As much as this Foundation would like to praise the Affordable Care Act, we have to state very clearly that the Act will not help anyone who needs to get into the high risk pool (PCIP) immediately, unless you have been without insurance for six (6) months prior.  The rules are laid out here.

Six months without insurance before you can apply–that is one of the qualifications.  Six months without insurance means you have been six months without your disease modifying drugs if you have Multiple Sclerosis or you have had to pay around $2,000 per month for those drugs, if you are fortunate enough to be able to pay.

If you are unemployed or cannot afford your disease modifying drugs, it means you may have to go without before you can even apply.  And in this country of ours that is simply disgraceful especially compared to all other democratic and industrialized nations whose citizens benefit from Universal Health Plans.

We are writing letters today to our senators to call attention to the ridiculousness and cruelty of this qualification.  If you live in a state where your public servants were pro-health insurance reform, we urge you to write.  If you live in a state where your public servant was against something as basic as a high-risk pool, writing to him or her will most likely be ineffectual, but we urge you to write anyway.  Be heard.

As of this date, the Foundation did not receive a reply from Ms. Abigail Johnson of Fidelity Investments.  We have decided to post the letter on this site.  Please note we have removed the last names of two Fidelity employees for obvious reasons.

-Margaret Welman Paez

We are finishing up all our legal paperwork and getting ready to launch the entire website.  I urge you all to write in to us if you have any questions (or stories to share) about what the Foundation aims to do for people with Multiple Sclerosis.  You can reach me at margaret@msactivism.org or snail mail is 703 Pier Avenue, B-301, Hermosa Beach, CA  90254.

The first letter written by the Foundation was sent to Ms. Abigail Johnson, the President of Fidelity Investments and Paul’s former employer.  As of this writing, I have yet to receive a reply and it has been a few weeks, so we shall see.

It was a first step in, hopefully, opening up the eyes of corporate America to the fact that we won’t sit back and allow it to keep happening. All too often, many employees all across this country are ushered out of their roles because they had the grave misfortune of contracting an incurable disease, from MS to cancer. That is discrimination, pure and simple.

Policy changes to deal with ensuring fair workplace environments and making illegal the fraudulent insurance practices dealt to people with devastating illnesses, are two of the issues we aim to focus on immediately.  People with MS have a lot to deal with: An incurable and debilitating disease, medications, treatments, paying for all of this and not knowing what your body is going to allow you to do from one day to the next.  Keeping your job and the ability to receive treatment should not have to be on that list as well.

-Margaret Welman Paez

The powers that be are at it again, yes, another of the “defending against ERISA litigation” conferences is scheduled. Who will be in attendance?  The usual suspects, CIGNA’s general counsel, Fidelity’s general counsel and a whole slew of Federal judges–the ones who may be hearing your ERISA case.

If you have Multiple Sclerosis and were denied your claim, and you are headed towards Federal court, check the list below to make sure one of these judges is not hearing your case. Please read through the whole posting and if your Federal judge is on the list this year, time to start writing letters.  If you need help with a letter, please email us.

Here is the URL http://americanconference.com/employment_benefits/ERISA.htm, from AmericanConference.com’s website:

You can’t miss the only conference that is devoted entirely to the defense of claims, and led by an unparalleled faculty of in-house counsel, federal judges and top outside defense counsel.

The last year has been completely unprecedented in the world of ERISA litigation. The first 401(k) fee case went to trial and the Supreme Court handed down a decision in Hardt v. Reliance that expanded plaintiffs’ ability to recover attorneys’ fees when plan administrators fail to follow proper procedure in reviewing a claim for benefits. Corporate scandals, major bankruptcies, and a volatile stock market have resulted in billions of dollars in retirement plan losses – all contributing to mounting discontent by employees and a corresponding increase in scrutiny by the plaintiffs’ bar. Throw in ever expanding theories of fiduciary liability, a recessionary economy in recovery, the growing retirement age demographic and the still unknown implications of the Patient Protection and Affordable Care Act, and it becomes evident that in defending and managing these complex claims, counsel for companies, plan fiduciaries, sponsors, administrators, advisors and insurers face a distinct uphill battle, including:

• A rise in class action claims testing novel theories of fiduciary liability
• Health care reform, which:
  • Has given rise to the need to evaluate and overhaul plan documents
  • Will lead to new theories of liability with no legal precedent to turn to for guidance
• Managing plan administrators, fiduciaries and sponsors to properly implement and follow the claims review process
• Expanded precedent allowing plaintiffs to recover attorneys’ fees
• Educating the court on the legal complexities of plan documents
• Identifying the proper parties and permissible recovery under the complex scheme of §502(a) and confusing case law interpreting it

Defending and Managing ERISA Litigation

Permalink to the New York Times article here: http://www.nytimes.com/2010/06/29/health/29vein.html.  The outcry for treatment, proven or not, is desperate.  The MS Society seems to be forgetting what it is they are supposed to be doing.

Many MS patients not only have to suffer the indignation of their disease and what it does to their bodies but they have to suffer financial and emotional injustices as well–work, insurance and disability issues and sometimes with disastrous effects and no immediate solutions.

My comment to this article here where I outlined the reason we began this journey: http://well.blogs.nytimes.com/2010/06/28/an-unproven-treatment-for-multiple-sclerosis/?apage=8#comment-543291

Unacceptable!

If this final appeasement is left to stand, not only does the health care bill lose any significant impact in terms of reform, it also signals, I am afraid, a final victory for civic irresponsibility, which has had a cultural strangle-hold on this nation since the Reagan administration; and the torch of which has been carried by Libertarians and irrational Tea Bagging Parties to its grave. The Democrats will also be tainted as the leadership party that failed to lead.

In the void, I’m afraid, will be the beginning of the fall of the United States’ economic, political and even moral dominance–if this has not begun already.

It will be clear in the sharp relief granted future historians that when the nation had to make a pivotal decision; it chose to support the rights of its corporations over the health and lives of its people.

What will history say about such a nation, about its people and about its culture?

I fear they will say the obvious. That we were perverse, inhumane, and most ironically, economically incorrect.

That is, if one were to accept the argument put forward by Senator Lieberman and others that we are making a decision not to expand Medicare or create a government option because the nation cannot afford it. This argument is perverse and inhumane considering the riches of this country, and it is simply wrong. Those who who cling to the argument must admit to being uninformed, uneducated, perhaps even ignorant; or, if they prefer, admit they are disingenous.

If anything has been proven over the last 18 months is that this country can afford anything as long as it deems it necessary. This is how we have been able to fund two un-budgeted wars of aggression, bail out irresponsible corporations, and even flood our own money supply with more than $1 trillion in newly printed bills–all at price tags larger than health care reform.

Yet, when it came to the health of its people (not to mention the education of its children) the nation stopped short. It essentially placed the needs of war and financial profiteering ahead of the health and lives of its people.

What’s more, and most ironically, is that the expansion of Medicare or any other government health care program, would actually REDUCE costs, not increase them. This is the very nature of the economics of insurance. The larger the pool the fewer the risks, and thus, the lower the cost to insure. I know, I passed the less-than-challenging Insurance License exam in the state of California. So, even the least competent insurance salesman can confirm this. More authoratatively, the government’s own budget office has confirmed this; as has the very experience of Medicare and the government’s ability to deliver health care effectively AND cost efficiently. So, if indeed costs were the issue, this would suggest an immediate EXPANSION of Medicare to Everyone (Medicare Part E), not its restriction.

But the Insurance industry, their lobbyists and their “paid” representatives in Congress argue that the expansion of Medicare is not only too expensive, it may actually threaten their business model. On the second point, they are correct.

However, they’re business model is based on profiteering from the health and death of our citizens; and although I support free-market principals, I believe even the most liberal interpretation of free-market philosophy would consider such a model criminal. Yet, in our public debate on this issue, we actually hear voices from Congressional represenatives that we must protect this profiteering as if it was a moral imprerative.

I believe, however, that if we must choose between profits of an illegal business model or the health and lives of our people, I feel strongly that we, as a nation, should make the obvious choice; and if our current represenatives do not, we must replace them with others who will implement this action on our behalf.

For the “bleeding heart” conservatives who fear for the well-being of insurance corporations, I offer a form of compassionate liberalism: use the savings from Medicare expansion to fund re-training programs for insurance company employees, offer a fair bailout of shareholders, and if necessary, set up an annuity fund to insure a comfortable retirement for over-paid executives.

As a middle-aged man suffering from progressive Multiple Sclerosis, I know first hand the struggles to maintain ones health, income, family and sanity when insurance companies and their large corporate clients conspire to deny your right to survive.

If this development is left to stand, I’m afraid the legacy of this nation will forever be tainted.

Paul Edward Paez

More on our Foundation to follow.