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Arizona Cuts Financing for Transplant Patients
PHOENIX — Even physicians with decades of experience telling patients that their lives are nearing an end are having difficulty discussing a potentially fatal condition that has arisen in Arizona: Death by budget cut.
Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.
“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”
Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.
Francisco Felix, 32, a father of four who has hepatitis C and is in need of a liver, received news a few weeks ago that a family friend was dying and wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant.
He was prepared anyway at Banner Good Samaritan Medical Center as his relatives scrambled to raise the needed $200,000. When the money did not come through, the liver went to someone else on the transplant list.
“I know times are tight and cuts are needed, but you can’t cut human lives,” said Mr. Felix’s wife, Flor. “You just can’t do that.”
Such high drama is unfolding regularly here as more and more of the roughly 100 people affected by the cuts are becoming known: the father of six who died before receiving a bone marrow transplant, the plumber in need of a new heart and the high school basketball coach who struggles to breathe during games at high altitudes as she awaits a lung transplant.
“I appreciate the need for budget restraints,” said Dr. Andrew M. Yeager, a University of Arizona professor who is director of the Blood and Marrow Transplantation Program at the Arizona Cancer Center. “But when one looks at a potentially lifesaving treatment, admittedly expensive, and we have data to support efficacy, cuts like this are shortsighted and sad.”
State Medicaid officials said they recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.
“As an agency, we understand there have been difficult cuts and there will have to be more difficult cuts looking forward,” said Jennifer Carusetta, chief legislative liaison at the state Medicaid agency.
The issue has led to a fierce political battle, with Democrats condemning the reductions as “Brewercare,” after Gov. Jan Brewer.
“We made it very clear at the time of the vote that this was a death sentence,” said State Senator Leah Landrum Taylor, a Democrat. “This is not a luxury item. We’re not talking about cosmetic surgery.”
The Republican governor has in turn blamed “Obamacare,” meaning the federal health care overhaul, for the transplant cuts even though the Arizona vote came in March, before President Obama signed that bill into law.
But a top Republican, State Representative John Kavanagh, has already pledged to reconsider at least some of the state’s cuts for transplants when the Legislature reconvenes in January. Mr. Kavanagh, chairman of the Appropriations Committee, said he does not believe lawmakers had the full picture of the effect of the cuts on patients when they voted.
“It’s difficult to be linked to a situation where people’s lives are jeopardized and turned upside down,” he said in an interview. “Thankfully no one has died as a result of this, and I believe we have time to rectify this.”
Across the country, states have restricted benefits to their Medicaid programs, according to a 50-state survey published in September by the Kaiser Commission on Medicaid and the Uninsured. But none have gone as far as Arizona in eliminating some transplants, which are considered optional services under federal law.
Before the Legislature acted, Arizona’s Medicaid agency had provided an analysis to lawmakers of the transplants that were cut, which many health experts now say was seriously flawed. For instance, the state said that 13 of 14 patients under the state’s health system who received bone marrow transplants from nonrelatives over a two-year period died within six months.
But outside specialists said the success rates were considerably higher, particularly for leukemia patients in their first remission.
“Something needs to be done,” said Dr. Emmanuel Katsanis, a bone marrow transplant expert at the University of Arizona. “There’s no doubt that people aren’t going to make it because of this decision. What do you tell someone? You need a transplant but you have to raise the money?”
Just before the Oct. 1 deadline, Mark Price, a father of six who was fighting leukemia, learned he needed a bone marrow transplant. But his doctor, Jeffrey R. Schriber, found donor matches for his transplant the very day the new rules went into effect, and Mr. Price no longer qualified for coverage by the Arizona Health Care Cost Containment System, the formal name for the state’s Medicaid program.
What happened next was at once inspirational and heart-rending.
Out of the blue, an anonymous financial donor quickly stepped forward and agreed to cover the hundreds of thousands of dollars needed for Mr. Price’s surgery. But Mr. Price died last weekend, after his cancer returned before the operation could be done. He was buried on Thursday, next to his grandfather.
“It’s not correct to say that he died as a result of the cuts,” said Dr. Schriber, who is active in lobbying for the financing to be restored. “Did it prey on his mind? Did it make his last days more difficult? No doubt.”
Elsewhere, the fund-raising is already under way.
Mr. Felix and others are now trying to raise enough for new organs through NTAF, a nonprofit organization based in Pennsylvania formerly known as the National Transplant Assistance Fund that helps transplant patients pay for their medical costs. National coverage of their plight has already led to more than $100,000 in donations for some of the patients affected by the budget cuts. The Felix family is also planning a yard sale this weekend so he does not lose the chance to get another liver.
There has been a flurry of lobbying to persuade the state to reverse the decision. Dr. Gruessner said he and others met with state health officials recently to propose other cuts associated with transplants, like eliminating tests typically conducted before surgery.
If the Legislature does decide to reconsider the cuts, one of the affected people, a plumber and father of three named Randy Shepherd, 36, who has an ailing heart and needs a transplant, plans to attend the debate.
“I’m trying not to take it personally,” he said of being cut out of the program. “None of the politicians had heard of me when they made their decision. They didn’t say, ‘Let’s kill this guy.’ ”
http://www.medhelp.org/posts/new_with_new_subject?forum_id=76
Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.
“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”
Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.
Francisco Felix, 32, a father of four who has hepatitis C and is in need of a liver, received news a few weeks ago that a family friend was dying and wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant.
He was prepared anyway at Banner Good Samaritan Medical Center as his relatives scrambled to raise the needed $200,000. When the money did not come through, the liver went to someone else on the transplant list.
“I know times are tight and cuts are needed, but you can’t cut human lives,” said Mr. Felix’s wife, Flor. “You just can’t do that.”
Such high drama is unfolding regularly here as more and more of the roughly 100 people affected by the cuts are becoming known: the father of six who died before receiving a bone marrow transplant, the plumber in need of a new heart and the high school basketball coach who struggles to breathe during games at high altitudes as she awaits a lung transplant.
“I appreciate the need for budget restraints,” said Dr. Andrew M. Yeager, a University of Arizona professor who is director of the Blood and Marrow Transplantation Program at the Arizona Cancer Center. “But when one looks at a potentially lifesaving treatment, admittedly expensive, and we have data to support efficacy, cuts like this are shortsighted and sad.”
State Medicaid officials said they recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.
“As an agency, we understand there have been difficult cuts and there will have to be more difficult cuts looking forward,” said Jennifer Carusetta, chief legislative liaison at the state Medicaid agency.
The issue has led to a fierce political battle, with Democrats condemning the reductions as “Brewercare,” after Gov. Jan Brewer.
“We made it very clear at the time of the vote that this was a death sentence,” said State Senator Leah Landrum Taylor, a Democrat. “This is not a luxury item. We’re not talking about cosmetic surgery.”
The Republican governor has in turn blamed “Obamacare,” meaning the federal health care overhaul, for the transplant cuts even though the Arizona vote came in March, before President Obama signed that bill into law.
But a top Republican, State Representative John Kavanagh, has already pledged to reconsider at least some of the state’s cuts for transplants when the Legislature reconvenes in January. Mr. Kavanagh, chairman of the Appropriations Committee, said he does not believe lawmakers had the full picture of the effect of the cuts on patients when they voted.
“It’s difficult to be linked to a situation where people’s lives are jeopardized and turned upside down,” he said in an interview. “Thankfully no one has died as a result of this, and I believe we have time to rectify this.”
Across the country, states have restricted benefits to their Medicaid programs, according to a 50-state survey published in September by the Kaiser Commission on Medicaid and the Uninsured. But none have gone as far as Arizona in eliminating some transplants, which are considered optional services under federal law.
Before the Legislature acted, Arizona’s Medicaid agency had provided an analysis to lawmakers of the transplants that were cut, which many health experts now say was seriously flawed. For instance, the state said that 13 of 14 patients under the state’s health system who received bone marrow transplants from nonrelatives over a two-year period died within six months.
But outside specialists said the success rates were considerably higher, particularly for leukemia patients in their first remission.
“Something needs to be done,” said Dr. Emmanuel Katsanis, a bone marrow transplant expert at the University of Arizona. “There’s no doubt that people aren’t going to make it because of this decision. What do you tell someone? You need a transplant but you have to raise the money?”
Just before the Oct. 1 deadline, Mark Price, a father of six who was fighting leukemia, learned he needed a bone marrow transplant. But his doctor, Jeffrey R. Schriber, found donor matches for his transplant the very day the new rules went into effect, and Mr. Price no longer qualified for coverage by the Arizona Health Care Cost Containment System, the formal name for the state’s Medicaid program.
What happened next was at once inspirational and heart-rending.
Out of the blue, an anonymous financial donor quickly stepped forward and agreed to cover the hundreds of thousands of dollars needed for Mr. Price’s surgery. But Mr. Price died last weekend, after his cancer returned before the operation could be done. He was buried on Thursday, next to his grandfather.
“It’s not correct to say that he died as a result of the cuts,” said Dr. Schriber, who is active in lobbying for the financing to be restored. “Did it prey on his mind? Did it make his last days more difficult? No doubt.”
Elsewhere, the fund-raising is already under way.
Mr. Felix and others are now trying to raise enough for new organs through NTAF, a nonprofit organization based in Pennsylvania formerly known as the National Transplant Assistance Fund that helps transplant patients pay for their medical costs. National coverage of their plight has already led to more than $100,000 in donations for some of the patients affected by the budget cuts. The Felix family is also planning a yard sale this weekend so he does not lose the chance to get another liver.
There has been a flurry of lobbying to persuade the state to reverse the decision. Dr. Gruessner said he and others met with state health officials recently to propose other cuts associated with transplants, like eliminating tests typically conducted before surgery.
If the Legislature does decide to reconsider the cuts, one of the affected people, a plumber and father of three named Randy Shepherd, 36, who has an ailing heart and needs a transplant, plans to attend the debate.
“I’m trying not to take it personally,” he said of being cut out of the program. “None of the politicians had heard of me when they made their decision. They didn’t say, ‘Let’s kill this guy.’ ”
http://www.medhelp.org/posts/new_with_new_subject?forum_id=76
This is insane, but the obvious answer will never be accepted. As millionaires & billionaires receive their tax cut and corporations continue to pay slave wages, and not to mention the benefits our "government representatives" receive.
My answer has become to do with less, and try not to support the corporate, war machine. \
Check out Scott and Helen Nearing.
carry one, do the best, love,
Mary4now
My answer has become to do with less, and try not to support the corporate, war machine. \
Check out Scott and Helen Nearing.
carry one, do the best, love,
Mary4now
National Transplant Medical Experts Insist Arizona Transplant Cuts Are Based On Flawed Data
Article Date: 14 Dec 2010 - 0:00 PST
The American Society of Transplant Surgeons (ASTS) has reviewed the evidence base used by Governor Jan Brewer (R-AZ) and the Arizona Legislature to deny coverage for specified transplants and determined the data is both flawed and outdated. In addition, the recommendations of designated medical consultants were ignored in many instances.
"This decision should be condemned on humanitarian and egalitarian grounds and focuses our attention on the health care rationing debate. It is a legitimate debate that our nation will inevitably be forced to have, but these important and necessary decisions should not be based on faulty medical evidence"
"The exclusion of coverage for these specified transplants is baseless," says ASTS President Michael M. Abecassis, MD, MBA. "We have made the case convincingly, yet several patients awaiting transplants are still being denied coverage, putting the lives of Arizona citizens in serious peril."
As one of the major medical societies representing transplant professionals, the ASTS calls on Governor Brewer and the Arizona state legislature to act immediately and rectify the fact that attempts to balance the budget have led to coverage decisions with no medical justification.
"This is not a political issue, but a life and death issue for medically approved transplant candidates who are being denied standard of care treatment (i.e., transplantation) for their end stage organ failure," states Dr. Abecassis. "We cannot knowledgeably comment on Arizona's financial situation, nor do we desire to be involved in any of the politics that surround the decision. Instead, as a primary society in the United States representing the field of organ transplantation, we have a responsibility to set the record straight regarding the flawed and outdated evidence used to deny life-saving transplants for patients with organ failure."
"This decision should be condemned on humanitarian and egalitarian grounds and focuses our attention on the health care rationing debate. It is a legitimate debate that our nation will inevitably be forced to have, but these important and necessary decisions should not be based on faulty medical evidence," adds Dr. Abecassis.
The ASTS in collaboration with other primary transplant organizations has compiled the information below to compel the Arizona legislature and Governor Brewer to reconsider this decision expeditiously, so that patients who would have enjoyed a longer and more productive life with transplantation will not die unjustly:
- Liver transplantation for hepatitis C may not be curative of hepatitis C, but it is curative of end-stage liver disease, it is life saving, and it results in excellent long-term survival exceeding 80% at 1 year and 60% at 5 years. In addition, with new antiviral therapies for hepatitis C, sustained viral response (curative of hepatitis C) can now be achieved in the majority of patients (>70%) and the current long-term survival rates will improve as a result.
- Lung transplantation is life saving, not palliative, for the majority of patients with end stage lung disease that receive lung transplants today. Indeed, the current system for organ allocation in the United States allocates donor lungs based on a scoring system designed to decrease the number of patients who die on the waiting list and to maximize survival following transplantation.
- The exclusion of heart transplantation for non-ischemic cardiomyopathy is not based on an accepted medical definition of non-ischemic cardiomyopathy. Instead, the definition used by the legislature is unique to the Arizona legislature, hardly a medical expert. As a consequence, this exclusion remains confusing to the transplant community. We have offered our assistance to clarify exactly what is being excluded and why. However, from a practical standpoint, only patients who have failed all known beneficial therapies are considered appropriate transplant candidates by the heart transplant community. In addition, since the priority for allocation of hearts to candidates on the waiting list is based on the likelihood of dying on the waiting list, it is rare that patients other than those being supported with mechanical support (heart assist pumps) or intravenous medications to support heart function even receive heart transplants in today's era of donor organ shortage.
- Pancreas after kidney transplant is clearly effective for highly selected recipients and, in fact, encourages living donor kidney transplantation followed by deceased donor pancreas transplantation in appropriate candidates. With the kidney donor waiting list currently exceeding 80,000 candidates, the use of living donor kidneys followed by pancreas transplantation, when needed, is better stewardship of the nation's limited donor organ supply. Recent data show that the results of pancreas after kidney are similar to those of combined kidney and pancreas transplantation suggesting that the decision made by the State of Arizona was based on outdated information.
"Transplantation is not experimental - it is accepted, beneficial care for patients with end stage organ failure," states Dr. Abecassis. "We cannot dictate what the Arizona lawmakers will ultimately decide, however we can unequivocally state that the cuts in transplant coverage will result in the unjustified and needless death of Arizona citizens. If this is not enough to justify reconsideration of coverage for these specified transplants, at least we will have provided Arizona lawmakers with accurate and current information so that their decisions can no longer be portrayed as having any medical basis."
Source:
American Society of Transplant Surgeons (ASTS)
http://www.medicalnewstoday.com/articles/211257.php
Article Date: 14 Dec 2010 - 0:00 PST
The American Society of Transplant Surgeons (ASTS) has reviewed the evidence base used by Governor Jan Brewer (R-AZ) and the Arizona Legislature to deny coverage for specified transplants and determined the data is both flawed and outdated. In addition, the recommendations of designated medical consultants were ignored in many instances.
"This decision should be condemned on humanitarian and egalitarian grounds and focuses our attention on the health care rationing debate. It is a legitimate debate that our nation will inevitably be forced to have, but these important and necessary decisions should not be based on faulty medical evidence"
"The exclusion of coverage for these specified transplants is baseless," says ASTS President Michael M. Abecassis, MD, MBA. "We have made the case convincingly, yet several patients awaiting transplants are still being denied coverage, putting the lives of Arizona citizens in serious peril."
As one of the major medical societies representing transplant professionals, the ASTS calls on Governor Brewer and the Arizona state legislature to act immediately and rectify the fact that attempts to balance the budget have led to coverage decisions with no medical justification.
"This is not a political issue, but a life and death issue for medically approved transplant candidates who are being denied standard of care treatment (i.e., transplantation) for their end stage organ failure," states Dr. Abecassis. "We cannot knowledgeably comment on Arizona's financial situation, nor do we desire to be involved in any of the politics that surround the decision. Instead, as a primary society in the United States representing the field of organ transplantation, we have a responsibility to set the record straight regarding the flawed and outdated evidence used to deny life-saving transplants for patients with organ failure."
"This decision should be condemned on humanitarian and egalitarian grounds and focuses our attention on the health care rationing debate. It is a legitimate debate that our nation will inevitably be forced to have, but these important and necessary decisions should not be based on faulty medical evidence," adds Dr. Abecassis.
The ASTS in collaboration with other primary transplant organizations has compiled the information below to compel the Arizona legislature and Governor Brewer to reconsider this decision expeditiously, so that patients who would have enjoyed a longer and more productive life with transplantation will not die unjustly:
- Liver transplantation for hepatitis C may not be curative of hepatitis C, but it is curative of end-stage liver disease, it is life saving, and it results in excellent long-term survival exceeding 80% at 1 year and 60% at 5 years. In addition, with new antiviral therapies for hepatitis C, sustained viral response (curative of hepatitis C) can now be achieved in the majority of patients (>70%) and the current long-term survival rates will improve as a result.
- Lung transplantation is life saving, not palliative, for the majority of patients with end stage lung disease that receive lung transplants today. Indeed, the current system for organ allocation in the United States allocates donor lungs based on a scoring system designed to decrease the number of patients who die on the waiting list and to maximize survival following transplantation.
- The exclusion of heart transplantation for non-ischemic cardiomyopathy is not based on an accepted medical definition of non-ischemic cardiomyopathy. Instead, the definition used by the legislature is unique to the Arizona legislature, hardly a medical expert. As a consequence, this exclusion remains confusing to the transplant community. We have offered our assistance to clarify exactly what is being excluded and why. However, from a practical standpoint, only patients who have failed all known beneficial therapies are considered appropriate transplant candidates by the heart transplant community. In addition, since the priority for allocation of hearts to candidates on the waiting list is based on the likelihood of dying on the waiting list, it is rare that patients other than those being supported with mechanical support (heart assist pumps) or intravenous medications to support heart function even receive heart transplants in today's era of donor organ shortage.
- Pancreas after kidney transplant is clearly effective for highly selected recipients and, in fact, encourages living donor kidney transplantation followed by deceased donor pancreas transplantation in appropriate candidates. With the kidney donor waiting list currently exceeding 80,000 candidates, the use of living donor kidneys followed by pancreas transplantation, when needed, is better stewardship of the nation's limited donor organ supply. Recent data show that the results of pancreas after kidney are similar to those of combined kidney and pancreas transplantation suggesting that the decision made by the State of Arizona was based on outdated information.
"Transplantation is not experimental - it is accepted, beneficial care for patients with end stage organ failure," states Dr. Abecassis. "We cannot dictate what the Arizona lawmakers will ultimately decide, however we can unequivocally state that the cuts in transplant coverage will result in the unjustified and needless death of Arizona citizens. If this is not enough to justify reconsideration of coverage for these specified transplants, at least we will have provided Arizona lawmakers with accurate and current information so that their decisions can no longer be portrayed as having any medical basis."
Source:
American Society of Transplant Surgeons (ASTS)
http://www.medicalnewstoday.com/articles/211257.php
The latest (Dec 11) I saw in the local news:
The Governor's Office is looking at possible ways to find money, such as seeking waivers from the federal government on mandatory medical services. Transplants are optional under Medicaid rules.
For example, a request to not cover gastric-bypass operations under the state's Medicaid alternative, the Arizona Health Care Cost Containment System, was rejected.
Brewer is now asking for a waiver on non-emergency medical transportation, such as to doctor's appointments for people in urban areas.
If OK'd, money would be redirected to transplant coverage.
Also, thankfully, one of our local representatives has introduced a bill to reinstate transplant coverage to all covered by AHCCCS.
speed
The Governor's Office is looking at possible ways to find money, such as seeking waivers from the federal government on mandatory medical services. Transplants are optional under Medicaid rules.
For example, a request to not cover gastric-bypass operations under the state's Medicaid alternative, the Arizona Health Care Cost Containment System, was rejected.
Brewer is now asking for a waiver on non-emergency medical transportation, such as to doctor's appointments for people in urban areas.
If OK'd, money would be redirected to transplant coverage.
Also, thankfully, one of our local representatives has introduced a bill to reinstate transplant coverage to all covered by AHCCCS.
speed
Interesting topic for sure! I heard about this on CNN! Gov Brewer is beyond belief and is bound to walk into somebody's fist or worse, soon!! I can't believe the ppl of AZ are letting her get away with this krap and some of the other stuff she is known for!! The lady is wacko!!
Does anyone remember the old butter or guns question concerning where a country puts its finances?
It is high time our government stop funding wars and start caring for its people.
It is high time our government stop funding wars and start caring for its people.
We alway's new capitalism was far from fair!, In the next 20 years only the top 2% of wage earners will be on the waiting list!
I couldn't agree more. If every elected official and there immediate family had to make do with the services offered to Medicaid patients things would improve for everyone immediately.
Why is there always enough money for war, but not for health care, education? It is a sad commentary when money is more valuable than a human life. Strange Brew,
I agree, what a great idea, all our "representatives" should have the benefit of being covered by medicaid.
I agree, what a great idea, all our "representatives" should have the benefit of being covered by medicaid.
I think this is what happened to my ex-husband. He was in Arizona waiting for a liver transplant and then went back to MA saying he couldn't get it any longer. Now he has liver cancer and not a good prognosis.
As an exercise in fiscal responsibility, Arizona should mandate only Medicaid health insurance availability for all state Medicaid agency representatives, their legislators, their governor, and immediate family members. After all, not having to contribute to state and elected officials' health premiums could probably save Arizona taxpayers more than $4.5 million a year.
Well, I guess it is progress. After all these are hard times and the last thing we need to spend money on is saving lives of people without adequate insurance.
Arizona - the fiscally responsible state.
Mike
Arizona - the fiscally responsible state.
Mike
Dat *****, I know a person there. Only diabeties meds that work for her they wont pay for. so instead of gluclose around 140 (not the best) she takes other insulin and remains over 400. She will die young there. Arizona needs a shake up. thanks for the 411.
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