health care reform

V.20 No.7 | 2/17/2011

Miss Diagnosis

Get Your Hands off My Health Care Reform

Health reform opponents say the Patient Protection and Affordable Care Act is unconstitutional and expensive. Miss Diagnosis says they're wrong.
V.19 No.15 | 4/15/2010


Medicaid is Not a Herpes Cream

A health reform tutorial

Before becoming a nurse, I would have guessed that Medicaid was something you buy over the counter to rub on private ailments. More than anyone, I understand that the world of health policy can be confusing. Here’s a list of select terms to ease the pain of reading about health reform, (which you can do pain-free in this week’s news section here and here). Study up! At the very least, knowing the distinction between Medicare and Medicaid will help you impress bookishly cute fox at the coffee shop you’ve been eyeing.

Medicare: Government-run health insurance for the elderly and disabled. Medicare beneficiaries must meet certain eligibility criteria and typically pay premiums, deductibles and other out-of-pocket expenses to receive benefits.

Medicare Part A covers hospital-related stuff, while Medicare Part B covers other medical stuff like outpatient services and medical equipment. Medicare Part D covers prescription drugs.

The Medicare program also funds physician residency programs. The federal government funds Medicare.

Medicare Advantage: Also known as Medicare Part C. Medicare plans that are managed by private insurance companies. Instead of the government directly supplying a senior’s insurance, the senior can opt for an Advantage plan instead, where the government pays a private company to insure the senior.

Part D “donut hole”: Refers to the coverage gap for prescription drugs under Medicare Part D. Once Medicare beneficiaries have exceeded the prescription drug coverage limit, they are responsible for the entire cost of medications until they reach the “catastrophic” threshold. Medicare coverage kicks back in at the catastrophic threshold.

For 2009, Part D covered 75 percent of the cost of prescription drugs (after the beneficiary pays their $295 deductible) up until drug costs exceed $2,700. Drug expenses between $2,700 and $6,154 were NOT covered by Medicare, and the person had to pay 100 percent out of pocket. Once drug expenses exceeded $6,154, Medicare Part D kicked back in and covered 95 percent of the cost of drugs beyond this threshold. Many seniors get caught in the donut hole and pay thousands of dollars out-of-pocket for their medicines.

Medicaid: State-run insurance program for those with low incomes. The federal government sets certain regulations for Medicaid and supplies funds, but up to half of Medicaid funding occurs at the state level. Medicaid programs differ from state to state. Rather than being an entitlement program like Medicare (which all people over age 65 can participate in, regardless of income), Medicaid is a needs-based program.

Primary Care Providers: Primary care typically refers to the sector of the health care system that handles general medical concerns, prevention, screening and health/wellness promotion. Primary care providers serve as the “gatekeepers” into the medical system and refer more complicated patients to specialty services, such as neurology or dermatology.

Family physicians or general practitioners, pediatricians, some OB/GYNs, nurse practitioners and certified nurse midwives are examples of providers that often serve as primary care providers.

V.19 No.14 | 4/8/2010
Nancy Ridenour, dean of UNM’s College of Nursing, had a hand in crafting portions of the nation’s health reform bill.


The Reform Prognosis

How will New Mexicans be affected? An insider explains.

Navigating health reform legislation is no small task. This enormous Patient Protection and Affordable Care Act does everything from impose a 10 percent tax on tanning salon services to reworking the country’s massive Medicare program. That’s why the Alibi turned to health policy expert and seasoned clinician Nancy Ridenour, Ph.D., RN. (Read web extras here, and see a list of basic terms defined here.)

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V.19 No.12 | 3/25/2010

Ortiz y Pino

Whose Waterloo Was It?

If I’ve been critical of President Obama and congressional Democrats for watering down legislation during the health reform debate (and I certainly have, on many occasions these last months), then why did I feel such a sense of elation over the bill’s passage Sunday night?

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V.18 No.50 | 12/10/2009

Miss Diagnosis

How Health Reform Can Get You Laid

’Tis the season, and few things go better with spiked eggnog and mistletoe than a naughty roll in the manger. But anyone who is single and ready to tingle these days knows the dating market has become increasingly competitive since the economic downturn. Decreased financial security means few people have the luxury of just lookin’ for a good time. And while foxiness will never go out of style, many of us are more inclined to choose a mate with job security and a sizable benefits package (of the health care variety, sicko) in these tough times.

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Cheery Health News From Miss Diagnosis

Health reform developments continue to roll in at press-defying speeds. The Senate bill's public option may be on its death bed, as Democrats consider replacing it with a Medicare buy-in option for people 55 or older and expansion of Medicaid from 133 percent to 150 percent of the federal poverty level.

Another option on the table is allowing the government to contract with insurers to set up coverage for uninsured people, similar to the Federal Employees Health Benefits Program. Additionally, the Senate rejected Sen. Bill Nelson's amendment, which was nearly identical to the House bill's Stupak amendments and would have further restricted abortion services.

Drug makers, however, are still on the docket, with an amendment under consideration that would allow pharmacies and and drug wholesalers to purchase FDA-approved generic prescription drugs from certain foreign countries instead of Big Pharma. Guess who doesn't want to see that amendment pass?

Not to be outdone, H1N1 jostles for a place on the front page. A new study published by the Public Library of Science estimates that illness, hospitalization and death from the fall and winter H1N1 season will NOT exceed that of regular seasonal flu.

However, the prevalence of death and severe illness will be primarily experienced by young adults and young children rather than the elderly. The authors warn that their estimates depend upon an assumption regarding the total rate of infection, and that severity could increase if the virus mutates or if stress on the health care system leads to suboptimal treatment of severe cases.

Another study from NYU and the NIH found severe airway damage upon autopsy of H1N1 victims as well as an increased risk of death for young people, obese people or those with chronic underlying conditions such as asthma.

V.18 No.48 | 11/26/2009

Miss Diagnosis

Health Reform: Act STAT or Die

Before we begin, allow me to introduce myself: I'm a registered nurse and a family nurse practitioner graduate student. My background includes newborn, maternal and general medical-surgical nursing. You can bet that my column will be liberally peppered with many big words and things that sound like facts. Medicine is super cool, and nurses learn how to be fierce patient advocates, which is why I'm passionate about both disciplines. I believe health care should focus on prevention and wellness. I love babies, old people and hot doctors. Reading my column may unclog your arteries and make you more fabulous.

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