in this issue, pleasepost your comments and ideas below or directly on the NursingHome Safety Task Force website. Finally, if you suspect your loved one is being chemically restrained inan Illinoisnursing home facility, contact your regional ombudsmanwho will investigate your complaint.  

    Mar 31, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young: Where We Are Now on Health Reform, from the March 30th Huffington Post

    From the Huffington Post, posted: March 30, 2010 03:29 PM
    Dr. Quentin Young

    Dr. Quentin Young

    Where We Are Now on Health Reform

    Withthe passage of the Democrats' health bill, Congress and President Obamahave created a new (and not so new) legislative framework for healthcare finance in the United States. Now that we've officially enteredthe post-legislative period, it's worth noting how we got to where weare.

    The for-profit insurers and their health industry allies sunk their claws into the legislative process early and hung on to the very end. The new bill largely reflects their handiwork. Stock prices for virtually all the leading private insurers remain high and have been trending upward.Investors are also bullish on the promising prospects for the drugcompanies and for-profit hospitals in the wake of the bill's passage.

    The attacks on the Democrats' bill from the right-wing Republicansand their proto-fascist allies, including many so-called tea-baggers,were fierce, sometimes absurd and frequently despicable. The racist and homophobic assaults on supporters of the bill set a disturbing, new low for contemporary U.S. politics.

    Politically, it can be argued that Obama and his administrationsqueaked through a highly significant victory, made so by the shamefulstrategies of the Republicans and their allies. It's a fact that adefeat for Obama engineered by these reactionary forces would havepoisoned the climate of political discourse seriously. Nevertheless,the bill is full of pitfalls that harbinger ill for the American publicas patients.

    Blue Dog and anti-abortion Democrats held out for their agenda untilthe very last minute, wresting still more restrictions from theirparty's leadership (at the expense of millions of women and ordinaryworking people) and making the final vote very close. The bill'scurtailment of reproductive choice prompted an appropriately stinging response from the National Organization for Women.

    For those of us who wanted to see more fundamental and progressivereform - specifically, those of us who called for sharply reducing therole of the profit-driven insurance companies and Big Pharma in ourhealth system - it's fair to say that virtually no gains were made.

    The systemic cause of our universally judged "broken" health caresystem - the role of the private insurance industry - was notsubstantively addressed. In fact, the role of that industry wasactually strengthened with the passage of this bill.

    So what did we end up with?

    There are a number of qualified virtues in the bill. Among these arecertain restrictions on the ability of insurers to deny coverage topersons with pre-existing conditions, the allowance of children up tothe age of 26 to be covered under their family's insurance plan, theexpansion of Medicaid by approximately 16 million additional people(although it must be noted that the Medicaid remains badly underfundedand therefore provides substandard care), and new appropriations forcommunity health centers and the training of primary care doctors.

    It's worth noting that all of these modestly positive measures couldhave been enacted separately. Instead, they were linked with measureslike a burdensome individual mandate on middle-income uninsured peopleto buy health insurance (a defective product, as many who use theirinsurance quickly find out), the handing over of about $450 billion intaxpayer money to the insurers in the form of subsidies, an excise taxon workers' health plans exceeding a certain threshold, and newrestrictions on women's reproductive rights, to name just a few. Atleast 23 million people will still be uninsured by 2019.

    Given the big role the insurers played in writing the new law, it'ssafe to assume they've created sufficient loopholes to protect theirinterests over both the short and long term. One example: only a fewdays after the bill was passed, insurers deniedthat they were obligated to issue coverage to children withpre-existing conditions, a key pro-reform talking point of thepresident. Under pressure, they've apparently retreated from this stance. But it's only a symptom of a larger problem.

    The main cause of our dysfunctional health system, the for-profit private insurance industry, remains in the driver's seat, as the statement of Physicians for a National Health Program stresses.

    The bill will do little if anything to check the runaway health system costs and their ability to visit bankruptcy and other forms of penury on the American people.

    Simply put, the one rational remedy for all of this, single-payernational health insurance, is more urgent than ever. It's critical toour nation's health and well-being. It has been noted, accurately, that our persistent health care mess is threatening our economic status domestically and in global competition.

    We have learned bitterly that the unlimited lobbying resources ofthe health industry giants can prevail in both chambers of Congress.Where, for instance, was the serious challenge from the 90representatives on record in favor of H.R. 676, the single-payer proposal?

    While the raucous and dangerous right-wing assault was unmitigatedthroughout the campaign, virtually no serious demand came from theprogressive wing of the Congress.

    Our work is cut out for us. We have the same important challengefaced by the civil rights advocates of the 1950s and '60s, which endedvictoriously. The same steady expansion of popular awareness and demandto the level of a movement is the requirement to end the currentcorporate control of our health system.

    Mar 29, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Two Good Health Reform Bill Resources from Fire Dog Lake

    Mar 29, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Resources on Health Information Exchange

    Health & Medicine recently held "Beyond Medical Services: Developing a Roadmap forImproved Health in an Era of HIE,” a regional forum (co-hosted by The Metropolitan Chicago Healthcare Council and theHealthcare Consortium of Illinois) and the first in aseries of forums focusing on Safety Net Issues. In attendance were public health, medicine, behavioral health, andother safety net professionals, who came together to learn what washappening in HIE planning in Illinois; to hear from experts in nursing,public health, case management, and behavioral health informatics, andto discuss action steps for improving health as state-wide healthinformation exchange is developed. View and download speaker presentations.

    Mar 29, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Link to Studies on Social Inequalities in Health

    Here is a valuable link to all of the PDFs from a collection of papers on socialinequalities in health by the McArthur Network on SES and Health published as anNYAS volume under the title "Biology of Disadvantage"

    Mar 24, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    HMPRG's Margie Schaps Speaks About The Health Reform Bill in Chicago Current and on Vocalo Radio

    Hear Margie being interviewed by MollyMolly on Vocalo, WBEZ's youth radio station

    Chicago Current

    Cook health officials brace for changes after passage of national reform bill

    • By Alex Parker
    • March 23, 2010 @ 8:30 AM

    Politicians across the nation are still debating what the healthcare reform bill will and won't do. But good or bad, it could havemajor consequences right here in Cook County.

    The Health and Hospitals System, already faced with a reduced budgetsince the lowering of the county's sales tax, must now also contendwith the uncertainty of broader health care reform.

    Health board chairman Warren Batts says he is still trying to sortout what the bill means for Cook County. But Batts and others expressedfears that the county health system might become a victim of a healthcare program that may encourage people to look elsewhere for care.

    “Wethink there are some good things in it, but overall it’s prettyproblematic,” says Margie Schaps, executive director of the Health& Medicine Research Policy Group.

    Schaps complains that it doesn’t extend benefits to illegalimmigrants and could leave as many as 400,000 people in the Chicagoarea without coverage.

    “The concern is the people who get insurance, Medicaid or another private insurance are going to be drawn away,” she says. Read the full post

    Mar 24, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    More great resources to help clarify what's happening with the Health Reform Bill

    Mar 24, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Simple Document Clarifying The Health Reform Bill's Key Points

    Download this helpful document which is permanently being added to our section on the bill on the HMPRG website. 

    It was prepared by AXIS Benefits Consultants, using the following sources:
    Library of Congress Bill Summary, Kaiser Family Foundation comparison, National Association of Health Underwriters (NAHU) analysis.

    Mar 22, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Making Sense of the Health Reform Bill

    Mar 22, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    A Cautionary Tale from Miami's Public Health System...

    On March 5, 2010, The NY Times ran a story about the possibility that the cash-strapped City of Miami might close two of its public hospitals. A follow-up story on March 18 revealed that the city had adopted a bailout plan, albeit temporary.  The situation in Miami mirrors that of many other large cities in fiscal crisis.  Excerpts from both stories are posted below, with links to the full articles.

    March 5, 2010
    Miami Board Looks to Close Two Hospitals

    MIAMI — At risk of running out of money in May, Miami’s public health care system is considering closing two of its five hospitals and laying off 4,487 employees — a third of its work force, the chief executive said Friday.

    Eneida Roldan, the chief executive, told the governing board of the system, Jackson Health, that 1,000 jobs would be eliminated from the main hospital, Jackson Memorial, and that most of the rest would come with the closing of its two community hospitals, Jackson South and Jackson North. The closings would mean the loss of 581 acute-care beds.

    The closings would be “a community disaster,” said Brian E. Keeley, chief executive of Baptist Health South Florida, the largest private hospital organization in the county.

    Jackson is the largest public health care provider in the region, with more than 2,200 beds and 12,000 employees. It is projecting a budget shortfall of $229 million this year.

    Mr. Keeley said that some of Jackson’s problems were a result of the rise in the number of uninsured. “Nationally, that number is around 18 or 19 percent,” he said. “In South Florida, that number is between 20 and 30 percent.”

    “As a community,” he added, “we need to step up to help provide a safety net.”  Read the full story

    The follow up story explores a "temporary bailout" adopted by Miami, but also points to similar crises in other cities.

    March 18, 2010
    Public Hospitals in Miami Tackle Deficit With Pain

    MIAMI — After warning two weeks ago that it would run out of money within weeks, Miami’s public hospital group has cobbled together a stabilization plan that will keep most services intact through the end of September.

    The plan, approved Thursday by county officials, would lead Jackson Health System, the third-largest public hospital system in the nation, to cut 655 positions, delay debt payments and, if possible, exact $30 million in concessions from unions.

    Compared with an earlier proposal that would have closed two hospitals and laid off nearly 4,500 workers, the new plan is a reprieve. But health officials said it was also just a “first step” in a restructuring that could reshape how South Florida’s poor and sick receive care.

    Without a tax increase, private benefactor or rearrangement of who pays for the uninsured, experts expect the Jackson system to shrink significantly. Programs will be consolidated. Jobs will be lost. Wait times will probably increase.

    “The solution is not without pain, if we’re realistic,” said Merrett R. Stierheim, a former county manager who is acting as an unofficial adviser to the Jackson system. “The current way of doing business is unsustainable.”

    The system’s struggle, in many ways, mirrors the situation at public hospitals in New York, Atlanta and other cities. As safety-net providers with missions to serve the poor, public hospitals have been increasingly overwhelmed with patients who cannot pay. At the same time, government support — through taxes and reimbursement for programs like Medicaid — has continued to decline.  Read the full story

    Mar 19, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    More on the Responsibility of Nonprofit Hospitals to Deliver Charity Care...

    From the Chicago Tribune front page, today, March 19, 2010:

    Burden higher for nonprofit hospitals, Illinois Supreme Court says

    Court backs withdrawal of tax exempt status for Provena Covenant Medical Center

    By Bruce Japsen and Jason Grotto, Tribune reporters

    March 19, 2010

    An Illinois Supreme Court decision Thursday puts nonprofithospitals on notice that they must provide an adequate amount ofcharity care to patients or risk losing significant tax exemptions.

    Thedecision, closely watched at a time when medical centers and thegovernment are straining to cover health care costs for the poor, is ablow to the state's hospital industry. It sets the stage for apotential debate about exactly how charitable hospitals must be, withsome experts predicting that Springfield could seek to pass a lawmandating the amounts.

    In the meantime, state officials indicatedthey could incorporate the court ruling into their assessments ofwhether to renew hospital tax exemptions. In its decision upholding alower court ruling, the high court found that the Illinois Departmentof Revenue was correct in withdrawing Provena Covenant Medical Center'sproperty tax exemption in 2004 because the Urbana hospital failed tojustify adequately the exemption through charitable giving.

    IllinoisAttorney General Lisa Madigan called the ruling "good news" for thestate's nearly 2 million uninsured residents "who lack access toaffordable health care."

    The Illinois Hospital Association, whichrepresents 200 hospitals in the state, described the ruling as"disturbing" because of the way it reverses precedent.

    "Ahospital that treats patients regardless of their ability to pay andthat does not provide profits to private individuals is charitable andmerits an exemption from property taxes, without regard to the specificamount of free care it provides," association President MaryJane Wurthsaid in a statement. She warned that imposing new tax burdens couldforce a hospital to reduce services and increase health care costs

    Foryears, state lawmakers have debated whether to require hospitals toprovide a set level of charity care to qualify for tax exemptions buthave never been able to put a standard in place.

    Legal expertssaid Thursday's ruling sets up a confusing and unpredictable standardfor nonprofit hospitals, which make up about three out every fourhospitals in the state.

    "I don't think it brings clarity or muchdirection to the exemption issue," said John Durso, an attorney in thehealth care practice at Ungaretti & Harris in Chicago. "It's notthe end of the debate. It's the beginning of the debate."

    It'salso unclear how national health care reform, which Congress isexpected to vote on as early as Sunday, could impact the issue ofcharity care. Under provisions currently being considered, about 32million of the nation's 48 million uninsured could receive some type ofcoverage.

    In the meantime, the ruling was seen as a warning tononprofit hospitals that aggressive collection practices and weakcharity policies could jeopardize their tax exemptions.

    "Therecord showed that during the period in question here, Provena did notadvertise the availability of charity care," Justice Lloyd Karmeierwrote for the majority. "Patients were billed as a matter of course andunpaid bills were automatically referred to collection agencies."

    Indeciding the case, the justices focused on two tests required forproperty tax exemptions in Illinois: whether the institution that ownsthe property is charitable and whether the property is used forcharitable purposes.

    On both counts, the court ruled againstProvena Covenant, one of six Catholic hospitals owned by Mokena-basedProvena Health, which also has facilities in Aurora, Danville, Elgin,Joliet and Kankakee. It is sponsored by three religious orders.

    Thejustices found that Provena Covenant is not a charitable organizationbecause the vast bulk of its income comes from charging for medicalservices, not from charitable donations; because it didn't dispensecharity care to all who needed and applied for it; and because itplaced obstacles in the way of those seeking charity by not advertisingits charity program while aggressively pursuing unpaid bills.

    Thejustices also found the hospital's campus was not used for charitablepurposes because both the number of patients and the dollar value ofthe free care those patients received were minuscule compared to thehospital's revenues and patient population.

    In 2002, Provenaprovided charity care to 302 patients, or less than one-half of 1percent of the total number of patients it served. The value of thatcare, meanwhile, was 0.7 percent of the hospital's revenues. The courtalso noted that even under parts of its charity care program, Provenamade a profit despite giving discounts of 25 to 50 percent.

    Staterecords show that 13 nonprofit hospitals in Cook County posted similarcharity care numbers in 2008, the most recent year for which numbersare available.

    The largest hospital among that pool is theUniversity of Chicago Medical Center, which provided 0.8 percent of its$1.1 billion in revenue for charity care while receiving tens ofmillions in tax breaks. The university hospital's charity care figuresdropped by 30 percent between 2007 and 2008.

    NorthwesternMemorial Hospital and Rush University Medical Center, which along withU. of C. make up the three largest nonprofit hospitals in the county,had increases in their charity care figures.

    Northwesternprovided 2.4 percent of its total revenues for charity care in 2008, a24 percent increase from 2007, while Rush saw a 65 percent increase,bringing its charity care figure to just above 1 percent of its totalrevenues, according to state records.

    Many nonprofit hospitals,including the University of Chicago Medical Center, have maintainedthat care provided under Medicare and Medicaid should be consideredcharity because government reimbursements under the programs fall farshort of hospitals' costs.

    "When you take a careful look at thecharitable provision of medical services to the poor — including purecharity care, losses due to unpaid hospital bills, and underpayment byMedicaid and Medicare — the Medical Center contributes about $200million each year, which equals nearly 20 percent of total operatingrevenues," the U. of C. said in a statement. "State officials are awareof this substantial annual contribution. In addition, as an academicinstitution the medical center provides more than $70 million a year tosubsidize medical education and research."

    The court rejectedthis argument, pointing out that the Medicare and Medicaid programs areoptional and that hospitals reap federal tax breaks by participating inthem. The justices also pointed out that facilities and equipment aremore fully utilized by accepting patients insured under the federalprograms.

    Being owned by a religious institution and providingeducation for graduate medical studies are also not enough to qualifyfor property tax breaks, the court found, in part because exemptionsfrom property taxes in Illinois have stricter standards than federalstandards, which take those things into account.

    Legal experts say the case could be appealed to U.S. Supreme Court.

    ProvenaCovenant Medical Center maintained that it is charitable, saying itprovided "more than $38 million in free care and other communitybenefits."

    Provena executives also encouraged state lawmakers to examine how charity care is defined but did not advocate a specific level.

    "Wecan only hope this troubling ruling prompts a dialogue among hospitalsand elected officials about not only how we define charity care butalso how we better ensure that the people who need financial assistanceget it," said David Bertauski, Provena Covenant's president and chiefexecutive.

    Mar 18, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Reductions in Medicaid Provider Payment Rates Create Serious Access Problems

    Our friends at The National Health Law Program sent along a good article from the March 16, 2010 New York Times on the impact of reduction in Medicaid reimbursement rates. Below is NHeLP Staff Attorney Leonardo D. Cuello's contexting and analysis of the article which is excerpted below and can be accessed through the link. 

    From the New York Times, an article illustrating the serious access problems cause by reductions in Medicaid provider payment rates.  In the face of reduced state revenues due to economic conditions, and the pressure to reduce spending, this is a problem which is playing out in state budgets nationwide.  The House’s health care reform bill contained a provision to raise Medicaid rates for primary care to Medicare levels within four years.  Medicaid rates were recently estimated to be 72% of Medicare rates generally, and 66% of Medicare rates for primary care.  However, the Senate bill did not include a similar provision.  Whether this will be addressed in reconciliation remains to be seen. As we’ve noted before, if health reform is enacted, it would add about 15 million new Medicaid enrollees, and another 15 million previously-uninsured individuals to Exchange insurance plans which will likely pay at rates well above Medicaid.  Thus, the failure to adjust Medicaid rates upwards could have a significant impact on Medicaid provider networks going forward. 
    AsMedicaid Payments Shrink, Patients AreAbandoned

    Published: March 15,2010

    FLINT, Mich. — Carol Y. Vliet’s cancerreturned with a fury last summer, the tumorsmetastasizing to her brain, liver, kidneys and throat.

    Carol Y. Vliet began chemotherapy to treat her cancer,but lost her doctor because he stopped seeing Medicaid patients.

    As shebegan a punishing regimen of chemotherapyand radiation, Mrs. Vliet found a measure of comfort in her monthly appointmentswith her primary care physician, Dr. Saed J. Sahouri, who had been monitoringher health for nearly two years.

    She wasdevastated, therefore, when Dr. Sahouri informed her a few months later that hecould no longer see her because, like a growing number of doctors, he hadstopped taking patients with Medicaid.

    Dr. Sahourisaid that his reimbursements from Medicaid were so low — often no more than $25per office visit — that he was losing money every time a patient walked in hisexam room.

    The finalinsult, he said, came when Michigan cut those payments by 8 percent lastyear to help close a gaping budget shortfall.

    Read the full article at NY Times Online

    Mar 18, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Illinois Supreme Court Tax Ruling on Provena -- Harbinger of More Lawsuits to Come???

    So many of us have been watching this case for years as a caution to otherhealth care institutions  re:  the expectation that they maintain bonafide community and publicresponsibility in order to retain tax exempt status.   The article below, from Crain's Chicago Business outlines the what portends to be the first of many similar lawsuits...

    Illinois Supreme Court upholds ruling against Provena in tax-exempt case

    By: Lorene Yue March 18, 2010

    (Crain’s) – Illinois’ highest court on Thursday ruled that stateofficials were justified in their decision to yank the tax exemption ofDownstate Provena Covenant Medical Center for not providing enoughcharity care, a ruling that could have implications for thousands ofhospitals nationally.

    “In this decision, the Supreme Courtupheld the denial of property-tax exemption for the tax year inquestion, agreeing with the appellate court that the record wasinadequate to demonstrate that Provena was a charitable institution,”the Supreme Court said in a statement.

    The decision will be watched closely by hospitals and policymakersnationally, following years of debate over how best to quantify thecharity care that non-profit medical providers dole out in exchange fortax exemptions.

    It’s the most notable case nationally in the past two decades of ahospital losing its tax-exempt status over questions of its charitablecommitment, says Elizabeth Mills, an attorney at Proskauer Rose LLP inChicago who specializes in tax exemptions for health careorganizations.

    “Everywhere I go in the country, people ask me about the Provena case,” she says.

    The case goes back to 2003, when Champaign County tax officialsstripped the hospital of its exemption. Officials cited the 210-bedhospital’s $831,724 spent on “charitable activities” a year earlier,saying it fell short of the medical center’s $1.1 million in propertytaxes. The state’s Department of Revenue upheld that decision.

    Provena sued to have its property tax exemption restored. A SangamonCounty District Court sided with the hospital in 2007, but a stateappellate court overturned that decision in 2008.

    The hospital, which is owned by Provena Health,a six-hospital system based in south suburban Mokena, has been payingroughly $1 million a year in property taxes since the Champaign Countytook away its exemption in 2002.

    Illinois law now requireshospitals to provide charity care to poor people to qualify for theirtax exemption, but it doesn’t specify how much.

    Attorney General Lisa Madigan has argued for a quantifiable benchmarkthat hospitals must clear to earn tax breaks. In 2006, she pushed forlegislation that would require them to provide free or discountedmedical care equal to 8% of their operating budgets. The bill wentnowhere, and subsequent discussions with the industry failed to reach acompromise.

    Federal law requires that hospitals meet a so-called “communitybenefit” standard to qualify for tax exemption. Under the law, adoptedin 1969, hospitals cite costs such as training of medical students,research and community outreach, along with free care, as justificationfor their tax exemption. Critics say the standard provides hospitalstoo much latitude.

    Download a copy of the article

    Mar 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Dennis Kucinich's Remarks as Prepared for Delivery to the House - Wednesday, March 17, 2010

    In case you have not already read this:

    Dennis J. Kucinich of Ohio

    The United States House of Representatives


    Remarks as Prepared for Delivery Wednesday, March 17, 2010

    Congressman Dennis Kucinich:

    Each generation has had to take up the question of how to provide for
    the health of the people of our nation.  And each generation has
    grappled with difficult questions of how to meet the needs of our
    people.  I believe health care is a civil right.  Each time as a nation
    we have reached to expand our basic rights, we have witnessed a slow and
    painful unfolding of a democratic pageant of striving, of resistance, of
    breakthroughs, of opposition, of unrelenting efforts and of eventual

    I have spent my life strugglingfor the rights of working class people
    and for health care.  I grew up understanding first hand what it meant
    for families who did not get access to needed care.  I lived in 21
    different places by the time I was 17, including in a couple of cars.  I
    understand the connection between poverty and poor health care, the
    deeper meaning of what Native Americans have called "hole in the body,
    hole in the spirit". I struggled with Crohn's disease much of my adult
    life, to discover sixteen years ago a near-cure in alternative medicine
    and following a plant-based diet.  I have learned with difficulty the
    benefits of taking charge personally of my own health care.  On those
    few occasions when I have needed it, I have had access to the best
    allopathic practitioners.    As a result I have received the blessings
    of vitality and high energy.  Health and health care is personal for
    each oneof us.  As a former surgical technician I know that there are
    many people who dedicate their lives to helping others improve theirs.
    I also know their struggles with an insufficient health care system.

    There are some who believe that health care is a privilege based on
    ability to pay.  This is the model President Obama is dealing with,
    attempting to open up health care to another 30 million people, within
    the context of the for-profit insurance system.  There are others who
    believe that health care is a basic right and ought to be provided
    through a not-for-profit plan.  This is what I have tirelessly

    I have carried the banner of national health care in two presidential
    campaigns, in party platform meetings, and as co-author of HR676,
    Medicare for All.  I have worked to expand the health care debate
    beyond the current for-profit system, to include a public option andan
    amendment to free the states to pursue single payer.  The first version
    of the health care bill, while badly flawed, contained provisions which
    I believed  made the bill worth supporting in committee.  The provisions
    were taken out of the bill after it passed committee.

    I joined with the Progressive Caucus saying that I would not support the
    bill unless it had a strong public option and unless it protected the
    right of people to pursue single payer at a state level.  It did not.  I
    kept my pledge and voted against the bill.  I have continued to oppose
    it while trying to get the provisions back into the bill. Some have
    speculated I may be in a position of casting the deciding vote.  The
    President's visit to my district on Monday underscored the urgency of
    this moment.

    I have taken this fight farther than many in Congress cared to carry it
    because I know what myconstituents experience on a daily basis.  Come
    to my district in Cleveland and you will understand.

    The people of Ohio 's 10th district have been hard hit by an economy
    where wealth has accelerated upwards through plant closings, massive
    unemployment, small business failings, lack of access to credit,
    foreclosures and the high cost of health care and limited access to
    care.  I take my responsibilities to the people of my district
    personally.  The focus of my district office is constituent service,
    which more often then not involves social work to help people survive
    economic perils.  It also involves intervening with insurance companies.

    In the past week it has become clear that the vote on the final health
    care bill will be very close. I take this vote with the utmost
    seriousness.  I am quite aware of the historic fight that has lasted the
    better part of the last century to bringAmerica in line with other
    modern democracies in providing single payer health care.    I have seen
    the political pressure and the financial pressure being asserted to
    prevent a minimal recognition of this right, even within the context of
    a system dominated by private insurance companies.

    I know I have to make a decision, not on the bill as I would like to see
    it, but the bill as it is.  My criticisms of the legislation have been
    well reported.  I do not retract them. I incorporate them in this
    statement. They still stand as legitimate and cautionary.  I still have
    doubts about the bill. I do not think it is a first step toward anything
    I have supported in the past. This is not the bill I wanted to support,
    even as I continue efforts until the last minute to modify the bill.

    However after careful discussions with the President Obama, Speaker
    Pelosi, Elizabeth my wife and closefriends, I have decided to cast a
    vote in favor of the legislation.  If my vote is to be counted, let it
    now count for passage of the bill, hopefully in the direction of
    comprehensive health care reform.  We must include coverage for those
    excluded from this bill.  We must free the states.  We must have control
    over private insurance companies and the cost their very existence
    imposes on American families. We must strive to provide a significant
    place for alternative and complementary medicine, religious health
    science practice, and the personal responsibility aspects of health care
    which include diet, nutrition, and exercise.

    The health care debate has been severely hampered by fear, myths, and by
    hyper-partisanship.  The President clearly does not advocate socialism
    or a government takeover of health care.  The fear that this legislation
    has engendered has deep roots, not inforeign ideology but in a lack of
    confidence, a timidity, mistrust and fear which post 911 America has
    been unable to shake.

    This fear has so infected our politics, our economics and our
    international relations that as a nation we are losing sight of the
    expanded vision, the electrifying potential we caught a glimpse of with
    the election of Barack Obama.  The transformational potential of his
    presidency, and of ourselves, can still be courageously summoned in ways
    that will reconnect America to our hopes for expanded opportunities for
    jobs, housing, education, peace, and yes, health care.

    I want to thank those who have supported me personally and politically
    as I have struggled with this decision.  I ask for your continued
    support in our ongoing efforts to bring about meaningful change.  As
    this bill passes I will renew my efforts to help those state
    organizations which are aimed atstirring a single payer movement which
    eliminates the predatory role of private insurers who make money not
    providing health care.  I have taken a detour through supporting this
    bill, but I know the destination I will continue to lead, for as long as
    it takes, whatever it takes to an America where health care will be
    firmly established as a civil right.

    Mar 17, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Chicago Tribune Article on the Impact of Health Reform on the Local Safety Net

    From the Chicago Tribune, March 16, 2010, an article examining the impact of reform on the local safety net, with input from local safety net institutions:

    Read the story on the Tribune site

    Health reform: Would it ease challenges for medical centers serving Chicago’s poor?
    Up to 600,000 poor people could join Medicaid in Illinois, significantly shrinking the ranks of the uninsured

    By Judith Graham, Tribune reporter
    7:36 PM CDT, March 16, 2010

    Flooded by needy patients and battered by state budget cuts, the area's medical safety net is growing overloaded as health reform commands center stage this week in Washington.

    Free and low-cost clinics and hospital emergency rooms in disadvantaged neighborhoods are bursting at the seams with patients seeking care.

    "Things continue to grow worse on a weekly basis," said Sarah Allen, director of primary care services for the Lake County Health Department.

    The medical safety net is a complex web of medical centers and programs, both public and private, serving people without economic security or health insurance. Even in flush times, these institutions struggle to stay afloat. But these are dire times, and the future is uncertain.

    Among key questions experts are asking: If legislation passes and 30 million to 35 million uninsured Americans gain health coverage, will the role of entities like the Cook County health system diminish? Or will medical centers serving marginalized populations be vitally important as more needy people get insurance cards and seek medical care?

    What is clear is that reform would reshape public health programs for the poor.

    Locally, 400,000 to 600,000 low-income Illinois adults who lack insurance could become newly eligible for Medicaid, according to estimates from the state. Currently, residents without dependent children don't qualify. The federal government would pick up the tab for a still-unspecified number of years.

    But serious holes in the safety net would remain. Even with reform, 18 million to 23 million people probably would continue to lack health insurance, the Congressional Budget Office says. There is no guarantee of medical coverage for noncitizens. More than 272,000 uninsured Latinos who aren't citizens live in Illinois.

    The Tribune asked safety net institutions across the area about their situation and what the future might hold. Without reform, they agreed, their struggles will mount.

    Cook County health system

    "We just can't see all the patients who come to us for care. We have waiting lists. We're at capacity," said Bill Foley, chief of Cook County's health system, Chicago's medical provider of last resort.

    At several primary care clinics, patients wait months for an appointment. At some specialty clinics, patients with non-urgent problems can wait up to a year. Currently, 3,500 patients are waiting for colonoscopies while 2,000 women are waiting for appointments with gynecologists.

    Financial threats loom. A planned sales tax rollback will slash $76 million annually from the health system's budget. In the longer term, the county could be a big loser if Congress eventually eliminates special payments for hospitals that serve large numbers of indigent patients, as proposed under health reform. Cook County received $297 million in "disproportionate share" payments in fiscal 2010, figures supplied by the state show.

    The county system is responding by slashing staff, working to raise revenues and become more efficient, Foley said. Under reform, its future could depend on how many patients choose its services over other providers when they get an insurance card.

    "We have to become more accessible and make ourselves more attractive to people who have a choice," said Foley, who's in the final stages of preparing a new strategic plan for the county health system. It is scheduled to be unveiled in June.

    Sinai health system

    Since 2007, emergency room visits at Mount Sinai Hospital have soared 60 percent. Half of that increase comes from uninsured patients unable to pay.

    Nearly three-quarters of Sinai's patients are on Medicaid, and the system has suffered as the state has delayed some payments. Medicaid pays Sinai about 74 cents for every $1 spent on medical care. The medical center receives almost $10 million in disproportionate share funding that could be jeopardized.

    Sinai Chief Executive Alan Channing predicts that up to two-thirds of uninsured patients seeking care at his medical centers would qualify for Medicaid under health reform. Will those people suddenly flock to better-off private hospitals? Channing doesn't think so.

    "My sense is, no, (Medicaid patients) will not all of a sudden be welcome at these other institutions" because the program's reimbursement rates are so low, he said. That will ensure a role for Sinai and other safety net institutions with deep experience in working with this disadvantaged population, he predicted.

    With reform, "my hope is that people will get more of their basic medical needs met outside the ER," said Dr. Leslie Zun, chair of Mount Sinai's department of emergency medicine.

    Free and low-cost clinics

    Among the new patients seeking help last year at Chicago's largest free medical clinic, CommunityHealth, was Mary Dobrovolny, 52, laid off from a purchasing position after 30 years in the work force.

    A diabetic with high blood pressure and cholesterol, she receives $700 worth of medications monthly — at no charge – from CommunityHealth. "Without them, I don't know what I'd do," said Dobrovolny, who is uninsured.

    In a sign of the recession's impact, new patient visits at CommunityHealth increased 33 percent last year. Rising demand has led the clinic to plan a second location in Englewood, which will open in June, said Executive Director Judith Haasis.

    Expansion is also on the mind of Erie Family Health Center and Access Community Health Network, which operate "federally qualified health centers" for low-income families. Under health reform, the federal government would pour tens of millions of dollars into these centers, which charge sliding-scale fees based on patients' income.

    The goal is to serve new Medicaid members who may have trouble finding medical care elsewhere. "These will be medically challenging, difficult patients," said Dr. Lee Francis, president of Erie Family Health, and "health reform isn't going to lift them out of poverty, find them jobs or ensure their literacy."

    "They help me a lot," said Javier Vertiz, 39, who turned to Erie Family Health after closing his construction business and getting divorced last year. Vertiz, who is uninsured and who has high cholesterol and blood pressure, has been earning about $400 a week working as a handyman.

    "Before I started going there, I didn't even have the strength to go out and look for a job and try to find customers," said Vertiz, who has been seeing a mental health counselor twice a week, for $10 a session. "Now, I'm much better."

    Suburban providers

    Needs are particularly acute in the suburbs, where growing numbers of people are poor and uninsured, said Donna Thompson, chief executive of Access Community Health, the nation's largest chain of federally qualified health centers. In DuPage County alone, four centers have seen a 20 percent increase in uninsured patients over the last two years, she noted.

    Emmitt Neal, 47, of Maywood, found his way to a nearby Access center after being laid off from a longtime trucking job, losing health insurance with Blue Cross and Blue Shield of Illinois, and starting his own business. "It makes me nervous hearing about health reform and not really knowing if it would make things better for people like me," he admitted.

    In suburban Cook County and northwest Chicago, Access to Care, a separate organization, has a waiting list of 4,000 people seeking low-cost medical care. The program charges $5 each for office visits, lab tests and routine X-rays, working in partnership with medical providers. Medications cost $10 and up for each prescription.

    A loss of $3 million in funding from the state in July has been devastating, said Victoria Bigelow, the organization's president. Before those cuts, demand for services had risen 50 percent, reflecting the recession's impact.

    In Lake County, six federally qualified health centers run by the county health department are meeting half of the demand for low-cost care at best, said Sarah Allen, director of primary care services. With 207,000 residents on Medicaid, uninsured or underinsured and few doctors willing to treat this financially challenged population, a crisis is at hand, she said.

    If health reform brought in extra money, Allen said, "that would be a huge, huge advantage."

    Copyright © 2010, Chicago Tribune

    Mar 16, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Interesting Take On New Medicare Part D Changes, From's Mark Miller

    From Mark Miller, syndicated newspaper columnist, blogger at, posted on the Huffington Post on March 11, 2010, 11:28 AM.  (Use the headline link to connect to the original post.)
    Mark Miller

    Feds' Decision to Boot Medicare Drug Plan, A Good Start

    TheFederal government ejected a big insurance company from the Medicareprescription drug program today--an unprecedented move and a shot inthe arm for health care reform advocates. My question: Why stop there?

    The Centers for Medicare & Medicaid Services (CMS) said it booted New York-based Fox Insurance afterit found that the company wrongly denied drug coverage to plan members.But even when Medicare Part D insurers play by the rules, seniors facedaunting challenges selecting a suitable plan, and they must wranglewith complicated rules that govern drug coverage.

    Seniors shop for Part D plans during an annual window that runs fromNovember 15 to December 31st. Last year, I researched articles on howto shop for these plans for my newspaper column and CBS

    My takeaway: this is a segment of health care crying out for asimple, single-payer approach--like the one we have with basic Medicare.

    The Part D program is much more complicated than it needs to be.Individual insurance plans are revised from year to year, and companiesroutinely add and subtract drugs that are covered. That means seniorsneed to review their plan choices at least once every couple ofyears--even if the medications they take haven't changed.

    Sometimes a drug appears to be included in a plan, but deeperdigging shows that there are restrictions on its use that requireseniors to jump through all kinds of hoops to get covered.

    And the premium costs can vary tremendously. For the CBS MoneyWatchstory, I tested the case of a healthy 76-year-old California manshopping 47 plans available in his area; the annual premiums that werequoted varied from $1,077 to $3,370.

    Computer-savvy seniors can use the reliable shopping tool at the Medicare websiteto guide their shopping. Others now turn to an array of companies thathave sprung up who will help consumers shop for a small fee, or tonon-profit agencies such as the State Health Insurance Programs (SHIP).

    Part D was a created as a privatization initiative during the Bushera, and many health reform advocates have argued that it's inefficientand should be rolled into the government-run basic plan. The currentstate of the health care reform debate shows that this kind of changeisn't in the cards. But let's hope CMS at least keeps cracking down onabuses by insurance companies.

    Mar 15, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Celebrate Public Health Week with the Nation's First State Public Health Advocate!

    Join Illinois’ Public Health Advocate and a multi-generational panel for an important conversation about:

    ·         doing science in thepublic interest;

    ·         maintaining activismin the tough times;

    ·         and persevering overa life-time.

    Monday, April 5, 2010, UIC SPH Auditorium, 1603 W. Taylor Street Chicago

    12:30 p.m. – 1:00 p.m. Screening of “Revisiting the Scene: Quentin Young’s Chicago”

    1:00 p.m. – 2:15 p.m. Conversation with Panel

    Download this flyer to share with colleagues and friends

    Get Public Transportation and Driving Directions

    View a clip from the film and/or order a copy

    Mar 12, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Medicare Physician Payment Cut Delayed Until Until Oct. 1

    On March 11, 2010, our friends at the National Health Law Program passed along a report from BNA on the Senate’s recent passage of an important piece of legislation, H.R. 4213, that extends for an additional six months a needed  increase in federal Medicaid funding to the states (who anticipated the end of the original extension of federal Medicaid funds in December 2010), delays a significant cut in Medicare reimbursement fees to physicians, and stalls a financial limit on Medicare Part B outpatient therapy services until the end of 2010.

    By Steve Teske

    By a 62-36 vote, the Senate March 10 approved a tax extenders package that delays a scheduled cut in Medicare reimbursement for physicians until Oct. 1, and also contains numerous other Medicare reimbursement provisions.

    The American Workers, State, and Business Relief Act of 2010 (H.R. 4213) would delay a 21 percent cut in Medicare reimbursement to physicians set to be implemented April 1. The bill now goes to the House for its consideration.
    The Senate bill includes Medicare provisions affecting nearly every provider. For example, the measure would until the end of 2010 delay implementation of the financial cap on Medicare Part B outpatient therapy services.
    The arbitrary cap of $1,860 for either physical and speech language therapies combined, or occupational therapy alone, went into effect Jan. 1. Lawmakers and providers have said beneficiaries with severe rehabilitation needs already have exceeded the cap. The bill also would extend for six months the increase in federal Medicaid funding included in the American Recovery and Reinvestment Act (Pub. L. No. 111-5).
    ARRA provided each state with a 6.2 percentage point bump in their federal medical assistance percentage along with an additional boost based on each state's unemployment rate, but the provision is set to expire at the end of December. Its extension has been a top priority for states, particularly as they try to craft their fiscal year 2011 budgets, most of which begin in July.
    The measure also includes provisions to extend unemployment insurance and the 65 percent federal tax credit for Consolidated Omnibus Budget Reconciliation Act (COBRA) health care coverage through the end of the year.
    Mar 11, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    HMPRG Hosting Two Training Sessions for Direct Service Workers Who Work with Women and Girls

    Health & Medicine is hosting  two important upcoming facilitator training sessions by Girls Circle

    May 19th/20th - Girls Circle Facilitator Training (Learn Skills to Lead Engaging Support Groups for Girls)

    May 21st - Mother-Daughter Circle Training(Promote Healthy Bonds between Mothers & Daughters)                                                                            

    Training Location: Mental Health America of Illinois 70 E. Lake Street, Ste. 900, Chicago, IL 60601

    Download the flyer to learn how you can become a Girls Circle facilitator and bring this evidenced-based program into your girl-serving agencies and organizations to improve the resilience of girls and young women

    Questions? Email Sarah Schriber, Senior Policy Consultant
    Health & Medicine Policy Research Group
    Mar 10, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Nursing Home Reform Legislation Led by AARP and Advocates

    Writing  The NursingHome Safety Task Force has released its final recommendations and has aworking group meeting twice a week to discuss translating these recommendationsinto legislation.  However, AARP and Advocates have also been busydrafting their own legislation addressing nursing home care in Illinois. Per AARP’s pressrelease early March 9, 2010:

    The legislation – Senate Bill 685– is sponsored by Senators Heather Steans (D-Chicago) and JacquelineCollins (D-Chicago), and is supported by AARP Illinois, The Community RenewalSociety,  SEIU Healthcare Illinois, Illinois Citizens for Better Care, theJane AddamsSenior Caucus, AFSCME, Illinois Association of Long Term Care Ombudsman, theIllinois Trial Lawyers Association, Age Options, Next Steps, Supportive HousingProviders Association, Health & MedicinePolicy Research Group, and the Shriver Center on Poverty Law, theIllinois Network of Centers for Independent Living and Health and DisabilityAdvocates.”

    Click here for a view of video footage from the AARP Press Release,from NBC Central Illinois News

    We will continue to keep you up-to-date on the variouspieces of legislation concerning Nursing Home Reform and let you know how youcan become involved as opportunities arise.  For more information, pleasecontact: Kristen Pavle, PolicyAnalyst, Health & Medicine’s Center for Long-Term Care Reform.312.372.4292 x 27 or email Kristen.

    Mar 03, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Robert Kuttner - Getting Real About Health Care Costs

    ...We wanted to share this insightful post by Robert Kuttner that appeared in the February 28, 2010 Huffington Post

    Robert Kuttner, Co-Founder and Co-Editor of The American Prospect

    The Cure That Dares Not Speak Its Name

    In all of the debates about health care reform, one of the stubborn realities is that neither the Obama plan, nor any of the Republican alternatives, will seriously alter the trajectory of relentless cost-escalation in health care. If you look at the Administration's own projections of federal deficits in the next decade and after 2020, virtually all of the alarming growth in deficit spending is Medicare and Medicaid.

    And that's only the public part of the health care bill. In 2009, total health care costs increased to 17.3 percent of GDP, with escalating premiums eating into both corporate profits and worker take home pay. The consensus among the usual policy experts is that there is no good solution. The march of technology and demography will just continue to raise health costs.

    But you can reach that conclusion only by ignoring how the rest of the club of affluent countries manages to insure everyone for 9 or 10 percent of GDP, and have a healthier and longer-lived population, to boot. They do it, of course, through universal, socialized insurance.

    There is no single formula. The Canadians do it with a single payer system for the insurance part, but physicians are private. The Brits have an integrated National Health Service. The Germans achieve near-universal coverage through a system of nonprofit health insurance plans.

    What every other nation has in common is that they have taken the commercialism out of their health systems. As a consequence, they can direct health spending to areas of medical need rather than letting the market direct health dollars to areas of greatest profit. And with everyone covered, they can use highly cost-effective strategies for prevention, wellness, and public health. That's how you cover everyone for ten percent of GDP.

    Our one island of single-payer medicine, Medicare, is phenomenally popular -- so popular that the Republicans' most effective attack on the Obama plan is that it would divert some money from Medicare. The Republicans, on the one hand, fiercely attack "government-run health insurance," while on the other they defend Medicare (which they would just as soon privatize).

    But most Democratic politicians and policy wonks behave as if the option of a national health plan simply did not exist. These blinders are the result of the immense power of the medical-pharmaceutical-insurance complex combined with a failure of political leadership. Sooner or later, mainstream politicians will stumble their way to some form of single payer because there are no good alternatives unless we want to spend half of our GDP on health care.

    In that regard, the best things about the still inconclusive end-game of Obama's efforts to enact his plan are that (1) the administration finally broke with the insurance industry, and (2) Obama is starting to get over the delusion of bipartisanship. So if we don't need either Harry and Louise, or John Boehner and Mitch McConnell, as part of the health-reform coalition, we might as well do it right.

    With Obama's health summit behind us, there will now be a mad scramble for Democratic votes in the House and Senate to pursue the strategy that Obama should have used all along -- a Democrats-only bill relying on 51 votes in the Senate via the reconciliation procedure.

    The problem is that Obama may have missed the moment. The prolonged, enervating battle for health reform, using a badly flawed bill, has scared off both conservative and liberal Democrats in both houses. The bill is politically toxic to legislators facing re-election, for good reason. The original formula, designed to enlist insurance industry allies, required a mandate to purchase insurance, diversion of Medicare funds, and unpopular taxes. Now that Obama has broken with the industry, an entirely different formula should be possible.

    Alas, we are too far down the present road to advance single-payer in this legislative session. The president has done nothing to move public opinion in that direction, and has backed away even from the truncated version of it, the so-called public option.

    I would put the odds at about one in three of Obama succeeding. Several Democrats who voted for the House-passed bill in November by the narrow margin of 220-215 have now defected, and several more are increasingly gun-shy. I don't much like this bill, but I still hope it passes so that the Republicans don't get rewarded for their relentless obstructionism.

    Win or lose, the next great push should be for single-payer, assuming Democrats have a working majority again in foreseeable future. Given the collateral damage of Obama's strategy, that could be a long time coming.

    Read the post online at the Huffington Post

    Feb 25, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Nursing Home Reform in Illinois

    Nursing Home Safety Task Force

    On October 3, 2009, Governor Pat Quinn formed the Illinois Nursing Home Safety Task Force.  The Task Force was charged with addressing the serious issue of mixing populations of persons with mental illness with the elderly and other physically disabled. 

    On February 19, 2010, the Task Force released its Final Report to the Governor.  The Final Report includes 38 recommendations applying to persons with mental illness that currently occupy nursing home beds. 

    Three broad categories are used toorganize the recommendations:

    • EnhancePre-Admission Screening and Background Check Process,
    • Setand Enforce Higher Standards of Care, and
    • ExpandHome and Community-Based Residential and Service Options.

    Task Force on Aggressive Timeline forReform

    TaskForce chairperson Michael Gelder has set an aggressive timeline to achieve theproposed recommendations.  Nine“Immediate Implementation Workgroups” have been assigned to implementrecommendations by April 30th, 2010. These workgroups will focus on areas including:

    • Pre-AdmissionScreen and Resident Review (PASRR) enhancement,
    • CriminalBackground Checks,
    • PsychotropicDrugs, and
    • SupportiveHousing Expansion.

    Center for Long-Term Care Reform Influences TaskForce

    Illinois leads the nation in caring forpersons with mental illness in nursing homes. Health& Medicine’s Center for Long-Term Care Reform recently produced on thesubject, looking historically at how Illinois finds itself in this currentsituation, “IllinoisNursing Homes as Care Providers for Mentally Ill: How Did We Get Here?”  The Center for Long-Term Care Reform has alsoresearched the federal Pre-Admission Screening and Resident Review (PASRR)program and submitteda report on PASRR to the Task Force.


    Recognition from Federal Government & MovingForward

    The Illinois Nursing Home SafetyTask Force has done a great job at convening the major state departments andproducing recommendations to reform the current system of nursing home referral,admission, and care.  There has been alot of movement around nursing home reform since the inception of the TaskForce:

    • In aletter to chairperson Michael Gelder, Assistant Attorney General Thomas Perez ofthe United States Departmentof Justice expressed praise for the reform the Task Force promises.
    • AChicago Tribune article publicized Illinois Attorney General Lisa Madigan’soffice and local police are performing unannounced visits and safety checks attroubled nursing facilities as a result of the Task Force.
    • Multipleparties are drafting legislation for nursing home reform: the Nursing HomeSafety Task Force, advocates for the elderly and mentally ill (AARP and others),and the nursing home industry. 


    Feb 22, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Illinois Public Health Advocate, Quentin Young - ABC 7 Newsviews Interview

    Quentin Young, The Illinois Public Health Advocate (and Health & Medicine's Founder and Chairman) was featured on Newsviews, ABC News Chicago, Channel 7, on February 21, 2020 - where he was interviewed by anchor Alan Krashesky about his role, in particular, and the health of the public, in general. View the interview through the web link:

    Feb 22, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young on The Huffington Post: Put Single Payer Back on the Table!

    From  The Huffington Post, February 22, 2010

    One year after its much-ballyhooed launch, the Obama administration's approach to health reform is now in serious disarray.

    The president's health care summit on Feb. 25is being portrayed as a last ditch bid to find some common ground withhis "just say no" Republican opposition. He also faces an increasinglywary group of disgruntled Democrats, whose memory of the Massachusettsmassacre -- the election of a Republican to Sen. Edward Kennedy's seat-- remains fresh.

    The summit proceedings, which will be televised in the name of"transparency," will no doubt be laden with a formidable amount ofstagecraft. They will be preceded by the unveiling of the president's own legislative proposal -- presumably the odious Senate bill with some tweaks -- a few days before.

    But it's almost certain that this latest White House initiative,undertaken with the stated goal of salvaging and passing at least someelements of the stalled congressional bills, is foredoomed. Read the full post...
    Feb 22, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    The President's Health Proposal

    From our friends at the National Health LawProgram:

    Attached is a summary of the President’s proposal onhealth reform, released earlier today.   For the lowest-income individuals seekinginsurance in the Exchange, the amount an individual/family will have to spend onpremiums is higher than either theHouse or Senate bill.  In contrast, for higher income people who receive subsidies, thePresident’s proposal lowers theirpremium costs from the House and Senate legislation.  For cost-sharing, the proposal splits thedifference between the House and Senate bills, but this will be littleconsolation to those who face higher premiums and are unable to purchase healthinsurance.  There’s still an individual mandate but no publicoption.

    Medicaid is expanded to everyone up to 133% FPL.  Theproposal would pay states 100% of the costs for these new enrollees from FY 2014-2017,95% for 2018-2019 and 90% thereafter.  But the Proposal’s changes in the incomedisregards (applicable to Medicaid and the Exchange) will likely force manycurrent enrollees off Medicaid and into the Exchange, where the costs willvastly increaseeven with subsidies.  CHIP would continue through FY 2019, withfunding extended through FY 2016.  Starting in FY 2016, the Proposal wouldincrease states’ CHIP matching rate by 23% to help coverchildren.

    ThePresident’s proposal fails to include any of the positive provisions in theHouse and Senate bills addressing health disparities (except for improving data collection),language access, women’s health or immigrants.Additional information on the Proposal is available at    

    Feb 18, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    From Today's Newswires: Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009

    Largest Ever One-Year Increase Illustrates Medicaid's Role InCovering People During Economic Downturns But Further Strains TightState Budgets

    WASHINGTON, Feb. 18/PRNewswire-USNewswire/ -- With the country mired in a deep recession,nearly 3.3 million more people were enrolled in state Medicaid programsin June 2009 compared to the previousJune, according to a new analysis by the Kaiser Family Foundation'sCommission on Medicaid and the Uninsured. It was the biggest everone-year increase in terms of absolute numbers, and boosted the Junemonthly Medicaid enrollment by 7.5 percent to 46.9 million peoplenationally.

    Itwas the first time in decades that every state experienced an increasein Medicaid enrollment, and in 32 states enrollment grew at least twiceas fast as the year before, according to the analysis, which includesdata breakouts by state.

    "State Medicaid programs have been able to help millions of Americans who have nowhere else to turn in a recession," said Diane Rowland,Executive Vice President of the Foundation and Executive Director ofKCMU. "But the states obviously face significant fiscal pressures asincreases in enrollment push up costs at a time when state budgets arealready severely constrained."

    Theincrease in enrollment reflects the role that Medicaid plays inreducing the numbers of people who become uninsured when the economyfalters, with many people turning to the program for help after beinglaid off and losing their employer-based health insurance. Millionsmore who were not eligible for Medicaid likely joined the ranks of thenation's uninsured.

    A new Kaiser survey of state Medicaid directors finds that 44 states and the District of Columbiaare experiencing higher than expected program enrollment, resulting inincreased spending for fiscal year 2010. At least 29 states say theyare considering additional mid-year cuts in provider rates and programbenefits. Read the full post...

    Feb 18, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Marcus Brandon, Candidate for North Carolina House, Promises State Single-Payer System

    From a February 17th post by David Swanson to After Downing Street:

    By David Swanson

    A bill to create single-payer healthcare in California has passedthat state's senate for the third time now. Californians just need topersuade a governor to sign it. Single-payer healthcare bills areadvancing in Pennsylvania, Ohio, Minnesota, Massachusetts, and agrowing list of states, including New Mexico, where State Senator JerryOrtiz y Pino, a long-time supporter of single-payer healthcare, isrunning for Lieutenant Governor.

    Now North Carolina house candidate Marcus Brandon has pledged tointroduce a bill to create single-payer healthcare in that state.Brandon, whom I know and like and who worked for Congressman DennisKucinich's 2008 presidential campaign, is a candidate in North CarolinaHouse District 60. That's near Greensboro, where I can just pictureMarcus sitting at a lunch counter and refusing to be provoked.

    Brandon has promised that if he is elected, the first piece oflegislation he will introduce will be the "North Carolina HealthcareAct" which will provide universal single-payer healthcare to everycitizen of the state.

    Brandon says that he remains a supporter of national single-payerhealthcare and will continue lobbying for passage of HR 676,Congressman John Conyers' bill:

    "The HR 676 fight is definitely not over, but we must nowstrategically shift the focus to the state level. When other states seethat we can cut the cost of healthcare, streamline our medicalindustry, and still provide universal coverage to all NorthCarolinians, then all of the sudden, single-payer health care doesn'tlook so bad." Read the complete post...

    Feb 18, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    NPR "Morning Edition" Feature on Trauma and Violence in the Lives of Young Black Men

    Recommendation from Sarah Schriber, Senior Policy Consultant with Health & Medicine's Court Involved Girls Project:

    Last week, NPR's Morning Edition ran an interview  Dr. John Rich, MD, MPH, author of Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men. The website contains the interview (in print and as an audio file) plus an excerpt from the book.

    February 9, 2010

    Inthe 1990s, Dr. John Rich worked at Boston City Hospital. It was aviolent time in the city's history, and Rich started noticing a steadystream of young black men who turned up at the emergency room. He alsostarted wondering why, exactly, all these young men were ending up inthe hospital.

    Most of them were believed to be thugs or drugdealers, Rich says. Even among doctors and nurses, the assumption wasthat these young black men weren't true victims; that they had donesomething to get themselves shot.

    So Rich began taking the timeto interview the knife and gunshot victims who came to the hospital. Helearned that many of them weren't, in fact, responsible for their owninjuries — some had been robbed, others had talked to the wrong girl ata party or been caught in the line of fire while walking home.

    Rich eventually compiled the men's stories in his book, Wrong Place, Wrong Time.Among those he interviewed was Boston native Roy Martin. The two metthrough a mentoring program when Martin was in a prerelease programfrom prison. Read the rest of the interview

    Feb 18, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Illinois Nursing Homes as Care Providers for Mentally Ill: How Did We Get Here?

    The Illinois Nursing Home Safety Task Force has taken the initiative to address the serious situation of mixing populations of persons with mental illness with the elderly and others with physical disabilities in nursing homes.  In moving forward to address the current challenges, it is helpful to look historically at how we arrived here.

    Please read Health & Medicine’s Center for Long-Term Care Reform’s research report that looks at the care of persons with mental illness after deinstitutionalization in the United States and in Illinois.  It is our hope that this review will help as we plan for the future.  If you have questions or comments about the document, please do not hesitate to call or email Kristen Pavle, or call Kristen at (312) 372-4292 ext. 27.

    Feb 11, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    NOTICE: Screening of the film “The Chicago Maternity Center Story (1976)” and a panel discussion

    Chicago Maternity Center provided safe home deliveries for mothers. Funding from Northwestern University declined and the center wasclosed. This film portrays the history of the center and the center'sfight to stay open.

    Date: March 10, 2010
    Time: 6-8pm
    Location: University of Illinois Chicago - School of Public Health (SPH) Auditorium, Room 109

    • Sabina Dambrauskas, Chairperson, American College of Nurse- Midwives, Illinois Chapter • Stacie E. Geller, PhD, G. William Arends Professor in Obstetrics and Gynecology and Director, Center for Research on Women and Gender & National Center of Excellence in Women's Health • Suzanne Davenport, filmmaker, “The Chicago Maternity Center Story”

    This event is free and open to the public.

    If you have questions, please contact Jaime Klaus at 312-996-0724 or
    Feb 01, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Quentin Young Letter to the Editor, New York Times, January 28, 2010

    To the Editor:

    President Obama’s State of the Unionaddress had a high point when he pledged that anyone with a “betterapproach that will bring down premiums, bring down the deficit, coverthe uninsured, strengthen Medicare for seniors, and stop insurancecompany abuses, let me know.”

    Thank you, Mr. President. Theanswer is the reform supported by 65 percent of the public and even 59percent of physicians. It’s remarkably simple, and the nation hasalready had 44 years of successful experience with it in financinghealth care for our elderly and the totally disabled.

    It is, ofcourse, Medicare-for-all, single-payer, not-for-profit national healthinsurance. Its superiority lies in excluding profit-seeking insurancecompanies and Big Pharma from controlling and undermining our healthsystem. This is your answer, Mr. President.

    Quentin Young
    Chicago, Jan. 28, 2010

    The writer, a doctor, is national coordinator of Physicians for a National Health Program.

    Download link to the New York Times

    Jan 19, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Sun Times Article About Quentin Young and MLK Day


    Health care hot issue on MLK Day

    King's Chicago doctor says Congress' legislation falls short of satisfying civil rights hero's dream
    Tue, 19 Jan 2010 04:00
    BY ABDON M. PALLASCH Political Reporter/

    At churches and schools, living rooms and nursing home parlors across the land Monday, people gathered to remember the Rev. Martin Luther King Jr. and to give their own takes on what his legacy means.

    Is it racial harmony, African-American empowerment or about fighting for access to medical care?

    Dr. Quentin Young, who dressed the head wound King received from a rock to the head in Marquette Park in 1966, told an audience of King's contemporaries and fellow marchers -- King would be 81 had he lived -- at an Oak Park nursing home that King would want people to fight for health-care justice -- and that means a single-payer system, Young said.

    Earlier Monday at Northwestern University's Law School, Sen. Dick Durbin invoked King's memory to urge passage of the health-care plan as senators and congressmen try to iron out their differences over it.

    Forty-four years ago, King told a Chicago audience, "Of all the forms of inequality, injustice in health care is the most shocking and most inhuman," Durbin said.

    Durbin pointed to a man in the audience who owes $100,000 in medical bills for treatment of his T-cell lymphoma and said, "Repeat that story 47 million times and tell me that it isn't time for health-care reform in America. The critics of health-care reform tell us it's too much government. . . . This bill we're working on would increase the number of insured by 30 million. We would start to end the injustice ... to make sure that the work of Martin Luther King is finally done."

    But the plan only orders everyone to buy insurance, profiting the drug companies, Young argued. Invoking the same quote Durbin used from King -- Young was actually at the meeting where King said it --Young argued the current bill would not satisfy King's dream.

    "What's coming out of the Congress is really bad. It's rotten," Young said. "It keeps the power in the insurance companies." Read more
    Jan 19, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Chicago Tribune Article About Aida Gaichello and the Midwest Latino Center

    This past Friday, January 15, the Chicago Tribune ran an article about Health & Medicine Board member Aida Gaichello:
    Aida Giachello, creator of Latino health center, looks out for minorities
    Creator of health center tries to raise awareness among all communities

    By Patty Pensa
    Special to the Tribune
    January 15, 2010

    At an early age, Aida Giachello knew what it meant to be poor. It meant welfare, with her father living somewhere else because the family needed the checks. It meant gangs and drugs in the Spanish Harlem neighborhood where she lived for seven years. And it meant starting to work early -- at age 13.
    But being poor also gave shape to her life's work as a health activist for Chicago's Hispanic community, which numbers some three-quarters of a million residents. "Being raised in poverty, seeing the struggle of my parents really created a sense of direction about the kinds of problems we experience as a group, as minorities and women," said Giachello, 64.

    The native of Puerto Rico found her way to Chicago through a post-graduate research project with Northwestern University. After finishing her doctorate in sociology, Giachello settled in Chicago and immersed herself in social work in the Hispanic community. She came to focus on health issues.

    Her early work led her in 1993 to create the Midwest Latino Health, Research, Training and Policy Center at the University of Illinois at Chicago, where she also teaches. Giachello has gained prominence as director of the Midwest Latino center, which she helped replicate in fast-growing Hispanic hubs throughout the Midwest. Read more

    Jan 19, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Please Support Hospital Albert Schweitzer (HAS) in Haiti!

    In this time of crisis and catastrophe in Haiti, please consider providing immediate aid to earthquake victims, by supporting Hôpital Albert Schweitzer (HAS) in central Haiti — which survived the earthquake and is now delivering critical medical care to those affected.

    Located 4...0 miles NW of Port-Au-Prince, was able to withstand the recent devastating earthquake and is currently operating with full staff helping victims, evaluating each patient, performing diagnostic tests and delivering life saving care. (Due to the expertise developed over its 54 year history, Hôpital Albert Schweitzer Haiti (HAS) is one of the few institutions positioned to provide timely hospital care for the injured. As the flow of people urgently seeking care increases over the next few days and weeks, their resources will be pushed to the breaking point. It is critical that they receive support to help them continue with their mission. (BTW Schweitzer's birthday was January 14... help the people of Haiti while honoring Schweitzer's vision and dedication!)

    You can donate securely through this link

    Jan 14, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Closing Comments from January 12th Candidates' Forum Sponsored by The Emergency Network to Save Cook County Health Services

    On January 12th the Emergency Network was joined bycandidates for Cook County Board President for a Candidates Forum onthe County Health System.

    The event, “Strengthening the County HealthSystem,” was open to the public and was moderated by Phil Kadner, fromthe Southtown Star.

    Here, to help you contemplate your "choices" are candidates' closing comments.  Stay tuned over the next few days for clips of additional panel footage. Don't forget to vote on February 2...

    Jan 11, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Governor Pat Quinn Names Quentin Young as Illinois' Public Health Advocate


    Photo from posting at

    Health & Medicine Policy Research Group is pleased to announce the naming of our Founder and Chairman, Quentin Young, as the Illinois Public Health Advocate. The official State of Illinois press release is below.

    Governor Quinn Names Public Health Advocate

    Dr. Quentin Young to Champion Wellness Programs, Public Health Awareness

    CHICAGO – January 9, 2010. Governor Pat Quinn todaynamed Dr. Quentin Young Illinois’ Public Health Advocate. Dr. Youngwill develop wellness and education programs to help improve the healthof the residents across Illinois.

    “Throughout his long and distinguished career, Quentin Young hasstood up for patients everywhere,” said Governor Quinn. “He will be astrong voice for Illinois families and will fight to ensure thateveryone has easy-to-understand information about critical publichealth issues facing our state.”

    Dr. Young, who has accepted the position for $1 a year, has been aconstant advocate for patient rights, changing the face of medicine inChicago and around the nation. Dr. Young founded the Committee to EndDiscrimination, which would eventually help to desegregate Chicagohospitals. In 1964, he helped launch the Medical Committee for HumanRights, serving as national chairman for the group that would becomethe medical arm of the Civil Rights Movement.. (Background Information)

    Serving as personal physician to Dr. Martin Luther King Jr., Dr.Young marched beside him in 1966 during a peaceful protest in Chicago,treating King’s wound when an angry spectator hit him with a rock.

    ”I am honored to be appointed to be Illinois Public Health Advocateby Governor Quinn,” said Dr. Young. “I look forward to utilizing mylifetime of experience to develop effective programs that will improvethe health of the people of Illinois.”

    Dr. Young served successfully as chairman of the Department ofMedicine at Cook County Hospital, president of the Chicago Board ofHealth, and president of the American Public Health Association. Dr.Young founded the Chicago-based Health and Medicine Policy ResearchGroup and co-founded the Physicians for a National Health Program. In2001, a 78-year-old Dr. Young walked across Illinois with GovernorQuinn in support of quality healthcare for everyone.

    Governor Quinn signed an executive order to create the position ofIllinois’ Public Health Advocate on November 21, 2009. The office willrecommend and facilitate the development of public health strategiesdesigned to prevent, diagnose, treat, and cure diseases. (Executive Order)

    In his position Dr. Young will focus on assisting residents inunderstanding health coverage provisions and help them betterunderstand their public health rights. He will also work to ensure thatpublic health reports are easily accessible and understandable. Theposition will be housed within the Department of Public Health and willutilize existing public health programs, staff and resources.

    Additional links to coverage: 

    Interesting commentary on the appointment:


    Local News coverage

    AP Link





    Jan 08, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Emergency Network to Host Candidates Forum on County Health System Five Candidates for Cook County Board President Confirmed!

    Emergency Network to Host Candidates Forum on County Health System

    Five Candidates for Cook County Board President Confirmed!

    Chicago, IL – On January 12th the Emergency Network will be joined by candidates for Cook County Board President for a Candidates Forum on the County Health System. The event, “Strengthening the County Health System,” is open to the public. Esteemed journalist Phil Kadner, from the Southtown Star, will moderate, asking the questions that are on the minds of Cook County voters.The future of the County Health System and the independent board that oversees it promise to be critical issues for the Cook County Board, and for the County President’s race. An independent board was created a year ago,with those selected to the governing board asked to restore public faith in a vital public system. Board president Todd Stroger and those who will be challenging him for his seat will be asked to define their visions for a betterand more efficient county health system.

    WHAT: “Strengthening the County Health System”, Candidates Forum with Candidates for Cook
    County Board President

    WHO: Candidates for Cook County Board President: Dorothy Brown, John Garrido, Toni Preckwinkle, Todd Stroger, and Tom Tresser

    MODERATOR: The event will be moderated by esteemed journalist Phil Kadner, of the Southtown Star

    OPENING REMARKS: Dr. Quentin Young will give opening remarks

    FACILITATOR: Salim Al Nurridin, Chief Executive Officer of the Health Care Consortium of Illinois, will facilitate community questions

    WHEN: 6-7:30 P.M. Tuesday, January 12th, 2010

    WHERE: First United Methodist Church at the Chicago Temple, 77 W. Washington St., Chicago, IL, 60602

    About the Emergency Network to Save Cook County Health Services: In 2007 a large, diverse, and powerful coalition of over 70 organizations and elected officials came together to form the Emergency Network to Save Cook County Health Services. The network continues to work to restore availability and access to health services provided by Cook County, assure adequate funding to meet demand, and improve efficiency in the governance and provision of services. As Cook County is first and foremost a public system, not a corporation or a private hospital system, the Emergency Network will continue to be the "public voice" which will ensure that this vital public health system will thrive and grow.
    Network Members (Organizations): 13th District Community Health TF; Access Living; AFSCME Council 31; AIDS Foundation of Chicago; Alivio Medical Center; Illinois Chapter, American Academy of Pediatrics; American Heart Association; Arab American Family Services; Asian Health Coalition of Illinois; Campaign for Better Healthcare; Chicago Democratic Socialists of America; Chicago Federation of Labor; Chicago Foundation for Women; Chicago Interfaith Committee on Worker Issues; Chicago Legal Clinic, INC.; Children's Advocacy Center; Citizen Action/IL; Center on Tax and Budget Accountability; Deborah's Place; Guildhaus; Health and Disability Advocates; Healthcare Consortium of Illinois; Heartland Alliance Human Care Service; Heartland Health Outreach; Health & Medicine Policy Research Group; House Staff Association of Cook County Hospital; Illinois ACORN; Illinois Caucus for Adolescent Health; Illinois Coalition for Immigrant and Refugee Rights; Interfaith Council for the Homeless; Jewish Child and Family Services; Lakeview Action Coalition; Lawndale Christian Health Center; Loyola; University Medical Center - Dept. of Psychiatry; Lutheran Social Services of Illinois; Marillac Social Center; March 10th Movement; Methodist Youth; Services, Inc.; Near North Health Services; National Nurses Organizing Committee; Ounce of Prevention Fund; Physicians for a National; Healthcare Program; Planned Parenthood/Chicago Area; Power-PAC; Proactive Community Services; Protestants for the Common Good; Rogers Park Community Action Network; Safety Net Hospitals; Sankofa Safe Child Initiative; SEIU Illinois Council; Sargent Shriver National Center on Poverty Law; South Suburban Council on Alcoholism & Substance Abuse; Stroger Hospital Doctors Council, SEIU Loc 20; Westside Health Authority; Xilin Association; YWCA
    Evanston/North Shore
    Jan 06, 2010 Written By: Health & Medicine Policy Research Group (HMPRG)

    Chicago-Area Author Appearances: “The Spirit Level: Why Greater Equality Makes Societies Stronger”

    Richard Wilkinson, Professor Emeritus, University of Nottingham Medical School, and Honorary Professor, University College London; Kate Pickett, Professor of Epidemiology, University of York, and U.K. National Institute for Health Research Career Scientist

    Epidemiologists Richard Wilkinson and Kate Pickett are authors of The Spirit Level: Why Greater Equality Makes Societies Stronger (Bloomsbury USA, 2009). In this book, Wilkinson and Pickett examine how large gaps in income inequality create significant problems within societies. Using as examples countries such as Britain and the United States, with between-state comparisons for the U.S., they explain how inequality causes a range of problems, including low life expectancy, illiteracy, stress, and high crime rates. Wilkinson has played a formative role in international research in the social determinants of health and conducted groundbreaking research on the impact of inequality on health. Pickett has also conducted wide-ranging research on the social determinants of health, with a particular focus on the health of mothers and children. Over several years, Wilkinson and Pickett have collaborated on more than a dozen research papers, synthesized in The Spirit Level.

    Chicago-Area Event Information:
    • Monday January 11th, University of Chicago, 12:00 p.m., Billings Hospital, L-168, 5841 S. Maryland Ave. Chicago
    • Tuesday January 12th, Northwestern University, 4:00 - 5:15 p.m. Hardin Hall, Rebecca Crown Center 633 Clark Street, Evanston Campus, The Center on Social Disparities and Health, INSTITUTE FOR POLICY RESEARCH • NORTHWESTERN UNIVERSITY and the Department of Medical Social Sciences. For more information, visit us on the Web or contact Patricia Lasley at 847-467-6905 or by email
    • Wednesday January 13th, University of Illinois, Chicago, Noon–1 p.m., Molecular Biology Research Bldg. Auditorium, 900 S. Ashland Ave. , Chicago (Enter from Marshfield), Sponsored by the UIC Institute for Health Research and Policy. Barbara’s Bookstore will be selling The Spirit Level before and after the lecture. The authors will sign copies of the book following their discussion. Email to reserve a book to purchase 
    Can’t make it? Listen to Kate Pickett’s interview on Canada’s The Sunday Edition

    Download a copy of the flyer to share with colleagues and friends

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