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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!

Health reform after King with Professor Timothy Jost and Henry Aaron


DFA Senior Advisor and University of Chicago professor Harold Pollack talks with two of the Nation's leading experts on health reformProfessor Timothy Jost, and Henry Aaron of the Brookings Institution. They discussed the implications of the King v. Burwell victory and the future challenges and strategies for improving the Nation’s health care.

A full audio recording of the call is available here.

Guest Speakers:

Timothy Jost
Timothy Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a co-author of a casebook,Health Law, used widely throughout the United States in teaching health law, and of a treatise and hornbook by the same name. He is also the author of HealthCare Coverage Determinations: An International Comparative Study; Disentitlement? The Threats Facing our Public Health Care Programs and a Rights-Based Response; and Readings in Comparative Health Law and Bioethics, the second edition of which appeared this spring. He has also written numerous articles and book chapters on health care regulation and comparative health law and policy, and has lectured on health law topics throughout the world. His most recent book is Health Care at Risk: A Critique of the Consumer-Driven Movement, which was published by Duke University Press in 2007.

Henry J. Aaron
Henry J. Aaron is currently the Bruce and Virginia MacLaury Senior Fellow in the Economic Studies program at the Brookings Institution. From 1990 through 1996 he was the director of the Economic Studies program.  He is a member of the Institute of Medicine, the American Academy of Arts and Sciences, the advisory committee of the Stanford Institute for Economic Policy Research, and the visiting committee of the Harvard Medical School. He is a member of the board of directors of the Center on Budget and Policy Priorities. He was a founding member, vice president, and chair of the board of the National Academy of Social Insurance. He has been vice president and member of the executive committee of the American Economic Association and was president of the Association of Public Policy and Management. He has been a member of the boards of directors of the College Retirement Equity Fund and Georgetown University.


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A Victory for Doctors and their Patients

By Donald Nguyen, MD

Last week the Supreme Court ruled 6-3 on King v. Burwell and emphatically declared the Affordable Care Act (ACA) is here to stay. It upheld the provision of ACA that provides subsidies to millions of Americans in 36 states, including Ohio, where the Health Insurance Marketplaces are set up by the federal government.

Why are doctors involved in this fight? Doctors are in the front line of fire and we care that patients have coverage and access to care. For those who do not have health insurance through their workplace or through Medicare, the ACA provides two options. There is Medicaid for the very lowest income citizens and there are competing private health insurance plans available for purchase from health insurance exchanges, also called marketplaces. Thanks to the ACA, last year 8.8 million Americans received health coverage through health exchanges and over 16.4 million remarkably have signed up as of 2015. A key strategy of the ACA’s goal of expanding coverage, especially to the working poor, is to use a sliding scale to subsidize the cost of premiums for the private plans purchased through the exchanges.

In King v. Burwell, King claimed that the ACA requires such subsidies only in state health care exchanges. Thirty-six states, including Ohio, declined to set up their own exchanges and instead decided to let the federal government set up exchanges for their states. Most legal experts agreed that King v. Bur-well is about semantics. It is clear from the rest of the ACA that the law means to provide subsidies to Americans in states such as Ohio where the exchange was created and is run by the federal government as well as to provide subsidies in states such as Kentucky that set up their own exchanges. This case is about focusing on a few words in one sentence of the law and ignoring the clear intent of the rest of the law. This case is about hurting those who need health care and who would lose their health insurance without a tax credit. Because King v. Bur-well was not upheld by the Supreme Court, more than 8 million Americans can stay with their insurance and 10,000 would not have to die annually because of lack of health coverage.

Our country has struggled for more than 100 years to find a way to make sure patients don’t die because they don’t have enough money. We have made progress we can all be proud of. In 1965, the Medicare and Medicaid Act was signed into law and thousands of lives are saved every year because of it. On March 23, 2010, the landmark ACA was passed. For the first time in American history, our country can say that it will no longer accept anyone dying for lack of money. The 6-3 ruling confirmed and reaffirmed that the ACA is about improving health and saving lives, not to worsen or destroy them. The SCOTUS has now spoken twice. The ACA is the law of the land, and it is here to stay. So, let’s stop the frivolous repeal attempts. Let’s work on expanding Medicaid to the rest of the nation, and build on the success of countless benefits and protections of millions of Americans.

As a physician, I am proud of my profession, and thank you to the U.S. Supreme Court for siding with my patients.

Donald Nguyen, M.D., is a pediatric urologist in Beavercreek


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National ASK Day

By Dr. Seanta Clark

We are deeply saddened by recent events here in South Carolina. Like too many communities across this country, ours was touched this week by horrific violence. 

As a Nation, we must grapple with the deep issues of racism and intolerance that allowed this terrible tragedy to happen in such a sacred space.  At the same time, we also know that violence - both intentional and accidental - is impacting the health and lives of too many families across the country.

At times like these it’s easy to feel helpless, but we are not. As physicians and advocates we have a sacred role in caring for our patients and in creating safer communities.

On this National ASK Day and every day, please join me in encouraging parents to ask if there is a gun where their children spend time. Every day, 48 children are shot and 7 die from gun injuries. We must prevent this senseless loss of lives. It’s a simple question that can make a difference. ASKING SAVES KIDS.

Please join me and over 19 million households in taking the pledge today to ASK this life-saving question. Gun violence prevention starts at home.

I hope you will join us in this moment of reflection and opportunity to stop gun violence. 


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My Story

By Jose Raul Rivera

I want to thank members of Doctors for America for their continued efforts in fighting for my right to be healthy!  I've lived without medical insurance and life is scary without it. I became ill and lived with some strange symptoms that I could not explain and struggled to ignore. Seven years later, I was diagnosed with Multiple Sclerosis. 

When I was uninsured, I earned just enough that I did not qualify for Medicaid. I could not afford private insurance, but would have benefited from an expanded Medicaid. Treatments for MS existed in 2006; an earlier diagnosis would have allowed any of those treatments to slow the progression of MS. There are still days when touching my daughter’s hair is literally painful and others when I cannot carry her down the stairs. I am grateful that I now have medical insurance through my employer, but I know that there are too many who cannot afford coverage and live in states that have not expanded Medicaid. I do not want any of them to suffer from preventable or treatable conditions. This is why DFA is so important to me and my family.

Today, I can play with my daughter because treatment has slowed the progression of my MS and allowed me to manage the permanent symptoms. Because of the ACA, when I decided to explore different career options, I was not denied insurance because of a pre-existing condition. Because of the ACA, if difficult times hit again, we will have medical insurance since we live in a state that has expanded Medicaid. Because of the ACA, I know that our future is secure.

My wife and I have supported DFA since its beginnings and want to encourage all of you to help further its cause. We have the ACA but there is still much more to do before all Americans have access to quality and affordable health care.  

This is why we are pledging to match the first $1,000 of every dollar donated to DFA today.

Combined with Dr. Murali Sivarajan's offer it brings the total challenge for today to $11,000. If you donate -- before midnight -- your donation will be matched dollar-for-dollar.


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Act Now: Ask the Senate to Extend CHIP

By Matthew Molloy, MPH

We need to act now to protect children's health.

This week, the Senate will vote on bipartisan legislation to fund the Children's Health Insurance Program (CHIP), which provides health insurance to over 8 million children. The number of uninsured children has dropped by more than 50% since CHIP's bipartisan beginning 17 years ago.

Call your Senator directly or call the U.S. Capitol switchboard at (202) 224-3121 and an operator will connect you with your Senate office.

There are many important reasons to keep CHIP strong:

  1. Benefits: CHIP plans are designed for children and provide more comprehensive benefit packages than most Marketplace plans.
  2. Networks: Because CHIP plans are for children, they have larger provider networks than Marketplace plans, including access to specialists that are important for the sickest kids.
  3. Affordability: CHIP plans keep out-of-pocket costs down for low-income families.
  4. "Family-Glitch": Up to 2 million children could lose their insurance coverage because they have a parent who receives employer-based insurance and cannot qualify for financial subsidies in the Marketplace

The Affordable Care Act reauthorized CHIP through 2019, but funding for the program will run out onSeptember 30, 2015 unless Congress acts.

In March, the House of Representatives passed H.R.2, Medicare Access and CHIP Reauthorization Act of 2015, by a wide margin of 392-37 - an impressive display of bipartisanism. H.R.2 repeals the Medicare Sustainable Growth Rate (SGR) and extends funding for CHIP through 2017. Now it must pass the Senate.

Call your Senator directly or call (202) 224-3121 and an operator will connect you.

Thank you for all you do to advocate for patients.

Matthew Molloy, MPH

Maryland State Director



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Celebrating 5 years

By Dr. Mona Mangat

For years, opponents claimed nobody would sign up for coverage under the Affordable Care Act. They said people would not pay their premiums. They said there would be death panels, and that the law would kill jobs and be a disaster for our country. They were wrong.  

Five years later, the sky hasn’t fallen but the uninsured rate has – to record lows. 

Today, 16.4 million Americans have new coverage and we have seen the largest reduction in the uninsured in four decades. Millions of people no longer have to worry about being refused coverage or getting charged more for a pre-existing condition.

By every measurable standard the ACA is working and providing real and powerful change in people’s lives! 

Just look beneath the numbers and you’ll find success stories of patients whose lives have been saved by their new coverage. People like Lisa Gray who finally has access to the care she needs. Lisa, featured in the Los Angeles Times, was diagnosed with Leukemia and credits the ACA with saving her life. If not for the ACA, she would have been unable to receive chemotherapy.

Thanks to your advocacy, Lisa – and the millions like her – are alive today with access to lifesaving care. You stood up, spoke out, organized in your communities, lobbied Congress, rallied in the rain and used your voice as a trusted physician to speak for patients in need.

Together, we changed our Nation’s healthcare system and got it working better for patients. We know there is still much work to be done to increase access and improve care but we are making real progress as a movement toward a better, healthier America.

Mona Mangat is the Board Chair of Doctors for America and an Allergist-Immunologist based in St. Petersburg, Florida.


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Health Care Reform in East Harlem

By Andrea Jakubowski

The DFA National Conference in April of 2013 came at an incredibly exciting time. The health insurance marketplaces were set to launch October 1st, Medicaid eligibility had expanded, and we were witnessing a historic step towards improving American’s access to health care. As a group of Mount Sinai medical students new to DFA and attending the conference for the first time, we were caught up in the excitement. But we also learned the sobering fact that millions of individuals who would be newly eligible for Medicaid or private insurance on the marketplace weren’t aware of how health care reform could benefit them. Doctors for America had helped pass the ACA and defend it from attack, and now we would need to help with its implementation.

Our group of medical students came away from the conference impressed by the urgency and importance of helping spread the word about health care reform. Mt. Sinai is located in East Harlem, a neighborhood with a high burden of disease and many barriers to health care access. Students at Mt. Sinai have a long tradition of working and serving in East Harlem, and we began brainstorming how we might bring the message of health care reform to our patients and fellow community members.

We decided to start a Mt. Sinai Doctors for America student chapter. We knew we wouldnt be working alone in East Harlem, as the neighborhood is rich in trusted organizations serving devoted clients and patients. Our first step was to form a partnership with the East Harlem Community Health Committee (EHCHC), a coalition of community organizations with a history of working on implementation of health policy changes in the community.

Our goals in forming the partnership were: 1) Educate East Harlem residents about new options for health insurance and how to enroll 2) Describe and document East Harlem’s experience of enrollment from the perspective of community organizations and 3) Facilitate communication and collaboration between community based organizations (CBOs) working on enrollment.

A group of twelve medical students, we dedicated ourselves to forming partnerships with local organizations, including three major community health centers and two large social service agencies in the neighborhood. From September 2013 until the end of the open enrollment in April 2014, we gave nine presentations with over 115 in attendance, including for a NYC Department of Health ACA forum, part-time staff of Union Settlement Association, clients of several small community organizations, and the Mt. Sinai medical community. We tabled at health fairs and tax clinics, talking with attendees about the ACA. Finding that the outreach resources from the state marketplace often lacked adequate information about eligibility and how to apply for insurance on the marketplace, we created over ten outreach documents in English and Spanish that we used and shared with navigators and many organizations in the neighborhood.

One our group’s most significant contributions was creating linkages between organizations in East Harlem. Working closely with a certified application counselor, students were able to invite her to several of our community presentations and connect East Harlem residents with her services if they needed assistance enrolling. Every month, we presented updates at the EHCHC meetings to share what we were learning through our outreach and enrollment efforts and to generate discussion about how we, as a community, could strengthen our ACA work.

Now, a year after the health insurance marketplaces launched, it seems clear that the health insurance marketplace has been a great success. In New York State, there were approximately 2.7 million uninsured before the launch of the Marketplace. By August, the number of uninsured was just over halved, with 1.4 million signing up for insurance. But as impressive as these gains are, there is still work to be done. Building on the lessons we learned through our work, we are excited to continue our efforts in East Harlem and throughout New York City to keep spreading the word about the ACA and getting covered.

Andrea Jakubowski along with the Icahn School of Medicine at Mt Sinai Student Chapter of Doctors for America


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Call for coverage

By Donald Nguyen, MD

The deadline for open enrollment is this Sunday. Join me and Doctors for America members across the country in spreading the word out about the final week to enroll for 2015 health coverage.

On Saturday February 14, we are going to help connect Americans with health insurance by picking up the phone to talk with consumers about where and how they can enroll.  It’s something you can do from your living room.

You can make calls in three easy steps:

Step One: Request a Phone List
If you want to host a phone bank or make calls on your own, fill out the Request Form and you will receive the call link and script. Please fill out the request format least 2 days before you plan to make calls.Important: If you are going to phone bank with us on 2/14 be sure to request your form by Friday.

Step Two (optional): Get Friends to Join You!
Once you’ve filled out our Request Form, get ready to make your calls! It can be more fun if you recruit friends to make calls with you, or you can make calls on your own. Everyone needs a computer and should have some time to get familiar with the script. Please note, you may get a list of phone numbers for another state, depending on where the need is greatest.

Step Three: Make Your Calls! You never know whose life can be saved or touched with the knowledge of the new health coverage now available. Pick up the phone and make your calls! 

Don't forget to take a picture and post it on Facebook and Twitter using the #getcovered hashtag or just send it to us, and we'll post it for you!


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Why Young People Should Get Enrolled

By Jose Tapia, DFA Intern

Young people my age tend not see the need to enroll in health insurance. Many of us assume that we are way too young to get sick, and that the Affordable Care Act, or “Obamacare,” was passed only to help older, sick people. The reality is that we all can get sick at any age or suffer from an accident.

A friend of mine named Emily who is the first to go to college in her family, is a prime example of the need for health insurance at our age. She currently suffers from Irritable Bowel Syndrome (IBS). It’s a chronic condition that affects a person’s digestive system. Typical symptoms include severe stomach pain, nausea, tiredness, and diarrhea. There is currently no cure for this condition, only long-term treatment. Emily lived her entire teenage years as healthy as many of us did, until IBS symptoms arose from no apparent cause at the age of 19. Physicians do not fully comprehend what caused her condition.

Her symptoms quickly escalated and followed her through college. Emily’s parents could not afford private insurance, and she did not qualify for Medicaid in the state of California at the time. Her only viable alternative was to turn to free clinics in her community, but sadly wait times and limited resources prevented her from receiving the care she needed. Emily’s condition worsened so much that she had to drop out of college. She realized that the only hope she had to see a physician was to go to Emergency Room and wait for countless hours, and sometimes even days.

After President Obama signed the Affordable Care Act into law in 2010, Emily was able to receive health care coverage. The ACA expanded Medicaid coverage, and she was now able to qualify for the program. Being covered under Medicaid allows Emily to receive the treatment she needs for free. Having coverage meant she was able to receive the proper exams needed to diagnose her condition, and a specialist has been able to properly treat her condition with medication. This treatment has allowed her to go back to college and continue her undergraduate studies. She was able to regain control of her life, no longer having to live with constant, debilitating pain.

Once Emily graduates from college, she may obtain quality and affordable health care coverage through her employer. There are other simple ways Emily can get covered even if her employer doesn’t provide her insurance, or if she works in a nontraditional job. Many nontraditional jobs do not provide health insurance- common examples include baristas, waitresses, retail workers, and self-employment. If that were the case Emily could still very easily obtain insurance, and the costs could be as affordable as a monthly cellphone bill thanks to a provision in Obamacare that could help her pay for health insurance. Additionally, there is another important provision in Obamacare that now prevents insurance companies from denying Emily health coverage simply because she suffered from an illness in the past.  

We can all learn from Emily’s experience. Just because we are young does not make us completely immune to disease or accidents. Plus, with the passage of the ACA it’s now more easy and affordable to obtain health insurance than ever before. Today Emily is 25 and is a great example of why young adults should enroll in health insurance. She is thankful for the passage of the ACA and California’s choice to expand Medicaid access. The benefits the ACA provides are not age- restrictive, and we should all be conscious of our need to get enrolled. To learn more check out this link for an easy and interactive presentation on enrollment

To get covered and take advantage of all the benefits the ACA has to offer, enroll online before the February 15 deadline:

- Jose Tapia, DFA Intern


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MLK Day of Service

By Dr. Manisha Sharma

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” 
– Martin Luther King, Jr.

The enrollment deadline is fast approaching. It’s not too late for you to help your neighbors, patients and friends get health coverage before February 15th

Let’s come together on Martin Luther King Day of Service and honor Dr. King by helping educate our communities about the importance of getting covered.
Not able to attend an event or don't see one near you?  Share this graphic on Facebook and Twitter to remind people to get covered. And, don’t forget to use our pocket card to learn how to screen patients for health insurance, answer basic questions, and point them in the right direction.
Together, we can improve lives and ensure everyone has access to the care they need and deserve.


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