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I just went to Ms. Hillary's website and sent her the following:

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Do you realize that Mr. Spitzer is not happy with the latest round regarding the State Childs Health Insurance Program (SCHIP)?  It seems that the state of New York will not get any funding for this, as they have not yet got the appropriate percentage of currently eligible children enrolled, therefore making New York State residents ineligible on the most recent level of care.  To further this, as the health care plan progresses, this means that New York State residents will be paying more to help children all over the country, while we will be recieving no additional money.  Is there some way that you can think of to have this rectified?  I would appreciate if you would reply via e-mail as this would be the quickest way for me to receive and the cheapest for all involved.  
Thanks,
Kevin

I'll let you know if I get a response.  (It's more a matter of if, not when)

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Dear Mr. March:

Thank you for contacting me about the Children's Health Insurance Program (CHIP). I strongly believe that every child deserves a healthy start in life, yet far too many children in our nation - more than nine million - do not have health insurance. I am committed to expanding CHIP and improving our ability to help children get needed medical care.

During my time as First Lady, I was proud to help create and advocate for CHIP, and worked to help parents and their children understand what this new program could mean for them.  Today, CHIP provides health insurance for six million children, including almost 400,000 children in New York State .

           I am a strong supporter of the CHIP legislation that recently passed Congress, which will help to ensure that an additional 72,000 children in New York will have access to health insurance coverage, and assist in enrolling many of the 300,000 children who are eligible for Medicaid and CHIP in our state. Nationwide, the CHIP legislation that just passed Congress will help nearly four million children gain access to coverage - reducing the number of uninsured children by one-third over the next five years. This legislation not only expands access to care, but it also improves the quality of care received, ensuring that children will be able to obtain necessary dental and mental health coverage.

           While Congress was able to set aside partisanship to reauthorize this important legislation, the President has chosen to place ideology before the health of almost 4 million children.  The bill that passed Congress is a practical, fiscally responsible, bipartisan compromise that will allow us to reauthorize this important program and expand coverage, and I will work with my colleagues to get it signed into law.

           Thank you again for contacting me about this legislation. For updates on CHIP and other health care issues, please visit my website at http://clinton.senate.gov.

Sincerely,

Senator Hillary Rodham Clinton

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Listen people, this can not become a law. We will be placing a tremendous burden on the next generation. There will be even LESS smokers by then, and then where will they get the funds from? Yup, the next generation will have to cough up the almighty tax dollar to foot the bill.

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SCHENECTADY
Health Centers may drop Ellis, jail
Nonprofit agency eyes options amid fiscal pressures
BY JAMES SCHLETT Gazette Reporter

   Hometown Health Centers is contemplating abandoning its operations at Ellis Hospital and the Schenectady County Jail as a surge in visits from uninsured patients throws the federally qualified health center into dire straits.
   Within three weeks, HHC could decide to not pursue another one-year contract to provide health care services at the jail.
   By November, the nonprofi t organization could decide to relocate its health center primarily for elderly patients at the Ellis Medical Arts Center, HHC President and Chief Executive Officer John Silva said in Thursday interview with The Daily Gazette.
   “We don’t want to do this. It’s penny-wise and [pound] foolish. But we’re out of options,” Silva said.
   Mounting financial pressures from a dramatic upswing in uninsured patient care is forcing HHC to take a harder look at it the viability of those operations. Center officials are currently drafting a budget for 2008.
   For the first nine months of 2007, the organization headquartered on State Street had 3,346 total uninsured visits, more than double the 1,619 for all of 2006. Visits from uninsured children tripled to 1,115, according to HHC statistics.
   The surge in uninsured patient visits, Silva said, is due to more county residents losing their employer-provided health benefits, an influx of illegal immigrants and recent eligibility criteria changes for Family Health Plus, the state program for the uninsured.
   The increase in uninsured traffic is forcing HHC to offer more reduced, charitable and bad-debt care. For those services, it charges patients as little as $20 for services that can cost hundreds of dollars.
   The federal government provides HHC with $1 million annually to offset losses stemming from that uninsured care. But that funding is increasingly becoming insufficient to help the center balance its budget. In 2005, the center provided $1.9 million in reduced-cost, charitable and baddebt care. The audit for 2006 is not complete.
   The rising cost of treating uninsured patients and the potential retreat from the jail and Ellis threaten to erase much of the progress HHC has achieved since Silva took it over in 2001.
   Six years ago, the center — then based in a former school on Craig Street — faced an imminent threat of closure. It had $1.5 million in long-term debt and was losing $400,000 annually.
   Silva brought HHC to a surplus of $21,000 by the end of 2005. But the uninsured care surge quickly wiped out that gain. HHC is projected to report a loss for 2006 of between $200,000 and $350,000.
   “Each year this organization falls further into debt because there is more need and less money to support it,” Silva said.
   To stabilize HHC, Silva added more insured patients to its payer mix. It now has over 21,000 federally registered patients. Silva in 2004 also pursued the jail contract and hospital satellite office to secure more patients and revenues.
   However, work at the jail, where HHC doctors and nurses provide
round-the-clock care, has been far less lucrative that Silva expected. The margin of gain there has been slim, and it might not be worth the strain it puts on the center’s resources, Silva said.
   County Attorney Chis Gardner said the jail would have to hire another contractor if HHC walked away from another contract. The county’s ability to sweeten the contract and entice HHC to stay at the jail is limited, Gardner said.
   “There are other vendors out there, but I would hate to lose Hometown,” said county Sheriff Harry Buffardi.
   HHC’s Ellis operation has also been a financial disappointment. Prior to 2004, Ellis ran the primary care center on Nott Street, at an annual loss of $800,000.
   HHC has reduced that annual loss to $150,000, but Silva had higher hopes for it. The Nott Street office’s woes stem from commercially insured patients outweighing Medicare patients.
   Medicare payments can be two times greater than those for commercial plans. When HHC took over the operation, it had an opposite payer mix. In 2006, the Ellis satellite had 11,000 visits from 3,500 registered patients.
   Silva also said the approximately $7,000 monthly rent for the 2,750-square-foot satellite office is too steep. The operation’s two physicians and one nurse practitioner might be relocated to HHC’s headquarters.
   “If we decide it’s not viable, we’ll be moving out of this location,” Silva said.
   Ellis spokeswoman Donna Evans said the hospital has supported HHC and referred patients to the satellite office. But she added its consolidation “might make sense for them financially.”
   HHC’s financial woes have been exacerbated by a state attorney general audit, which uncovered improper Medicaid billing practices at the center’s dental operation, Silva said.
   The Attorney General’s Medicaid Fraud Unit has directed the state Department of Health to withhold 15 percent of HHC’s weekly Medicaid reimbursement payments. They amount to up to $40,000 each month.
   To keep HHC afloat, Silva said he needs more financial support from the city, county and state. From the city, he said HHC needs a significant one-time investment.
   Schenectady Director of Operations Sharon Jordan said the only funding the city could provide to HHC would come in the form of a federal Community Development Block Grant, which can range from $5,000 to $60,000.
   Silva said he would like to see the county establish a tax designed to support HHC. He said the tax could be similar to the 3 percent hotel and motel occupancy tax the county Legislature created in 1985 to support the revival of Proctors.
   “There is not enough money in the system to support the need. The need continues to grow, and the common refrain is ‘It’s not our problem,’ ” Silva said.

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HHC’s financial woes have been exacerbated by a state attorney general audit, which uncovered improper Medicaid billing practices at the center’s dental operation, Silva said.
   The Attorney General’s Medicaid Fraud Unit has directed the state Department of Health to withhold 15 percent of HHC’s weekly Medicaid reimbursement payments. They amount to up to $40,000 each month.

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State health race gap noted
Study records discrepancies
BY SARA FOSS Gazette Reporter

   In upstate New York cities, blacks are three times as likely as whites to be hospitalized because of short-term complications caused by diabetes, and two-and-a-half times more likely to have their lower extremities amputated due to the disease.
   Not only do upstate blacks suffer from diabetes at higher rates than whites, but they often seek care and treatment later than whites, meaning complications from the disease are often worse, according to a report, titled “The Quiet Crisis,” released by the University at Albany’s Center for the Elimination of Minority Health Disparities.
   “We found a very marked discrepancy between African Americans and whites,” said Richard Alba, who worked on the study and heads the Center for Social and Demographic Analysis at the University at Albany.
   When it comes to health care, such discrepancies are not unusual.
   Although new data show progress in reducing health disparities in New York and improving access to health care, minorities continue to suffer from diseases and a lack of access to health care at higher rates than whites.
   “Although some gains have been made, racial and ethnic minorities continue to experience a disproportionate burden of disease,” New York state Health Commissioner Richard Daines said in a statement. “People of color continue to have dramatically higher rates of HIV infection, Hispanics have higher incidence of diabetes deaths and African Americans have higher rates of death from cancer.”
   The report, which looked at health data for 2003-2004, shows lower death rates for minorities in a number of areas, including HIV/AIDS, heart disease, asthma, male colorectal cancer, prostate cancer and breast cancer, when compared with data from 10 years earlier. Rates were also lower for homicide, suicide, motor vehicle injuries and other injuries, and teenage pregnancy, according to the New York state Department of Health’s Minority Health Surveillance Report, released last month. The rate of early diagnosis of prostate cancer, for example, was nearly 90 percent for all racial/ethnic groups, compared with rates ranging from 68 percent to 77 percent a decade earlier.
OBESITY RATES
   Other news was less positive.
   A study of low-income white, black and Hispanic children showed higher rates of obesity in 2004 than 1995, while the percentage of low birth weight births increased for all groups except Hispanics.
   Approximately 40 percent of New Yorkers are racial and ethnic minorities.
   In the report, blacks fared the worst of all racial/ethnic groups. They had the highest age-adjusted rates of diabetes mortality, female breast cancer mortality, prostate cancer incidence and mortality, female and male colorectal mortality, HIV/AIDS mortality, death due to asthma, cerebrovascular disease deaths, heart disease deaths and homicide.
   Black adults also had the highest rate of diabetes and adult obesity, and black high school students reported the lowest rates of physical activity and the highest rates of television watching.
   The report also found that although white women are 40 percent more likely to suffer from breast cancer than black women, black women are more likely to die from the disease.
   Similarly, black men are more likely to die from colorectal cancer, even though the disease is more common among whites.
   Still, the health of black New Yorkers has improved in several areas. The age-adjusted HIV/AIDS death rate fell by 75 percent, the homicide rate decreased by 40 percent and deaths due to asthma were almost cut in half. The percentage of black women receiving first trimester prenatal care increased 23 percent.
   Hispanics fared the worst on issues related to access to health care.
   They were least likely to have early stage diagnoses of prostate cancer and colorectal cancer, and they were most likely to experience cost as a barrier to doctor visits, have no regular health care provider and lack health insurance.
   Hispanics were also most likely to report poor or fair health and mental health in the past month, suffer from asthma and experience premature death.
HEALTH CARE ACCESS
   But there are some areas where Hispanics do well: They have a female breast cancer mortality rate that is lower than black and white women, a prostate cancer incidence and mortality rate that is lower or equal to white men and an increasing rate of early stage diagnosis of prostate cancer that is almost equal the rate of all other men.
   The ethnic group that fared best in the report was Asian and Pacifi c Islanders, who are the fastest-growing population in the state and make up approximately 7 percent of the state’s population.
   They were least likely to report fair or poor health, and had the lowest asthma rates.
   Minorities often have a more difficult time accessing health care services than whites, and a shortage in physicians and nurses has only exacerbated the problem, said Wilma Alvarado-Little, program manager for the administrative core at the Center for the Elimination of Minority Health Disparities. Another issue is that minorities are more likely to be unaware of what services are available to them, and what providers accept different types of payments, she said. “There’s not an awareness of what’s out there,” she said.
   At a meeting last month of the New York State Minority Health Council, Daines said he has asked state Health Department programs to increase their efforts to find better ways to improve the prevention and management of chronic diseases in minorities and increase their access to quality health care.
   He asked the minority Health Council to study and make recommendations in three areas:
   How to get more minorities who are eligible for public health insurance programs to enroll in these programs.
   How health care reimbursement formulas can be changed to encourage and reward greater delivery of primary and preventive care.
   Develop incentives for more minorities to become physicians in order to increase access for minorities to culturally and linguistically appropriate health care.
LANGUAGE A FACTOR
   Minorities prefer health care that is delivered by someone of their own race or ethnicity and speaks their language, Daines said.
   In a speech in June, Daines said, “In order to effectively target community initiatives to eliminate health disparities, we must know the people, their environment, their lifestyles and their health problems.” He noted that nationally, 33 percent of Hispanics and 25 percent of African Americans are uninsured, compared with 13 percent of whites.
   At the Center for the Elimination of Minority Health Disparities, researchers have found that the availability of doctors who speak the same language as minority patients doesn’t always eliminate health care barriers, Alvarado-Little said, noting that there are cultural differences within the Latino community.
   But she said providers who lack “cultural competency” can scare away patients, who may not want to be told that they shouldn’t be eating certain types of foods.
   Alba’s study found that upstate the rate of diabetes in minorities is sometimes higher than in New York City.
   This came as something of a surprise, because New York City has a bigger minority populations and more residential segregation. “Upstate is not fundamentally different from New York City in terms of diabetes,” he said. “It’s a quiet crisis up here. It’s something people should know about.”  

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Insurers act on health center pressure
BY JAMES SCHLETT Gazette Reporter
Reach Gazette reporter James Schlett at 395-3040 or jschlett@dailygazette.net.

   An Adirondack health center in financial distress has delivered an ultimatum to four of its major commercial health plans: Increase their reimbursement payments or compromise the coverage of thousands of members.
   In a bid to garner more support from the state, the Hudson Headwaters Health Network is pressuring private health plans to bring their reimbursement rates to a level on par with what the 12-clinic health network receives from Medicare.
   Hudson Headwaters is making that demand so it does not look like it is subsidizing privately insured care while asking for more public dollars. The Glens Falls based-nonprofit organization has 60,000 federally registered patients — almost half of whom are covered by private health plans.
   “We know we’re in no position to continue those discussions [with the state Department of Health] until we made it clear with the private plans that they have to do their share,” said Hudson Headwaters Chief Executive Officer Dr. John Rugge.
   Hudson Headwaters has threatened to sever ties with MVP in Schenectady, Capital District Physicians’ Health Plan in Albany, Empire BlueCross BlueShield in New York and BlueShield of Northeastern New York in Latham if they do not raise their 2008 reimbursement rates.
   Given that Hudson Headwaters is the leading health care provider between Glens Falls and the Adirondack High Peaks region, the health plans are taking the threat seriously.
   CDPHP last month agreed to increase its reimbursement rate and Empire followed suit Monday, Rugge said.
   “CDPHP recognizes the significant challenges associated with delivering care in rural communities … [W]e’re trying to be part of the solution to ensure our members have access to quality care, such as that provided by Hudson Headwaters,” CDPHP spokeswoman Kristin Marshall said in a prepared statement.
   Empire spokeswoman Lisa Greiner in a prepared statement said: “We view this as an investment in one of our key providers and we hope to expand on this investment to improve the health status of additional communities within New York.”
   BlueShield only last week received Hudson Headwaters rate increase demand, which the Latham insurer is reviewing. BlueShield spokeswoman Karen Merkel-Liberatore said the company will “work in good faith to come to a resolution as quickly as possible.”
   MVP spokesman Gary Hughes said the Schenectady health plan is reviewing Hudson Headwaters’ reimbursement hike demand. He said a rate increase could have a ripple effect on premiums and push employers out of the private health insurance market.
   The Schenectady-based Mohawk Valley Medical Associates provides MVP with its provider network. Hughes said he was aware of no Hudson Headwaters physicians wanting to sever their contracts with MVMA. But Rugge said those physicians are employees of Hudson Headwaters, which has say over their insurer relationships.
   The Glens Falls organization employs 490, including 80 physicians. Rugge said Hudson Headwaters needs higher reimbursements to attract and retain doctors.
   “One leads to the other. If you don’t balance the books, you can’t raise salaries,” said Rugge.
   Hudson Headwaters’ financial woes stem from its unusually high number of commercially insured patients — roughly 45 percent of its payer mix. Federally qualified health centers are commonly viewed as a community’s “safety-net” health provider — one of the few institutions that offers care specifically for the working poor and uninsured.
   The Glens Falls organization gets about 260,000 visits annually, which are covered either by commercial plans, Medicare or Medicaid. It receives $2 million from the federal government mostly to offset costs stemming from charity, reduced-cost and bad-debt care.
   The high concentration of commercially insured patients becomes problematic because the private plans reimburse Hudson Headwaters less per visit than Medicare does — $74 and $108 respectively, on average last year — resulting in a $1.5 million shortfall in commercial care in 2006, according to Rugge.
   “This is something of an earthquake in our backyard and a harbinger of shakeups to come,” said Rugge.
   Hudson Headwaters, which has a $30 million annual budget, managed to defray most of its 2006 commercial care losses through fund-raising efforts and grants. But it ended last year with a $500,000 defi cit.
   The organization had gone years with a surplus before sinking into the red in 2006. Group officials will meet with Health Department officials today and attempt to negotiate higher reimbursement rates or a pay-for-performance payment structure.
   Health Department spokesman Jeffrey Hammond said the state agency is aware of Hudson Headwaters’ situation, but could not say what type of aid it could offer.
   Schenectady’s federally qualified health center — Hometown Health Centers — is also running into financial troubles. However, HHC’s woes stem mostly from a surge in uninsured patient visits.
   But a high concentration of commercially insured patients at its Ellis Medical Arts Center satellite office might prompt HHC officials to abandon that operation, which it acquired from the Ellis Hospital in 2004.
   HHC President and CEO John Silva said his organization, with 21,000 federally registered patients, is not in a position to make the types of demands the much-larger Hudson Headwaters is making of private health plans. But Silva said Hudson Headwaters’ ultimatum to private health plans could set a precedent and open doors for his organization.

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Schenectady’s federally qualified health center — Hometown Health Centers — is also running into financial troubles. However, HHC’s woes stem mostly from a surge in uninsured patient visits.
   But a high concentration of commercially insured patients at its Ellis Medical Arts Center satellite office might prompt HHC officials to abandon that operation, which it acquired from the Ellis Hospital in 2004.
   HHC President and CEO John Silva said his organization, with 21,000 federally registered patients, is not in a position to make the types of demands the much-larger Hudson Headwaters is making of private health plans. But Silva said Hudson Headwaters’ ultimatum to private health plans could set a precedent and open doors for his organization.

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Black adults also had the highest rate of diabetes and adult obesity, and black high school students reported the lowest rates of physical activity and the highest rates of television watching.

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LANGUAGE A FACTOR
   Minorities prefer health care that is delivered by someone of their own race or ethnicity and speaks their language, Daines said.

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SCHENECTADY
Medicare rule proposal riles Sunnyview officials
Hospital asks Schumer for help in fighting change
BY MICHAEL LAMENDOLA Gazette Reporter

   Sunnyview Rehabilitation Hospital leaders say a proposed change in Medicare rules would ration acute care rehabilitation services to patients, and they have asked U.S. Sen. Charles Schumer to help them fight it.
   Schumer, D-New York, said the proposed change, called the “75 percent rule,” is “Draconian” and that it would force some inpatient rehabilitation facilities to close. He vowed to stop the change from taking effect in July 2008.
   A spokesperson for the Centers for Medicare and Medicaid Services, which supports the rule change, was not available for comment Wednesday. The rule change would limit federal support of rehab services generally.
   Schumer made his announcement at a news conference Wednesday at Sunnyview Hospi- tal. He was joined by Sunnyview CEO Chip Eisenman and Daniel Sisto, president of the Healthcare Association of New York State.
   The 75 percent rule would require that 75 percent of patients admitted to rehabilitation hospitals like Sunnyview have at least one of 13 predetermined medical conditions. The current threshold is 62 percent in New York.
   Eisenman said the rule change would reduce the number of patients able to receive high-quality, short-term rehabilitation care while recovering from common medical procedures. It would create a “quota system that determines who has access based on diagnosis rather than on the need for rehabilitation,” he said.
   Schumer said the rule change would prevent patients from obtaining certain medical procedures “because Medicare and Medicaid won’t pay for them, and if they won’t pay for them, you’re out.”
   Sisto said the 62 percent threshold already has forced rehabilitation hospitals to turn away some 88,000 patients nationwide. The 75 percent threshold would force Sunnyview to turn away “hundreds of patients,” Eisenman said.
   Schumer said the rule change “would result in the immediate loss of $200 million in reimbursement” for New York hospitals and closure of 23 percent of inpatient rehabilitation facilities.
   Sisto said Sunnyview is not in danger of closing because of its “well-established brand name and strong network connections in the Northeast.
   A spokesperson for Northeast Health Rehabilitation Services, which also offers rehabilitation services in the Capital Region, was not available for comment on Wednesday.
   Schumer has co-sponsored Senate legislation to freeze the rule at the current level. He is a member of the Senate’s Finance Committee, which controls Medicare and Medicaid spending, and said he has the support of committee members for his legislation. “I think we will succeed,” he said.
   The federal government established the 75 percent rule in 1983 but froze it at 62 percent “because of the harm it caused,” Schumer said. The rule was designed to control rising Medicaid and Medicare costs. In 2005, the Centers for Medicare and Medicaid Services proposed reinstatement of the rule.

Quoted from mikechristine1

And this has nothing whatsoever to do with the availabiliby of health insurance.  If Hillary gets in and we wind up with socialized medicine, statisics as this will not change.  The government cannot legislate behavior, nor should taxpayers be expected to pay for it, i.e., pay higher taxes to provide more insurance to cover people who get sick from lack of exercise and too much TV watching.  There is no cost to the taxpayers for a person to get exercise by walking.  

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Carl Strock THE VIEW FROM HERE
Carl Strock can be reached at 395-3085 or by e-mail at carlstrock@dailygazette.com.
New York is
dead last in
health what?

   Here’s something I bet you have never heard of: an “index of health ownership.”
   And here’s something I bet you didn’t know: New York state ranks last in “health ownership.”
   And here’s a philosophical or anthropological proposition I bet you never encountered: health ownership is the “state of nature.”
   At which point you may well be asking, what have I been smoking? And what the devil is “health ownership” anyway.
   I’ll explain as best I can. First of all, I haven’t been smoking anything, but I have been eating lunch at the Fort Orange Club in Albany, which is intoxicating in its own way, since I was in the company of a health-care thinker from the Pacific Research Institute in San Francisco, John R. Graham, who adheres to a rigorous free-market ideology and who was in town to propound it. (I got invited by mistake, I think.)
   And second, health ownership is … well, I’m still not sure what it is. As near as I can figure, it’s you and me being on our own to pay for our health care as best we can, or buy whatever insurance a free unregulated market might make available, without any government involvement, which in the speech and writings of Mr. Graham is invariably “massive government intrusion.”
   In other words, glorious freedom.
   I think that’s what health ownership means. And I admit it’s something I had never thought of before listening to Mr. Graham at this meeting the other day with a few carefully selected policymakers and opinion-shapers, and it’s certainly not something I had ever fretted over.
   I may not have been the best audience for his presentation. My wife had just returned from a visit to her homeland, where her aging parents own 100 percent of their health care, and what it means for them is they don’t get any, or they get only what they have cash in pocket for, which is not much.
   That’s generally how the Third World operates: you want to go to a doctor, you pay for it. If you don’t have the money, you go to the curandero in the next barrio and he rubs herbs on your forehead and does a little chant for you, and you give him a chicken.
   Most of the rich industrialized world, on the other hand, has government-run health-care, which provides tax-funded care to everyone at a total cost much lower than our own patchwork of governmentprivate care, and with better results in terms of national health.
   This is of course anathema to Mr. Graham’s concept of freedom, and he has pointed out in his writings that even with the higher cost of our patchwork system we still have more money left over after paying for health care than Europeans do, so the higher cost doesn’t really matter, he says, which proves once again that think-tank analysts can always find a way to slice statistics to support the ideological position they are committed to.
   As for health ownership being the state of nature, I don’t dispute that. But then, hitting your neighbor over the head with a club is probably also the state of nature.
   Anyway, Mr. Graham has developed a scale to show to what extent we “own” our health, state by state, and on it, Utah ranks first and New York last, which, when I heard it, made me want to move right away to Salt Lake City, though in the end I managed to resist.
   The only thing that gave me pause was his report, based on research by a professor at Duke University, that government health regulations in this country kill 22,000 people a year. I heard that and I finally said to myself, well, for God’s sake, let’s get rid of government regulations. Let’s have freedom, like in the state of nature.