August 2014Whatcom Watch4

Whatcom: Chronic & Acute

by Robert A. Duke

The name itself, Statewide Health Insurance Benefi ts Advisor (SHI-BA), sounds like a godsend to the sick and dying and their caregivers desperate to understand their health insurance.

For Whatcom County caregiv-ers, patients and health insurance beneficiaries, SHIBA symbolizes hope for getting care and treatment information and advice about the complexities of health insurance during times of sickness, dying and the threat of medical fi nancial ruin. This was also my image of SHIBA, but unfortunately I have to tell you this common notion about that SHIBA’s role in providing health insurance advice is a myth.

I fi rst encountered the SHIBA myth in August 2009 when my wife, Shearlean, was diagnosed with terminal brain cancer. I searched Whatcom County for some form of social, medical, healthcare or insur-ance assistance for two weeks follow-ing Shearlean’s diagnosis, but found nothing we were eligible for until I stumbled upon our local SHIBA of-fi ce in downtown Bellingham. The offi ce, then as now, was staffed with trained and knowledgeable people eager to provide health insurance benefi ts advice.

I wager nobody wanted more than I for SHIBA to be what its name implied: Statewide. Health. Insur-ance. Benefi ts. Advisor!

As a college professor, my wife was a state employee covered by state health insurance. We needed to know the extent of her health insurance benefi ts and how the in-surance worked to get the care and treatment she required. Her condi-tion was so desperate that we were forced to plow ahead with treatment regardless.

Western Washington University, her employer, was responsible for administering her health insurance benefi ts but, as I quickly learned,

knew little. Her insurance fl owed through the state’s Health Care Au-thority (HCA), Uniform Medical Plan (UMP) or Public Employee Benefi t Board (PEBB). Outside of UMP, whose name appeared on her health insurance card, we had never heard of HCA or PEBB, or others such as ODS (now Moda Health), Washington State Rx Services or MedImpact, which we eventually had to deal with.

When I fi rst visited SHIBA in 2009, I found its staff knew nothing more about the alphabet soup of state health insurance organizations than I did. I knew only that our insurer was Uniform Medical Plan (and even that later proved wrong according to ODS information). My questions were the widest and wildest: What does brain surgery cost? Is it negotiable? Are there brain surgery or cancer options we can elect or cancel? Who can I ask for information? Whose job is it to answer my questions? My ultimate question in any category of care or treatment was: What do I do? The staff did know about Medicare, but my wife was too young for it. The patient and sympathetic SHIBA representative could offer no advice or referral. I was disappointed but not discouraged. Until my wife’s death in February 2011, I repeatedly returned to SHIBA seeking help in obtaining care for her. I thought if I asked new questions or asked old questions differently, I would fi nally get answers. That never happened.

After 18 months of caring for my wife, by dealing with the state health insurance system and endlessly questioning Whatcom healthcare providers, I had assembled my own knowledge of the system. In so doing I was horrifi ed to discover that I had acquired greater expertise about HCA, UMP and PEBB than SHIBA or any Whatcom provider.

But my patient, my wife, had died of her disease, and suddenly all of my hard-won information was no longer relevant.

Desperate to use what I had learned, I got involved with the Whatcom Alliance for Health Ad-vancement (WAHA) with the in-tention of contributing to the push for healthcare reform in Whatcom County. This put me back in touch with SHIBA, and I tried to interest it in the knowledge I had accumulated about the state’s employee health insurance. But SHIBA’s Medicare mandate made that impossible. Dur-ing one of my proselytizing missions, though, I heard about an occasional SHIBA visiting advisor who was reputed to know something about state employee health insurance.

Ever hopeful, and though my wife was gone, I made an appoint-ment and we met. Though we talked pleasantly for a half an hour, I learned nothing from her while she scribbled notes as I talked about

Washington’s HCA and PEBB. This advisor turned out to be another dead end in a long string of dead ends when it came to learning about Washington’s own health insurance for state employees.

With so much hard won knowl-edge and experience on the verge of being wasted, and other motiva-tions, I decided to document what I learned by writing a book. I titled it “Waking Up Dying” to answer my not-so-hypothetical question: What do you do if one day you wake up dying on the doorstep of Whatcom County’s healthcare system, blessed with undefined health insurance benefi ts that neither you nor anyone else know how to use?

Over the 20 months it took to write and publish a 318-page book I continued trying to unravel the organization and function of HCA to at last understand how its services should be used to obtain care and treatment for a terminally ill state employee. Calls to HCA and the offi ce of the Washington State Of-fi ce of the Insurance Commissioner, Mike Kreidler, always resulted in referrals back to my local SHIBA office. By late 2013 I had been wandering around the healthcare maze for four years and still hadn’t found my way through it. To vent my frustration and disseminate the information and experience I had accumulated, I decided to also blog about my experience. For the blog, robertaduke.com, I commissioned a cartoon to illustrate my vision of being a caregiver and patient in the

Whatcom County and Washington State healthcare systems. It depicted a bewildered hospital-gowned patient pushing an IV stand pausing at the entrance to an endless maze illustrat-ing the healthcare system.

Today, as the fifth anniversary of my wife’s cancer diagnosis ap-proaches our healthcare maze is still as impenetrable (maybe more so) than when I started. Unfortunately it has grown more complex with the addition of the Affordable Care Act (ACA) and national Palliative Care Initiative, which have added two additional layers to the already multi-layered American healthcare system. When caring for my wife I once cataloged 32 layers of healthcare providers (doctors, nurses, social workers, records clerks, dieticians, laboratory, imaging) I might have had to penetrate to reach a practitio-ner or obtain a procedure she needed. Now, to my way of thinking, there were 34 layers.

And the SHIBA myth is stronger than ever. On Tuesday, June 10 the audience at PeaceHealth’s Adult Day Health Center’s Caregiver Support Group conference I attended men-tioned SHIBA as a source for health insurance information. I knew it wasn’t so, but SHIBA’s promising title had more endurance than my outcry that it wasn’t so. And to my chagrin, I discovered I was not yet immune.

SHIBA — State Health Insurance Benefi ts Advisor — I found the idea

Whatcom’s Beloved Healthcare MythAn ideal Too Appealing to Abandon

Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: boshduke@gmail.com

Healthcare maze©Robert A Duke, courtesy Robert A Duke

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Tests Indicate Bee-killing

Pesticides in ‘Bee-friendly’ Plants from

Garden Centers Nationwide

One hundred and seventy-fi ve thousand people demand Lowe’s, Home Depot stop sell-ing “pre-poisoned plants”

Many “bee friendly” home garden plants sold at Home Depot (NYSE: HD), Lowe’s (NYSE: LOW) and other lead-ing garden centers have been pre-treated with pesticides shown to harm and kill bees, according to a new, fi rst-of-its-kind pilot study released today by Friends of the Earth and allies (http://libcloud.s3.amazonaws.com/93/88/f/3354/Gardeners-Beware-Report-11.pdf) .

The pilot study, co-authored by the Pesticide Research In-stitute, found that seven of 13 samples of garden plants purchased at top retailers in Washington D.C., the San Francisco Bay Area and Minne-apolis contain neurotoxic pesti-cides known as neonicotinoids that studies show could harm or kill bees and other pollinators.

A growing body of science has implicated neonicotinoids (neonics), which are used in agriculture and also for cosmetic purposes on garden plants, as a key factor in recent global bee die-offs. Beekeepers across the country reported losses of 40-90 percent of their bees last winter. The European Union is set to suspend the use of three neonic pesticides later this year, after a scientifi c review (http://www.efsa.europa.eu/en/press/news/130116.htm) by Europe-an Food Safety Authority found that neonicotinoids pose an unacceptably high risk to bees.

“Our investigation is the fi rst to show that so called ‘bee-friendly’ garden plants contain pesticides that can poison bees, with no warning to gardeners,” said Lisa Archer, director of the Food and Technology Program at Friends of the Earth. “Bees are essential to our food system and they are dying at alarming rates. Neonic pesticides are a key part of the problem we can start to fi x right now in our own backyards.”

Friends of the Earth, Sum of Us and allies sent letters (http://libcloud.s3.amazonaws.com/93/5b/e/3116/letter_to_Companies.pdf) today — along with petitions signed by more than 175,000 people — to Lowe’s, Home Depot, Target and other top garden retailers asking the stores to stop selling neonicotinoids and plants pre-treated with the pesticides. A majority of the UK’s largest gar-

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August 2014 Whatcom Watch 5

Being Frank

of it still tempting. Why not a health insurance advisor, I asked myself? It seems like such a good idea to provide advice about state health insurance (in general) and benefi ts (in particular) for the public at large, but especially for the 230,302 active PEBB members* such as my wife was.

I recently talked with Maureen Kane, the current director of the Bellingham SHIBA offi ce, and she confi rmed that Medicare informa-tion is indeed the focus of SHIBA’s benefits advice. Although under-standably somewhat defensive about her organization, she acknowledged in so many words that SHIBA’s name does promise a lot more than it delivers.

SHIBA in Whatcom County is

sponsored by the Whatcom Alliance for Health Advancement (WAHA) with which it shares facilities. On WAHA’s Web site SHIBA’s rela-tively new posting now makes it clear about SHIBA’s Medicare orientation with a page titled SHIBA/Medicare and explanatory text mentioning Medicare in each paragraph.

I also spoke with Todd Dixon, SHIBA Program Manager, in the Washington State Offi ce of the In-surance Commissioner, appointed Oct. 16, 2013. He thoroughly reiterated SHIBA’s mission and charter. He emphasized that SHIBA is a volunteer-staffed organization that serves 56,000 persons annually. When I asked whether it didn’t all boil down to providing consumer information about health insur-ance, he in so many words agreed. As a counterpoint, I asked, “I am not going to get care and treatment benefi ts explained to me by calling SHIBA, am I?”

Without getting into any discus-sion with Dixon, I pointed out that

SHIBA’s name promised a lot and this was reinforced by the About SHIBA services page on Washing-ton’s www.insurance.wa.gov Web site, which, in a bulleted list, states SHIBA can help you: Understand your health care cov-erage options and rightsFind affordable health care cover-ageEvaluate and compare health insurance plans

“That’s promising a lot more than consumer information about Medi-care,” I said, not expecting or getting a reply.

So what information had I wished Washington had provided for my wife when I was her caregiver? Infor-mation about the components and functions of Washington State Rx Services then managed by ODS un-der Uniform Medical Plan (UMP) would have been of great help. In February 2013, two years after my wife’s death, while fact-checking my book, I uncovered a simple organiza-tion chart, which clearly showed the existence and relationship of Med-Impact to UMP a key component in PEBB.

ODS was a health plans sales company that sold a prescription benefi ts plan to Washington State. When Washington bought the plan, it hired ODS to manage the plan. Since ODS was a sales organization and not a benefits management company it hired MedImpact,

whose business it was to manage prescription services.

Medimpact decided when to refi ll prescriptions and for what quantity. For example, though Shearlean’s doc-tor prescribed 42 doses of Temodar cancer drug, MedImpact approved only 30 doses, which was insuffi cient to complete initial treatment and in full contradiction to published medi-cal protocol for glioblastoma tumor treatment. In fact, MedImpact de-cided whether a prescription would get fi lled in the fi rst place even if a life were at risk — and MedImpact answered only to ODS.

Asked about MedImpacts relation-ship to MODA/ODS, Jonathan Nicholas, VP of Marketing for Modahealth, replied in an email, “We have a contract with Med-Impact to provide certain services in certain markets. That’s about as direct as it can get.”

I bet you thought your doctor decided about your prescription!

No, that’s another myth.Aside from requiring every health

insurer to write a user’s manual for patients, what do I recommend, after fi ve years of trying, that you do to make the best use of your health-care benefi ts? Demand! And I mean demand that your doctor or nurse fully explain exactly how a practice, procedure, treatment or care will begin, proceed and terminate before you agree to it.

At all times your greatest power as a patient or caregiver is to say, “No!”

by Ed Johnstone

Our planet is talking to us, and we better pay attention. It’s telling us that our climate and oceans are changing for the worse and that every living thing will be affected. The signs are everywhere. The only solution is for all of us to work together harder to meet these challenges.

We are seeing many signs of climate change. Our polar ice caps and glaciers are melting and sea levels are rising. Win-ter storms are becoming more frequent and fierce, threatening our homes and lives.

It is believed that we are wit-nessing a fundamental change in ocean and wind circulation patterns. In the past, cold water full of nutrients would upwell from deep in the ocean, mix with oxygen-rich water near the surface, and aid the growth of phytoplankton that provides the foundation for a for a strong marine food chain that includes all of us.

The change in wind and ocean patterns is causing huge amounts of marine plants to die and de-compose, rapidly using up avail-able oxygen in the water. The result is a massive low oxygen dead zone of warmer waters off the coasts of Washington and Oregon that is steadily growing bigger, researchers say. Large fish kills caused by low oxygen levels are becoming common, at times

leaving thousands of dead fish, crab and other forms of sea life lining our beaches.

Low oxygen levels and higher water temperatures are also con-tributing to a massive outbreak of sea star wasting syndrome all along the West Coast. It starts with white sores and ultimately causes the star fish to disinte-grate. While outbreaks have been documented in the past, nothing on the scale we are seeing now has ever been recorded.

We are also seeing basic chang-es in the chemistry of our oceans. Our atmosphere has been steadi-ly polluted with carbon dioxide for hundreds of years. When that carbon dioxide is absorbed by the ocean, those waters become more acidic and inhospitable to marine life. Young oysters, for example, are dying because the increasingly acidic water prevents them from growing shells. Researchers say that ocean acidification could also amplify the effects of climate change.

Because we live so closely with our natural world, indigenous

people are on the front line of climate change and ocean acidification. That is part of the reason that native people from throughout the Pacific re-gion will gather in Washington, D.C. in July for our second First Stewards Symposium. Tribal leaders, scientists and others will examine how native people and their cultures have adapted to climate change for thousands of years, and what our future—and that of America—may hold as the impacts of climate change continue.

President Obama’s commit-ment to addressing adaptation to climate change in a real and substantive way is encouraging. Tribes stand ready to partner with the Administration and others any way we can to protect our homelands and the natural resources on which our cultures and economies depend. Only by all of us working together – sup-porting one another – will we be able to successfully face the challenges of ocean acidification and climate change.

Listen to the Planet

Ed Johnstone is the Northwest Indian Fisheries Commission treasurer and the natural resources policy spokesperson for the Quinault Indian Nation.

Whatcom’s Beloved Healthcare Myth

*HCA PEBB Enrollment Report for May 2014 Coverage, Report 1. This report also indicates PEBB members in all categories total 350,305.

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