According to an article in Sunday's New York Times, health insurance companies are raising their rates by double digits again, despite the promise of some 30 million new customers in the coming year.
It's not big businesses that are getting hit with these 20-percent increases, but individual customers and small businesses; big companies are seeing rate increases of about 4 or 5 percent.
In California, where the request by Anthem Blue Cross Blue Shield to raise rates by 39 percent in 2010 helped put the Affordable Care Act over the top, companies once again are seeking rate increases of up to 26 percent.
Not all states are subject to the whims of Big Insurance, though. New York, for example, has a commission that must approve rate hikes, and insurance companies must prove they need the revenue to get the raise. So far, 37 states allow regulators to reject or reduce increases of 10 percent or more.
Under the Affordable Care Act, regulators are required to review any request for a rate increase of 10 percent or more; the requests are posted on the federal Web site,, along with regulators’ evaluations.
Historically, Big Insurance has gotten its way almost every time it has wanted something. Its lobbyists were able to gut the plan for a public option in the Affordable Care Act, which would have made the industry face some competition.
Now, the industry has a monopoly with nowhere near enough regulation, and we the consumers have nowhere to turn if we're treated unfairly, overcharged, denied coverage.
Yes, the Affordable Care Act provides for appeals, but the states will set the specific rules for those appeals. In the law passed by the NC House in 2011, the consumer protections were minimal at best and the insurance company protections were strong as steel. Fortunately, that law never made it through the state Senate and North Carolina will partner with the federal government in its insurance marketplace.
The proposed NC law for its marketplace also allowed oversight of the Benefits Exchange by insurance companies and health care business associations, making the chances for successful challenges even tougher. It seems no one understands the meaning -- or the danger -- of conflict of interest anymore.
So, perhaps it's time to change tactics -- maybe we should start making a lot of noise about getting a public option added to the Affordable Care Act so we can have a real choice.
Let me buy into Medicare.
Let me escape the greedy grasp of the insurance companies.

Dear Gov. McCrory,
I didn't vote for you, partly because I didn't believe you were a moderate Republican. You can prove me wrong.
Soon now, you will announce whether North Carolina will expand Medicaid to about a half-million people in the state. The action won't cost the state a dime in the first three years, and then we'll pay just 10 percent of the cost each year after that.
I urge you to stand up to people who for ideological reasons alone would allow 500,000 people to be denied basic health care.
People who make less than 133 percent of the federal poverty level can't afford even the most basic care, so they don't get checkups and they can't manage chronic illnesses. 
So, let's look at the logic here. If we deny them care, we will pay a whole lot more down the road as people show up in the emergency room in renal failure or with a massive stroke or heart attack, or with cancer that has progressed beyond the point of any hope for a cure.
People who don't have access to care are much sicker by the time anything is done for them, and by then it may be too late to save their lives.
That's what happened to my son, Governor. He couldn't get insurance because a birth defect was a pre-existing condition, and without it, he couldn't get the screening tests he needed. He got sick and he got sicker and was finally admitted to the hospital weighing just 110 pounds (he was 6 feet tall). He was so sick it took them five days to stabilize him, and his cancer was stage 3. He had to leave his wife to get Medicaid, and his chemo cost about $600,000. That's just the chemo, not the two surgeries, the radiation, the other medications and the loss of his tax revenues. So, by cheaping out on his care, we probably spent more than $1 million.
My son would be an attorney now, making decent money and paying his fair share in taxes.
Multiply that by 500,000 people, and I'm just talking about the financial cost. 
How about the emotional cost? How about the cost to our souls as human beings?
Have you ever lost a child, especially one who shouldn't have died? I wished my own heart would stop when his did, and many days I still do.
You have the chance to save thousands of lives of people in this state. I know your buddy, Art Pope, is advising  you to let those poor people fend for themselves, but I hold out hope that you have more character and compassion than that.
Make no mistake about it, Governor, we are talking about letting people die just to make a political point.
If that isn't evil, what is?

Several states have chosen to opt out of the expansion of Medicaid, and it is not in the best interests of their people or their health care businesses, especially hospitals.
The Affordable Care Act cuts the amount of money hospitals receive to compensate them for the care they provide to people who can't pay. The logic was that the expansion of insurance coverage, especially the expansion of Medicaid, would cut down on the amount of uncompensated care hospitals need to give.
But the Supreme Court threw a wrench into that plan when it decided that states don't have to expand Medicaid. Several states have said they won't expand Medicaid, but the law still provides for cuts to the money the federal government pays to hospitals for uncompensated care.
Although some are calling for an increase in federal money for hospitals in those states that refuse to expand Medicare, others are saying the states that refuse to cover more people under Medicaid shouldn't be rewarded -- especially because the expansion costs states nothing for the first three years and then the costs to the state rise to 10 percent of the total cost of the expansion. In other words, federal money is already available to these states and if they choose not to take it, that's their problem; the government shouldn't reward them with money from somewhere else. Here is the solution. Get on board or not, but those are your only choices.
When Medicaid was enacted in 1965, few states wanted anything to do with it. But eventually, all 50 states saw the advantages of a centralized system to care for people in need.
Those states that refuse to get on board will face a lot of pressure from hospitals, which will be less able to care for the poor, and probably from voters who don't understand why people in their state can't get care when it doesn't cost the
Let me start by saying I'm tired of the politicization of life-and-death issues in this country. Twenty children and seven adults are dead in Newtown, Conn., and people are screaming about politics. 
It's political because lobbyists pay billions to make it so.
We can't talk about gun safety without being political. I noticed the same thing during the health reform debate. 
I know what it is to lose a child who shouldn't have died and I'm trying to wrap my heart around all of those families in Connecticut. I at least got to say goodbye to my child. 
This is a tragedy beyond my ability to even comprehend. I have spent much of the time since hearing the news praying for healing that I know will never really come completely. Losing a child is not something you ever get over.
This is about people's lives, and gun manufacturers have made it Republican vs. Democrat. They have many of us believing that guns are perfectly safe; it's people who are dangerous.
Well, it's people with guns who are dangerous. Not all of them, mind you, but enough of them to cause havoc every few weeks.
This is not a simple problem with a simple solution. This is not just about guns, although guns certainly play a huge part.
I see this as a three-pronged problem:
  • The ease with which people can get guns and ammunition;
  • The lack of diagnosis and treatment for mental illnesses;
  • Our country's love affair with violence.
This is a public health issue and an education issue. The gun lobby has too much power and it has billions of dollars driving that power. A lot of the talking points I'm hearing come from those dollars.
  • We shouldn't regulate guns because then only criminals will have them.
  • We should put guns in the hands of more people so they can shoot back.
  • We should honor the victims by not discussing gun laws.
  • Guns don't kill; people do.
  • Only crazy people go on rampages so we all need guns to protect ourselves from them.
  • People will find other ways to kill if we take away their guns.

And on and on ...
Without going into all the anti-gun rhetoric, let me just say 20 children and seven adults were killed yesterday. Three people died in a mall in Oregon less than a week ago. The bodies are piling up and we're still arguing instead of talking.
We as a nation regulate cars more than we do guns -- we require a licence that has to be renewed periodically. We have more laws regulating the manufacture of teddy bears than we do guns.
It's well past time to have some sensible regulation of guns, including banning of assault weapons and background checks of everyone who wants to buy a gun -- even at a gun show.
The reason so many "nut cases" go on killing sprees is because they have a chronic illness that gets worse when it isn't treated, and we keep cutting funds for mental health. People with serious mental illnesses don't often have insurance because they can't hold a job and our access to care is tied to employment. In addition, most insurance policies don't cover much mental health care, although that will change in 2014, thanks to the Affordable Care Act.
I have watched as our mental health system in North Carolina has imploded because of state "reform," which privatized much of the system. Add to that the defunding of the system in recent years and you have a disaster. 
So, people with severe and persistent mental illnesses don't get the treatment they need, and their illnesses get worse, just like any untreated chronic illness.
Until we address this problem, we will continue to see "nut cases" with guns going on shooting rampages -- unless, of course, we make it more difficult for them to get guns.
We can demand improvement in our mental health system, and we will see it if enough of us demand it. Call your legislators and let them know you won't back down.
Finally, we have a love affair with violence in this country. We adore it. It's in our movies, on TV and in the games we play. The military uses violent video games as a recruiting tool -- go to the Army's web site and play for free.
Every year, the special effects in our entertainment get more grisly and realistic and the violence more graphic because it takes more to shock us. We've become desensitized to it, and there's some good scientific research to back that up.
I do not advocate censorship, but I do think parents should try to protect their children from it. If we don't buy the violent video games or go to the grisly movies, they won't be profitable so they won't be made. 
We are the ones who drive the market.
We are the ones who can make change.
Now is the time -- before the pain of this loss of innocent life diminishes.
While our hearts are still broken, let's honor the victims by being the force of change needed to prevent another massacre.

As happens most days, I got a call this morning from someone who needs health care information. She recently lost one son to cancer and another son is ill, was recently injured and now needs rehabilitation services.
Because this son only recently got SSI disability, he has to wait two years for Medicare to kick in. Because he has a 401K savings plan from when he was able to work, he isn't eligible for Medicaid. He was planning to buy a small mobile home with that money, but now he has to spend it down -- even though he can't withdraw it without paying a penalty because he isn't of age yet.
There is no reason to make people who get disability wait two years for health coverage; the reason they get disability is because they can't work, and in this country, health coverage is tied to work.
This is not an unusual situation; thousands of people are caught up in this gap every year. Many lose their savings and their homes and some die. Four years ago I interviewed a family caught in this gap and they received four calls from the bank during the two hours I was there. The woman told me they were getting eight to ten calls every day. Their power had been turned off once and the woman couldn't find a dentist who would take care of her infected teeth, which were damaged by the drugs she was taking for another condition and causing her a great deal of pain.
She had nowhere to turn.
The same is true of this family I spoke with this morning. If they can't pay for the bed in rehab, the man will be sent home, where there is no one to care for him properly.
If someone has Medicaid before getting disability, they often lose eligibility for Medicaid when they begin receiving disability checks because the $400 or $600 a month they get puts them over the income threshold in their state. In Texas, someone making just 12 percent of the poverty level can be kicked off Medicaid. And a single male adult isn't eligible, no matter what.
Congress could fix this easily by making anyone on disability eligible for Medicare immediately instead of making them wait two years.
If states expand Medicaid to over anyone with an income less than 133 percent of the federal poverty level, people won't lose eligibility for Medicaid so easily. But a number of states have said they won't expand Medicaid even though they won't have to pay a cent for it for three years and in the long run will only pay 10 percent of the cost. 
Only Congress can change this, but they haven't been inclined to do so. It seems they haven't been inclined to do much to help people in need in recent years.
It seems to me this family has been through enough, but there are those who would call them moochers because they need help because of circumstances beyond their control

The Kansas City Star just completed a yearlong investigation of the beef industry, and it's worth reading if you care about what you and your family are eating.
The industry was reformed somewhat a century ago after Upton Sinclair's book, "The Jungle" was published in 1906. Although the writing style is dated, the book is worth reading because government regulation seem to have regressed back to that time.
The problems are different today, though, and it makes the meat much more dangerous.
Beef cattle are pumped full of antibiotics, which make the bacteria that survive extremely virulent. Plus, the antibiotic we ingest with our burgers makes those very drugs less effective when we really need them, increasing the number of antibiotic-resistant infections. When these cows' manure is used to fertilize crops, bacteria in the soil can strengthen and become resistant to antibiotics. The Star details the story of children in Joplin, Mo., getting antibiotic-resistant infections following the tornado there because dirt with resistant bacteria got into their wounds.
But animals that have no infections are still being pumped full of antibiotics and there aren't likely to be laws against it any time soon, thanks to the lobbying power of the beef and pharmaceutical industries.
Cattle also are given beta blockers to make them grow faster and fatter, and the residual amounts of the drugs we get with our meat can cause cardiovascular problems. They're also given growth hormones, which cause them to grow faster, but also are found in the meat we eat.
The way cattle are kept before being slaughtered is nothing short of revolting. They stand in feedlots, shoulder-to-shoulder, sometimes knee-deep in their own feces, eating things cows were never meant to eat, including corn and ground up bone meal from other cows.
The new machines used to tenderize the meat push dangerous pathogens (including e. Coli) into the middle of the meat, which is less likely to be cooked to a high enough temperature to kill the bacteria. The same is true of ground beef. 
To combat this, some of the meat -- the stuff once deemed unusable -- is processed with ammonia. The resulting mush, called pink slime, is added to ground beef. Almost every frozen ground beef patty in America contains some of this slop.
Regulations in this country are so lax that if federal inspectors find bacteria in meat, they can't even force a recall -- recalls are voluntary. Fortunately, meat processors still have to worry about adverse publicity, so they do recall bad meat.
The retailer Costco has more rigorous inspection criteria than the US government, although even its inspections don't find every bad batch of meat. According the the Star, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the US Department of Agriculture does nationwide at all other beef plants combined.
In fact, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the USDA does nationwide at all other beef plants combined.
And it's not just the beef industry that's troubling; pork and chicken share many of the same problems.
The solution is to buy pasture-fed beef, pork and chicken, and buy it from local producers. Meat that's pasture-fed is lower in saturated fat and cholesterol, so it's healthier, and it's tastier. It's more expensive, but you get what you pay for. It probably won't hurt you to eat less meat.

I had an e-mail from a surgeon this morning from a physician who said he wanted some help getting the word out that any woman who has had a mastectomy is covered by insurance for breast reconstruction. The insurance company can't turn you down.
I know people don't know their rights under the Affordable Care Act, but this law was passed 14 years ago. I looked it up.
Nearly 300,000 people (mostly women, but a few men as well) face breast cancer every year. A generation ago, women routinely got a radical mastectomy with their diagnosis. You signed the permission before the biopsy, so you woke up minus a breast and a whole lot of muscle tissue if the pathology lab found cancer. There was no discussion because doctors offered no alternative to this body-mangling surgery.
Studies found that the survival rate was just as good when only the breast was removed, and that just removing the tumor and some surrounding tissue was also adequate in many cases.
Women lobbied to be given the choice of lumpectomy or simple mastectomy. Doctors, mostly male at the time, resisted, but women didn't back down.
Fewer women today get mastectomies, but it is indicated in many cases, and these women can have reconstruction, either at the time of mastectomy or later. Either way, insurance companies must cover the procedure.
Not all women want to have reconstruction, and no one should have it done without getting all the information available. This document by the American Cancer Society is a good place to start gathering information:
Your decision will depend on your age, the stage of your cancer, whether you have enough extra tissue to construct the new breast (very thin women sometimes don't have enough), even whether you smoke.
Each case is unique. However, if you and your surgeon decide breast reconstruction is best for you, insurance coverage (IF you are insured) is not an issue. It's covered.

Although some governors are still saying they want nothing do do with the Affordable Care Act, it will move forward.
Despite the secession petitions, health reform will move forward.
There will be those corporate hacks who try to get out of offering health care benefits by reducing people's work hours -- especially big-box stores and restaurant chains like Wal-Mart and Papa John's Pizza.
State governments can refuse to expand Medicaid, leaving millions without access to care.
All of it reminds me of my grandson having a temper tantrum when he was 3 and his mother wouldn't replace his "broken" slice of cheese with a new one.
I came across him screaming on the kitchen floor and asked what was wrong. In his whiniest, most pathetic voice, he whimpered, "My cheese is broken and Mama won't give me a new one."
"We don't waste food like that," I said. "That piece is perfectly good."
He started kicking and screaming again and I just stepped over him and walked away. After a few minutes, he stopped screaming and ate the "broken" cheese.
Opponents of Obamacare are acting like spoiled 3-year-olds and we need to stop paying attention to them and move ahead. They won't stay behind for long because they hate being ignored, and public pressure will force them to move ahead.
When Medicaid was enacted in 1965, only six states opted in. It didn't take long for the pressure became too much and the other states opted in. 
The thing about the expansion is that it doesn't even affect state budgets for three years; after that, states pay only 10 percent.
The sad truth, though, is that much, much more is at stake than a broken piece of cheese. 
Several states have refused to build insurance benefits exchanges, the marketplaces where consumers will shop for insurance. They say they don't want the federal government dictating to them. So, in what one might call a bit of irony, the federal government will step in and create -- and operate -- exchanges in those states.
I can't boycott my state (North Carolina), which went totally red this election, but I can try to educate legislators about the importance of caring for people.
I can, however, boycott businesses that act like 3-year-old children, and I plan to do just that. I would love to see Papa John's go out of business because customers stay away in droves.
The good news, though, is that the Affordable Care Act won't be repealed. Nearly half the states are moving forward with health benefits exchanges (see the graphic), others have said they will work in partnership with the federal government (including North Carolina).
In 2014, millions more people will have a choice and those CEOs and state politicians who are resisting will no longer be relevant.
I won't stop advocating for universal access to care, but the Affordable Care Act is a big step toward that goal. I feel like I have stepped over my grandsh
We've had a busy couple of weeks. what with the election, Mike's and my birthday and our annual dinner and auction, Eat at Mike's. It was exhausting but worth it. I kind of think of Eat at Mike's as the WNC Health Advocates birthday party. It was our first event, beginning just after we became an official nonprofit in 2009.
But now it's time to get back to the work of fighting for access to health care for all Americans.
Already, the lame duck legislature in Ohio is voting to defund Planned Parenthood  the agency that provides affordable health care to millions of low- and moderate-income women. I used it as my main health care provider when my kids were little and I didn't have health insurance.
This isn't about abortion; this is about hurting women and children, who need healthy parents.
Employers, angry at having their candidates lose the election, are firing employees because they don't want to provide health care. The owner of Papa John's Pizza, who lives in a castle surrounded by a moat and can afford to give away 2 million pizzas in a football-related promotion, can't stand the thought of having to pay for health insurance for the people who work for him, so he will cut the hours of people who are already living on the edge rather than allow them to be eligible for coverage.
The corporation that owns Olive Garden and Red Lobster had announced it will do the same thing.
A franchise owner of Applebee's will also cut hours and fir employees.
I wrote to Applebee's about this and they sent me a reply saying it's not their decision because the man has free speech. Well, he's using his free speech to make their corporation look bad, and if that's OK with Applebee's, then I'm OK with never setting foot in one of their restaurants again. Companies can fire people who make them look bad, free speech or not. Their business  depends on their good name.
My solution to all this is to avoid eating in any corporate-owned restaurant. I will eat in locally owned establishments and I will contribute to local economies. With smart phones and GPS devices able to display lists of local restaurants and reviews in any town in the country, I see no need to ever contribute to these greedy corporate types ever again.
Although we didn't get a so-called public option that would have allowed us to buy into a government-paid insurance program like Medicare, we will have an option other than the for-profit insurance companies come 2014.
At least two health plans will be offered in every state, operated under contract to the government as the health benefits exchanges come online. Under the Affordable Care Act, one of the plans must be operated by a nonprofit.
It is an alternative to the public option that so many of us hoped would be included in the law.
The plans will compete with others in the marketplace, but they will have some advantages, including the federal government stamp of approval. I know that means little to some people, but those are people who don't trust anything the government does anyway.
In addition, the premiums and benefits of the policies will be negotiated by the US Office of Personnel Management, the same entity that negotiates the terms of the federal government's benefits.
Right now, no one is certain who will operate the plans, but the most likely candidate is the Government Employees' Health Association, which is the second largest provider of government plans, after Blue Cross Blue Shield.
The GEHA began in 1937 as an association to help railroad employees with their health care expenses and grew from there. Today it has high ratings from its customers, according to an article in the NY Times.
The Obama Administration expects about 750,000 people will enroll in the new plans, but some advocated worry about the plans not having to meet state-by-state standards. Because it is a federal plan, its provisions will override state standards. That could be good or bad. Since the plan hasn't been defined yet, we just don't know. I'm afraid a lot depends on the outcome of next week's election.