To Speaker Quinn: Support the Paid Sick Time Act!

So often, in my office, someone will come in clearly having waited to come see me. I used to wonder why people waited so long- why did they walk around in debilitating pain until they couldn't walk, why did they let their child stay sick and infect everyone else in the household, etc etc. It's not that people don't know better, or that they don't want to. It's often that they can't afford to. And not being able to get off work is frequently the reason. Either out of concern that they may get fired, or because they can't afford not to get paid. And of course, the jobs that are least likely to provide paid sick time are also the ones that pay the least, leaving hard working people- single mothers, manual laborers, young adults- with hard choices to make. Is it going to be rent or going to the doctors this month? No one should ever have to make that choice.

So a coalition of physician advocacy organizations decided to visit City Council Speaker Christine Quinn's office today. Dr. Bill Jordan and I from NPA-New York joined with members of CIR (including our ring leader, Tim Foley) and Doctors for America. We learned that although the Council had heard from a few health care professionals, it seemed that the physician voice had been missing. And that the business interests had been the overwhelming lobby in their office. It was important for us to show them how this affected real people, and how the health care field was accomodating this reality.

We told them stories of our patients. The first one that came to my mind was during my second job as a Sexual Assault Forensic Examiner. This young woman had come in late on a Friday night after having been sexually assaulted- on Wednesday. Often people come several days after the assault because of fear and shame, but that wasn't the case with her. She came 2 days later because she had to work, as she was the main breadwinner in the house, since she was taking care of her bed-bound mother and siblings. Besides not having time to be able to process this traumatic event until a few days later, she was also too late to get medicines to reduce her chances of contracting HIV, and the morning after pill I gave her was much less effective 2 days later. No one, no one, should have to go through this- not the assault, and not the 2 days of waiting.

Others told stories of people resorting to using the Emergency Room for their care, because they couldn't take time off during the day. We spoke about how many of our clinics had shifted their hours to a later time, as well as on weekends, to accomodate for this. We reminded them that contagious illnesses know no bounds. We recounted the conversations we've had with our patients trying to convince them that they need to take time of work because they are sick and need rest or to not transmit their illness to others- often falling on deaf ears because that person cannot afford the time.

We really hope that Speaker Quinn and her colleagues in the City Council hear our voices, and pass the Paid Sick Time Act.

Why we support the New York City Paid Sick Time Act

This week, a coalition of advocacy groups is advocating for the passage of the New York City Paid Sick Time Act. The idea of this act is that all workers deserve paid sick days. It's hard to believe, but only 37% of the lowest paid workers have any paid sick leave available to them. These are the workers who are most likely to be living paycheck to paycheck, and the least likely to be able to afford a day off from work when they or a family member are sick. This is harmful not only to workers and their families, but also to all of us. If a mother can't take time off to care for her sick child, that child may end up going to school and infecting his classmates, and the mother goes to work and passes the infection on to her colleagues as well.

Workers who don't take time off when they or a family member are sick aren't selfish people who don't care about the effects of their behavior on their neighbors. They are people who simply cannot afford to miss even a day of work, or who can't afford a baby sitter for a sick child even for one day. These people suffer, as do their family members.

When I was working in the pediatric emergency department a few years ago, I evaluated a seven-year-old girl who was having a severe asthma attack. She had a history of mild asthma, and usually only needed medications a few times a year, but she was suffering from the kind of attack that I usually see only in children with severe asthma. When I spoke with her mother, she revealed that she had contracted a cold a week earlier, and for the last three days was having more and more trouble breathing.

It was about 11:30 PM. I asked the mom why she hadn't brought her daughter in sooner. Her face immediately fell, and she started crying. She explained that she knew her daughter was sick, but she was unable to change her work schedule. She was a home health aide, a job at the bottom of the pay scale that rarely comes with benefits. She explained that her rent was late and she simply couldn't take an unpaid day off. Unfortunately, because her daughter had been sick for so long before she came to the hospital she required admission overnight. If she had seen her pediatrician earlier that week she likely would have avoided the ED visit and hospitalization entirely.

Yet the consequences of this situation go far beyond the effect on this mother and daughter. Her daughter was in school with a cold for several days, and likely passed it on to her classmates. The mother, while she didn't yet have symptoms, quite likely would get the cold herself and pass it on to her elderly home care patient.

The lack of paid sick days affects all of us, and disproportionately affects the poor. Our families, neighbors, friends, and all of us deserve to be able to take a day off when we're sick and not have to worry about the impact it will have on our economic stability.

6 months of health reform!

It's hard to believe it's been 6 months since the Affordable Care Act (aka Health Reform) was signed into law by President Obama. New benefits that have just started include:

Extension of coverage to young adults
Now young adults whose parents have insurance can be included on their parents' plans, meaning access to affordable health care for young adults up to age 26. For more information see the Young Invincibles website. The Young Invincibles were a critical voice for health reform and continue to work for better health access for young adults.

No more coverage exclusions for children with pre-existing conditions
Believe it or not, up until now children could be denied for coverage for pre-existing conditions, even conditions they were born with. In 2014, the same will be true for adults as well.

Restrictions on annual limits
Many people who have insurance find themselves facing astronomical bills after a serious illness. Starting now, insurers must pay at least the first $750,000 of expenses incurred in a year, and in 2014 these annual limits will be eliminated.

For more information see the Kaiser Health News website

New Directions

Hello to all! I am the new director of the NPA New York Local Action Network. Now that healthcare reform has become law, we have many exciting new directions in which to go. We will mostly be focusing on local and state-wide projects and plan to continue to work with our community partners to improve the health of all New Yorkers. Some legislation currently on the horizon that we support:

Sugar-Sweetened Beverage Tax - Obesity is a challenging problem for all of New York, especially among the poor. In the future, obesity and the diseases that come with it, including diabetes, hypertension, and heart disease will take up more and more of our health care dollars. Heavily sweetened beverages are a large source of calories that can lead to obesity, and by taxing them at a higher rate than other beverages we hope to discourage their consumption and also to raise much-needed revenue for obesity prevention programs. There are many competing interests against such a tax and it appeared to be off the table until recently, when Governor Paterson announced he would consider it again.

Midwifery Modernization Act - Maternity care in New York has become increasingly medicalized and C-section rates are skyrocketing, without any improvement in the health of women or babies. Midwives who specialize in home births offer a safe alternative for women who want to deliver in the comfort of their own home. Home births are safe when women are at low risk of complications and when attended by a qualified midwife. Current regulations require that midwives attending home births have a "written practice agreement" with an obstetrician. Unfortunately, this regulation does not improve the safety of women giving birth and serves only to limit their choices of where and how to deliver their babies because few obstetricians are willing to sign this agreement. We as physicians know that midwives are highly trained professionals who work in collaboration with other providers; a formal written practice agreement should not be required. All women should have the option of a home birth attended by a midwife. This legislation is currently on the Governor's desk awaiting his signature.

The New York City Paid Sick Time Act - Currently many workers have no paid sick days at their jobs. As a result, they risk losing valuable income if they don't go to work either to care for themselves or their children. This puts all of us at risk of contracting infectious diseases. Similar initiatives in other cities such as San Francisco have had minimal impact on business productivity.

Reproductive Health Act - Around the country, access to abortion services is under threat. The Reproductive Health Act seeks to change arcane state laws about abortion services and to regulate abortion under the same code as with all other legal medical procedures. It will also ensure that even if national laws about abortion change, New York will continue to offer abortion services up to 24 weeks, which is consistent with the landmark Supreme Court case (Roe v Wade) that legalized abortion throughout the country nearly 40 years ago. This law will allow women to consult with their doctors in privacy to make the best decisions for themselves. The legislature declined to move on this legislation in this past session.

Looking forward to working with you this year!

Sincerely,

Sharon Phillips