The Star-Ledger

Sen. Menendez Meets With N.J. Health Officials Over Upcoming Reform Debate

The Star-Ledger — Tuesday, April 7, 2009

By MaryAnn Spoto / The Star-Ledger

U.S. Sen. Bob Menendez (D-N.J.) spent today in closed-door meetings with doctors, nurses, patients and others with a stake in the future of America's health care system, gathering an arsenal of complaints and concerns he plans to take to the talks in Washington, D.C.

The future of America's health care system may rest on horror stories such as Kia Moore and her 20-month-old son. Xavier Hylton was born at Our Lady of Lourdes Medical Center in Camden with two malfunctioning kidneys and requires daily dialysis treatments as he awaits a transplant.

He had grown enough to medically qualify for that transplant by March, but Moore said the procedure was delayed at least six months by a struggle over insurance coverage. Today, she said, her son should already have a functioning kidney and be on his way to living a near-normal life.

Moore, who spends more than $1,000 a month just for her son's prescriptions, is hopeful her story will resonate with lawmakers.

"It's almost as if we're held hostage by the insurance companies, and the lawmakers are allowing that to happen," she said after meeting with Menendez and a group of other patients with similar stories at Rutgers University in New Brunswick. "My fear is they'll try to set policy and talk themselves into the status quo."

Stories such as these are expected to soon take center stage as Congress debates President Obama's promise to reform the health care system.

In arranging the meetings, Menendez, a member of the Senate Finance Committee, said he wants to ensure the needs of New Jersey residents are met in the upcoming debate on health care reform. Noticeably absent from the meetings were insurance company representatives.

"It's no secret to anyone that our health care system is badly in need of reform," Menendez said. "There are few things more important to the families in this state than fixing it, making sure in this great nation of ours that no one goes to sleep without health coverage, that no one has to choose between paying for heat in the winter and paying for medication that keeps them alive."

Menendez had asked participants to critique a plan by Sen. Max Baucus (D-Mont.), who chairs the finance committee and is leading the charge on health care reform.

Most notable under the Baucus proposal is the creation of a Health Care Exchange composed of a nationwide group of private insurance companies that would be prohibited from discriminating against pre-existing conditions. Because the proposal would require every resident to obtain health insurance, it also provides for federal subsidies for families and small businesses unable to afford coverage through the exchange.

Baucus designed the subsidies as an incentive for participation in the exchange, resulting in a bigger pool of customers and lower premiums. Baucus has said he hopes to see some form of reform passed in the Senate by August.

Jeffrey Brenner, a physician in private practice in Camden, said New Jersey's health care system is heavily weighted toward specialists and fails to provide basic care for patients with preventable illnesses.

In Camden, half the city's population visits an emergency room at one time or another during the year – twice the national average, he said. One patient in Camden alone was responsible for 113 visits in a single year, he said.

In all, the public spent more than $460 million in charity cases in Camden during the past five years, he said.

Brenner advocates a system that brings those emergency room patients into the system for follow-ups so they can receive the appropriate care and are less of a financial drain on the system.

"Somehow we lost sight of the fact that the purpose of the home-care delivery system is to heal the sick, care for wounded and prevent illness," he said. "It's not to make physicians wealthy or pharmaceutical representatives wealthy or stockholders or insurance companies wealthy. The patient should be at the center of the system and indeed should be our top priority."

Carolyn Torre, director of regulatory affairs for the New Jersey State Nurses Association, said advance-practice nurses – those with specialized training – should be allowed to play a greater role in the delivery of care. They would help reach more people before their conditions become chronic and would help lower the cost of health care, she said.

"If there were more advance-practice nurses working in Camden, there would be fewer emergency room visits and there would be fewer hospitalizations," she said, using Brenner's statistics about Camden as an example.

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