Monday, December 16, 2013

The See What Had Happen: 2.0

Smoking in the City

In case you haven't noticed and most likely you have not, even as the ACA mandate ramps up to be the law of the land, before this roll out there has been some significant cash spread around with sites on "stamping out smoking." According to the Minority Initiative Sub-Recipient Grant Office website, since its inception in 2002, the Minority Initiative Sub-Recipient Grant Office has been at the forefront of the fight to eliminate the negative effects of tobacco consumption on minorities in Arkansas.

To date, the Minority Initiative Sub-Recipient Grant Office has funded more than 50 Arkansas organizations and more than $7 million has been placed in minority communities. The purpose of the Minority Initiative Sub-Recipient Grant Office is to change society's norms regarding tobacco consumption and continue educating Arkansans about the dangers of tobacco products.

 Part of the Solutions was among those awarded funding to launch its "40 Days to Freedom" curriculum that is designed to assist with kicking butt when it comes to smoking. In the meantime, all of this comes about as more individuals are making noticeable moves to those new fangled "E-cigs" that have become the next trendy accessory in local gay bars.

This is of notice due to the fact that as the LGBT Health Initiative was organizing to "assess" the issue of smoking in the LGBTQ community, most members seemed unaware to actually what was really going in the very community that they were seeking to assess. Most members didn't "do bars" or even know how many or where they were really located. Furthermore, most had no significant knowledge to as if there was "smoking" going in them nor did they factually know if cigarettes were being sold as well. And surely most had no clue as to just how the usage of E-Cigs including the even more fancy vapor gadgets are being favored as the flavored nicotine delivery system.

To help with gathering this "big data" the group enlisted the consult of Gustavo Torrez, Program Manager of The Network of LGBT Health Equity in concert with our own Tobacco  Prevention and Control Program. It was his job to fly in from Boston to assist the local folk in understanding just how they were to "get to know" the LGBT community. After all it seems that the good TPCP personnel smoked through quite a bit of tobacco dollars because they had been "looking for the gays," for up to 2 or perhaps 3 years!!  Listen up my readers, "you just can't make this stuff up," and yes this requires a collective "LOL" moment.

COP 24/7 was made aware that their was "mandate" to move boldly forward with education and such in the LGBT community. However, "what had happen was" that it seems that Mr. Toney Bailey who appeared to be a driving force behind this matter seems to have found greener pastures elsewhere in the ADH health care system, thus leaving the entire issues somewhat questionable as to its final destiny.

Recently COP 24/7 spotted a media piece citing the need for folks to use their smart phones to unleash  a survey from the cute "QR" code on the front of the placard. As an incentive, you could be in the running for an I-Pad if you name happens to be chosen from those who complete the process. So I guess that this will require some follow up and additional digging to determine who is really getting smoked. Stay tuned....if you dare.

ACA Implementation: Progress and Problems

On Wednesday, the U.S. Department of Health and Human Services (HHS) released data showing that nearly 365,000 people have enrolled in health insurance plans offered in the Affordable Care Act’s (ACA) health insurance marketplaces. The enrollment number was included in an issue brief highlighting cumulative national and state-level enrollment information for Oct. 1 – Nov. 30, 2013. For local enrollment information you can call The Living Affected Corporation at 501-379-8203.

The data was from the 36 states whose enrollment is through the federally run website,, and the 14 states and Washington, D.C. that operate their own health insurance marketplace under the ACA. The figures from some of the state-run marketplaces were partial. HHS Secretary Kathleen Sebelius noted the enrollment numbers in a House Energy and Commerce health subcommittee hearing that also was held Wednesday of last week.

In addition to the number of people enrolled in private insurance plans, the issue brief reported that 803,000 were determined or assessed to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP), bringing the total number of people enrolled in an insurance plan or eligible for Medicaid/CHIP to 1.2 million. An additional 1.9 million people were determined to be eligible for an insurance plan but had not yet selected a plan by Nov. 30.

A state-by-state breakdown (including the District of Columbia) of the enrollment figures can be found by clicking here.
While the problems related to the health insurance marketplaces’ websites, most notably, continue to get resolved and the sites’ enrollment operations improve, some more fundamental problems and issues of ACA rollout and implementation are getting much needed attention.

 Many HIV advocates have been foreseeing the problems for months and are actively engaged and now the mainstream media  is beginning to take notice. A number of the problems and issues cluster around the concern that health insurers are discouraging people with chronic illnesses, including HIV disease, from enrolling in their plans by offering drug coverage that either is not adequate for people with chronic disease or too expensive in terms of co-pays or co-insurance.

Instances of particular HIV drugs not being covered under a marketplace plan, including some single tablet regimens, prior authorization requirements, and placing needed drugs in high pricing tiers are among the issues causing concern. Such policies and practices can be seen as violating the anti-discrimination provisions of the ACA.

 Limitations on the choice of providers in a plan’s network is also a concern as well as the limited number of plans that may be available in areas within a state, notably rural areas. Compounding these problems is the difficulty many consumers, advocates, and case managers are experiencing in getting clear information on the coverage offered under a plan and clear information on the amount of co-pays for prescription drugs.

HIV and other healthcare advocates, many of whom have been strong supporters of the ACA, are focusing advocacy on the problems emerging as the ACA is implemented. This includes advocacy focused on ensuring clearer and stronger federal rules and regulations consistent with the letter and spirit of the ACA and vigorous oversight by the federal government and, when appropriate, state governments. And most certainly, we must continue to advocate Medicaid expansion in the states that so far have opted out. No surprise, the ACA is not a panacea but a work in progress and our advocacy on behalf of people living with HIV and other chronic diseases is very much a part of the work.

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