Letters to the Editor<\/a>\u00a0is a periodic feature. We\u00a0 welcome all comments<\/a>\u00a0and will publish a selection. We edit for length and clarity and require full names.<\/em><\/p>\n

Coming Full Circle on Protections for Those With Disabilities<\/strong><\/p>\n

As a retired special education teacher, I\u2019m wondering why our elderly in retirement homes aren\u2019t covered by the American with Disabilities Act (\u201c\u2018Impending Intergenerational Crisis\u2019: Americans With Disabilities Lack Long-Term Care Plans<\/a>,\u201d Dec. 11). The act covers all the issues faced by our elderly in retirement homes as for children with these same needs. Students get a yearly prescription plan through a meeting with their parents, all who come in contact with them to provide services, and an administrator. Why isn\u2019t this yearly plan in place for our elderly in retirement or nursing homes? Children go from newborns to toddlers, and on up through the growth and maturity ladder. Our elderly go through these same stages but in reverse. The care we give the elderly should mirror the care given to children albeit for, perhaps, a longer time in each stage. This would necessitate some major changes to existing federal, state, and local legislation. I get that all but the most dedicated and involved would fight this idea and consider our older population as throwaways. As Florida Gov. Ron DeSantis said, \u201cLet them die.\u201d Thank you for allowing this opportunity to throw in my two cents.<\/p>\n

\u2014 Judy Galt, Orange Park, Florida<\/em><\/p>\n

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I hadn\u2019t given this much thought but I do see it. Baby-boomer generation will pass and disabled offspring may more often lack adequate plans: \u201cImpending Intergenerational Crisis\u2019: Americans With Disabilities Lack Long-Term Care Plans\u201d | Kaiser Health News https:\/\/t.co\/4VIOUwbLVk<\/a><\/p>\n
\u2014 Carl Hindy, Ph.D., Clinical Psychologist (@DrCarlHindy) November 11, 2022<\/a><\/p><\/blockquote>\n
\u2014 Carl Hindy, Exeter, New Hampshire<\/em><\/p>\n
Revoking the Disability Tax<\/strong><\/p>\n
Thank you so much for highlighting the difficulty blind individuals have with medical bills (\u201cThe Disability Tax: Medical Bills Remain Inaccessible for Many Blind Americans<\/a>,\u201d Dec. 2). I almost never see anything related to blindness and accessibility go through my news feed, so even though your findings are depressing, it made my day to know this issue was being highlighted in the national news!<\/p>\n
\u2014 Brandon Keith Biggs, Atlanta<\/em><\/p>\n
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Not surprised. I\u2019m #deaf<\/a> & medical providers still expect me to be able to hear & understand important info over the phone. The Americans With Disabilities Act has no teeth. #blind<\/a> #ada<\/a> #kaiser<\/a> #hhs<\/a> #California<\/a> #Indiana<\/a> #aetna<\/a> #anthem<\/a> #MedTwitter<\/a> #hoh<\/a> https:\/\/t.co\/1F9TusBBGa<\/a><\/p>\n
\u2014 Jim Hankins (@ltecato) December 2, 2022<\/a><\/p><\/blockquote>\n
\u2014 Jim Hankins, <\/em>Anaheim, California<\/em><\/p>\n
I want to personally thank you for reporting on this issue. There are workarounds for many of us to get around them. Unfortunately, it\u2019s a separate but equal predicament. And this is not just with the medical system. Persons who are blind, who utilize technology, often rely on paid subscription services for completing visual tasks. One of them is called Aira. Trained people guide blind people through various tasks like navigating and filling out forms on inaccessible websites or take pictures of bills and read it to them.<\/p>\n
The separate-but-equal status comes in because the general population is unaware the blind are unemployed or underemployed. The employment rate for the blind is under 20% less than convicted felons. The underemployment rate is 78%, in part because of outdated subminimum wage laws under Section 14(c) of the federal Fair Labor Standards Act that allows disabled people in America to be paid below federal minimum wage by all the major corporations, and everything in between.<\/p>\n
Again, thank you for reporting on information that most people and the media won\u2019t because they are not the fluffy, fuzzy, feel-good issues like blind people finishing college or doing something most people with vision simply do every day.<\/p>\n
\u2014 William F. O\u2019Donnell, Austin, Texas<\/em><\/p>\n
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Good article on how plan sponsors grab manufacturers\u2019 copay support & patient assistance funds for themselves (instead of for patients)Not news to Drug Channels readers, but still nice to see mainstream press coverage @Julie_appleby<\/a> @KHNews<\/a> https:\/\/t.co\/V6WfPeUDc6<\/a><\/p>\n
\u2014 Adam J. Fein (@DrugChannels) December 11, 2022<\/a><\/p><\/blockquote>\n
\u2014 Adam J. Fein, Philadelphia<\/em><\/p>\n
A Benefit for Big Pharma<\/strong><\/p>\n
Who profits from employer patient assistance and employee copay plans? It should come as no shock that the wolf in sheep\u2019s clothes are, indeed, the pharmaceutical companies.<\/p>\n
Your article \u201cEmployers Use Patient Assistance Programs to Offset Their Own Costs\u201d<\/a> (Dec. 6) neglected to report on a frequently employed strategy that represents a massive return on investment for Big Pharma: A pharmaceutical manufacturer will cover the costs of a patient\u2019s copay, sometimes even the entire deductible, to keep the patient on its more expensive product (over potentially cheaper alternatives the patient\u2019s health care plan might prefer). Once the deductible is met the patient\u2019s health care plan is forced to pay 80% or more of the patient\u2019s drug costs. And, once the patient reaches their maximum out-of-pocket (MOOP) threshold, their health care plan starts paying 100% costs \u2014 and the drug company returns to making 100% profit and no longer paying any assistance.<\/p>\n
Pharmaceutical manufacturers say the assistance programs are evidence of their commitment to maintaining the affordability of prescription drugs, but according to a recent report by the Congressional Research Service, \u201cPrescription Drug Discount Coupons and Patient Assistance Programs (PAPs),\u201d<\/a> while a drug discount coupon may reduce the amount an insured consumer must pay out-of-pocket for a drug, it generally does not reduce the price charged to an insurer or government program for the drug.<\/p>\n
The recently published \u201cDrug Manufacturers\u2019 Billion-Dollar Scheme,\u201d<\/a> by the Regence Health Policy Center, asked this intriguing question: Are copay coupons \u201cthe solution for the unreasonable cost of specialty medications or a carefully crafted trojan horse disrupting affordability in our health care system?\u201d<\/p>\n
We know the answer, and it should have been addressed in your article, which otherwise portrays Big Pharma as heroes.<\/p>\n
If pharmaceutical manufacturers really wanted to assist patients, they should stop subsidizing patient copays and deductibles, ripping off patients (and their health care plans), and establish reasonable drug prices in the U.S., as they do in every other developed nation.<\/p>\n
\u2014 James Gelfand, president of The ERISA Industry Committee<\/a>, Washington, D.C.<\/em><\/p>\n
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If companies, including insurers, channeled their creativity into making care better and more affordable for patients, what a wonderful world it would be. https:\/\/t.co\/s1M5V1UTZF<\/a> Comment if you agree.<\/p>\n
\u2014 David Johnson (@4sighthealth_) December 14, 2022<\/a><\/p><\/blockquote>\n
\u2014 David Johnson, Chicago<\/em><\/p>\n
Community Health Centers Are Transparent, Trusted, and Essential<\/strong><\/p>\n
In what appears to be a pattern, the KHN article by Phil Galewitz and Bram Sable-Smith about community health centers (\u201cWhen Malpractice Occurs at Community Health Centers, Taxpayers Pay<\/a>,\u201d Nov. 28) uses selective data and outlier cases to paint a grossly inaccurate picture of the life-sustaining care that community health centers provide to 30 million Americans.<\/p>\n
Contrary to the distorted conclusions drawn by the article\u2019s focus on very few proceedings, health centers provide high-quality care for tens of millions of underserved and vulnerable patients in the U.S.<\/p>\n
Given the critical role health centers play in health care delivery and the substantial increase in the number of health centers and patients, malpractice claims are an unfortunate reality. KHN\u2019s narrative focuses on a few cherry-picked cases even as it acknowledges that \u201csettlements and court judgments do not measure the clinics\u2019 overall performance.\u201d The article\u2019s focus on claims payouts during 2018 and 2021, though tragic, represents a tiny fraction of 117 million patients served and 477 million visits \u2014 meaning the reporters focused on far less than 1 percent of patients.<\/p>\n
The larger and unassailable story is that health centers enforce rigorous safeguards to ensure the best patient care. Federal Tort Claims Act coverage \u2014 the federal coverage that is the focus of this article \u2014 is not automatically granted to health center grantees. Rather, health centers must implement solid quality improvement and risk management programs to qualify for and maintain FTCA coverage. Such coverage allows essential health care services to remain affordable and accessible to economically challenged patients when and where they need it. Additionally, health centers are subject to on-site auditing of these processes to ensure they meet appropriate standards and function as intended. FTCA coverage makes health centers even more vigilant on quality of care \u2014 not less.<\/p>\n
Every dollar invested in health centers returns value to American taxpayers. The program generates annual system-wide savings of $24 billion yearly because fewer health center patients require emergency room visits and hospitalizations. More important than dollars saved, health centers are transparent, trusted, and essential stewards of public health. We stand by their long and successful track record.<\/p>\n
\u2014 Rachel Gonzales-Hanson, interim CEO and president of the National Association of Community Health Centers, Bethesda, Maryland<\/em><\/p>\n
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and another recent story about malpractice at community health centers https:\/\/t.co\/bh7XIMfVMA<\/a><\/p>\n
\u2014 Taylor Emrey Glascock (@tayloremrey) November 30, 2022<\/a><\/p><\/blockquote>\n
\u2014 Taylor Emrey Glascock, Chicago<\/em><\/p>\n
STD Testing: Don\u2019t Try This at Home?<\/strong><\/p>\n
Though home testing for sexually transmitted infections would be valuable, maximizing the testing technology we have now would be even more valuable (\u201cA New Use for Dating Apps: Chasing STDs<\/a>,\u201d Nov. 30). Sixty percent of all STIs in high-risk persons cannot be diagnosed via a urine sample because they are extragenital (in the throat or rectum). STI testing should include screening urine as well as throat and rectum swabs for many people. This could be accomplished by labs giving clients swabs to self-collect, however Hologic (the company that produces the Aptima system pictured in your article) has not done the validation studies to allow its system to be used on self-collected extragenital tests. Thus, a patient must go to a provider to get the swabs collected, rather than just go to the lab directly after orders are submitted. This is not an issue of new technology; this is an issue of ensuring we are using what we have to its full capacity, ensuring adequate extragenital screening, and ensuring it can be done in the most convenient way possible. Molecular screens allow for home-based testing (collected at home and sent back to be processed). Halogen tests, the system used by Quest, Labcorp, CPL, etc., do not. Though having home-based rapid results would be great (which, of course, would require self-collected samples), ensuring we are able to maximize the technology we have available now would be a big step forward.<\/p>\n
\u2014 Christine Brennan, New Orleans<\/em><\/p>\n
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The use of apps may have exploded since, but we were doing this 20 years ago when I was an #EIS<\/a> officer @CDCgov<\/a>. In fact I had to get access to certain blocked websites \u2013 it was interesting explaining that to the IT folks. https:\/\/t.co\/8zsq887ECp<\/a><\/p>\n
\u2014 Michael Greenberg MD (@greenbergepi) December 4, 2022<\/a><\/p><\/blockquote>\n
\u2014 Dr. Michael Greenberg, Bethlehem, Pennsylvania<\/em><\/p>\n<\/div>\n