Medical Assistance Reform = Death Sentences By Legislative Pens?

An Arizona man was denied a liver that had been type-match perfectly to him after it was delivered to the hospital where he lay waiting for it to save his life because budget cuts to the medical assistance program couldn't afford to pay for it, nor could he as he was indigent.

See: Arizona man sentenced to death by legislative budget cuts

If you were thinking that wouldn't happen in Wisconsin, think again.

Governor Walker's proposed budget reform bill includes a medical assistance reform act that may limit or even eliminate Badger Care, Wisconsin's medical assistance program that pays for transplants.

Governor Walker's medical assistance reform act seeks to push through a change that doesn't appear all that harmful on its face, but when you read between the lines, it is a formula for deletion of the medical assistance benefits that save the lives of many, many people in Wisconsin. People who have lost their jobs, and thus lost their insurance benefits, often find themselves meeting the federal povery guidelines and qualifying for Badger Care. The bill cleverly excludes those who are disabled. But the reality of the situation of a person who needs a transplant is that they are not considered to be 'disabled' by the administrative definition of that word until the moment at which they receive the transplant, per the department of Social Security. His bill has the potential to eliminate transplants for Wisconsin people in need of them who could not afford to pay the price.

That person could be you.

Cut budgets, cut pay raises, increase the costs of pensions and insurance to state employees to equalize what the rest of the private sector is paying, but don't play God and take life from people who need transplants.

Obviously, people in need of joint or bone replacements would also fall under the 'excluded' list because neither would be considered to be 'disabled' until such time that they were receiving the replacement, hence no benefits would be available until after the transplant were done unless they already qualified due to being impoverished provided that those benefits were still available after the study and changes.

Public Assistance Reform under Walker

Walker's bill provides appropriation of TANF program funds from Federal Government:

PUBLIC ASSISTANCE
Reflecting the receipt of emergency contingency funds under the Temporary Assistance for Needy Families (TANF) block grant program, this bill increases by $37,000,000 the amount of TANF moneys allocated for the earned income tax credit.

Walker's bill also spins off extensive medical research and medical provisions, including blood stem cell research, leukemia research, bone marrow transplant facilities, research and funding, and the list goes on as to those areas in which UW-Madison has contributed through UW Hospitals and Clinics:

OTHER HEALTH AND HUMAN SERVICES
This bill eliminates the UW Hospitals and Clinics Board, a state agency assigned the single duty to enter into a contractual services agreement with the UW Hospitals and Clinics Authority to provide the services of state employees who are in clerical, blue collar and nonbuilding trades, building trades crafts, security and public safety, and technical collective bargaining units. The bill also transfers all employees of the UW Hospitals and Clinics Board to the UW Hospitals and Clinics Authority.

Walker's Medical Assistance Reform Act

Walker's bill on Medical Assistance
Although the language is illusive, the outcome is this: current law requires changes to Badger Care to be manifested from the Federal Government and administered locally. The new bill removes Federal law governance and places the administration and law making into one body under the state Governor. This change has the distinct possibility of extensively reducing benefits to Badger Care insured persons or revoking them. The bill's MA provisions are quoted verbatim below.

It is one thing to make state employees pay for benefits that the private sector can only dream about (pensions are all but history in the private sector) and the insurance benefits long enjoyed by state employees would make you drule, but it is quite another thing to play God.

In Arizona, a family man in need of a liver transplant to survive was denied the operation after a matched donor had been found. He will die before the end of this years. At some point while the legislature that sentenced him to death is driving around in his mercedes benz or playing with his children on his back lawn, the family man that was denied a transplant will explain to his elementary-aged daughter that he will die this year. Congratulations, Arizona, we didn't know God had entered your legislature. Congratulations, Wisconsin, you are not far behind.

HEALTH AND HUMAN SERVICES
MEDICAL ASSISTANCE

Under current law, DHS administers the Medical Assistance (MA) program, which is a joint federal and state program that provides health services to individuals who have limited resources. Some services are provided through programs that operate under a waiver of federal laws related to medical assistance (MA waiver programs).

This bill requires DHS to:

1. study potential changes to the MA state plan and
2. study potential changes to waivers of federal law relating to: medical assistance for certain purposes, including increasing the cost effectiveness and efficiency of care for the MA program and MA waiver programs and improving the health status of individuals who receive benefits under the MA program or an MA waiver program.
3. If DHS determines, as a result of the study, that revision of existing statutes or rules would be necessary to advance any of the purposes for which the study was conducted, DHS may promulgate rules to implement certain changes, including making certain requirements, modifying benefits, revising provider reimbursement models, developing standards and methodologies for eligibility, and reducing income levels for purposes of determining eligibility.
4. Before promulgating a rule, DHS must submit the proposed rule and any plan developed as a result of the study to JCF for review.
5. DHS must submit an amendment to the state MA plan or request a waiver of federal laws related to medical assistance, if necessary, to the extent necessary to implement any proposal.
6. If the federal Department of Health and Human Services does not allow the amendment or does not grant the waiver, DHS may not put the rule into effect or implement the proposal.
7. To reduce the eligibility income levels to a certain amount, DHS must request a waiver from the secretary of the federal Department of Health and Human Services to permit DHS to have in effect eligibility standards, methodologies, and procedures that are more restrictive than those in place on March 23, 2010.
8. If DHS does not receive approval for the waiver, DHS must reduce the eligibility income levels for MA programs and MA waiver programs to 133 percent of the federal poverty line for adults who are not pregnant and not disabled, as allowed under federal law.
9. DHS may promulgate the rules as emergency rules.

PUBLIC ASSISTANCE
Reflecting the receipt of emergency contingency funds under the Temporary Assistance for Needy Families (TANF) block grant program, this bill increases by $37,000,000 the amount of TANF moneys allocated for the earned income tax credit.

Read the bill here (http://legis.wisconsin.gov/JR1SB-11.pdf)

Federal Poverty Levels (FPL)

The poverty income levels are used to determine enrollment for BadgerCare Plus. Those may be found at access.wi.gov or here.

Federal Poverty Income Levels - Wisconsin 2011

Federal Poverty Levels (FPL)

The following income levels are
used to determine enrollment for BadgerCare Plus.  To see if you may be
able to enroll, go to access.wi.gov
and apply today.

Effective February 1, 2011

Family size	100% Monthly Income	150% Monthly income	200% Monthly income	300% Monthly income
1	$   907.50	$1,361.25	$1,815.00	$2,722.50
2	$1,225.83	$1,838.75	$2,451.67	$3,677.50
3	$1,544.17	$2,316.25	$3,088.33	$4,632.50
4	$1,862.50	$2,793.75	$3,725.00	$5,587.50
5	$2,180.83	$3,271.25	$4,361.67	$6,542.50
6	$2,499.17	$3,748.75	$4,998.33	$7,497.50
7	$2,817.50	$4,226.25	$5,635.00	$8,452.50
8	$3,135.83	$4,703.72	$6,271.67	$9,407.50
For each additional person, add:
	$318.33	$477.50	$636.67	$955

TOP CANCER HOSPITALS WITH APLASTIC ANEMIA FOCUS

U. S. News publishes the top cancer hospitals list:
http://health.usnews.com/health/best-hospitals/cancer-hospital-rankings/

Mayo Clinic, Rochester Minnesota
http://health.usnews.com/health/best-hospitals/mayo-clinic-5000000/cancer
Reputation Score: 27.8%
Ranking: #4
Score: 59.6

University of Washington Medical Center, Seattle, Washington
http://health.usnews.com/health/best-hospitals/univ-of-washington-medical-ctr-6910750/cancer
Reputation Score: 18.7%
Ranking: #6
Score: 47.7

University of Massachusetts General Hospital, Boston, Massachusetts
http://health.usnews.com/health/best-hospitals/massachusetts-general-hospital-6140430/cancer
Reputation Score: 14.2%
Ranking: #7
Score: 43.8

How top hospitals selected

Allogeneic Stem Cell Transplant

What is a stem cell transplant?

Most stem cells are in your bone marrow. You also have some that circulate from your marrow into your blood. Bone marrow stem cells turn into red blood cells, white blood cells, or platelets to help your body stay healthy. If your bone marrow is damaged or destroyed, it can no longer make normal blood cells. In a stem cell transplant, healthy stem cells are placed in your body through an IV to help your bone marrow start to work right.

When the stem cells come from another person, it is called an allogeneic transplant. The donor may be a relative or a complete stranger. The important thing is that the donor's immune system markers are closely matched to yours. This is more likely when the donor is your brother or sister.

When the stem cells come from your own blood or bone marrow, it is called an autologous transplant.

Stem cells can also be found in your bloodstream and in the blood inside a newborn's umbilical cord.

Bone Marrow Transplants

The bone marrow—the sponge-like tissue found in the center of certain bones—contains stem cells that are the precursors of white blood cells, red blood cells, and platelets. These blood cells are vital for normal body functions, such as oxygen transport, defense against infection and disease, and clotting. Blood cells have a limited lifespan and are constantly being replaced; therefore, healthy stem cells are vital.

In association with certain diseases, stem cells may produce too many, too few, or otherwise abnormal blood cells. Also, medical treatments may destroy stem cells or alter blood cell production. The resultant blood cell abnormalities can be life threatening.

There are three types of bone marrow transplants:

Bone marrow transplantation involves extracting bone marrow containing normal stem cells from a healthy donor, and transferring it to a recipient whose body cannot manufacture proper quantities of normal blood cells. The goal of the transplant is to rebuild the recipient's blood cells and immune system and hopefully cure the underlying ailment.

Treatment

In secondary aplastic anemia, removing the cause is critical. In some cases it can lead to recovery.

Mild Aplastic Anemia
Mild cases of aplastic anemia may be treated with supportive care, or may not need treatment. Blood and platelet transfusions will help correct the abnormal blood counts and relieve some symptoms in moderate cases.

Mild Aplastic Anemia
Severe aplastic anemia, which causes a very low blood-cell count, is a life-threatening condition. Younger patients with a severe case of the disease will need a bone marrow transplant. Older patients, or those who do not have a matched bone marrow donor, can be treated with medications that suppress the immune system, such as antithymocyte globulin (ATG), tacrolimus, or cyclosporine.

ATG - Antithymocyte Globulin
ATG consists of antibodies made in horses or rabbits against a type of white blood cell in humans called T cells. It is used to suppress the body's immune system, allowing the bone marrow to start generating blood cells again.

Cyclosporine, Cytoxan
Other medications to suppress the immune system, such as cyclosporine, tacrolimus, and cyclophosphamide (Cytoxan) also may be used. Corticosteroids and androgens have been used as well.

http://healthtools.aarp.org/adamcontent/secondary-aplastic-anemia

Donor Matching HLA Test

Transplants rely upon matching donors to the recipient. For bone marrow transplants, basically, there are 6 key factors analyzed for a match. They are classified as Class 1 and Class 2 HLA markers: Class 1 (A, B, C) and Class 2 (DR, DQ, DP). For a match, the first 4 HLA markers must match, being A, B, C and DR. Matching DQ is beneficial, but not necessary. Matching DP is a bonus.

From a medical standpoint, there are 8 key factors in the matching process.

Class 1 A, HLA Locus A - must be matched
Class 1 B, HLA Locus B - must be matched
Class 1 C, HLA Locus C - must be matched
DR A - need not be matched
DR B 1 - must be matched
DR B 3, 4, 5 - patient is typed, need not be matched
DQ A 1 - need not be matched
DQ B 1 - uncertain whether matching improves success
DP A 1 - need not be matched
DP B 1 -uncertain whether matching improves success

For more information, refer to http://www.marrow.org/PHYSICIAN/Adv_in_Auto_Allo_Tx/Adv_in_HLA_Typing/index.html

Donor Matching - Private Typing

Getting Tested : Pricing and Kit Ordering


** All test turnaround times are from receipt of sample at laboratory and do not include weekends/holidays.

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HLA- A,B,DR (Class I and II) STANDARD

TURNAROUND of 7-10 business days. $175.00

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HLA- A,B,DR (Class I and II) STAT

TURNAROUND of 2-4 business days. $375.00

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Price Includes:

■Shipping and handling to the donor and back to the lab of the sample. Once shipped from Kashi Clinical Laboratories, the kit will take approximately 2-4 business days for delivery. A return pre-paid air bill with mailing envelope for the return of the sample to the lab. **See alternate shipping methods below.

■All supplies, testing for the designated HLA antigens, Preparation and/or hard copy of test results. The report can also be faxed or mailed to a search coordinator or personal physician that you designate on our "Private Testing Requisition"
■A hard copy of the results sent to the donor for his/her own medical records.

**Alternate Shipping Methods:

■Priority Overnight: please add $35 per kit.
■International Shipping: please add $150.00 per order.
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IMPORTANT:
Approximately 20% of all samples may require additional testing in the form of a "repeat" test or "high-resolution" test. This is not the fault of the donor but possibly the manner in which the sample was collected or shipped, or additional testing is required in order to resolve specific serological ambiguities. This re-test will delay results past the original time quoted. Kashi Clinical Laboratories does not refund testing fees or accept any liability if this condition delays results or complete typing cannot be obtained from the sample submitted.

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RETURN POLICY:

No returns on donor kits. Credit can be applied to buyer's credit card if extenuating circumstances prevent donation and only within 60 days of purchase. A 25% handling charge applies and will be deducted from any credit.

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ALL CREDITS MUST BE PRE-AUTHORIZED

by calling 1-877-527-4452.

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For additional information about testing, you can contact us at 1-877-527-4452 between 8:30 a.m. and 5:00 p.m. Pacific Standard Time.

HLA Tissue Typing

The HLA gene products can be grouped into three classes. Class I consists of the products of the genes located on the HLA-A, HLA-B, and HLA-C loci. These HLA antigens are found on all nucleated cells. Class II molecules consist of antigens inherited as genes from the HLA-DR, HLA-DQ, and HLA-DP loci. These HLA antigens are normally found only on B-lymphocytes, macrophages, monocytes, dendritic cells, endothelial cells, and activated T-lymphocytes. Class III molecules are not evaluated in histocompatibility testing.

Because the HLA loci are closely linked, the HLA antigens are inherited as a group of six antigens is called a haplotype. The probability of siblings having identical haplotypes is one in four. Therefore, siblings provide the opportunity for the best matches. They can donate bone marrow, a kidney, and a section of their livers, but they cannot donate other solid organs. Approximately 85% of transplants are organs from cadavers, and because the HLA antigens are so highly polymorphic, the chance of identical haplotypes decreases quickly.

Histocompatibility testing consists of three tests, HLA antigen typing (tissue typing), screening of the recipient for anti-HLA antibodies (antibody screen), and the lymphocyte crossmatch (compatibility test). HLA antigen typing may be performed by serological or DNA methods.

A laboratory will perform HLA typing by either the serological (blood fluid) or DNA method. In either case, HLA typing of HLA-A, HLA-B, HLA-DR, and HLADQ antigens is performed for solid organ transplants. HLA typing of HLA-C antigens is also included when tissue typing is performed for bone marrow transplants.

The antibody screen is performed in order to detect antibodies in the recipient's serum that react with HLA antigens. The most commonly used method of HLA antibody screening is the microcytotoxicity test. If an antibody against an HLA antigen is present, it will bind to the cells. The higher the number of different HLA antibodies, the lower the probability of finding a compatible match.

The third component of a histocompatibility study is the crossmatch test. In this test peripheral blood lymphocytes from the donor are separated into B and T lymphocyte populations. In the crossmatch, serum from the recipient is mixed with T-cells or B-cells from the donor. A positive finding indicates the presence of preformed antibodies in the recipient that are reactive against the donor tissues. An incompatible T-cell crossmatch contraindicates transplantation of a tissue from the T-cell donor.

Read more: http://www.surgeryencyclopedia.com/Fi-La/Human-Leukocyte-Antigen-Test.html#ixzz0U1qXSSPR

Blood Transfusions Preliminary To Transplants

Blood transfusions preliminary to transplants can cause issues with the transplant due to the antigens fed into the recipient from the donor blood. HLA type matching is not done preliminary to blood transfusions.

When you get a blood transfusion, you only get red blood cells. Whole blood transfusions haven't been done in many, many years. A donated unit of blood is "spun down" and separated into three layers: Bottom is Red Blood Cells, thin layer is WBCs and platelets, and top liquid is plasma. The plasma is frozen, and platelets can be harvested from the thin layer, so nothing goes to waste.

That said, it is possible then when they separate the two, they don't squeeze off all of the WBC layer. You can ask for Leuko-poor packed RBCs. They have a filter that goes between you and the unit, and "strains" out the much bigger white cells.

Read more: http://www.surgeryencyclopedia.com/Fi-La/Human-Leukocyte-Antigen-Test.html#ixzz0U1p5btRn

Bone Marrow Transplant Outcomes & Results

Several factors are involved in any successful transplant, but none more important than having a donor, having that donor be an excellent match, and remaining infection free.

Bone Marrow Donors
The ideal donor is an identical male twin, and then an identical female twin. Next, a male sibling, then a female sibling. Next, a non-related male donor, then a non-related female donor. Next, a non-related male donor, then a non-related female donor. If no match is found within those groups, then testing is conducted on related donors, and if all attempts to find a donor fail, the transplant team will resort to blood stems from donor cords and parents.

http://www.marrow.org/PHYSICIAN/Tx_Indications_Timing_Referral/Tx_Outcomes_by_Disease_and_Dis/index.html#other

When siblings do not match, private potential donors will be considered. If you would like to donate to a particular person, the following website offers kits to begin the screening process: https://www.bonemarrowtest.com/pricingandkitordering.htm.

If you wish to register with the national registry to donate to anyone with whom your marrow is matched, please visit http://www.marrow.org/.

Transplant Outcomes
The outcome of a transplant depends greatly on the level of matching between the donor and the patient, and then upon the age of the patient at the time of the transplant.

Bone Marrow Typing

What is bone marrow typing?
Bone marrow typing is the processs of identifying the HLA - human leukocyte antigen - markers on blood cells. During the typing process, proteins on blood cells are analyzed. To obtain the tissue samples for analysis, a blood draw is taken from the patient and the potential donors.

The human leukocyte antigen (HLA) test, also known as HLA typing or tissue typing, identifies antigens on the white blood cells (WBCs) that determine tissue compatibility for organ transplantation (that is, histocompatibility testing). There are six loci on chromosome 6, where the genes that produce HLA antigens are inherited: HLA-A, HLA-B, HLA-C, HLA-DR, HLA-DQ, and HLA-DP.

Currently, medical teams seek to match 4 of the 6 markers: Class 1 A, B and C, along with Class 2 DR loci. DQ matching is preferable, but not mandatory. DP matching is beneficial, but also not required.


Unlike most blood group antigens, which are inherited as products of two alleles (types of gene that occupy the same site on a chromosome), many different alleles can be inherited at each of the HLA loci. These are defined by antibodies (antisera) that recognize specific HLA antigens, or by DNA probes that recognize the HLA allele. Using specific antibodies, 26 HLA-A alleles, 59 HLA-B alleles, 10 HLA-C alleles, 26 HLA-D alleles, 22 HLA-DR alleles, nine HLA-DQ alleles, and six HLA-DP alleles can be recognized. This high degree of genetic variability (polymorphism) makes finding compatible organs more difficult than finding compatible blood for transfusion.

Read more: http://www.surgeryencyclopedia.com/Fi-La/Human-Leukocyte-Antigen-Test.html#ixzz0TyvXKnQG

Private Typing
If you wish to register to donate to any matched recipient, then the national registry is the route to go to begin typing your tissue. If however, you wish to be tested for a match to a particular donor, then the following source should be used:

https://www.bonemarrowtest.com/pricingandkitordering.htm

Potential Donors - Am I a donor? Can I be a donor?

When it is determined that a bone marrow transplant should or will take place, the next step is to find a suitable donor. The primary candidates for a suitable donor are the siblings of the intended recipient. There is a 25% chance of each sibling matching. If a sibling does not match, then the next step is to go to the National Bone Marrow Registry to seek a donor. Information about the process of donating, how bone marrow is matched and how to be a donor is provided below.

Listed Potential Donors
If you have been listed as a potential donor for a person who will need a bone marrow transplant, that person's cancer team will direct you to the appropriate facility for collection of your blood sample or buckle test (cheek swab), typing and communication of your typing. They will likely call you shortly after a determination has been made that a bone marrow transplant either is or may be done. They will give you the name and address of the location to which they want you to go to. When you arrive, they will process your paperwork, confirming your identity and proceed to take a sample of your blood or a swab sample from the incide of your cheek (buckle test). In almost all instances, it will be the original cancer team that will contact you to inform you of whether you are a bone marrow match.

Unlisted Potential Donors
If you are not listed as a potential donor on the recipient's donor list, it is likely because you are not the potential recipient's sibling; only siblings are listed and contacted in the first steps of seeking a matched donor. If a sibling does not match, then the next step is to seek a donor from the national registry, or if there are people who want to be considered as a donor then from their results.

Can I Be A Donor?
Perhaps. There are two types of donors - those who want to donate to a particular person, and those who want to donote to anyone with whom they match. The type of donor you wish to be determines the method for your testing.

Anonymous Donors Registry
If you wish to become a registered donor with the national registry, which would include being assessed for your desired recipient if time permits for your results to be entered into the national database in time for your intended recipient's search. The national registry process takes more time to process donor information, so that must be taken into consideration. But the national registry is free. The process is quite simple. You register, answer a few health questions for preliminary acceptance, and ask that a kit be sent to you; you swab the inside of your cheek, send the results back, and are listed in the registry. IF YOU WANT TO USE THE FREE SERVICES OF THE REGISTRY, BE SURE TO ASK THAT YOUR RESULTS BE MAILED TO YOU AS WELL AS ADDED TO THE REGISTRY. Remember, that listing with the national registry is a committment on your part stating that you will donate to anyone if asked. For private matching, please see private matching below. More information about the national registry is available at their website, http://www.marrow.org/.

In all instances, the testing process through the registry is free. If you are an intended recipient's sibling, it is very likely that the recipient's insurance company will cover the costs of the test.

Private Bone Marrow Donor Matching
If you wish to be tested for matching to a particular intended recipient, then the national registry is not the way to go. Rather, you should seek information on the website, http://www.bonemarrowtest.com/.

To be tested to match a particular intended recipient, you will need to find a collection center near you. Because the HL Testing process is unique, it is not done by most doctors or hospitals.

The second step is to ask your insurance company if they will cover the costs for you to be tested for an intended recipient (in most cases, they won't if you are not a sibling). The cost of the test is dependant upon the type of HLA test being conducted. In the preliminary testing process, it would likely be sufficient to test for Class 1 AB HLA Matching. If those two factors match, you can then be tested for the subsequent factors (Class 1 C, Class 2 DR, DQ and DP). If time is of the essence, you may want to be tested for Class 1 ABC, Class 2 DR; and if cost is not a factor for an additional one test, then also DQ; and lastly, if it is not cost prohibitive, then for DP.

Be sure to ask that your results be mailed to you. When you receive them, you can then fax them to the coordinator for the intended recipient's bone marrow matching.

See Bone Marrow Matching for more information.

Blood Type & Bone Marrow Transplants

Blood types do not matter, and are not used in the bone marrow matching process; before marrow is transplanted, existing bone marrow and blood stem cells are destroyed. During marrow transplants, new blood stem cells are interveneously injected into the bloodstream of the recipient to make their way into the marrow. Remaining blood cells in the recipient die off within hours of the initiation of a transplant (as they were radiated prior to the transplant). The transplanted marrow then builds new blood stem cells, and in some situations the recipient's blood type will change.