Health - Patient Money: Pre-existing Condition? Now, a Health Policy May Not Be Impossible |
- Patient Money: Pre-existing Condition? Now, a Health Policy May Not Be Impossible
- Japan Races to Restart Reactors’ Cooling System
- Radiation Plume Reaches U.S., but Is Said to Pose No Risk
- Radiation Fears Cloud Japan’s Recovery
- Elite Runner Back After Radical Cancer Surgery
| Patient Money: Pre-existing Condition? Now, a Health Policy May Not Be Impossible Posted: 19 Mar 2011 12:40 AM PDT SIX years ago, Jerry Garner, 45, a real estate agent in Gowen, Mich., underwent a kidney transplant. He recovered nicely, and thanks to diligent adherence to his drug regimen and frequent checkups, he has been healthy ever since — “a miracle,” said his wife, Stephanie. Fabrizio Costantini for The New York TimesJerry Garner, here with his wife, Stephanie, lost his health insurance when the couple mistakenly neglected to fill out a health survey the insurer sent. RelatedBut last year, the Garners were starting to believe that their good fortune had run out. Mr. Garner’s insurer asked that he fill out a survey, but somehow this piece of mail slipped through the cracks at the Garner household. As a result, he lost his health insurance. (Ms. Garner, 44, and three of the children — their oldest child is grown — were covered under a different policy.) But because of his pre-existing condition, Mr. Garner proved impossible to insure. Transplant recipients must take expensive immunosuppressant medications. Without them, the new kidney will not survive. The couple paid Mr. Garner’s $2,000 monthly drug bill out of pocket and prayed nothing went wrong. Some months they had to choose between the medication and the mortgage. Finally, after weeks of searching the Internet, making phone calls and praying, Ms. Garner saw a television ad for Michigan’s new pre-existing condition insurance plan. P.C.I.P.’s, as they are known, are state and federal programs for people previously deemed uninsurable because of pre-existing conditions. They offer a bridge to 2014, when the new health insurance exchanges, which must accept all comers, are to open. Mr. Garner applied to Michigan’s plan and was accepted. Now he pays less in premiums than he did under his previous plan, and he receives more comprehensive coverage. “It was definitely an answered prayer,” said Ms. Garner. “Two thousand dollars when you’re already struggling is just impossible.” Plenty of people with pre-existing conditions like Mr. Garner are struggling to find affordable insurance. These plans offer a real alternative, but consumers are only now becoming aware of them. Plus, there are some tough restrictions. Here is what you need to know: FINDING A PLAN Pre-existing condition insurance plans, required by the new health care law, opened for business in July. The new plans come in two flavors: 27 states run their own plans with federal money, while the rest rely on the federal Department of Health and Human Services to administer the plans within their borders. The new plans did not replace state high-risk pools, which have long offered insurance to people with pre-existing conditions. But the premiums in the new plans are generally much lower. That is why experts had worried that the new plans could be overwhelmed by a deluge of desperate applicants. In fact, the P.C.I.P.’s got off to a slow start, and many consumers still have no idea they exist. In January, premiums in the federally run plans were reduced nearly 20 percent. Since then, enrollment in all of the new plans has increased 50 percent to 12,000 members. To find a plan in your state, start with the federal government’s Web site, PCIP.gov, which offers lots of application information and details about each of the state plans the department administers. An interactive map at www.pcip.gov/StatePlans.html links to each federal- and state-run plan. Next, you will need to compare the plan offerings in your state. Federally run P.C.I.P.’s offer three options: standard coverage; extended coverage, with a lower deductible and higher premiums; and an option that combines a high deductible with a health savings account. For a side-by-side comparison of the three choices, click on bit.ly/gs3z9i. Premiums for all three options are also listed online. State plans that are not administered by the federal government may also offer more than one option. The details can be found at the interactive state map mentioned above. People without access to the Internet can call the Department of Health and Human Services at 866-717-5826 to find out which plans are available in their states. ELIGIBILITY RESTRICTIONS The plans were not intended to solve the health insurance mess. They were intended as a temporary Band-aid, and they have some frustrating limitations. You must be uninsured for at least six months to be eligible for a plan. That means people already enrolled in state high-risk pools or private insurance cannot apply, even if the new plans would be far less expensive. Unemployed people who are on Cobra or whose benefits have only recently expired are also not eligible. Plans run by the federal government and those administered by individual states have slightly different application procedures. To qualify for a federally run plan, you will need proof that you have applied for individual insurance and that a carrier denied you coverage because of a pre-existing condition, or proof that a carrier approved coverage but with a rider that excluded payment for your pre-existing condition. (Do not buy a policy with such a rider, as you will no longer be eligible for a P.C.I.P.) An uninsured patient may have to apply for insurance simply to get proof of denial to enroll in a plan. Proof may take the form of a denial letter. State-run plans may have less stringent eligibility requirements. Some require proof of denial, but in others people with certain pre-existing conditions, like diabetes or asthma, qualify for coverage more or less automatically. Those people need only obtain a letter from their doctors or other health care providers confirming that they have one of the conditions recognized by the plan. Patients who live in Vermont and Massachusetts can qualify for those state plans if they can show proof that the premiums they have been offered by a private insurer in the individual market are at least twice as high as the P.C.I.P. premium. But they cannot be enrolled in those plans. If you are newly uninsured, have a pre-existing condition and are shopping for private insurance in the individual market, keep a record of any denials you may receive. If you do not find insurance on your own and you live in a state that requires denial confirmation, you will have the documentation you need. THE RIGHT COVERAGE The federal government set aside $5 billion to subsidize the new plans. Even with the subsidies, an individual premium in the federally run standard plan for a 50-year-old can range from $320 to $570. State-run plans determine their own premiums based on what the private insurance market charges insurable members. In Connecticut, for example, monthly premiums for the plan can be as much as $890. Review your coverage options carefully. In the plans sponsored by the federal government, all three options cover 100 percent of preventive care, like annual physicals and screenings. All charge a 20 percent co-pay (40 percent for out-of-network providers) for other care, with a $5,950 out-of-pocket annual maximum for in-network care ($7,000 for out of network). The difference is in the deductible. The standard plan has a $2,000 deductible for in-network care ($3,000 for out of network), compared to the extended plan’s $1,000 and $1,500 deductibles. In Massachusetts, for example, standard plan premiums for people ages 35 to 44 are $324 a month, compared to $438 a month for the extended plan. If you can afford the higher out-of-pocket costs, it may make sense to opt for lower premiums. This posting includes an audio/video/photo media file: Download Now |
| Japan Races to Restart Reactors’ Cooling System Posted: 19 Mar 2011 09:01 AM PDT This article is by Ken Belson, Hiroko Tabuchi and Keith Bradsher. MultimediaRelated
TOKYO — Scrambling to corral a widening crisis, engineers linked a power cable to the crippled Fukushima Daiichi Nuclear Power Station early Saturday as they struggled to restart systems designed to prevent overheating and keep radiation from escaping. The Tokyo Electric Power Company, which runs the plant, said it hoped to connect the electric cord to the cooling equipment inside the facility later Saturday in an attempt to stabilize the reactors that were damaged by the powerful earthquake and tsunami that struck Japan eight days ago. In a brief statement on Japanese television Saturday morning, an official for Japan’s Nuclear and Industrial Safety Agency said that workers had managed to restart a diesel pump and restored cooling functions at two of the reactors, Nos. 5 and 6, early Saturday morning. He did not provide any details. Those reactors were not in use when the disaster occurred, but they contained spent fuel rods, and engineers were concerned this week when temperatures in the reactors began to rise. About 150 of its people were working on the electrical cable, the power company said, and they were planning to start with Reactor No. 2, which on Friday was seen spewing steam, perhaps containing radioactive particles. Officials have cautioned, however, that restoring electricity to the reactor would prove fruitless if the pumps were not working. In that case, a new cooling system would be needed, leading to more delays in an emergency that has bedeviled the power company and the government and caused anxiety and frustration overseas. The nuclear safety agency said that the crisis now had wider consequences, and raised its assessment of the accident’s severity to Level 5 on a seven-level scale established by the International Atomic Energy Agency. Hidehiko Nishiyama, a senior official at the agency, said the assessment was retroactive to Tuesday and based on the fact that officials now assumed that more than 3 percent of the nuclear fuel at the plant had experienced meltdown. The adjustment was an admission by Japanese officials that the problem was worse than it had previously stated. “We could have moved more quickly in collecting information and assessing the situation,” said Yukio Edano, the chief cabinet secretary. Outside experts have said for days that this disaster is worse than the one in 1979 at Three Mile Island — which the United States classified as a 5 on the international scale but which released far less radiation outside the plant than Fukushima Daiichi already has. Engineers are starting the power cord effort with Reactor No. 2 because its outer building has not blown off, thus making it hard to spray in water the way they can with Nos. 1, 3 and 4, according to NHK, Japan’s national broadcaster, which cited power company officials. The plan was to lay a 1.5-kilometer power cable between Reactor Nos. 1 and 3 to get to No. 2. If they can hook it up, it will theoretically be able to power all six reactors. The main hazard was the exposure of workers. Unable to contain the catastrophe on its own, Tokyo Electric has received help from Japanese police and fire departments and the country’s Self-Defense Forces. Assistance has started to flood in as well, with nuclear experts arriving from the United States and international agencies. France and South Korea are also providing support. Overnight in Japan, crews from the Tokyo Fire Department doused water on Reactor No. 3, which was doused earlier Friday by teams from the Self-Defense Forces and the United States military. Workers planned to continue the spraying on Saturday. In a further sign of spreading alarm on Friday that uranium in the plant could begin to melt, Japan planned to import about 150 tons of boron from South Korea and France to mix with water to be sprayed onto damaged reactors, French and South Korean officials said Friday. Boron absorbs neutrons during a nuclear reaction and can be used in an effort to stop a meltdown if the zirconium cladding on uranium fuel rods is compromised. Tokyo Electric Power said this week that there was a possibility of “recriticality,” in which fission would resume if fuel rods melted and the uranium pellets slumped into a jumble on the floor of a storage pool or reactor core. Spraying pure water on the uranium under these conditions can actually accelerate fission, said Robert Albrecht, a longtime nuclear engineer. Nuclear reactions at the plant were halted immediately after last week’s 9.0-magnitude earthquake and before the tsunami arrived minutes later.
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| Radiation Plume Reaches U.S., but Is Said to Pose No Risk Posted: 18 Mar 2011 11:07 PM PDT Faint traces of very low levels of radiation from the stricken nuclear complex in Japan have been detected in Sacramento, European officials reported Friday, bringing the distant atomic crisis to American shores for the first time. Related
The readings, picked up by highly sensitive detectors set up to monitor clandestine nuclear blasts, were the first solid evidence of the leading edge of a long radioactive plume that has drifted slowly across the Pacific with the prevailing winds over the past week and has now reached the continental United States. Health experts said the plume’s radiation had been diluted enormously in its journey across thousands of miles and — at least for now, with concentrations very low — would have no health consequences in the United States. In a similar way, radiation from the Chernobyl disaster spread around the globe and reached the West Coast of the United States in 10 days, its levels detectable but minuscule. Late Friday, the Department of Energy confirmed the European statements about the arrival of the radioactive plume in Sacramento, saying the federal station there detected “minuscule quantities” of radiation that posed no health hazard. But the Obama administration’s initial reluctance to release its own radiation information and the haphazard way that thereadings came dribbling out of Europe first — not the United States — raised questions about whether American officials were being as forthcoming as they had pressed the Japanese to be. Throughout the nuclear crisis, Japanese officials have been accused of withholding information and understating the severity of the risks. But on Friday, pressure mounted on the Obama administration to release information it has gathered on the radiation coming from Japan, with six environmental and watchdog groups sending the White House a letter calling for “transparency on the part of the government.” In many respects, the plume underscores the lack of a global system for monitoring nuclear emergencies and making the results public. European officials said the system was designed to be hugely sensitive to detect cheaters trying to develop clandestine nuclear arms — but not radioactive plumes from commercial reactor failures, which are easier to detect. “What we can measure is almost a single atom, which has absolutely no danger” for human health, said Lars-Erik De Geer, research director of the Swedish Defense Research Agency, a part of the monitoring system. “It has to be very sensitive because we are looking for people who are trying to hide the testing of weapons.” The Sacramento readings were made on Air Force equipment shared with the Comprehensive Test Ban Treaty Organization, an arm of the United Nations in Vienna. Its mandate is to monitor the global ban on the testing of nuclear arms. The United Nations agency has more than 60 stations that sniff for radiation spikes and uses weather forecasts and powerful computers to model the transport of radiation on the winds. Earlier this week, its scientists forecast the plume’s arrival in the continental United States around the end of this week. European officials said that — outside of Japan — its global network of detectors first picked up the presence of the Japanese plume at a station on the Kamchatka Peninsula, in Russia. Then, on Friday, they said, the station in Sacramento began to register the faint radiation. The government declined to release further details. In both cases, officials said, the detectors found minuscule levels of iodine-131 and cesium-137 — highly dangerous byproducts of reactor operation that in large amounts can cause cancer. The measured levels are judged to be many millions of times lower than concentrations that would pose a danger to human health. Experts tracking the plume said it would continue to drift east and might arrive in the New York region early next week. By definition, the current measurements are tracking relatively old radiation that was released into the atmosphere at the start of the Japanese crisis. It began on March 11 when an offshore earthquake with a magnitude now estimated at 9.0 shook the reactor complex. A tsunami rolled into northeast Japan minutes later, swamping six reactors lined up along the coastline.
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| Radiation Fears Cloud Japan’s Recovery Posted: 19 Mar 2011 12:40 AM PDT Add fears of radiation to the long list of troubles threatening Japan’s export-led economy. Rungroj Yongrit/European Pressphoto AgencyOfficials from Thailand's food safety agency take samples of frozen fishes and food products imported from Japan at the Bangkok airport. Related
Chaiwat Subprasom/ReutersFood testing in Bangkok. No significant contamination has yet been found in Japanese products. As Japan struggles to contain radiation leaking from crippled nuclear reactors, many countries, including China, Indonesia, South Korea and Thailand have already started to test food imported from Japan for radiation, and the European Union has recommended that member countries do so. Manufacturers have also begun sweeping cars waiting for oversea shipment. No reports of significant product contamination have surfaced. Some sushi restaurants in Asia are reportedly dropping fish from Japan from their menus. In Hong Kong there was a run on baby formula from Japan because mothers feared future supplies would be contaminated or unavailable. In the United States, the Food and Drug Administration said Thursday that it was considering increasing the monitoring of imported food and raw ingredients made in Japan, or that had traveled through the country. However, the agency said, “based on current information, there is no risk to the U.S. food supply.” Despite the excellent reputation of Japan’s Kobe beef, premium tuna belly sushi or toro and fine sake, food is only a minor part of Japanese exports. The country imports far more food than it exports. Far greater damage could occur if Japanese automobiles or electronics get contaminated with radiation, or if fear spreads among consumers that they could be exposed to radiation by sitting in a Prius or playing a DVD. Among the steps that Japanese manufacturers are starting to take to reassure customers are trips to ports in Japan. For example, workers at Nissan, armed with radiation detectors, are testing some of the company’s cars waiting to be shipped overseas. On Friday, Carlos Tavares, chairman of Nissan Americas, confirmed the scanning of autos: “It’s clear that we have found nothing, but that doesn’t mean we shouldn’t do it. We are just doing it to make sure nothing is there.” Radiation experts said there was virtually no chance of major contamination of industrial products, even if the leakage were to worsen. Particles like the ones containing radioactive iodine or cesium escaping from the Fukushima Daiichi power plant can be deposited on products. But given the nature of the manufacturing industries in Japan, there is little danger of contamination reaching harmful levels, the experts said. For one, most manufacturing in Japan happens far from the nuclear plant (and many of the cars and electronics from Japanese companies are actually made outside Japan). Moreover, manufacturing is usually done indoors. A product would most likely not be contaminated “unless it sits outside for long periods and gets a significant amount of deposits on it,” said William F. Morgan, director of radiation biology and biophysics at the Pacific Northwest National Laboratory. Also he noted, most products were in packages, and the radioactive particles would not damage the product inside. If a product is known to have deposited particles, they can be washed off, or a contaminated box could be opened by someone wearing gloves and thrown away. Manufacturing is likely to be halted in areas with high levels of radiation. “If the levels are high enough, that there would be a concern for a product being shipped, there would be a much greater concern for the people working there,” said Jerrold T. Bushberg, director of health physics programs at the University of California, Davis, School of Medicine. So if the nuclear accident hurts Japan’s exports, some experts say, it is more likely to be attributable to disruptions in operations and logistics there, much as the earthquake and tsunami have done, not because the reactor damage is contaminating products. A huge plume of radiation heading toward Tokyo could bring commerce and manufacturing in that area to a halt. A nuclear meltdown at Fukushima could cause Japan to shut other nuclear plants as a precaution, adding to power outages. Food is a much more pertinent issue for radioactive contamination because crops and animals are often raised outdoors and because they are ingested. Still, some experts say the risk is low to Americans because Japan accounts for only 4 percent of American food imports. And even less of that is food with the highest risk of contamination. “We are not worried about imports from Japan, and we are not recommending that consumers be concerned,” said Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest, a consumer group. She said that in the five years after the Chernobyl nuclear accident, which was far worse than Japan’s radiation problem so far, only 1.4 percent of the food products entering the United States from Eastern Europe exceeded standards for radiation. Much of that was meat and poultry. Imports of raw beef from Japan, including premium Kobe beef, have been suspended since last April, because of concerns about foot and mouth disease, according to a spokesman for the United States Department of Agriculture. Poultry and egg imports are barred because the Agriculture Department has not determined that Japan has a sufficient inspection system for those products. Dairy products can be contaminated if cows eat grass that radioactive isotopes have fallen on; this was a major source of radiation after the Chernobyl accident. But dairy accounts for only 0.1 percent of food imported from Japan, according to the F.D.A. There is also relatively little fresh produce. Some seafood does come from Japan. However, much of the fish served in sushi restaurants here does not, and even fish caught by Japanese fleets might not be from waters near Japan. The F.D.A. said it was taking steps to measure contamination in fish, but added, “The great quantity of water in the Pacific Ocean rapidly and effectively dilutes radioactive material, so fish and seafood are likely to be unaffected.” The United States Customs and Border Protection already monitors incoming cargo for radiation, part of the response to the Sept. 11 attacks. It said in a statement this week that it had instructed its field officers to specifically monitor maritime and air traffic from Japan. “We don’t have any dirty bombs or nukes coming through here because of these processes,” said Ron Boyd, the chief of police at the Port of Los Angeles. He said he was confident that the procedures would also be able to detect radioactive cargo from Japan. There are already reports of passengers arriving from Japan setting off radiation detectors at Chicago’s O’Hare and at Dallas-Fort Worth airports, but those levels were reported to be very low. Customs and Border Protection said in a statement that no aircraft entering the United States “has tested positive for radiation at harmful levels.” |
| Elite Runner Back After Radical Cancer Surgery Posted: 18 Mar 2011 10:34 PM PDT Dr. Patrick J. Boland, an orthopedic oncologist at Memorial Sloan Kettering Cancer Center in New York, had operated on many patients with sarcomas — cancers of soft tissues — but he had never had a patient like Serena Burla, a 27-year-old elite distance runner from St. Louis. She had a potentially deadly cancer, a synovial sarcoma, that arose in and replaced one of the muscles in her right hamstring. Treatment was to remove that muscle, the biceps muscle of her hamstring. “You can’t stitch it back together,” Boland said. “There’s just nothing there.” Before he operated on Feb. 26, 2010, Boland went to the medical literature to see if there was any other athlete who had that hamstring muscle removed, recovered and competed again. He could not find one. “We did such a radical operation,” Boland said. He was not sure Burla would be able to run, and even if she could, he doubted if she would compete again at an elite level. She proved him wrong. Last November, Burla competed in the New York City Marathon, her first. She came in 19th, in 2 hours 37 minutes 6 seconds. She came in second in the national half-marathon championship in January. She had planned to run in the New York City Half Marathon on Sunday, but her left hamstring — the healthy one — hurt a bit on Friday when she was doing a training workout on a track. She decided to pull out of the race rather than risk aggravating it. “It’s a little bump in the road,” Burla said of her left hamstring injury. “In the grand scheme of things, it will pass and I will be fine. After last year, it doesn’t seem like that big of a deal.” And Burla has bigger things in mind. She has qualified for the Olympic marathon trials next January. She loves to run. “I am very competitive,” she said. That, said Steve Edwards, the husband and coach of Shalane Flanagan, who competed against Burla last year in the national half-marathon and in the New York City Marathon, is an understatement. “The girl is tough as nails,” Edwards said. Burla grew up running — her father was a high school track and cross-country coach in Waukesha, Wis. — and said she began racing short distances in the third grade. She wanted to win every race and would break down in tears if someone beat her. “I think I drove my dad crazy,” she said. “He was like: ‘It’s O.K. You’re not going to win every time. You won’t get to run again if you don’t stop crying.’ ” Burla ran in college, at Missouri, and was an all-American 10,000-meter runner in 2006. But after college, she stopped competing. She married her college boyfriend, Adam Burla, a shot-putter at Missouri, and moved to St. Louis, where she got a job teaching 3- and 4-year-old children in special education classes. She ran, but just for fun. “It was my stress relief,” Burla said. “I loved it.” She asked people in St. Louis if they knew anyone who would run with her. “They were like, ‘I know this one guy who has run with girls,’ ” Burla said. The man, Andy Koziatek, 29, who is still her running partner, “gives me someone to chase and a supportive voice to propel me on,” Burla said. And, she added, ever the competitor, “We have a friendly rivalry of back-and-forth personal records.” Burla also joined a running team, Riadha, after she got a call from its coach, Isaya Okwyia. He noticed how well she ran in high school and college and was recruiting athletes who “needed support.” Burla, he said, “clearly had not realized her potential.” She wanted to run a marathon and she had what it takes, Okwyia said, and she is “fiercely competitive but incredibly patient.” The plan was for Burla to train for a few years, then run her first marathon in the spring of 2010. But the previous fall, what had started gradually as an intermittent ache in her right hamstring became nearly constant, and agonizing.
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