BRIDGEPORT — St. Vincent’s Medical Center this month becomes the first and only hospital in Connecticut to become a member of MD Anderson Cancer Network, a program of the University of Texas MD Anderson Cancer Center. This affiliation will provide certified physicians at St. Vincent’s, through the Medical Center and its Elizabeth Pfriem SWIM Center for Cancer Care, access to evidence-based guidelines, treatment plans and best practices developed by MD Anderson experts. These are disease-specific guidelines for cancer treatment, cancer prevention, early detection and follow-up care.
“This affiliation represents a tremendous development in our cancer program,” said St. Vincent’s President Stuart G. Marcus, MD, FACS. “The affiliation will enable us to successfully expand the scope of our services and raise the standard for cancer diagnosis and treatment in collaboration with the nation’s leading cancer center.”
NEW HAVEN — Bee stings are no fun, and for people who are allergic to the bee’s venom, they can be deadly. But a new study from the Yale School of Medicine finds that the key toxic component in bee venom — the major allergen — can actually induce immunity and protect against future allergic reactions to the toxin.
The Yale research team examined the effect in mice of an allergic component called Phospholipase A2 (PLA2). They found that, once detected by the innate immune system of the mice, the PLA2 triggered a cascade of immune responses designed to fight the intruding toxin.
“These findings support the argument that allergic responses evolved to protect us from noxious environmental substances,” said senior author Ruslan Medzhitov, professor of immunobiology at Yale School of Medicine and a Howard Hughes Medical Institute investigator.
Medzhitov cautions, however, that when the allergic response over-reacts, it can lead to a dangerous condition known as anaphylactic shock. “We found that there is a very thin line between protective and potentially life-threatening allergic reactions to bee venom.”
Connecticut had the third highest rate of employer-sponsored health insurance coverage among the under-65 population, at 69.7 percent in 2011/2012, a new Economic Policy Institute report reveals.
After falling every year since 2000, the share of non-elderly Americans with employer-sponsored insurance essentially held steady between 2011 and 2012, increasing slightly to 58.4 percent.
For 2011/2012.1 Massachusetts has the highest rate of employer-sponsored insurance coverage in the nation, at 70.8 percent. It is followed by New Hampshire (70.0 percent), Connecticut (69.7 percent), Minnesota (69.0 percent), North Dakota (67.6 percent) and Maryland (67.3 percent). By contrast, less than half of New Mexico’s non-elderly population has ESI, at 47.2 percent.
Because most Americans — particularly those under age 65 — rely on health insurance offered through their jobs, their health coverage correlates closely to the strength of the labor market. The labor market’s slow improvement over the past two years ended the long-standing downward trend in employer-sponsored health coverage, with ESI increasing slightly by 0.1 percentage points in 2012.
Connecticut companies scramble to comply with new ACA mandates
It is the morning of October 1, 2013, a historic day. Depending on whom you speak with, it is a day that either begins to close the door on health-care autonomy, or officially opens the door to much-needed health-care reform.
Access Health CT, the state’s health-care exchange, portrays the Affordable Care Act — a/k/a ObamaCare — as the latter. As befitting the times, it took to online social media to enthusiastically announce its first sign-up.
“We just confirmed our first enrollment!” AHC relayed through the social network Twitter at 10:48 a.m. “A #CT family of 3 just got access to affordable health care coverage thanks to #Obamacare.”
The next day HealthCare.gov, the national website for ACA information, was just as eager to tout the public response it has received. It boasted, “4.7 million unique visitors to HealthCare.gov. 190k calls. Millions want to #Get Covered.”
October 1 was the beginning of open enrollment for health insurance, through state-established marketplaces, as mandated by the Affordable Care Act. ACA calls for U.S. residents to be insured by January 1, 2014. Coverage for those who sign up by December 15 will begin the first-of-the-year launch. There is an open enrollment grace period, through March 31, 2014.
Those who believe the new health-care law ultimately will have a negative effect have likewise not been reticent about making their case. For example, American Action Forum, a conservative organization based in Washington, D.C., issued a report the day after open enrollment became available warning that health-care costs for young adults will skyrocket under ObamaCare.
“Crucial to the success of the Affordable Care Act’s (ACA) health insurance exchanges,” states the report, ”is the participation of 2.7 million uninsured 18-35 year olds, sometimes referred to as the ‘young invincibles.’ With lower than average incomes and generally good health, ‘young invincibles’ are more likely to forego health coverage than others, or be attracted to plans offering basic coverage at minimal prices. Due to the ACA’s sweeping market reforms, rates for low-premium plans have increased exponentially between 2013 and 2014. In fact, on average, a healthy 30 year old male nonsmoker will see his lowest cost insurance option increase 260 percent.”
The report goes on to state that since 18- to 35-year-olds use health-care services less than other, older demographic groups, the premiums of those “young invincibles” are necessary to help subsidize the costs for services to older populations.
ACA opponents also cite the varied nature of its application from state to state. Reportedly, Connecticut is among the states with the highest premiums.
One reason for this could be that “[p]remiums tend to be lower in states where there is more competition and transparency,” according to a brief released in September by the Department of Health & Human Services’ Office of the Assistant Secretary for Planning and Evaluation.
The ACA was enacted to increase the number of individuals who have access to health insurance. Among several other goals is making health care more affordable.
“What we need to think about today is how we pay for health care,” said Zachary Cooper, assistant professor of public health and economics at Yale, several days before open enrollment launched. Cooper was one of several speakers participating in a September 27 Yale-sponsored seminar about ACA. Reining in health-care costs should be a primary objective, he said.
“The U.S. spends $700 billion more than our wealth would predict we did,” Cooper asserted. Multiple inpatient procedures, physician pay and routine practices by health-care employees all add to increased costs, he said.
To comply with ACA, Connecticut lawmakers in 2011 established Access Health CT as the official marketplace, or “exchange” for health insurance.
Access Health CT is overseen by a 14-member board of directors chaired by Lt. Gov. Nancy Wyman. Four advisory committees provide input on various operational aspects. The exchange is being funded initially through a federal grant.
“Connecticut is one of 16 states and the District of Columbia [currently] with [their] own exchanges,” explained Jacob Hacker, director of Yale’s Institution for Social and Policy Studies, at the Yale symposium. All 50 states are expected to eventually have their own exchanges — though to date 26 states have been reluctant to accept at least parts of the mandate, most notably its expansion of Medicaid.
According to the U.S. Department of Health & Human Services, 242,738 Connecticut residents who have been uninsured are eligible and expected to become newly insured as a result of ACA. That represents eight percent of Connecticut’s population. Of this group 98,487 (41 percent) are 19 to 34 years old and more than half (146,630, or 60 percent) are male. A breakdown by race shows that 55 percent (133,199) of these eligible uninsured are white, 13 percent (31,910) are African-American, 24 percent (58,771) are Latino/Hispanic and 5 percent (12,671) are Asian-American or Pacific Islander.
Yale Law School Professor Abbe Gluck noted at the Yale symposium that getting people into the system should be the primary concern at outset, and communication is a key element for that initial step.
“People are worried that some of the states won’t do the kind of outreach necessary,” she says.
Here’s a brief overview of what the new law means to business organizations and individuals:
Platinum, gold, silver and bronze. Those are the various levels of coverage choice, with platinum being the top level and bronze the lowest. There are varying costs, depending on which level you choose. The broader your health-care network, the higher the cost. Sole-proprietor entrepreneurs who do not currently have health insurance for themselves are required to sign up for it.
If your enterprise is a second career and you already have insurance coverage through another job, you are sufficiently covered and don’t need to sign up with the new plan. For those who do purchase insurance through Access Health CT, financial assistance may be available. Subsidies might also be available for individuals making $45,960 or less and a family of four earning $94,200 or less. A subsidy calculator can be found on the AccessHealthCT.com.
Small-Business Owner (Under 50 Employees)
The ACA defines full-time employees as those working an average of 30 hours or more per week. Small businesses with 50 or fewer full-time employees are exempt from having to provide health insurance coverage to their workers. However, the Small Business Health Options Program, or SHOP, has been established to help small businesses that would like to opt into coverage. SHOP allows the employer to control the coverage offered and how much the employer will pay toward premiums. Businesses that take this option could be eligible for a tax credit for up to 50 percent of premium costs. Businesses with less than 25 full-time, or full-time equivalent, employees who each earn an average of less than $50,000 annually could be eligible for a tax credit of as much as 50 percent of premium costs
Other Business Owners (More Than 50 Employees)
Businesses with more than 50 full-time employees that do not already offer health insurance to their workers are required to do so under ACA. By 2015, any business in this category that does not offer health insurance will be subject to a hefty fine. If a business does offer insurance but it is not in accordance with ACA requirements — the plan should meet certain employee “affordability test” criteria, for example — a fine could still be imposed.
To be sure, there have been glitches as the new system rolls out. There’ve been reports of system stalls as well as confusion about specifics, in states throughout the country, including Connecticut.
But with implementation of a brand new, comprehensive system, that’s to be expected, said Kevin Counihan, CEO of Access Health CT, during the Yale symposium.
“Many of you know that we’ll have glitches. We’re already having glitches,” Counihan said. He predicted then that it would take some time before the system is perfected.
“This is going to take three years to stabilized,” Counihan said. “That’s just the inevitable buzz when you build something big and bold like this.”
Counihan touted the exchange as helpful to businesses.
“We’ve got the fourth-highest medical costs in the country. We know it’s unsustainable,” he said.
So, is ACA good or bad for business?
The answer is still up in the air, according to Joseph McDonagh, owner of Hamden-based Joseph P. McDonagh Insurance.
“I’m afraid I can’t answer the question as to whether it’s a good idea or not,” says McDonagh. Shortly before press time, he was busily working on quotes for clients — among them about 40 small businesses — for premiums, in accordance with the new law.
McDonagh does, however, see a number of flaws with ACA as it now stands.
“If I were health-care czar, I would fix about two dozen things in the law,” says McDonagh. “Some of them are really simplistic, but as an insurance agent they make my life more difficult.”
For example, up until now McDonagh calculated insurance rates based on the age of an employee. But under the new law, rates will be based not only on the worker’s age, but the ages of dependents as well. So McDonagh must access and work with a greater amount of information than he previously did.
“It’s making my life horrible in that regard,” he says.
Marketing Access Health CT to the public also could have been substantially improved. McDonagh goes so far as to call it “horrific.”
“There’s no reason it should have been more difficult” to understand changes taking effect, he says. “If I were the [health-care] czar, I would have phased it in a little bit more.”
He also believes many clients could be disappointed by restricted choice.
“It is quite possible the plans on the exchange, Access Health CT, will not have as good a physician network,” McDonagh says, adding that some physicians may choose not to participate in the exchange. With new rules and regulations, “They might decide it’s just not worth it,” he notes.
However, although McDonagh has some misgivings about some of aspects of the exchange’s execution and believes “it will take a great deal of getting used to,” he concedes that “We’re beyond overdue” for health-care overhaul.
In the long run, “I don’t think it’s going to have as dramatic an impact as many people think, because there will be many things that will average out,” says McDonagh. Moreover, he says, the system glitches being experienced now probably will be a distant memory in a few years, overshadowed the benefits of universal health care.
“In four years, after [ACA] is in place, people won’t remember what it was like when people could be denied health care.”
ACA and Workforce Demographics
Under the Affordable Care Act, it is highly likely that a company with a large contingent of young male workers will see its insurance costs go up.
“If you have a lot of 28-year-olds, your [insurance costs] will be more expensive,” says Joseph McDonagh, owner of Joseph P. McDonagh Insurance in Hamden.
So, with implementation of ACA, will companies with a few more than 50 employees decrease their workforce to under 50 in order to be able to opt out of the health-insurance mandate? Or will small businesses try to decrease health-care costs by favoring one workforce segment — that would be less costly in terms of insurance premiums — over another?
Probably not, says McDonagh.
For example, he doesn’t envision that companies will halt their hiring of older workers, if that’s been a practice. McDonagh explains that under ACA an insurance premium for a 62-year-old cannot exceed three times the premium for a 22-year-old. “Now it can be six times,” says McDonagh, adding, “They’re narrowing the band.”
While McDonagh is reluctant to predict the ACA’s overall effect on business at this time, he does know for sure how it will affect his insurance business over the next few months.
“It’s going to ruin my winter,” he quips, “because there’s so much to do.”
NEW HAVEN — James E. Rothman, the Fergus F. Wallace Professor of Biomedical Sciences and professor and chair of the Department of Cell Biology at Yale University, has been awarded the 2013 Nobel Prize in Physiology or Medicine for his work on how molecular messages are transmitted inside and outside of our cells, the Royal Swedish National Academy announced.
Rothman, who is also professor of chemistry at Yale, shares the prize with Randy Schekman of the University of California/Berkeley and Thomas Südhof of Stanford University.
“This is fitting recognition of Jim Rothman’s brave, important, creative scientific research,” said Yale University President Peter Salovey. “Yale is absolutely thrilled to have one of our most distinguished faculty — who is also one of our most distinguished alumni — receive this great honor.”
Rothman helped reveal the mechanism that allows information-containing cellular compartments called vesicles to transmit information both in the interior of the cell and to the surrounding environment.
“Jim Rothman is one of the most brilliant researchers of our time,” says Robert J. Alpern, MD, dean and the Ensign Professor of Medicine at Yale School of Medicine. “When he started his career, a number of successful biochemists were recognizing the importance of studying molecular processes in cell-free systems, but no one imagined that you could study vesicle trafficking in a cell-free system. Jim had the courage to try and the skills to succeed, and this bold approach revolutionized the field.”
Rothman, who serves as director of the Nanobiology Institute on Yale’s West Campus, has received numerous honors, including the Louisa Gross Horwitz Prize, the Lasker Award for Basic Medical Research, and the Kavli Prize in Neuroscience.
Rothman was graduated summa cum laude from Yale College in 1971 with a degree in physics. He earned a Ph.D. in biological chemistry from Harvard Medical School in 1976.
NEW YORK — Memorial Sloan-Kettering is forming an alliance with Hartford HealthCare, a network of five Connecticut hospitals including MidState Medical Center, the Hospital of Central Connecticut and Hartford Hospital.
Under the alliance, patients will be eligible to participate in clinical trials overseen by Sloan-Kettering. Connecticut doctors will be paired with specialists in New York to discuss new treatments and difficult cases.
Hospitals under the alliance will have signs that say they're members of the "Memorial Sloan-Kettering Cancer Alliance." The alliance is a means for Sloan-Kettering to increase its patient base for clinical trials and gather more data about new drugs.
Hartford HealthCare has about 5,000 new cancer patients a year.
NEW HAVEN — Columbus House has unveiled a new Respite Program for Yale-New Haven Hospital patients who are homeless and too sick to return to the streets but not sick enough to warrant additional in-patient hospital care. Qualifying patients who are homeless and being discharged from YNHH will now have a safe and secure place to recuperate while receiving medical follow-up care and case management support to help identify and overcome those issues that led to their homelessness.
Columbus House, a 501(c)3 non-profit that provides services to the homeless, hosted an October 7 ribbon-cutting ceremony at its 586 Ella T. Grasso Boulevard facility.
HAMDEN — Cynthia Barrere of Prospect, a professor in the School of Nursing at Quinnipiac University, will receive the Virginia A. Henderson Award for Outstanding Contributions to Nursing Research at the annual meeting of the Connecticut Nurses’ Association October 23. The award cites Barrere for her research expertise as well as the impact her leadership in nursing research has had on the state, regional and national levels. The award also recognizes Barrere’s achievements in creating an atmosphere among colleagues, faculty and students that inspires scholarship and research.
Barrere joined the Quinnipiac faculty in 2004. She holds a doctorate in medical sociology from the University of Connecticut. She holds master’s degrees in sociology and nursing from the University of Connecticut and a bachelor’s degree in nursing from Western Connecticut State University. She occupies leadership positions in the American Holistic Nurses Association Research and Grants Committee, and the Academy of Medical-Surgical Nurses.
The Connecticut Nurses’ Association is the professional organization of registered nurses in Connecticut, a constituent member of the American Nurses Association.