DBSA Board Chair, Cheryl Magrini, Shares Her Admiration and Issues a Challenge to All Chapter Leaders
I bring you greetings on behalf of your Board of Directors, made up of seventeen dedicated persons from across the United States. I was elected to the Board in 2012 and started my two-year term as chair January 1, 2014. I will confess, I was not quite sure what I was getting into! The Board consists of peers, family members of a person living with a mood disorder, those with business, corporate and managed care experience, a C.P.A., an attorney, clinicians, a certified yoga instructor, two certified Reiki masters, an author, myself as a minister, and more. Each person has in some way, had their life touched by a person living with a mood disorder. The national Bylaws state that 51% of the Board must disclose as living with a mood disorder and at present we are at 52%.
While the Board is charged with carrying out the governing duties of DBSA, at the forefront of the decisions made, are peers, their family members and friends, and the communities in which we live. At every meeting, we begin by sharing the writing of a peer whose life has been impacted in some way by being part of DBSA. Their stories shared are honest and inspiring as journeys of not only struggles, but of triumphs are told. In the support groups that I facilitate, I have a plaque on the table that reads, “Your Story Matters.” Your story does indeed matter.
I know firsthand how DBSA changes a person’s life. Taking the peer specialist training in 2011 transformed my work as a minister and I was so moved to hear the story of my peers in the training. My family founded the DBSA Chicago Loop Chapter also in 2011, located in the heart of Chicago. I started by no one showing up, then two, then needing a larger room in five months, and now we fill two rooms every week at both the Tuesday family/friends group, and the Thursday for those with a mood disorder. Always, always, a person says that they now know they are not alone, that the group is their family, that someone cannot make it through another day or week. We cry and we laugh. When I lost my vibrant twenty-three year old son to bipolar disorder in 2011, the DBSA family of the national staff were a rock for me in my healing journey. His memorial fund was donated to DBSA. However and wherever I can, I share his story. I hope that in I can then in turn be a source of strength for someone else.
I close with this challenge. Ask ten people whom you do not know, what inspires them and then share your own inspiration. Just this morning I met Dr. Don Breen from Phillipsburg, NJ, who is beginning a new support group in November at St. Luke’s Warren Hospital. I met Daisy Jabas, soon to be acting state director in TN, where her goal is to have a chapter in each of the state’s ninety-five counties. I am inspired by Don and Daisy.
As I say to close my support group meetings, “You are amazing, courageous, beautiful people in mind, body and spirit.”
Ordinary heroes: Drains honored for speaking out for health care equality
y Linda Braden
Larry and Linda Drain are quiet, unassuming people. But when circumstances arose that threatened Linda’s life, they both began speaking out, their voices ringing loudly to bring awareness to — and a solution for — themselves and others who have fallen through the cracks of the health care system in Tennessee. Their income is too high to qualify for TennCare, Tennessee’s public insurance program, and too low to qualify for federal subsidies under the Affordable Care Act, also called Obamacare.
In acknowledgement of their efforts, the Tennessee Health Care Campaign presented the Drains with the 2014 Heroes for Health Award in August at the John Seigenthaler First Amendment Center, Nashville. The award was given “for your dedicated support to affordable access to high-quality health care for all Tennesseans.”
The event honoring the Heroes was part of the Tennessee Health Care Campaign’s 25th Anniversary celebration. In addition to the Drains, Laura Sell was honored for the major work she did as a volunteer to promote and support enrollment in the Patient Protection and Affordable Care Act, collaborating with the Blount County Public Library.
Larry said, “It was a very eventful night. We got to speak to a lot of people, meet a lot of people that were heavy-hitters that we knew about or read about. That was neat. And to get people to treat us like we were important. As we were walking out the door, I said, ‘Linda, do you ever get over being surprised when people treat us nice?’ I’m surprised every single, solitary time. It’s just been a strange happening. When it first started out, we didn’t have a clue ... The way we look at it is that we are extraordinarily ordinary people, and the idea that people would know who we are or that people would listen to what we have to say — I wouldn’t have predicted that in a thousand, million years. Then when it took off, it went insane.”
The story began with Linda, who has been drawing Supplemental Security Income (SSI) for some time because of epilepsy, brain surgery and additional health conditions. Larry said, “She has TennCare. She has to have the TennCare in order to live. If she does not have the medication, if she doesn’t have the medical care, she will die.
“Ten years ago, a good day for her was having 10 to 15 grand mal seizures. She went through brain surgery, and the last 10 to 14 years have been extraordinarily eventful, but the medication is her pathway to life.”
After Larry turned 62 last September, he decided to take early retirement and begin drawing Social Security.
“If I had to take all the dumb, stupid, worst things in my entire life that I have ever done, that one is so far to the top that there is not a second place,” he said. “The way we had it figured out, we could live if we took what she made in SSI and what I made in retirement. We weren’t going to be rich — in fact, we were going to be poor — but we would be able to pay our bills, do what we needed to do. We were going to be OK.
“After a couple of months, Social Security called us in and said, ‘You guys make way too much money.’ They were very nice, not cruel or mean or anything like that. ... But they said, ‘We have a limit on unearned income, and you guys are way over it.’”
Larry questioned how that could be, and was told that his Social Security retirement is considered unearned income. He said, “I asked them, how could that be unearned income? I worked 47 years for that. It’s my money. They said, legally it’s unearned income. They told Linda that her check for $720 was going to become $20. We were going to lose $700. I said, ‘I’ll just give the retirement back. I’ll just get another job and we’ll be OK.’ And they said, ‘Well, you can do that, but the only way you can do that is to give us back every single penny we have given you today.’ Well, if I could give it all back today, I would never have needed it to begin with.”
Larry thought he could continue drawing his retirement and also have a job to make ends meet. He said, “What they said after that has basically driven the whole situation. They said, ‘You have to understand, that because your wife is on TennCare, if you make over $85 in a month, she will lose her TennCare.’ So we went home, and we did all the figuring we could.”
Their projected budget for January would leave them with $30 for essentials such as food and gasoline, and the following months would be worse. “We looked at everything we could, trying to find a way. ... But there wasn’t a way,” Larry said. “We were in a position where, if I got a job to give us enough money to live on, it would kill my wife. It would take her insurance away, and it would kill her. If I didn’t get a job, we couldn’t live. We couldn’t live on a dollar a day. It just wasn’t doable. So on Dec. 26, after 33 years of marriage, we separated.”
The original plan was for Linda to stay with a relative until they could find her a permanent place so she could retain her SSI and TennCare. Larry would then find a place as close by as he could. Larry said, “At that time, our understanding was that, according to the way the laws were in the state of Tennessee, we would never again live together as man and wife.”
There were two possible solutions: Change Social Security laws or expand TennCare, the state’s managed Medicaid program which provides health care coverage primarily for low-income children, parents, pregnant women and elderly or disabled adults. Social Security laws were not going to be changed, but Tennessee Gov. Bill Haslam could spearhead expansion of Medicaid. Larry said, “If he expanded Medicaid, then Linda didn’t have to be a member of a category, she didn’t have to be ‘disabled,’ to get it. All she had to do was be poor. If he expanded Medicaid, then she would have her insurance, which meant we could live together, I could get a job, and although we’d struggle, we would live. Without him expanding Medicaid, we had no help at all.”
Letters to governor
Larry began drawing attention to the need for TennCare expansion by writing a series of letters to the governor. Some were very personal, some general and policy oriented, but in each letter, Larry pleaded with Haslam to submit a plan for TennCare expansion. The 100th letter was emailed on Sept. 2. As of that date, the governor had not responded to the Drains, but he did announce on Aug. 28 that he plans to submit a proposal to Washington to expand Tennessee’s Medicaid program. He did not release any details, however.
Larry said more than 1,200 individuals from across Tennessee have told him they also contacted Haslam. Larry’s 100th letter to the governor begins to list the names, and he plans to continue adding names in subsequent letters until every one is included.
Each letter is available atdeargovernorhaslam.wordpress.com and is viewed by 4,000 to 6,000 persons daily. In addition, a petition entitled “Gov. Haslam: Expand TennCare and Let Me Stay With My Wife!” at www.thepetitionsite.com has almost 46,000 signatures in support of the Drains.
The Drains’ story was told in the Nashville Tennessean and other major news outlets, drawing even more attention to those who, as Larry said, “didn’t fall through the cracks — we live in the cracks.”
Twenty-five miles separate this couple now. Linda is in Knox County, while Larry is in Blount County. They are waiting for the time when they can once again live together as man and wife without Linda losing her life.
Larry said, “I should not have to drive 25 miles to see my wife. It’s wrong in every sense of the word.”
Help available for dealing with depression
Beth Knoll 12:39 a.m. CDT August 27, 2014 The Jackson Sun
A life lived with depression can feel like a "deep, dark place," said Steve Brannon. But with a variety of pathways to recovery, hope is never out of reach — even during the toughest times.
Society often views depression in extremes, said Brannon, state director of Depression and Bipolar Support Alliance of Tennessee, as depression is often seen as an untreatable illness — or not as an illness at all. Depression should be taken very seriously, he said, but it shouldn't be approached in a "fatalistic" manner.
"Depression is treatable, and it responds quite well to treatment," Brannon said.
Describing depression as the "common cold of emotional mental disorders," Paul Deschenes — clinical psychologist and director of counseling services at Union University — said most people experience depression at some point in their life
Deschenes said depression can be caused by a variety of factors, including the weather or the loss of a loved one. Because depression can be genetically based, it has the potential to be passed from one generation to the next, Brannon said.
In many cases, feeling depressed is normal, as no one is happy all the time, Deschenes said. What is not normal is when the grief and sadness continues indefinitely and begins to interfere with major areas in a person's life — signaling a more significant form of depression.
"They might experience things like negative thinking, self-criticism," Deschenes said. "They might experience feelings of hopelessness. Some people have thoughts of self-blame, and generally the thinking gets very negative, pessimistic. They might see the glass as being half-empty rather than half-full."
Additional symptoms can vary and even seem contradictory, Brannon said. Some people develop an increased appetite when they are depressed, while others may lose their appetite. Some people may sleep more often, while others experience insomnia. Some people may voice their thoughts of hopelessness, while others may not say a word.
Brannon said that a person with depression may stop bathing or using proper hygiene, and he or she may stay in the same clothes for weeks at a time. Deschenes also noted that a person may feel a loss of energy in accomplishing everyday tasks, as well as experience a decreased sex drive.
People who are depressed are more likely to develop other health conditions such as diabetes and heart disease, Brannon said. Their lifespan also can be shortened up to 25 years.
"It might affect their relationships," Deschenes added, because people experiencing depression often decline invitations for social engagements or drop out of church. "Ultimately, left untreated, some depression might get so bad that it turns to suicide."
Deschenes said a depressed person often wants to sit at home and be alone with their thoughts, which can fuel negative feelings. As a result, he said people should get out of the house and begin taking small steps to return to a healthy level of functioning.
Picking up an enjoyable hobby or volunteering can help ease depression, Deschenes said. Because depression can cause distorted thinking, spending time with positive people can halt irrational and harmful thoughts as well.
Exercise also can help people overcome depression and could be as effective as medication in some cases, Deschenes added. In addition, he encouraged people to return to church if they have stopped attending, as a person's faith speaks to issues such as hope.
"Whatever help an individual goes for, we recommend that folks not only be very religious about medication but also go to counseling," Brannon said.
With new medical treatment options introduced regularly, Brannon said treatments can include transcranial magnetic stimulation, in which part of the brain is stimulated with magnetic waves. While the success rates can vary, he said the results have been encouraging and the technology is expected to continue improving.
Brannon added that people with depression should develop a support group. The individuals who form a person's support group need to check up on how the person feels emotionally, know whether the person is taking his or her medication and be available to talk whenever the person may need them.
The support group also needs to be able to recognize the symptoms of depression, as well as know when the depressed person is in need of medical attention, Brannon said.
Noting that teenagers and the elderly are more susceptible to suicidal tendencies, Deschenes said people should not be afraid of causing a suicide by asking if someone is suicidal. If someone is hinting at suicide or displaying suicidal tendencies, he said family and friends should approach the situation seriously and take the person to a mental health professional.
People also should not think that a suicide is inevitable for someone experiencing suicidal thoughts, Deschenes said. Most of the time, a person averted from a suicide attempt and helped by professionals can regain and lead a normal life.
"When people get into a deep, dark place like Robin Williams did, trust seems to go away," Brannon noted, as a dangerous sign of suicide is when a person stops trusting others to help them manage their depression. "It is times like that the support network has to realize that they can't help this individual they love — they need someone to call."
The National Suicide Prevention Lifeline, which can be reached at 1(800) 273-8255, is a valuable resource for people contemplating suicide, Brannon said.
Brannon noted that Jackson also has a mood disorder support group, called "A Better Tomorrow." Meeting at 6:30 p.m. each Monday at St. Mary's Catholic Church, the group provides encouragement, education and information services for people with depression, as well as their family and friends.
The group often becomes like an extended family for members, Brannon said, as people with depression can understand what other group members face.
"It's something about being understood that's healing in itself," Brannon said. "That is so valuable for someone living with depression. You can't put a price on that."
To learn more about the Jackson depression support group, visit the Depression and Bipolar Support Alliance of Tennessee's website at www.dbsatennessee.org. The alliance also can be reached at (731) 215-7200.
Reach Beth Knoll at (731) 425-9641. Follow her on Twitter @merribethknoll.
What to know
• The National Suicide Prevention Lifeline, which can be reached at 1(800) 273-8255, is a valuable resource for people contemplating suicide.
• Jackson's mood disorder support group, called "A Better Tomorrow," meets at 6:30 p.m. each Monday at St. Mary's Catholic Church. The group provides encouragement, education and information services for people with depression, as well as their family and friends.
• To learn more about the Jackson depression support group, visit the Depression and Bipolar Support Alliance of Tennessee's website at www.dbsatennessee.org. The alliance also can be reached at (731) 215-7200.
Steve Brannon(Photo: Submitted)
Paul Deschenes(Photo: Submitted)
Haslam may submit Medicaid expansion plan in fall
Tom Wilemon, firstname.lastname@example.org and The Associated Press
1 day ago
Larry McCormack / File / The Tennessean
Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee’s Medicaid program but did not release any new details on how it might work.
The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed national organization focusing on depression and bipolar disorder. The organization fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date,
scientifically-based tools and information. DBSA supports research to promote more timely diagnosis, develop more effective and tolerable treatments and discover a cure. The organization works to ensure that people living with mood disorders are treated equitably. Assisted by a scientific advisory board comprised of the leading researchers and clinicians in the field of mood disorders, DBSA has more than 750 peer-run support groups across the country. Nearly two million people request and receive information and assistance each year. DBSA’s mission is to improve the lives of people living with mood disorders. For more information about DBSA or depression and bipolar disorder, please visit www.DBSAlliance.org or call (800) 826-3632.
Allen Doederlein, President, DBSA
Steve Brannon, State Director, DBSA Tennessee
Healthy Lifestyle May Buffer Against Stress-Related Cell Aging
UC San Francisco Study Suggests Healthy Diet, Sleep and Exercise Can Mitigate Negative Impacts of Stress
Newswise, July 24, 2014 — A new study from UC San Francisco is the first to show that while the impact of life’s stressors accumulate overtime and accelerate cellular aging, these negative effects may be reduced by maintaining a healthy diet, exercising and sleeping well.
“The study participants who exercised, slept well and ate well had less telomere shortening than the ones who didn’t maintain healthy lifestyles, even when they had similar levels of stress,” said lead author Eli Puterman, PhD, assistant professor in the department of psychiatry at UCSF. “It’s very important that we promote healthy living, especially under circumstances of typical experiences of life stressors like death, caregiving and job loss.”
The paper will be published in Molecular Psychiatry, a peer-reviewed science journal by Nature Publishing Group.
Telomeres are the protective caps at the ends of chromosomes that affect how quickly cells age. They are combinations of DNA and proteins that protect the ends of chromosomes and help them remain stable. As they become shorter, and as their structural integrity weakens, the cells age and die quicker. Telomeres also get shorter with age.
In the study, researchers examined three healthy behaviors –physical activity, dietary intake and sleep quality – over the course of one year in 239 post-menopausal, non-smoking women. The women provided blood samples at the beginning and end of the year for telomere measurement and reported on stressful events that occurred during those 12 months. In women who engaged in lower levels of healthy behaviors, there was a significantly greater decline in telomere length in their immune cells for every major life stressor that occurred during the year. Yet women who maintained active lifestyles, healthy diets, and good quality sleep appeared protected when exposed to stress – accumulated life stressors did not appear to lead to greater shortening.
“This is the first study that supports the idea, at least observationally, that stressful events can accelerate immune cell aging in adults, even in the short period of one year. Exciting, though, is that these results further suggest that keeping active, and eating and sleeping well during periods of high stress are particularly important to attenuate the accelerated aging of our immune cells,” said Puterman.
In recent years, shorter telomeres have become associated with a broad range of aging-related diseases, including stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis diabetes, and many forms of cancer.
Research on telomeres, and the enzyme that makes them, telomerase, was pioneered by three Americans, including UCSF molecular biologist and co-author Elizabeth Blackburn, PhD. Blackburn co-discovered the telomerase enzyme in 1985. The scientists received the Nobel Prize in Physiology or Medicine in 2009 for their work.
“These new results are exciting yet observational at this point. They do provide the impetus to move forward with interventions to modify lifestyle in those experiencing a lot of stress, to test whether telomere attrition can truly be slowed,” said Blackburn.
Co-authors include senior author Elissa Epel, PhD, department of psychiatry, Jue Lin, PhD, department of biochemistry and biophysics, both of UCSF and Jeffrey Krauss, MD, division of physical medicine and rehabilitation at Stanford University. Lin, Epel and Blackburn are the co-founders of Telome Health Inc., a diagnostic company measuring telomere biology.
The study was supported by the Baumann Foundation and the Barney & Barbro Foundation. Puterman is supported by the National Heart, Lung and Blood Institute of the National Institutes of Health.
UCSF is the nation’s leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit www.ucsf.edu.
Source: University of California, San Francisco (UCSF)
Support for mood disorders: Allen Doederlien shares information Thursday
By Linda Braden Albert | email@example.com | July 20, 2014
A series of presentations focusing on mental health issues that began in March at the Blount County Public Library will continue Thursday as Allen Doederlein, president of the Depression and Bipolar Support Alliance (DBSA), speaks on bipolar disorder and depression. The presentations, sponsored by NAMI (National Alliance on Mental Illness) Maryville, are free and open to the public.
Doederlein said, “Our headquarters are in Chicago, Ill., and yet, we are really all over the country and have some incredible and important affiliates in Tennessee. The work they do is entirely volunteer. It’s done as a labor of love and it’s done from a very personal place.”
The organization is by and for people who live with depression or bipolar disorder. “That lived experience informs everything we do,” Doederlein said. “We provide information that’s easy and understandable, not written in ‘medicalese,’ not confusing but gets directly to what these conditions are and what you can do to live and get well. We provide empowerment. These are conditions that can make people feel disenfranchised, that can carry great stigma. We want to make sure that people are strong advocates for themselves.”
Doederlein said another goal is to raise concerns and needs to elected officials but also on a more personal level. “Also in their work places and their families — anyplace people with mood disorders may find themselves, to say, let’s work collaboratively and constructively to make sure everyone does well,” he said.
DBSA support groups provide valuable assistance and education for those with mood disorders. Doederlein said, “Our chapters operate free, in-person peer support groups. That’s a group that meets without a doctor or clinical professional present, just the people with a lived experience. There’s a great deal of scientific literature that shows that peer-to-peer experience is greatly beneficial and helps people get well and stay well.”
About 53,000 people are reached nationally in a year by these peer support groups, he added.
Doederlein said Larry Drain, president of the NAMI (National Alliance on Mental Illness) Maryville and initiator of the mental health informational series, is a wonderful example of someone with a great deal of power and intellect who has been challenged by mood disorders.
“He had taken that lived experience and made something in terms of giving back to others,” Doederlein said. “When you think that there are people doing that all over the country, it’s really, really something. Larry’s not only done that in terms of support but also as an advocate.”
At the national level, 50 percent of the paid professional staff and volunteers must, by charter, have personal experience in dealing with mood disorders.
“That perspective informs everything that we do,” Doederlein said. “That’s really important. Very often in health-related education or advocacy, it will be doctors talking to doctors, not really related to a person getting herself or himself well. We make sure that’s at the center of what we do.”
Mood disorders include a spectrum of conditions, including depression and bipolar disorder. Doederlein said, “About 21 million American adults are estimated to be affected by depression and bipolar disorder. That breaks down to about 14 million affected by depression, and between 6 and 7 million affected by bipolar disorder.”
Mood disorders are challenging, but they can be managed and those with the disorders can thrive and contribute to society, Doederlein said. A prime example — Abraham Lincoln.
To learn more, visit the DBSA at www.DBSAlliance.org or attend Thursday’s presentation. It begins at 6:30 p.m. at the Blount County Public Library.
Daisy Jabas, Assistant Director, submitted this abbreviated itinerary:
I wanted to give each of you Allen Doerderlein's Tennessee visit intenery as it is known now.
Exciting news is always welcome. One of our own steps out to bring national attention to those suffering due to lack of medical healthcare coverage. Links to articles in The Tennessean and USA Today are below.
The NBC Today show asked to interview Larry and Linda. The interview is expected to happen today. Airing of their interview is expected some time this week. Let's all send our best wishes and thoughts to this couple as they do all that they can to see that no one else needlessly suffers in like fashion.
Links to Larry and Linda's story:
Decision on Medicaid Expansion holds coverage for many Tennesseans in balance
By Kristi Nelson
Posted June 2, 2013, updated June 4 2013
It was supposed to be one of the strongest tenets of the 2010 Patient Protection and Affordable Care Act. Instead, it became a political football, a metaphor for states’ rights. After the Supreme Court ruled that the ACA could not force states to expand Medicaid, Gov. Bill Haslam was among those who rejected the Medicaid expansion, instead offering his alternative “Tennessee Plan” for federal government approval.
But whether the federal government and the General Assembly will accept Haslam’s plan remains to be seen, along with how well it will work to cover those who currently don’t have health insurance.
“He’s either politically brilliant, or he’s making one of the worst mistakes he could make,” Rep. Joe Armstrong, D-Knoxville, told the News Sentinel in March.
What the ACA intended
Originally, the Medicaid expansion provision was to give state health insurance coverage to a group of people who made too much to qualify for Medicaid but too little to afford insurance on the health insurance exchanges, even with the planned government subsidies.
It expanded Medicaid to qualify people younger than 65 whose income is below 138 percent of the federal poverty guideline (a little more than $15,860 annually for an individual, a little less than $32,500 annually for a family of four).
It meant that, for the first time, low-income adults who don’t have children could get state Medicaid coverage, and it standardized other qualifications.
Many states, including Tennessee, limit Medicaid enrollment to certain categories of people. To qualify for TennCare, for example, you have to be low-income and pregnant, a child, blind, disabled, aged, or fall under multiple, specific categories.
Tennessee has nearly 1 million uninsured residents, of whom at least 140,000 and maybe more than twice that number, by some estimates, likely would enroll in Medicaid if it were expanded under the ACA guidelines. About three-quarters would have been previously uninsured. Under the ACA expansion, the federal government would pick up the entire cost of new, previously ineligible enrollees for the first three years, phasing to 90 percent by 2020. In Tennessee, federal funds would have amounted to about $1.4 billion in the first year alone.
States could receive federal matching funds for covering additional low-income residents under Medicaid as early as April 2010, with wide-scale enrollment beginning this October and coverage starting Jan. 1, 2014. However, in June 2012, the U.S. Supreme Court ruled that the federal government could not make states expand Medicaid — making a linchpin of the ACA optional.
So far, 20 states have moved forward with Medicaid expansion. Ten have rejected it outright, while 10 others are not doing it now but are looking at alternatives and have not ruled it out for the future (the government gives no deadline, though states waiting much longer to decide stand to lose federal funds for the first year). Three states are still undecided, while seven — including Tennessee — are crafting their own, alternate plans.
On March 27, Gov. Bill Haslam announced that Tennessee would not expand TennCare rolls under the ACA, instead offering up an alternative he called the Tennessee Plan.
“I don’t think just pure expanding of a system that we all agree is too costly for us, is too costly for the federal government to afford long-term, is the right way,” he said then.
The ‘Tennessee Plan’
Haslam’s proposal is that the state use federal funds not to expand TennCare but to purchase private insurance through the insurance exchange for people who would have qualified for coverage under Medicaid expansion.
He outlined the proposal in the broadest terms, including five “key points”:
Individuals identified as being eligible for the Medicaid expansion group would instead be directed to the exchange, where they would be allowed to choose any qualified health plan that offers a certain level of benefits (the Silver Plan).
The state would pay the monthly premiums, matchable with 100 percent federal dollars, for those people to enroll in the Silver Plan.
People in the Medicaid expansion group would be treated like all other people enrolled in the Silver Plan, with access to the same benefits and appeals process as other people in the plans.
People in the Medicaid expansion group would have the same cost-sharing as other Silver Plan enrollees with incomes below 250 percent of the federal poverty guidelines. (On average, Silver Plan policies would pay for 70 percent of health care costs, with the remaining 30 percent paid by the planholder.)
The arrangement would have a “circuit-breaker,” or “sunset,” ending after the three-year period of 100 percent federal matching dollars, and could be renewed only with approval of the General Assembly. (This is true for states accepting the Medicaid expansion as well; they can stop using federal funds and drop the expanded coverage at any time.)
In addition, Haslam would seek to reform the way providers are paid for services, with payment based on outcomes rather than a set fee for services. The money saved, he said, would be enough to cover the state’s 10 percent share of costs after the government’s share goes to 90 percent.
“One option for covering the Medicaid expansion group is simply to add them to the Medicaid rolls, or the TennCare rolls, in our case,” Haslam said of the plan. “We don’t want to do that. There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible.”
But the federal government may not allow Haslam to forgo some of those requirements. While national Centers for Medicare and Medicaid Services guidelines indicate that the main tenets of the plan — using federal dollars to pay premiums for low-income people to have commercial insurance, and reforming payment — meet federal requirements, some of the details don’t align with federal requirements intended to protect Medicaid enrollees.
For example, Tennessee would need to give those with serious health conditions a choice of enrolling in TennCare or private insurance, unless CMS were to grant Tennessee a waiver to that requirement.
The federal government would require supplementation of benefits (sometimes called “wraparound”) to make sure the commercial insurance plans include all services that would be available through Medicaid. Hypothetically, this could be done through a supplemental premium to the Silver Plan insurance provider.
The government also limits co-payments for Medicaid-eligible enrollees.
There is also an appeals process in place, required by past Supreme Court rulings, so that Medicaid patients and their doctors can challenge insurance companies’ refusals to cover “necessary treatments.” Under federal law, Tennessee would have to allow Medicaid-eligible patients this due process.
A federal entitlement program, Medicaid was designed for a population upon whom “poverty imposes special needs and the need for special protections,” said Carole Myers, a nurse practitioner and associate professor in the University of Tennessee’s College of Nursing. “They don’t have the same voice in government as those with different economic statuses and organizational affiliations.”
Haslam acknowledged in April that Tennessee probably would have to limit co-payments and provide the wraparound services for Medicaid-eligible enrollees for the federal government to approve his alternative, but he said he still thinks his overall plan is “workable.”
Haslam’s plan is modeled on a plan by Arkansas, which also wants to use federal matching dollars to pay commercial insurance premiums for those eligible for the Medicaid expansion. But while Arkansas got legislators’ approval before approaching the federal government, Haslam has taken the opposite approach, presenting his plan to CMS first.
Haslam did not ask state legislators to vote on whether to take the federal Medicaid expansion funds this session, though he said he has not ruled out calling a special legislative session later this year to meet federal deadlines for the health exchange enrollment starting in October.
The Medicaid expansion is the only provision in the ACA that provides insurance coverage specifically to those between 101 percent and 138 percent of the federal poverty guideline. If Haslam fails to reach an agreement with the federal government, or does not opt to accept the federal Medicaid expansion plan (which he could still do), that population likely would remain uninsured.
However, the latest word among hospital executives and advocates is that an agreement could be near.
“I think (Health and Human Services) Secretary (Kathleen) Sebelius is really eager to find some alternative plans that meet the goals of the ACA but do so in creative ways and allow states to create plans beneficial to those individual states,” said Jerry Askew, senior vice president for governmental relations for Tennova Healthcare.
Through Tennova’s parent company, Health Management Associates, Askew works with hospitals in seven states. All of them, except those in Kentucky and West Virginia, have said no to the expansion.
“They’re all trying to figure out what to do. It’s really interesting to watch how the state is to meet their individual objectives,” Askew said. As for Tennessee, he added, “It is fair to say that the governor’s plan is being built on principles that the majority in the Legislature would agree with. But it’s not a given. It’s a lot of hard work.”
Consumer-advocate groups and hospitals were in favor of the expansion, especially since hospitals stand to lose money on uncompensated “charity” care that would have been partially covered, at least, if more people were insured through Medicaid. The Tennessee Hospital Association has said the state stands to lose 90,000 jobs and nearly $13 billion.
Having that population continue to go uninsured also means higher costs in the long run, Myers said, as studies have shown that those without insurance are less likely to get preventive or early care.
“When you are resorting to getting care only when it becomes so bad you can’t stand it, and you’re in the emergency room, it’s causing a major human toll,” she said. “We know that intervention on the earliest point of the illness trajectory is the most cost-efficient. The true measure of whether we’re successful in what we’re doing in health care is in whether people have long, happy, productive lives.”
Business writer Carly Harrington contributed to this report.
© 2013, Knoxville News Sentinel Co.
The death of the Murphy Bill: On being the national spokesman
The Murphy Bill as we know is dead. The Republican leadership in the House announced a change in strategy. They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.
It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so. It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.
Part of the problem was Murphy himself. He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform. He wasnt. Being a psychologist certainly didnt qualify for the role. Neither did being a member of the House of Representatives. It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered. In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.
He didnt understand that leadership was built or that it was a two way street. He alienated people who had lived mental health reform their entire adult lives. He thought it was about them joining him and never seemed to know it was the other way around. And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.
He was naive. The only people who believe federal laws change everything are federal lawmakers and most of them know better. To say that his law was going to prevent the next shooting was simply ego. He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.
Mental health reform is an ongoing effort by many, many people with different values and priorities. Sometimes it is its own worst enemy. People who cant stand each other have a hard time standing together for anything. Murphy I hope has to some degree taught people they can find unity despite their differences. And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.
He may indeed try again. He probably will. Dr. Torrey most surely will. He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.
Thanks for the support
by Larry Drain, hopeworkscommunity
The following organizations have offered support of "Dear Governor Haslam". They have put links to this site or printed the letters on their websites. I really appreciate it. I invite you or your organization to do the same.
Tennessee Health Care Campaign.
Tennessee Citizen Action.
Tennessee Disability Coalition.
Tennessee Chapter Depression and Bipolar Support Alliance.
WRITE GOVERNOR HASLAM TODAY
hopeworkscommunity | June 1, 2014
byLarry Drain, hopeworkscommunity
Rep. Murphy has not went gently into the good night. Dr. Torrey will never go gently into the good night. They are trying it sounds like to provide cpr to their bill. Rather the things that didnt work the first time will work on second effort is anyone's guess. I think sometimes it is really hard for annointed national spokesmen to realize they are not and never were.
But this post is not about that. It is about a fundamental misunderstanding of the American mental health system that was part of the reason that may have doomed the Murphy Bill from the start.
Murphy seemed to believe we were doing far too much for too many. He thought people who were doing better in the system were robbing those who were doing poorly of help and resources. And he thought if resources were properly allocated things would be okay. Using terms like "worried well" he seemed to want to pit one group against another or at least give worried family members someone to blame. Somehow, I never really understood how, he seemed to think that this misallocation of resources was the fault of Samsha. It was us against them, with guys in black hats, just lacking an afternoon channel from being great soap opera. People were getting rich, famous and powerful off the worried well and just abandoned those in serious need. It had drama, moral outrage, and more than a little passion. It just lacked truth.
Anyone who had watched or been part of the last few years would tell you that state after state year after year had cut their mental health budgets to the bone. In some places there was only skin. The bone had long since disappeared. It was not that too much was done for too many. Too little was done for everyone. Many people lacked insurance and couldnt even access the services that were there. It wasnt misallocation of funds. It was abandonment. Never, not once, have I ever heard anyone touting the Murphy bill ever acknowledge this.
The baggage from Dr. Torrey obscured their vision. No state bought his love affair with psychiatric hospitals. It was too little bang for way too much bucks. No one believed. It was a cash cow around their necks that threatened to bankrupt their community systems. There was little or no proof it worked. When insurance companies basically stop paying for a service that service is on borrowed time. No one drank the kool aid any more.
There will probably always be psychiatric hospitals. But they will never be the centerpiece of the mental health system again. Putting your money into backline services, what you do when things go wrong, destroys your ability to keep things from going wrong. There was never any conspiracy. People just decided what they thought mattered and all of Dr. Torrey's pr and marketing campaigns just didnt change that. In the end I dont think federal law can bring back psychiatric hospitalization as the gold standard of mental health care. The truth is that even people with "severe mental illness" can and do make it in their communities with effective support and services.
The notion that one group of people needing help was more worthy than another and that they were in competition just seemed like such a mean and stupid notion. It completely just ignored the reality of the bloody battle for funding that is the reality for so many states. It was a pseudo explanation for the fact that state after state just said "Dr. Torrey we dont buy what you say and your way will not increase the amount of services for people with severe needs but radically decrease it."
Count me cynical. Count me way cynical. Murphy lost because it was never about a battle for the "severely mentally ill." It was a battle for Dr. Torrey and a vision found lacking a long time ago.
hopeworkscommunity | June 11, 2014
Gun Violence Killed At Least 80 People The Week Prior To Elliot Rodger's Rampage
Sam Stein, Jason Cherkis05/28/14 12:00 AM ET
WASHINGTON --The Memorial Day weekend saw a community eviscerated by gun violence that left several dead and many more injured. But it wasn't UC Santa Barbara that witnessed this particular round of bloodshed. It was New Orleans. By weekend's end, the city had seen 19 people shot, four fatally. On Friday, a fight broke out at a high school graduation party that resulted in one person being killed and seven wounded. On Sunday, three men were shot with an assault rifle. That night, a murder took place at a Cajun seafood joint. On Monday morning, a triple shooting happened right outside a hospital, where people sitting in a car were hit with bullets in their backs, arms and legs. All survived. That same day, a 17-year-old died after being shot multiple times. Even earlier, a man riding his bike was shot under an overpass. The day ended with ahomicide in the Lower Ninth Ward. Outside of New Orleans, the U.S. was pocked with bad news. In the week prior to Elliot Rodger's shooting spree in Isla Vista, there were at least 80 gun-related deaths across the country, according to a Huffington Post analysis of local news reports. That these shootings failed to garner the national attention that the one in Isla Vista did shouldn't shock anyone who has followed the gun control debate. High-profile instances of gun violence are more likely to grab the spotlight than the everyday scourge of gun-related killings. And certainly, the shooting of three (and stabbing of three others) by the 22-year-old son of a Hollywood director who happened to leave a dark, depressing trail of self-made YouTube videos qualifies as high-profile. But instances such as the one at UC Santa Barbara are rare in respect to gun-related homicides. In fact, FBI data shows that there were 900 people who died in mass shootings from 2006 through 2012. By contrast, firearms were used in 11,078 homicides in 2010 alone,according to the U.S. Centers for Disease Control and Prevention. And for those on the frontline of the gun control debate, it's a bit of a head-scratcher as to how the press tends to cover instances of violence. "There's a grim calculus in the heads of journalists about what makes a shooting newsworthy," said Mark Glaze, executive director of the Bloomberg-backed Everytown for Gun Safety. "The total number killed and injured tends to be variable one. The role of young people as perpetrators or victims is a close number two." Glaze argued that press coverage was actually becoming more comprehensive, with reporters "actually paying more attention to the 33 daily gun murders in America than they did five or 10 years ago." That may be true. But, unlike with Rodger's killing spree, there was no national news coverage for the killings in New Orleans. Indeed, unless the shooting involved an athlete or a TV star, the only media that covered gun-related killings the week before Rodger took up arms was in the communities affected. Below are the local stories that The Huffington Post found from the week prior to Rodger's rampage. Alabama: