We Need to Do Better

Last week New Hampshire lost two young university women to suspected Ecstasy or MDMA overdoses.  We offer our deepest sympathies to the families and friends of these women.  Such tragedies highlight the problems we face of drug use and addiction in New Hampshire and serve as a call to action to do all we can to prevent the physical and emotional harm that result from substance use and abuse.

50 Years Ago Today

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” -- Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights, 1966

Fifty years ago today, nearly 250,000 people joined together in the March on Washington for Jobs and Freedom, calling for human, civil and economic rights for African Americans.  This march has been heralded as one of the greatest political rallies in our nation’s history and is widely credited for helping pass the Civil Rights Act of 1964 and the Voting Rights Act of 1965 (which has now recently come under attack).

Overdiagnosed? The wrong prescription?

I recently saw a patient who came to me looking for an antidepressant. She explained that she is under a great deal of stress at home and work. We talked about the impact of the stress on her ability to function, sleep and participate in enjoyable activities. I asked her about suicidal ideation and administered a standardized, evidence-based, depression screening tool, the PHQ-9 (Physician Health Questionnaire 9. (You can download it here)

Medicaid Expansion Part 2: Understanding the Health Insurance Premium Payment Program

Two weeks ago I wrote about the work that I am doing on the Medicaid Expansion Study Commission and mentioned the Health Insurance Premium Payment Program, or HIPP Program. Since I received a number of emails from you asking for more information about the program and what role it may play in Medicaid expansion, I am writing about it today.

The Medicaid expansion population includes adults with or without children who make 0-138% of the federal poverty level (FPL), meaning individuals who earn less than $15,500 annually. Many people in the expansion population work in low-paying jobs, often doing seasonal work or in the hospitality industry. Currently, only parents who make less than 54% of FPL (earning less than $6,300 annually) are eligible for Medicaid. So, childless adults and parents making more than 54% of FPL define the expansion population.

Violence as a Public Health Issue

The violent events of the past year and my writing about them here have provoked strong feelings among our members and raised, I think, good questions like: What can I do as a physician to impact this problem? Do I even have a role?  The problem seems so big that it is very difficult for us to get our hands around.  Are there only policy solutions? Are there clinical solutions?  Are there community solutions? Or, is this just the way things are and we should accept them? 

Moving Towards Medicaid Expansion

Because of our hard work on expanding coverage to the uninsured in New Hampshire, I was asked to serve on the Medicaid Expansion Study Commission and I wanted to share some updates from this.  The Commission was set up to give the State more time to study expansion so that the Legislature can possibly come back for a special session this fall so that we can take full advantage of federal funds.  So far we have met three times and have been given background information on the Medicaid program, what it costs and who it serves, and options for expansion.  In NH, Medicaid is a 50-50 partnership between the federal and state governments.  Under expansion, the newly covered population would be 100% financed by the federal government for 3 years and then would titrate down to 90% by 2021 and the state would be responsible for 10% into the future. 

Have I got your attention?

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too. - President John F. Kennedy, Sept. 12, 1962

The right to bear arms.....

"A 7-year-old boy was killed Thursday at a Fourth of July celebration in Virginia after someone evidently fired a gun in the air." July 4, 2013

Will Therapeutic Cannabis Be Part of Your Practice?

The New Hampshire House and Senate have crafted and passed a therapeutic cannabis bill that Gov. Maggie Hassan is poised to sign soon, and now we, the physicians of New Hampshire, must decide how to incorporate or not incorporate this into our practices.  New Hampshire's bill is unique, and, with input from NHMS, we helped make this the tightest therapeutic cannabis bill in the country by limiting its scope, eliminating the home-grow provision, establishing that there must be at least a three-month ongoing relationship with a physician or nurse practitioner and limiting patient possession to no more than 2 ounces.  

It's Playoff Time for Hockey, Basketball & the NH Legislature

This week, legislators have been meeting in committees of conference (C of C) to resolve House and Senate differences on many bills including four bills being followed closely by NHMS.

Last week, pathologists contacted NHMS after identifying a potential problem in the genetic counseling bill, SB135. Via emails, phone calls and live testimony, NHMS was able to explain the problem to key legislators and offer amended language. At Monday’s C of C, House and Senate conferees unanimously adopted the amendment.

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