Health Law

Two weeks ago, the US Supreme Court wrapped up three days of oral arguments and held an initial vote on the questions related to the ACA. Although the court's decision will not be available for three months, many are speculating about the future of the individual mandate. The critical question regarding the individual mandate is whether or not uninsured Americans are in the health insurance market, as Congress has the power to regulate a marketplace. Justice Anthony Kennedy, the likely deciding vote for or against the individual mandate, questioned Solicitor General Donald Verrilli on the mandate, saying, "Here the government is saying that the Federal Government has a duty to tell the individual citizen that it must act, and that is different from what we have in previous cases, and that changes the relationship of the Federal Government to the individual in a very fundamental way."

On the last day of arguments, the Supreme Court looked into the ACA's Medicaid expansion. The question before the court is whether it is within Congress' power to expand the Medicaid program under the ACA. Under the law, the federal government will pay 100 percent of the cost of Medicaid expansion for the first three years, and 90 percent or more of the cost after that. Opponents of the expansion argued that despite the fact participation in Medicaid is optional, because the expansion is so great, they are being coerced into expanding the program. Proponents of the expansion argued that Medicaid remains an optional program, and it has been modified and expanded many times in its history. Justice Elena Kagan summarized this point, saying "Why is a big gift from the Federal Government a matter of coercion? In other words, the Federal Government is here saying, we are giving you a boatload of money. There's no matching funds requirement, there are no extraneous conditions attached to it, it's just a boatload of federal money for you to take and spend on poor people's health care."

Read the argument transcripts.

            As many of you know, a new iPad hit the market just a few weeks ago.  The iPad series is a popular line of tablet computers designed, developed, and marketed by Apple Inc. The iPad is primarily used as a platform for audio and visual media including books, newspapers, magazines, photographs, movies, music, games, web content, and other applications.  One word of caution – I have learned through first-hand knowledge that caution should be used when the iPad is in the hands of a baby or toddler.  Our 21 month old son recently dropped his older brother’s iPad into a water filled bathtub.  Our baby son thought it was funny, his older brother did not agree.    

            Application software, also known as an application or an "app," is software that is downloaded from Apple's App Store that is designed to help the user perform specific tasks. Depending on the application, the apps are available either for free or at a cost.

            The following is a list of four apps, including the app store description, that may be of interest to seniors:

            Mint.com allows you to track, budget, and manage your money all in one place, so you can see where you're spending and where you can save. Open a Mint.com account, add your bank, credit, loan and retirement account information, and Mint.com will automatically pull in and categorize your transactions. It's safe, secure, and easy to keep your personal finances organized. If you don't have an iPad, then you can also use Mint.com on your computer.

•View all of your accounts including: checking, savings, credit cards, investments, and retirement.

•Mint.com automatically pulls in and categorizes your transactions. No need to enter your own transactions.

•Easy-to-understand graphs show you where your money is going, so you get a clear picture of your spending and your net worth (iPad only).

•Know how much you have left to spend. Mint.com creates a customized budget based on your actual spending.

•Add manual transactions at the time of purchase so you can track cash spending.

•Avoid late fees and monitor cash flow − get bill reminders, alerts, and advice sent right to your device.

•View your data even without a wireless connection (iPad only).

            Now you can take the AARP experience with you on the go. With the AARP app, you can save money, stay informed, and share favorite content with your friends.

•Easy access to AARP member benefits and discounts now with a stored copy of your membership card on your mobile device.

•Read the latest articles from AARP in a mobile-optimized format and access offline.

•Watch video clips from AARP's video library.

•Share interesting content with your friends on Facebook and Twitter.

            WebMD helps you with your decision-making and health improvement efforts by providing mobile access 24/7 to mobile-optimized health information and decision-support tools including WebMD's Symptom Checker, drugs and treatments, first aid information, and local health listings. WebMD also gives you access to first aid information without having to be connected wirelessly – critical if you don't have Internet access in the time of need. Personalize your app by saving drugs, conditions, and articles relevant to you through secure access and easy sign-in.

4. iHealth BPM ($99.95 includes Blood Pressure Monitoring System with Standard Cuff)

            This is the first ever blood pressure monitoring system for the iPod Touch, the iPhone, and the iPad.  iHealth turns your iPhone into a powerful blood pressure monitor. It includes a diary for tracking BP measurements taken by the iHealth BP dock. Its elegant user interface and vivid testing process make keeping an eye on vital signs more enjoyable than ever before. It also empowers you to see the changes and reasons behind them using simple analytical tools: interactive graph, statistics, smart World Health Organization (WHO) classifications, and a frequently asked questions (FAQ) section.

            These are just a few of the many applications that seniors and their families may find useful.

On December 21, 2011, Governor Christie signed into law "Physician Orders for Life Sustaining Treatment" or POLST.  The law moved NJ in line with more than 30 other states.

POLST allows individuals to remain in control when facing a life-limiting or teminal illness.  With POLST, an individual can choose whether or not to be resusitated, and can authorize a healthcare proxy to make decisions on their behalf if they become incapacitated.

POLST has to be signed by a physician or nurse practitioner, and unlike a living will, it has authority of a physician order and becomes part of their medical records, following the patient from one healthcare setiing to another, including home, hospital, nursing home, or hospice.    

A POLST form would only be valid if signed by the patient, or the patient's legal representative, as well as the attending physician or nurse practitioner, along with the date of signature.  A patient can amend or revoke a POLST form, or request treatment other than what was ordered on the form.  The patient can also spell out whether their healthcare representative or proxy has the authority to revoke or modify the POLST in the event the patient loses decision making capacity. 

The new law provides for a central database where health care providers can be notified of a patient's preference for care.

Many U.S. surgeons fail to discuss their patients' wishes in case a risky operation goes awry, and even more would not operate if patients limited what could be done to keep them alive, a survey found. Such medical wishes and plans for end-of-life care, called "advance directives," outline what can and cannot be done if patients are unable to decide for themselves. The most famous examples are so-called living wills. But the restrictions are debated among doctors, said the survey, published in the Annals of Surgery.

"(Surgeons) feel the advance directive basically ties their hands behind their back, and they're not given the tools to get them through the surgery," said Margaret Schwarze, an assistant professor at the University of Wisconsin School of Medicine and Public Health, who was one of the survey's authors. She and her colleagues asked 912 surgeons who regularly perform risky operations 14 questions on how they discuss a patient's advance directives and whether the directives influence their decision to operate. More than four out of every five surgeons discussed which forms of life support the patients would like to limit, but only about half asked specifically about the patient's advance directive, which can include restricting the use of feeding tubes and ventilators to keep a person alive. "I think some surgeons just don't discuss advance directives because they think it's so irrelevant," Schwarze added.

Source/more: Reuters Health

The Obama administration announced on October 14, 2011 that it will not move forward with a new long-term care law - because of problems with paying for it.

Congressional Republicans had vowed to kill the program, calling the Community Living Assistance Services and Supports program (CLASS) too expensive.

The CLASS act, a longstanding priority of the late senator Edward Kennedy, was intended as a voluntary plan.  But, a design flaw dogged CLASS from the beginning. Unless large numbers of healthy people willingly signed up during their working years, soaring premiums driven by the needs of disabled beneficaries would destabilize it, eventually potentially requiring a taxpayer bailout.