|January 13, 2017
Senate Votes to Repeal ACA in Budget Resolution
The Senate conducted a “vote-a-rama” Wednesday night until early Thursday morning considering a number of amendments supported by Democrats to S. Con. Res. 3, the budget resolution bill, to stall the total repeal of the 2010 Patient Protection and Affordable Cart Act (ACA). The Senate used the budget resolution bill as a way to repeal the ACA, since the budget resolution requires only a simple majority vote. The ACA was enacted by the same process.
None of the amendments offered by Democrats passed the Senate. The Brain Injury Association of America (BIAA) supported an amendment offered by Senators Mazie K. Hirono (D-Hawaii) and Joe Donnelly (D-Ind.), along with 17 Senate Democrats, to prevent changes to the Medicare and Medicaid programs without a supermajority in the Senate (60 votes). The Hirono-Donnelly amendment created a budget point of order to prevent changes to Medicare that raise the eligibility age, change eligibility requirements, or privatize and voucherize the program. The amendment also was to prevent changes to Medicaid that would reduce state funding from current levels. Any changes to either program would have required a supermajority in Congress. The amendment failed 49-47 with two Republicans voting for the amendment – Senators Susan Collins (R-Maine) and Dean Heller (R-Nev.). A wide range of organizations supported the amendment, including AARP, AFL-CIO, American Federation of State, SEIU, National Education Association, Healthcare Association of Hawaii, Hawaii Public Health Association, and the National Committee to Preserve Social Security and Medicare.
In the end, the Senate voted for the resolution early Thursday morning stripping fees, taxes, and subsidies relating to the ACA. Sen. Rand Paul (R-KY) was the lone Republican opponent of voting on a repeal bill before coming up with a replacement package. Democratic Sen. Dianne Feinstein (D-Calif.) was absent for the vote.
The reconciliation budget for 2017 sets levels of new budget authority, revenues, outlays and deficits for 10 years and projects Social Security funding also over 10 years. The bill directs certain Senate and House committees to each find at least $1 billion in cost cutting over 10 years and estimates the deficit to be over $1 trillion in 10 years as well. The bill largely retains parliamentary procedures such as dynamic scoring, a process under which The Congressional Budget Office (CBO) calculates the economic impact of bills out 40 years. The bill also shows Social Security in the black over the next 10 years. The House is poised to take up similar legislation.
Lawmakers to Introduce Bills to Repeal Therapy Caps
Lawmakers in both Houses have indicated plans to sponsor legislation to repeal therapy caps. Rep. Erik Paulsen (R-Minn.) and Rep. Ron Kind (D-Wis.) will introduce legislation in the House and Senators Ben Cardin (D-Md.), Susan Collins (R-Maine), Bob Casey (D-Pa.), and Dean Heller (R-Nev.) will introduce the Senate version. Under the Balanced Budget Act (BBA) of 1997, Congress placed an annual cap on rehabilitation services under Medicare. Since enacting the BBA, Congress has acted several times to prevent implementation of a hard cap. BIAA has signed on to the Therapy Cap Coalition’s letter to Members in support of the legislation.
Legislator Introduces Bill for Adult Day Programs
Rep. Barbara Lee (D-Calif.) has introduced H.R. 325 to expand and enhance existing adult day programs for younger people with neurological diseases or conditions, including traumatic brain injury (TBI), in order to support and improve access to respite services for family caregivers who are taking care of individuals with these conditions. She has introduced similar legislation in previous years.
Coalition Sponsors Briefing on Violence and Sexual Assault against Women
The National Science Coalition to Improve Lives is sponsoring a congressional briefing Feb 1. entitled “Violence and Sexual Assault against Women: Reducing its Prevalence via an Evidence-based Prevention Approach.” The briefing will take place from 1 p.m. – 2:30 p.m. in Room 2200 at the Rayburn House Office Building. Speakers include Rep. Gwen Moore (D-Wis.) and nationally-recognized experts on violence and sexual assault against women who will provide an overview of the problem and then discuss the sources of violence in particular settings and situations.
President-elect Appoints VA Secretary
President-elect Donald Trump has appointed David Shulkin, M.D., as Secretary of the Department of Veterans Affairs. He is currently the undersecretary having been appointed by President Barack Obama June 15, 2015. Dr. Shulkin received his medical degree from the Medical College of Pennsylvania and did his internship at Yale School of Medicine, and his residency and fellowship in General Medicine at the University of Pittsburgh Presbyterian Medical Center. He previously served as the president and chief executive officer of Beth Israel Medical Center in New York City and also served as president of Morristown Medical Center and the Atlantic Health System Accountable Care Organization.
U.S. Supreme Court Holds Oral Arguments on the IDEA FAPE Mandate
This week, the U.S. Supreme Court heard oral arguments in Endrew F. v. Douglas County School District, on the meaning of the free appropriate public education (FAPE) mandate for students with disabilities under the Individuals with Disabilities Education Act (IDEA). The case involves a child with autism whom the parents placed in a private school for services the parents believed to be more appropriate than what the public school provided. The parents are seeking reimbursement for the child’s tuition and related expenses. The question the Court is pondering is what educational benefits are guaranteed to a child with a disability by a public school under IDEA.
In response, Senator Patty Murray (D-Wash.), Ranking Member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a statement this week expressing concerns regarding the potential of rolling back fundamental protections and attempts to divert taxpayer dollars from public schools to fund private school vouchers that do not help all students. She is hoping that the Court will preserve Congress’ intent in IDEA to provide students with disabilities meaningful educational benefit from the instruction and services they receive. In November 2016, Senator Murray and Rep. Bobby Scott (D-Va.) led a bicameral group of 118 current and former Members of Congress in filing an amicus brief in the case, arguing that the statute clearly intended to provide meaningful and material educational benefits to students with disabilities so that they may reach their full potential and live independent lives.
ACL Staff Sends Message About Departure
Aaron Bishop, Commissioner of the Administration for Disabilities, acknowledging that his tenure will soon be coming to an end, sent a message to friends and advocates about his time with the newly created Administration for Community Living (ACL). Among ACL’s initiatives and accomplishments, was the transfer of the Federal TBI Grant Program from the Health Resources and Services Administration (HRSA) to the ACL. He supported the transfer and worked with stakeholders accordingly. He expects to be leaving Jan. 20 when the new Administration effectively begins.
I found this blog post by Ray Mullman and include it here as a topic of current relevance given the political climate of our country in 2017.
Replace Obamacare with Tort Reform?
By Ray Mullman on January 10, 2017 Posted in Tort Reform
How does taking away rights of victims of medical malpractice increase insurance coverage or the quality of care provided? Medical errors claim more than 250,000 lives annually, researchers estimated this year. That would make errors, which include cases of medical malpractice and negligence, the nation’s third-leading cause of death behind heart disease and cancer.According to researchers, industry experts, and undisputed facts, the nation’s medical malpractice insurance industry is running smoothly and has not been in crisis for decades.
Doctors are paying less for malpractice insurance than they did in 2001 — even without adjusting for inflation, according to the Doctors Company, one of the nation’s largest malpractice insurers. And the rate of claims has dropped by half since 2003.
“It’s a wonderful time for doctors looking for coverage, and it’s never been better for insurers,” said Michael Matray, editor of Medical Liability Monitor, a trade publication.
House Speaker Paul D. Ryan (R-Wis.) and Rep. Tom Price (R-Ga.), the nation’s top health official, are vowing to make tort reform a key part of their replacement plan for the Affordable Care Act. Consumer advocates say the GOP political agenda isn’t addressing the bigger goal of reducing overall patient harm. Republicans are going too far in reducing consumer access to the justice system and fair compensation for medical mistakes.
“What strikes me about these current proposals is that they really represent the agenda of medical professionals, which is all about limiting liability,” said Michelle Mello, a Stanford University law professor and health researcher. “To take any malpractice reform seriously, it has to offer something to improve the situation of patients and lead to safer outcomes.” Price’s proposals do neither.
Researchers caution that caps do not keep premiums down, saying economic cycles and insurers’ investment returns are most significant factors. And they note that courts have struck down caps in some states as ineffective or unconstitutional.
Meanwhile, plaintiffs’ lawyers say damage caps make them reluctant to take on cases, given the money often required for trial preparation and expert witnesses qualified to discuss medical practice. Many victims receive no compensation when arbitrary caps on damages are in place.
Caps on noneconomic damages for “pain and suffering” can also disproportionately hurt women and the elderly. They more often cannot get significant economic damages, which are calculated differently than pain and suffering damages, because they are not big wage earners.
Please receive joy and happiness this Christmas Day 2016. I am blessed this year and hope you are too.
Through the years challenges, battles, victories, losses, and relationship development, we all persevere. On this day may your worries be few, your direction aligned, your strength mighty, and your enthusiasm shining. Into another year we travel. Hope and inspiration lead the way.
New Holiday Traditions
The first holiday being separated or divorced can be the worst? Because old traditions or past routines are out of sync with the new you. One piece of advice given to us by a wise marriage counselor is to use this time to start new traditions. You have a clean slate to start something new upon. Use it. Yes, things in your life have changed. But, what a great time to start some new holiday traditions. Here are a few our clients have shared with us.
- Neighborhood Cookie exchange. Invite your neighbors over for a cookie exchange. Most of us don’t know our neighbors as well as we should. Now is a great time for new introductions. Don’t know if the men in neighborhood would be excited about cookies? Maybe add a beer or scotch exchange. Purchase, or make, festive drinks and have a tasting party.
- Make a holiday decoration. Paint an ornament, a wreath, a Star of David, holiday socks, or a tie that lights up. Anything creative and festive to do with your family.
- Plan a ride with friends to see Christmas lights. Go to the Las Vegas Speedway or to a neighborhood with decorated houses. But, everyone needs to be wearing pajamas, or an ugly holiday sweater. Make sure to play Christmas music while on your sleigh ride
- Target practice. Take a trip to the local gun range to express you second amendment rights for the holidays. Wear a Santa hat, drink hot cocoa and shoot at targets of St. Nick, or Rudolph. Shooting Santa a little too horrific? Then bring pictures of Scrooge, The Grinch, or Abominable Snowman.
- Write a letter each Christmas to your family. Only write about the good things that have happened, and what you are hopeful for in the coming year. Don’t mail it. Keep it in a journal. Each year when you write a new one, read the previous letters
- Sponsor a family. Your local Goodwill, or shelter has names of families who could use a little Christmas spirit in their stocking. Get with your family, or co-workers and go shopping for the adopted family. It is highly recommend to get together to wrap the gifts. Tis the season to get together with wrapping paper and tape.
- Load the Santa tracker on your phone. On Christmas eve keep track of where Santa is delivering presents. Pick random cities he has landed in to Google. See what the city looks like, and learn how they celebrate the holidays. It’s like going on a vacation with Santa.
Be refreshed and fill your new clean slate this year. Change is inevitable. Embrace it and move forward. Merry Holidays to All.
My best and most sincere wishes to all my friends, family and colleagues:
A most happy, joyful, peaceful, and prosperous New Year.
American Association for Justice
The Traumatic Brain Injury Litigation Group, 2016 Conference in Times Square New York City, was an unpredicted success. Attendance, during this festive time of year, was an astounding 210% of what was expected. Additional seating was necessary.
I was honored to co-chair the conference with TBILG Chair Antonio Romanucci, from Chicago. Tony had captivated attendees with a stunning cascade of medical experts and attorneys who were able to convey their messages so effectively. The knowledge for early and veteran TBI attorneys was plentiful.
This education is presented in 3 parts. This, the first, was about Mastering the Science of Traumatic Brain Injury. Part 2 will be in May 2017 in Washington DC, and part 3 will take place in Boston in July 2017.
We all believe that education and awareness are priorities in our quest and mission to assist those with Traumatic and Acquired Brain Injury.
My colleagues and I have been monitoring and posting on issues of CTE (recall the movie “Concussion”) Chronic Traumatic Encephalopathy. This has been widely exposed in NFL as retired players are experiencing CTE during life and autopsies bear out the damage caused by repeated trauma to the brain. I came across an article recently that addresses the same issues in WWE entitled Retired Wrestlers sue WWE Over Brain Injuries, by Chris Dolmetsch(Bloomberg). CTE is NOT limited to football. All contact sports are affected. This includes football, soccer, hockey and wrestling. Any sport that involves getting hit on the head is likely to contain risk for CTE.
This should make us re-think the whole little league, youth soccer and other sports historically viewed as good learning experiences for our kids. Maybe its time to teach the concept of team work in a different way. Thoughts?
The article published in the Claims Journal I reprinted below.
Retired Wrestlers sue WWE Over Brain Injuries
By | July 22, 2016
WORLD Wrestling Entertainment Inc. was sued on behalf of Jimmy “Superfly” Snuka and dozens of other retired wrestlers who claim the company hid the long-term effects of neurological injuries from years of being pounded in and out of the ring.
The suit makes the Stamford, Connecticut-based company the latest professional sports organization to face litigation over head injuries, following the National Football League and the National Hockey League.
The WWE is accused in the lawsuit of failing to care for wrestlers’ repetitive head injuries “in any medically competent or meaningful manner” and misrepresenting and concealing the nature of long-term neurological injuries they suffered as a result of their careers.
WWE “placed corporate gain over its wrestlers’ health, safety and financial security, choosing to leave the plaintiffs severely injured and with no recourse to treat their damaged minds and bodies,” the athletes said in the complaint, which was filed Monday in federal court in New Haven, Connecticut. WWE said it’s confident the case will be dismissed.
“This is another ridiculous attempt by the same attorney who has previously filed class action lawsuits against WWE, both of which have been dismissed,” the organization said in a statement. “A federal judge has already found that this lawyer made patently false allegations about WWE, and this is more of the same.”
Other wrestlers suing the WWE include the lead plaintiff, Joseph Laurinaitis, 55, also known as “The Road Warrior Animal,” and Chris Pallies, 60, the wrestler known as “King Kong Bundy.”
Unlike other sports, WWE matches involve specific moves that are “scripted, controlled, directed and choreographed” by the company, the suit says. The head injuries are a direct result of those moves, which include the “body slam” and the “piledriver,” the wrestlers say in their suit.
A “body slam” is a move in which a wrestler is picked up and thrown to the ground, and a “piledriver,” once popular but now largely banned, involves turning a wrestler upside down and dropping him head first to the mat. 2
The retired wrestlers say the WWE deliberately ignored and hid from them “medically important and possibly lifesaving information” about specific neurological conditions, such as Chronic Traumatic Encephalopathy, that affect wrestlers and athletes who play contact sports prone to head trauma.
“The WWE knows that its wrestlers including the plaintiffs are at great risk for these diseases such as CTE that can result in suicide, drug abuse and violent behavior that pose a danger to not only the athletes themselves but their families and community, yet the WWE does nothing to warn, educate or provide treatment to them,” the wrestlers said in the suit.
“These wrestlers don’t have medical benefits. They’re independent contractors,” said Daniel Wallach, a sports law expert with Becker & Poliakoff in Fort Lauderdale, Florida. “They completely fall through the safety net. They’re in worse shape than retired professional football players or retired hockey players. They’re the most disposable athletes in the sports and entertainment business. It was inevitable this day would come.”
More than 5,000 former NFL players sued the league seeking damages for head injuries, and the league agreed to pay $765 million to resolve the claims as part of a settlement approved in April 2015 and upheld on appeal earlier this year.
The NHL also faces a lawsuit by a group of retired players over claims it glorified violence and failed to protect them from repeated head injuries. The league lost a bid to throw out the case last year.
The case is Laurinaitis v. World Wrestling Entertainment Inc., 3:16-cv-01209, U.S. District Court, District of Connecticut (New Haven.)
In a study reported recently in the journal Nature, an NIH-funded team of researchers has begun to bring this map of the human brain into much sharper focus. By combining multiple types of cutting-edge brain imaging data from more than 200 healthy young men and women, the researchers were able to subdivide the cerebral cortex, the brain’s outer layer, into 180 specific areas in each hemisphere. Remarkably, almost 100 of those areas had never before been described. This new high-resolution brain map will advance fundamental understanding of the human brain and will help to bring greater precision to the diagnosis and treatment of many brain disorders.
To put this new map to good use in research and ultimately in the clinic, it’s important to confirm that these 180 areas can be found in any person. To develop a tool with this goal in mind, the researchers used a machine learning approach in which a computer was “trained” to recognize each of the brain areas. They then applied their tool to the brain scans of another 210 participants that were not included in the original mapping effort. The team found it could reliably detect nearly all (96.6 percent!) of the 180 areas.
Interestingly, particular areas of the cerebral cortex appear to switch places with one another in some people. The researchers found that even in those atypical brains, they could still correctly identify nearly all of the mapped areas. As the science progresses, it will be fascinating to learn how those fundamental differences in the brain arise and what it might mean for brain function.
I am again featuring Julia Merrill as guest blogger. Julia has been publishing tips and comments on how the signs, symptoms and consequences of traumatic brain injury affects peoples lives. This week she looks at how unemployment, a consequence of traumatic brain injury, can lead to suicide.
Why Your Unemployment Status Could Increase Your Suicide Risk
By Julia Merrill
Being unemployed is a stressful time that can lead to a host of personal, financial, and societal issues. Recent studies have shown that unemployment may increase your risk of suicide.
When meeting someone new, they will never fail to ask what you do for a living. Our jobs have become such an integral part of our identity that it is one of the first things people use to judge our character. When a person is unemployed, not only can it seem like they have lost their sense of self, it can also lead to a personal financial crisis, amongst a variety of other issues.
In these uncertain economic times, the lack of available jobs can only make things worse. With the stress that comes from unemployment, some people find it hard to believe that things will ever get better, as such, many turn to unhealthy coping mechanisms, including suicidal thoughts or behaviors.
How Unemployment Status and Suicide Correlate
Across the world, approximately 1 in 5 suicides are related to unemployment. Rates of suicide caused by unemployment are even higher than those caused by difficult economic times. In fact, researchers found that suicide rates tend to rise in conjunction with unemployment rates.
Unemployment can lead to a variety of issues, including:
- Financial crisis;
- Lack of health insurance;
- Loss of meaningful work;
- Loss of personal identity;
- Social withdrawal;
- Dependence upon or self-medicating with drugs or alcohol;
- Frustration and anger at the lack of available jobs;
- Sadness or irritation when applying for jobs; or
- Confusion or uncertainty about the future.
All of these issues can lead to feelings of hopelessness, worthlessness, isolation, and helplessness. Notably, these are all symptoms of an underlying mental health issue, such as depression. The negative mental state associated with depression can lead to thoughts of self-harm or actual suicide attempts.
Anyone who has ever applied for jobs can begin to understand the feelings of futility associated with unemployment. And it can be even more frustrating for those with disabilities who may not be able to meet certain requirements, cutting their potential job options dramatically. When unemployment begins to negatively affect your life (i.e. getting behind on bills, turning to drugs or alcohol for relief, or withdrawing oneself from friends and family), it can increase the risk of suicide attempts. This risk can be especially high when:
- There is an underlying mental health issue;
- The person suffers from other physical health issues;
- There are substance abuse issues;
- The unemployed individual has made previous suicide attempts; or
- The individual is experiencing other major life stressors (such as a breakup of a relationship).
What Can Be Done to Prevent Suicide Caused by Unemployment
Though the correlation is strong, there are steps that can be taken to prevent these serious repercussions associated with unemployment. Governments and state or local officials can aid in this process by:
- Creating and implementing a plan to increase employment opportunities;
- Making access to mental health services more easily accessible;
- Stronger laws and more emphasis on creating an accessible work environment;
- Incentives for employers who hire workers with disabilities;
- Providing additional resources and support for unemployed individuals;
- Offering additional benefits to those who are unable to find work; or
- Making it easier and more affordable to access health insurance benefits while unemployed.
As a friend, family member, or loved one of someone experiencing unemployment, it is important to know the signs and symptoms of depression. These include:
- Feelings of hopelessness, worthlessness, or helplessness;
- Social withdrawal;
- Changes in sleeping or eating patterns;
- Loss of interest in favorite activities; or
- Fatigue or lethargy.
It is also important to know the warning signs of a potential suicide attempt, including:
- Distribution of personal belongings;
- Access to means of suicide (such as weapons);
- Talking about death or suicide;
- Acting impulsively;
- Outward aggression or irritability; or
- Increased use or abuse of drugs and alcohol.
If your loved one is displaying any of these signs or symptoms, reach out and offer help. Encourage your loved one set up an appointment with a medical or mental health professional. If the person is in imminent danger, however, call 911 immediately. Please reach out for more information on the risk of suicide among the unemployed population.
Julia Merrill, is a retired nurse, who aims to provide tips on finding the right medical care, health insurance, etc. Her mission is to close the gap between medical providers and their patients.
There’s a saying, “What’s good for your heart is good for your brain.” Evidence supports preventing or controlling cardiovascular conditions such as high blood pressure to protect brain health as adults grow into old age.
One in three American adults has high blood pressure, putting them at risk for heart disease and stroke, conditions that are among the leading U.S. killers. High blood pressure (also called hypertension) can also impact brain health in significant ways. That’s reason enough to check blood pressure regularly and treat it if it’s high, experts say.
How blood pressure affects cognition—the ability to think, remember, and reason—is less well understood. Observational studies show that having high blood pressure in midlife—the 40s to early 60s—increases the risk of cognitive decline later in life. In old age, the impact of hypertension is not so clear.
At first glance, the connection between blood pressure and the brain makes perfect sense. While only about 2 percent of body weight, the brain receives 20 percent of the body’s blood supply. Its vast network of blood vessels carries oxygen, glucose, and other nutrients to brain cells, providing the energy the brain needs to function properly.
The blood flow that keeps the brain healthy can, if reduced or blocked, harm this essential organ. Exactly how high blood pressure contributes to vascular brain damage, and how vascular and dementia-related brain processes may interact biologically, is under study.
High blood pressure is common, affecting one-third of American adults and nearly two-thirds of adults age 60 and older. Many people don’t know they have “the silent killer” because it has no symptoms. Only about half of people with high blood pressure, including those who treat it with medication, have it under control.
To read more click here.