Sunday, May 15, 2011 6:16:58 AM
Health Insurers Making Record Profits as Many Postpone Care
Dr. Rebecca Jaffe, in Wilmington, Del., said that after years of resisting generic medicines, more patients were now requesting them to avoid paying hefty co-payments for brand-name drugs.
Tim Shaffer for The New York Times
By REED ABELSON
Published: May 13, 2011
The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.
The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use.
Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care.
Even with a halting economic recovery, doctors and others say many people are still extremely budget-conscious, signaling the possibility of a fundamental change in Americans’ appetite for health care.
“I am noticing my patients with insurance are more interested in costs,” said Dr. Jim King, a family practice physician in rural Tennessee. “Gas prices are going up, food prices are going up. They are deciding to put some of their health care off.” A patient might decide not to drive the 50 miles necessary to see a specialist because of the cost of gas, he said.
But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an MRI as soon as they have a bad headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.
For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.” Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. “The big question is whether it is going to stay weak or bounce back,” he said. “Nobody knows.”
Significant increases in how much people have to pay for their medical care may prevent a solid rebound. In recent years, many employers have sharply reduced benefits, while raising deductibles and co-payments so people have to reach deeper into their pockets.
In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.
Doctors, for one, say patients’ attitudes are changing. “Because it’s from Dollar 1 to Dollar 2,000, they are being really conscious of how they spend their money,” said Dr. James Applegate, a family physician in Grand Rapids, Mich. For example, patients question the need for annual blood work.
High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer. Mr. Welch, who has been a supporter of the need to overhaul insurance industry practices for the California Nurses Association union, said he hoped his medical training would help him determine when to go to the doctor. “I underestimated how much that cost would affect my behavior,” he said.
Dr. Rebecca Jaffe, a family practice doctor in Wilmington, Del., said more patients were asking for the generic alternatives to brand-name medicines, because of hefty co-payments. “Now, all of a sudden, they want the generic, when for years, they said they couldn’t take it,” she said.
The insurers, which base what they charge in premiums largely on what they expect to pay out in future claims, say they still expect higher demand for care later this year. “I think there’s a real concern about a bounce-back, a rebound, in utilization,” said Dr. Lonny Reisman, the chief medical officer for Aetna.
Because they say they expect costs to rebound, insurers have not been shy about asking for higher rates. In Oregon, for example, Regence BlueCross BlueShield, a nonprofit insurer that is the state’s largest, is asking for a 22 percent increase for policies sold to individuals. In California, regulators have been resisting requests from insurers to raise rates by double digits.
Some observers wonder if the insurers are simply raising premiums in advance of the full force of the health care law in 2014. The insurers’ recent prosperity — big insurance companies have reported first-quarter earnings that beat analysts expectations by an average of 30 percent — may make it difficult for anyone, politicians and industry executives alike, to argue that the industry has been hurt by the federal health care law. Insurers were able to raise premiums to cover the cost of the law’s early provisions, like insuring adult children up to age 26, and federal and state regulators have largely proved to be accommodating.
But 2014 and 2015 are likely to be far more challenging, as insurers are forced to adjust to the law’s greatest changes, like providing coverage to everyone regardless of whether they have an expensive pre-existing condition. “I think they’re going to go through a winter,” said Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, a research unit of the consulting firm Deloitte.
And while the slowing down of demand is good for insurers, at least in the short term, the concern is that patients may be tempted to skip important tests like colonoscopies or mammograms. The new health care law will eventually prevent most policies from charging patients for certain kinds of preventive care, but some plans still require someone to pay $500 toward a colonoscopy.
In recent times, insurers have prospered by pricing policies above costs, said Robert Laszewski, a former health insurance executive who is now a consultant in Alexandria, Va. The industry goes through underwriting cycles where the companies are better able to predict costs and make room for profits. “They’re benefiting from a very positive underwriting cycle,” he said.
“Maybe managed care is finally working,” he said. “Maybe this is the new normal.”
Still, he emphasized, health care costs, even if they are rising at 6 percent or 7 percent a year, are increasing at a much faster pace than overall inflation. “We haven’t solved the problem,” Mr. Laszewski said.
© 2011 The New York Times Company
http://www.nytimes.com/2011/05/14/business/14health.html [comments at http://community.nytimes.com/comments/www.nytimes.com/2011/05/14/business/14health.html ]
===
Rocky Clark, Paralyzed Athlete, Fights To Survive With No Health Insurance
By SHARON COHEN
AP
05/14/11 10:02 AM ET
ROBBINS, Ill. -- Rocky Clark sometimes dreams he's running track, racing around the oval as he once did, his heart pumping fast and his long legs a blur as he crossed the finish line.
Just thinking about it makes him smile.
Some nights, though, he has another recurring dream, this one pure fantasy. He sees himself in white shorts and track shoes, running again, then stopping, kneeling in prayer before a church door, somehow unable to make it inside.
When he awakens, Rocky Clark inhabits a world largely confined to four walls. Surrounding him are glass-encased autographed footballs and cherished memories of his glory days: Blue-and-gold ribbons. Trophies. And giant varsity letters from Eisenhower High School, his alma mater.
Clark can do little but swivel his head. He can't move his arms or legs. More than a decade ago, he was paralyzed from the neck down after being tackled in a high school football game. After nine months in rehab and a hospital bill approaching $1 million, he went home.
As a quadriplegic, his long-term prospects were slim. And over the years, there have been regular hospital stays and health scares – no surprise, considering Clark's fragile condition. He has just one working lung. His right lung is partially paralyzed; certain infections could kill him.
And yet Clark has endured. His doctor credits top-notch, round-the-clock home health care paid for by the school district's $5 million catastrophic health insurance policy. But that's run out, so the nurses and money are gone, replaced by his mother, growing financial pressures and a new sense of foreboding.
Rasul "Rocky" Clark beat the odds. And now he wonders if he's paying a price for his survival.
*
A week before his injury, Rocky Clark vowed to his mother that he'd strike it rich as an athlete one day and buy her a house.
Annette Clark remembers her son as an acrobatic kid who mastered back flips at age 7, ran too fast for a spanking and was always throwing balls and rocks – the inspiration of his nickname, bestowed upon him by an uncle. He took up track, football and baseball and excelled at all three, collecting ribbons, trophies and medals.
"I love awards," he now says. "It's a need thing."
On a warm September night in 2000 just four plays into the game, Clark – a high school junior and running back for Eisenhower's Cardinals – was grabbed by the shoulder and tackled. His head hit the ground. At first, he recalls, there was silence.
"When I started coming around, I heard a bunch of ringing," he says. "My whole body was vibrating, like a spring. I felt cold air. I tried to get up, but I couldn't."
Clark's neck had been broken in two places.
He spent about nine months at the Rehabilitation Institute of Chicago, wondering if his injury was some sort of cruel payback for something he had done in his 16 years.
"I said to myself ... `Maybe there was something I said I shouldn't have said. Maybe there was something I did that I shouldn't have done,'" he recalls. "I didn't do anybody wrong. I didn't get in trouble. ... I prayed every day. I didn't go to church all the time ... but I was good."
"Then," he says, pausing for a breath, "I realized things happen. Life doesn't always give us what we expect. I've got a spinal-cord injury, but there's nothing wrong with my brain. I've got a strong spirit and courage. You've just got to learn to deal with it."
Clark finished high school, donning cap and gown and having a friend wheel him across the stage so he could accept his diploma. He took some college courses, but a full-time schedule proved too difficult. (He'd like to return, but can't afford it.) He became a volunteer coach at Eisenhower, attending games.
All of it was made possible by the care provided through the district's insurance policy. And Clark says when the $5 million policy ran out several months ago, he assumed it would be renewed.
But it was not.
"A limit on life? That's crazy," Clark says, his pencil-thin frame covered by a white sheet. "I thought I'd be being taken care of the rest of my life."
His mother, Annette, who filed for bankruptcy because of financial problems, says they feel abandoned by the school. "They have a moral responsibility to take care of him," she says. "It depresses me and makes me angry. My son deserves better."
But the school district says both its new insurer and the one that held the $5 million policy refused its requests to obtain a new policy for Clark. "No one is going to sell us insurance for Rocky," says John Byrne, the school superintendent. "I feel kind of helpless."
Rocky Clark's injury is unusual, but his predicament is not.
A 2009 study estimated that 20,000 to 25,000 people in the U.S. reached the limits of their catastrophic health insurance. Many find themselves in dire straits – critically ill, facing crushing medical bills, struggling to remain in their homes, according to the state insurance commissioner.
"They're facing unenviable decisions that balance life, death, financial security and poverty – meaning the choice they make is a choice no person ever wants to make,'" says Michael McRaith, director of the Illinois Department of Insurance.
Annual limits are being phased out and lifetime caps ended last September as part of the new health reform law, so the ranks of those exhausting their policies will drop sharply over the coming years, and will totally be eliminated by 2014, McRaith says.
That doesn't help Clark, whose insurance has been so critical, according to Dr. Charles Beck, who has cared for him the past eight years. He wrote a letter to the school and insurance company, claiming "the loss of these benefits eventually is going to lead to his demise."
In recent weeks, Clark's mother, along with an array of supporters – some new, others longtime boosters – have drummed up attention with news stories, fundraisers, a letter-writing campaign to the school and two new websites. Their theory is simple: If they can keep his cause alive, they can keep him alive.
Denise King, whose husband is an associate pastor at a church in Chicago's Loop, knew about Clark and when she heard of his latest troubles, she couldn't sleep. "I thought this must be God telling me to do something," she says. The church hosted a small fundraiser in May.
This spotlight has helped: Dozens of people have donated money, supplies, even a water cooler.
They join others, notably the Chicago Bears, who've been generous supporters over the years, donating, among other things, more than $100,000 to make the Clark house in this southern Chicago suburb wheelchair accessible, according to Don Grossnickle, a deacon who heads Gridiron Alliance. The group helps disabled high school football players in the state and tries to draw attention to safety issues.
Clark's chances of surviving a decade or more were only about 10 percent, according to Beck. He credits Annette Clark – who receives government aid as a caregiver – and top-flight nurses with doing "an absolutely remarkable job," of protecting him from potentially fatal infections and illnesses.
He also praises the resilience of mother and son: "They don't fold," Beck says.
But Beck believes that Medicaid and other state support Clark now relies on aren't enough to provide the necessary supplies, medicine, breathing equipment and 24-hour specialized care. And moving him, Beck says, isn't a good option.
"If he had been living in a nursing home, he would have been dead five years ago," Beck says, and if he's sent to one now, "I would say goodbye to him. He would go to God. ... He requires more care than any nursing facility I am familiar with."
Insurance is a business, and Beck says he knows that. But he also believes that defying medical expectations has somehow become almost a punishment.
"It's confusing to me why their responsibility ends when that $5 million is gone ...," he says. "If he happened to outlive the actual projection ... does he suffer now because his care was good enough ... and he was lucky enough? I don't understand it."
*
At 27, the sculpted biceps that once filled the No. 21 red-and-white jersey have long since withered beneath a husk of skin and bones.
As Clark has grown from teen to a man, he's learned to adjust to a life where someone else has to brush his teeth or scratch an itch.
He misses using his hands: He liked to sketch as a teen – his walls are adorned with pencil drawings of people and dogs that show raw promise. And he wonders how far he could have gone as an athlete. "To have so much talent and never reach my full potential ...," he says, his raspy voice trailing off in a whisper.
But Clark tries to focus on what he has, not what he's lost. An iron will. Drive. And pride. "People tell me how inspirational I am," he says. "I've always been a motivator."
He relies on faith, too: "I leave it in God's hands." And he says it's pointless to be bitter.
"There's always someone who's got it worse than you," he says. And yet, he adds: "There are people who are not in my situation and they take life for granted. They have no determination. They don't know things can take a turn for the worse in the blink of an eye."
Annette Clark is her son's constant companion. She feeds him, washes him and sleeps on a recliner in the living room so she can hear him when he wakes at night. It's a punishing pace.
"Eventually, she'll break down," Beck says. "She has no ability to get a night's sleep. It's just a matter of time."
There's also sadness in her routine.
"It hurts for me to see him go down from muscle to nothing," she says. "It hurts for me when I have to turn him. It really hurts my heart. ... I have moments when I feel like throwing my hands up. I want to ask why. ... I have my moments when I want to run away."
Instead, she soldiers on.
From mid-April through early May, Rocky Clark was hospitalized with a blood clot in his paralyzed right lung.
The morning after he was admitted, at 1 a.m., Annette Clark says her son looked at her and declared: "`I'm tired of being sick.'"
"What are you telling me?" she asked. Then, sensing he might be giving up, she warned: "Don't say that to me anymore."
She walked out into the hall and cried.
When she returned, he was asleep, and she wiped a tear running down his face.
*
On the Net: http://www.rasulrockyclark.com/
*
Sharon Cohen, a Chicago-based national writer for The Associated Press, can be reached at features(at)ap.org.
Copyright 2011 The Associated Press
http://www.huffingtonpost.com/2011/05/14/rocky-clark-paralyzed-ath_n_861996.html [with comments] [also at e.g. http://www.seattlepi.com/news/article/Money-gone-paralyzed-athlete-fights-to-survive-1379544.php ]
===
U.S. House Speaker Boehner Assails Obama Health-Care Law in Court Papers
By Andrew Harris - May 11, 2011 4:21 PM CT
John Boehner, the Republican speaker of the U.S. House of Representatives, asked a U.S. appeals court to uphold a federal judge’s decision to invalidate the Obama administration’s health care reform legislation.
Boehner, an Ohio congressman, called the health law “job crushing” in a statement announcing the filing today. Republican Senate Minority Leader Mitch McConnell announced the filing of a brief by him and 43 of his party colleagues in a separate statement minutes later. Filing of the friend of the court briefs could not be independently confirmed.
In a lawsuit pressed by 26 states, U.S. District Judge C. Roger Vinson in Pensacola, Florida on Jan. 31 ruled unconstitutional a provision of the Patient Protection and Affordable Care Act requiring almost all Americans to obtain some form of health insurance coverage beginning in 2014.
Finding that the insurance mandate was a critical part of the law, Vinson invalidated the legislation in its entirety.
“While we continue working to repeal the job-crushing health care law, I’m proud to stand with these states and job creators in their efforts to overturn this government takeover that is destroying jobs, increasing costs, and jeopardizing coverage for millions of Americans,” Boehner said in his statement.
President Barack Obama’s administration is defending the legislation, which he signed last year, and has asked the Atlanta-based appellate court to overturn Vinson’s decision.
‘Commerce Power’
“The minimum coverage provision is a valid exercise of Congress’s commerce power,” the U.S. said in its brief filed April 1. “The interstate nature of the market for health care services is undisputed. Nor is it controverted that individuals participate in the market for health care services whether or not they have health insurance.”
McConnell, a U.S. Senator from Kentucky, said in his statement that the individual insurance mandate was “an unprecedented and unauthorized exercise by Congress” of its ability to regulate commerce.
Senate Majority Leader Harry Reid, a Nevada Democrat, together with former House speaker Nancy Pelosi of California, filed a joint friend-of-the-court brief last month in which they defended the health care law and asked the Atlanta court to reverse Vinson’s ruling.
Emergency Treatment
“The vast majority of uninsured Americans do seek and receive often expensive emergency medical care,” the Democratic leaders said. “The choice to opt out of paying for health insurance is not the same as opting out of the health care market.”
More than two dozen other briefs have been submitted by supporters and opponents of the law.
The appellate court is scheduled to hear argument from attorneys for the U.S. and the states on June 8.
The case is State of Florida v. U.S. Department of Health and Human Services, 11-11021, U.S. Court of Appeals for the 11th Circuit (Atlanta).
To contact the reporter on this story: Andrew Harris in Chicago at aharris16@bloomberg.net
To contact the editor responsible for this story: Michael Hytha at mhytha@bloomberg.net.
©2011 BLOOMBERG L.P.
http://www.bloomberg.com/news/2011-05-11/u-s-house-speaker-boehner-assails-obama-health-care-law-in-court-papers.html
===
Health Law to Save $120 Billion in Initial Years
By Drew Armstrong - May 12, 2011 11:03 AM CT
Medicare, the U.S. health insurance program for the elderly and disabled, said the health-care law will save the program $120 billion in the next five years through lower payments to hospitals and insurers.
About $50 billion of the savings come from reduced payments to insurers including Humana Inc. (HUM), WellPoint Inc. (WLP) and UnitedHealth Group Inc. (UNH), companies that lead the market in enrollees in Medicare Advantage, the privately run, government- subsidized portion of the U.S. health program.
The savings prove the health-care overhaul that Democrats passed last year is working, Medicare Deputy Administrator Jonathan Blum said.
“Savings are happening,” he said by phone. “The program is becoming more efficient. We are promoting payment reforms that are elevating quality, elevating performance and lowering costs.”
Cutting spending in Medicare was a major priority of the health-care overhaul U.S. President Barack Obama signed into law in March 2010. The law is projected by the Congressional Budget Office to reduce U.S. deficits by $143 billion, partly through almost $500 billion in cuts and savings from the Medicare program in a decade.
Other major savings in the law come from cutting payments to hospitals and providers of medical equipment like oxygen and wheelchairs.
Blum said the savings were in line with expectations [ http://cbo.gov/doc.cfm?index=11379 ] by the Obama administration. “We’re very much consistent with where we thought we would be,” he said.
To contact the reporter on this story: Drew Armstrong in Washington at darmstrong17@bloomberg.net;
To contact the editor responsible for this story: Adriel Bettelheim at abettelheim@bloomberg.net.
©2011 BLOOMBERG L.P.
http://www.bloomberg.com/news/2011-05-12/health-law-to-save-120-billion-in-initial-years.html
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Dr. Rebecca Jaffe, in Wilmington, Del., said that after years of resisting generic medicines, more patients were now requesting them to avoid paying hefty co-payments for brand-name drugs.
Tim Shaffer for The New York Times
By REED ABELSON
Published: May 13, 2011
The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.
The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use.
Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care.
Even with a halting economic recovery, doctors and others say many people are still extremely budget-conscious, signaling the possibility of a fundamental change in Americans’ appetite for health care.
“I am noticing my patients with insurance are more interested in costs,” said Dr. Jim King, a family practice physician in rural Tennessee. “Gas prices are going up, food prices are going up. They are deciding to put some of their health care off.” A patient might decide not to drive the 50 miles necessary to see a specialist because of the cost of gas, he said.
But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an MRI as soon as they have a bad headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.
For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.” Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. “The big question is whether it is going to stay weak or bounce back,” he said. “Nobody knows.”
Significant increases in how much people have to pay for their medical care may prevent a solid rebound. In recent years, many employers have sharply reduced benefits, while raising deductibles and co-payments so people have to reach deeper into their pockets.
In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.
Doctors, for one, say patients’ attitudes are changing. “Because it’s from Dollar 1 to Dollar 2,000, they are being really conscious of how they spend their money,” said Dr. James Applegate, a family physician in Grand Rapids, Mich. For example, patients question the need for annual blood work.
High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer. Mr. Welch, who has been a supporter of the need to overhaul insurance industry practices for the California Nurses Association union, said he hoped his medical training would help him determine when to go to the doctor. “I underestimated how much that cost would affect my behavior,” he said.
Dr. Rebecca Jaffe, a family practice doctor in Wilmington, Del., said more patients were asking for the generic alternatives to brand-name medicines, because of hefty co-payments. “Now, all of a sudden, they want the generic, when for years, they said they couldn’t take it,” she said.
The insurers, which base what they charge in premiums largely on what they expect to pay out in future claims, say they still expect higher demand for care later this year. “I think there’s a real concern about a bounce-back, a rebound, in utilization,” said Dr. Lonny Reisman, the chief medical officer for Aetna.
Because they say they expect costs to rebound, insurers have not been shy about asking for higher rates. In Oregon, for example, Regence BlueCross BlueShield, a nonprofit insurer that is the state’s largest, is asking for a 22 percent increase for policies sold to individuals. In California, regulators have been resisting requests from insurers to raise rates by double digits.
Some observers wonder if the insurers are simply raising premiums in advance of the full force of the health care law in 2014. The insurers’ recent prosperity — big insurance companies have reported first-quarter earnings that beat analysts expectations by an average of 30 percent — may make it difficult for anyone, politicians and industry executives alike, to argue that the industry has been hurt by the federal health care law. Insurers were able to raise premiums to cover the cost of the law’s early provisions, like insuring adult children up to age 26, and federal and state regulators have largely proved to be accommodating.
But 2014 and 2015 are likely to be far more challenging, as insurers are forced to adjust to the law’s greatest changes, like providing coverage to everyone regardless of whether they have an expensive pre-existing condition. “I think they’re going to go through a winter,” said Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, a research unit of the consulting firm Deloitte.
And while the slowing down of demand is good for insurers, at least in the short term, the concern is that patients may be tempted to skip important tests like colonoscopies or mammograms. The new health care law will eventually prevent most policies from charging patients for certain kinds of preventive care, but some plans still require someone to pay $500 toward a colonoscopy.
In recent times, insurers have prospered by pricing policies above costs, said Robert Laszewski, a former health insurance executive who is now a consultant in Alexandria, Va. The industry goes through underwriting cycles where the companies are better able to predict costs and make room for profits. “They’re benefiting from a very positive underwriting cycle,” he said.
“Maybe managed care is finally working,” he said. “Maybe this is the new normal.”
Still, he emphasized, health care costs, even if they are rising at 6 percent or 7 percent a year, are increasing at a much faster pace than overall inflation. “We haven’t solved the problem,” Mr. Laszewski said.
© 2011 The New York Times Company
http://www.nytimes.com/2011/05/14/business/14health.html [comments at http://community.nytimes.com/comments/www.nytimes.com/2011/05/14/business/14health.html ]
===
Rocky Clark, Paralyzed Athlete, Fights To Survive With No Health Insurance
By SHARON COHEN
AP
05/14/11 10:02 AM ET
ROBBINS, Ill. -- Rocky Clark sometimes dreams he's running track, racing around the oval as he once did, his heart pumping fast and his long legs a blur as he crossed the finish line.
Just thinking about it makes him smile.
Some nights, though, he has another recurring dream, this one pure fantasy. He sees himself in white shorts and track shoes, running again, then stopping, kneeling in prayer before a church door, somehow unable to make it inside.
When he awakens, Rocky Clark inhabits a world largely confined to four walls. Surrounding him are glass-encased autographed footballs and cherished memories of his glory days: Blue-and-gold ribbons. Trophies. And giant varsity letters from Eisenhower High School, his alma mater.
Clark can do little but swivel his head. He can't move his arms or legs. More than a decade ago, he was paralyzed from the neck down after being tackled in a high school football game. After nine months in rehab and a hospital bill approaching $1 million, he went home.
As a quadriplegic, his long-term prospects were slim. And over the years, there have been regular hospital stays and health scares – no surprise, considering Clark's fragile condition. He has just one working lung. His right lung is partially paralyzed; certain infections could kill him.
And yet Clark has endured. His doctor credits top-notch, round-the-clock home health care paid for by the school district's $5 million catastrophic health insurance policy. But that's run out, so the nurses and money are gone, replaced by his mother, growing financial pressures and a new sense of foreboding.
Rasul "Rocky" Clark beat the odds. And now he wonders if he's paying a price for his survival.
*
A week before his injury, Rocky Clark vowed to his mother that he'd strike it rich as an athlete one day and buy her a house.
Annette Clark remembers her son as an acrobatic kid who mastered back flips at age 7, ran too fast for a spanking and was always throwing balls and rocks – the inspiration of his nickname, bestowed upon him by an uncle. He took up track, football and baseball and excelled at all three, collecting ribbons, trophies and medals.
"I love awards," he now says. "It's a need thing."
On a warm September night in 2000 just four plays into the game, Clark – a high school junior and running back for Eisenhower's Cardinals – was grabbed by the shoulder and tackled. His head hit the ground. At first, he recalls, there was silence.
"When I started coming around, I heard a bunch of ringing," he says. "My whole body was vibrating, like a spring. I felt cold air. I tried to get up, but I couldn't."
Clark's neck had been broken in two places.
He spent about nine months at the Rehabilitation Institute of Chicago, wondering if his injury was some sort of cruel payback for something he had done in his 16 years.
"I said to myself ... `Maybe there was something I said I shouldn't have said. Maybe there was something I did that I shouldn't have done,'" he recalls. "I didn't do anybody wrong. I didn't get in trouble. ... I prayed every day. I didn't go to church all the time ... but I was good."
"Then," he says, pausing for a breath, "I realized things happen. Life doesn't always give us what we expect. I've got a spinal-cord injury, but there's nothing wrong with my brain. I've got a strong spirit and courage. You've just got to learn to deal with it."
Clark finished high school, donning cap and gown and having a friend wheel him across the stage so he could accept his diploma. He took some college courses, but a full-time schedule proved too difficult. (He'd like to return, but can't afford it.) He became a volunteer coach at Eisenhower, attending games.
All of it was made possible by the care provided through the district's insurance policy. And Clark says when the $5 million policy ran out several months ago, he assumed it would be renewed.
But it was not.
"A limit on life? That's crazy," Clark says, his pencil-thin frame covered by a white sheet. "I thought I'd be being taken care of the rest of my life."
His mother, Annette, who filed for bankruptcy because of financial problems, says they feel abandoned by the school. "They have a moral responsibility to take care of him," she says. "It depresses me and makes me angry. My son deserves better."
But the school district says both its new insurer and the one that held the $5 million policy refused its requests to obtain a new policy for Clark. "No one is going to sell us insurance for Rocky," says John Byrne, the school superintendent. "I feel kind of helpless."
Rocky Clark's injury is unusual, but his predicament is not.
A 2009 study estimated that 20,000 to 25,000 people in the U.S. reached the limits of their catastrophic health insurance. Many find themselves in dire straits – critically ill, facing crushing medical bills, struggling to remain in their homes, according to the state insurance commissioner.
"They're facing unenviable decisions that balance life, death, financial security and poverty – meaning the choice they make is a choice no person ever wants to make,'" says Michael McRaith, director of the Illinois Department of Insurance.
Annual limits are being phased out and lifetime caps ended last September as part of the new health reform law, so the ranks of those exhausting their policies will drop sharply over the coming years, and will totally be eliminated by 2014, McRaith says.
That doesn't help Clark, whose insurance has been so critical, according to Dr. Charles Beck, who has cared for him the past eight years. He wrote a letter to the school and insurance company, claiming "the loss of these benefits eventually is going to lead to his demise."
In recent weeks, Clark's mother, along with an array of supporters – some new, others longtime boosters – have drummed up attention with news stories, fundraisers, a letter-writing campaign to the school and two new websites. Their theory is simple: If they can keep his cause alive, they can keep him alive.
Denise King, whose husband is an associate pastor at a church in Chicago's Loop, knew about Clark and when she heard of his latest troubles, she couldn't sleep. "I thought this must be God telling me to do something," she says. The church hosted a small fundraiser in May.
This spotlight has helped: Dozens of people have donated money, supplies, even a water cooler.
They join others, notably the Chicago Bears, who've been generous supporters over the years, donating, among other things, more than $100,000 to make the Clark house in this southern Chicago suburb wheelchair accessible, according to Don Grossnickle, a deacon who heads Gridiron Alliance. The group helps disabled high school football players in the state and tries to draw attention to safety issues.
Clark's chances of surviving a decade or more were only about 10 percent, according to Beck. He credits Annette Clark – who receives government aid as a caregiver – and top-flight nurses with doing "an absolutely remarkable job," of protecting him from potentially fatal infections and illnesses.
He also praises the resilience of mother and son: "They don't fold," Beck says.
But Beck believes that Medicaid and other state support Clark now relies on aren't enough to provide the necessary supplies, medicine, breathing equipment and 24-hour specialized care. And moving him, Beck says, isn't a good option.
"If he had been living in a nursing home, he would have been dead five years ago," Beck says, and if he's sent to one now, "I would say goodbye to him. He would go to God. ... He requires more care than any nursing facility I am familiar with."
Insurance is a business, and Beck says he knows that. But he also believes that defying medical expectations has somehow become almost a punishment.
"It's confusing to me why their responsibility ends when that $5 million is gone ...," he says. "If he happened to outlive the actual projection ... does he suffer now because his care was good enough ... and he was lucky enough? I don't understand it."
*
At 27, the sculpted biceps that once filled the No. 21 red-and-white jersey have long since withered beneath a husk of skin and bones.
As Clark has grown from teen to a man, he's learned to adjust to a life where someone else has to brush his teeth or scratch an itch.
He misses using his hands: He liked to sketch as a teen – his walls are adorned with pencil drawings of people and dogs that show raw promise. And he wonders how far he could have gone as an athlete. "To have so much talent and never reach my full potential ...," he says, his raspy voice trailing off in a whisper.
But Clark tries to focus on what he has, not what he's lost. An iron will. Drive. And pride. "People tell me how inspirational I am," he says. "I've always been a motivator."
He relies on faith, too: "I leave it in God's hands." And he says it's pointless to be bitter.
"There's always someone who's got it worse than you," he says. And yet, he adds: "There are people who are not in my situation and they take life for granted. They have no determination. They don't know things can take a turn for the worse in the blink of an eye."
Annette Clark is her son's constant companion. She feeds him, washes him and sleeps on a recliner in the living room so she can hear him when he wakes at night. It's a punishing pace.
"Eventually, she'll break down," Beck says. "She has no ability to get a night's sleep. It's just a matter of time."
There's also sadness in her routine.
"It hurts for me to see him go down from muscle to nothing," she says. "It hurts for me when I have to turn him. It really hurts my heart. ... I have moments when I feel like throwing my hands up. I want to ask why. ... I have my moments when I want to run away."
Instead, she soldiers on.
From mid-April through early May, Rocky Clark was hospitalized with a blood clot in his paralyzed right lung.
The morning after he was admitted, at 1 a.m., Annette Clark says her son looked at her and declared: "`I'm tired of being sick.'"
"What are you telling me?" she asked. Then, sensing he might be giving up, she warned: "Don't say that to me anymore."
She walked out into the hall and cried.
When she returned, he was asleep, and she wiped a tear running down his face.
*
On the Net: http://www.rasulrockyclark.com/
*
Sharon Cohen, a Chicago-based national writer for The Associated Press, can be reached at features(at)ap.org.
Copyright 2011 The Associated Press
http://www.huffingtonpost.com/2011/05/14/rocky-clark-paralyzed-ath_n_861996.html [with comments] [also at e.g. http://www.seattlepi.com/news/article/Money-gone-paralyzed-athlete-fights-to-survive-1379544.php ]
===
U.S. House Speaker Boehner Assails Obama Health-Care Law in Court Papers
By Andrew Harris - May 11, 2011 4:21 PM CT
John Boehner, the Republican speaker of the U.S. House of Representatives, asked a U.S. appeals court to uphold a federal judge’s decision to invalidate the Obama administration’s health care reform legislation.
Boehner, an Ohio congressman, called the health law “job crushing” in a statement announcing the filing today. Republican Senate Minority Leader Mitch McConnell announced the filing of a brief by him and 43 of his party colleagues in a separate statement minutes later. Filing of the friend of the court briefs could not be independently confirmed.
In a lawsuit pressed by 26 states, U.S. District Judge C. Roger Vinson in Pensacola, Florida on Jan. 31 ruled unconstitutional a provision of the Patient Protection and Affordable Care Act requiring almost all Americans to obtain some form of health insurance coverage beginning in 2014.
Finding that the insurance mandate was a critical part of the law, Vinson invalidated the legislation in its entirety.
“While we continue working to repeal the job-crushing health care law, I’m proud to stand with these states and job creators in their efforts to overturn this government takeover that is destroying jobs, increasing costs, and jeopardizing coverage for millions of Americans,” Boehner said in his statement.
President Barack Obama’s administration is defending the legislation, which he signed last year, and has asked the Atlanta-based appellate court to overturn Vinson’s decision.
‘Commerce Power’
“The minimum coverage provision is a valid exercise of Congress’s commerce power,” the U.S. said in its brief filed April 1. “The interstate nature of the market for health care services is undisputed. Nor is it controverted that individuals participate in the market for health care services whether or not they have health insurance.”
McConnell, a U.S. Senator from Kentucky, said in his statement that the individual insurance mandate was “an unprecedented and unauthorized exercise by Congress” of its ability to regulate commerce.
Senate Majority Leader Harry Reid, a Nevada Democrat, together with former House speaker Nancy Pelosi of California, filed a joint friend-of-the-court brief last month in which they defended the health care law and asked the Atlanta court to reverse Vinson’s ruling.
Emergency Treatment
“The vast majority of uninsured Americans do seek and receive often expensive emergency medical care,” the Democratic leaders said. “The choice to opt out of paying for health insurance is not the same as opting out of the health care market.”
More than two dozen other briefs have been submitted by supporters and opponents of the law.
The appellate court is scheduled to hear argument from attorneys for the U.S. and the states on June 8.
The case is State of Florida v. U.S. Department of Health and Human Services, 11-11021, U.S. Court of Appeals for the 11th Circuit (Atlanta).
To contact the reporter on this story: Andrew Harris in Chicago at aharris16@bloomberg.net
To contact the editor responsible for this story: Michael Hytha at mhytha@bloomberg.net.
©2011 BLOOMBERG L.P.
http://www.bloomberg.com/news/2011-05-11/u-s-house-speaker-boehner-assails-obama-health-care-law-in-court-papers.html
===
Health Law to Save $120 Billion in Initial Years
By Drew Armstrong - May 12, 2011 11:03 AM CT
Medicare, the U.S. health insurance program for the elderly and disabled, said the health-care law will save the program $120 billion in the next five years through lower payments to hospitals and insurers.
About $50 billion of the savings come from reduced payments to insurers including Humana Inc. (HUM), WellPoint Inc. (WLP) and UnitedHealth Group Inc. (UNH), companies that lead the market in enrollees in Medicare Advantage, the privately run, government- subsidized portion of the U.S. health program.
The savings prove the health-care overhaul that Democrats passed last year is working, Medicare Deputy Administrator Jonathan Blum said.
“Savings are happening,” he said by phone. “The program is becoming more efficient. We are promoting payment reforms that are elevating quality, elevating performance and lowering costs.”
Cutting spending in Medicare was a major priority of the health-care overhaul U.S. President Barack Obama signed into law in March 2010. The law is projected by the Congressional Budget Office to reduce U.S. deficits by $143 billion, partly through almost $500 billion in cuts and savings from the Medicare program in a decade.
Other major savings in the law come from cutting payments to hospitals and providers of medical equipment like oxygen and wheelchairs.
Blum said the savings were in line with expectations [ http://cbo.gov/doc.cfm?index=11379 ] by the Obama administration. “We’re very much consistent with where we thought we would be,” he said.
To contact the reporter on this story: Drew Armstrong in Washington at darmstrong17@bloomberg.net;
To contact the editor responsible for this story: Adriel Bettelheim at abettelheim@bloomberg.net.
©2011 BLOOMBERG L.P.
http://www.bloomberg.com/news/2011-05-12/health-law-to-save-120-billion-in-initial-years.html
===
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