KNOXNEWS.COM

Decision on Medicaid Expansion holds coverage for many Tennesseans in balance

By Kristi Nelson

Posted June 2, 2013, updated June 4 2013

It was supposed to be one of the strongest tenets of the 2010 Patient Protection and Affordable Care Act. Instead, it became a political football, a metaphor for states’ rights. After the Supreme Court ruled that the ACA could not force states to expand Medicaid, Gov. Bill Haslam was among those who rejected the Medicaid expansion, instead offering his alternative “Tennessee Plan” for federal government approval.

But whether the federal government and the General Assembly will accept Haslam’s plan remains to be seen, along with how well it will work to cover those who currently don’t have health insurance.

“He’s either politically brilliant, or he’s making one of the worst mistakes he could make,” Rep. Joe Armstrong, D-Knoxville, told the News Sentinel in March.

What the ACA intended

Originally, the Medicaid expansion provision was to give state health insurance coverage to a group of people who made too much to qualify for Medicaid but too little to afford insurance on the health insurance exchanges, even with the planned government subsidies.

It expanded Medicaid to qualify people younger than 65 whose income is below 138 percent of the federal poverty guideline (a little more than $15,860 annually for an individual, a little less than $32,500 annually for a family of four).

It meant that, for the first time, low-income adults who don’t have children could get state Medicaid coverage, and it standardized other qualifications.

Many states, including Tennessee, limit Medicaid enrollment to certain categories of people. To qualify for TennCare, for example, you have to be low-income and pregnant, a child, blind, disabled, aged, or fall under multiple, specific categories.

Tennessee has nearly 1 million uninsured residents, of whom at least 140,000 and maybe more than twice that number, by some estimates, likely would enroll in Medicaid if it were expanded under the ACA guidelines. About three-quarters would have been previously uninsured. Under the ACA expansion, the federal government would pick up the entire cost of new, previously ineligible enrollees for the first three years, phasing to 90 percent by 2020. In Tennessee, federal funds would have amounted to about $1.4 billion in the first year alone.

States could receive federal matching funds for covering additional low-income residents under Medicaid as early as April 2010, with wide-scale enrollment beginning this October and coverage starting Jan. 1, 2014. However, in June 2012, the U.S. Supreme Court ruled that the federal government could not make states expand Medicaid — making a linchpin of the ACA optional.

So far, 20 states have moved forward with Medicaid expansion. Ten have rejected it outright, while 10 others are not doing it now but are looking at alternatives and have not ruled it out for the future (the government gives no deadline, though states waiting much longer to decide stand to lose federal funds for the first year). Three states are still undecided, while seven — including Tennessee — are crafting their own, alternate plans.

On March 27, Gov. Bill Haslam announced that Tennessee would not expand TennCare rolls under the ACA, instead offering up an alternative he called the Tennessee Plan.

“I don’t think just pure expanding of a system that we all agree is too costly for us, is too costly for the federal government to afford long-term, is the right way,” he said then.

The ‘Tennessee Plan’

Haslam’s proposal is that the state use federal funds not to expand TennCare but to purchase private insurance through the insurance exchange for people who would have qualified for coverage under Medicaid expansion.

He outlined the proposal in the broadest terms, including five “key points”:

Individuals identified as being eligible for the Medicaid expansion group would instead be directed to the exchange, where they would be allowed to choose any qualified health plan that offers a certain level of benefits (the Silver Plan).

The state would pay the monthly premiums, matchable with 100 percent federal dollars, for those people to enroll in the Silver Plan.

People in the Medicaid expansion group would be treated like all other people enrolled in the Silver Plan, with access to the same benefits and appeals process as other people in the plans.

People in the Medicaid expansion group would have the same cost-sharing as other Silver Plan enrollees with incomes below 250 percent of the federal poverty guidelines. (On average, Silver Plan policies would pay for 70 percent of health care costs, with the remaining 30 percent paid by the planholder.)

The arrangement would have a “circuit-breaker,” or “sunset,” ending after the three-year period of 100 percent federal matching dollars, and could be renewed only with approval of the General Assembly. (This is true for states accepting the Medicaid expansion as well; they can stop using federal funds and drop the expanded coverage at any time.)

In addition, Haslam would seek to reform the way providers are paid for services, with payment based on outcomes rather than a set fee for services. The money saved, he said, would be enough to cover the state’s 10 percent share of costs after the government’s share goes to 90 percent.

“One option for covering the Medicaid expansion group is simply to add them to the Medicaid rolls, or the TennCare rolls, in our case,” Haslam said of the plan. “We don’t want to do that. There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible.”

But the federal government may not allow Haslam to forgo some of those requirements. While national Centers for Medicare and Medicaid Services guidelines indicate that the main tenets of the plan — using federal dollars to pay premiums for low-income people to have commercial insurance, and reforming payment — meet federal requirements, some of the details don’t align with federal requirements intended to protect Medicaid enrollees.

For example, Tennessee would need to give those with serious health conditions a choice of enrolling in TennCare or private insurance, unless CMS were to grant Tennessee a waiver to that requirement.

The federal government would require supplementation of benefits (sometimes called “wraparound”) to make sure the commercial insurance plans include all services that would be available through Medicaid. Hypothetically, this could be done through a supplemental premium to the Silver Plan insurance provider.

The government also limits co-payments for Medicaid-eligible enrollees.

There is also an appeals process in place, required by past Supreme Court rulings, so that Medicaid patients and their doctors can challenge insurance companies’ refusals to cover “necessary treatments.” Under federal law, Tennessee would have to allow Medicaid-eligible patients this due process.

A federal entitlement program, Medicaid was designed for a population upon whom “poverty imposes special needs and the need for special protections,” said Carole Myers, a nurse practitioner and associate professor in the University of Tennessee’s College of Nursing. “They don’t have the same voice in government as those with different economic statuses and organizational affiliations.”

Haslam acknowledged in April that Tennessee probably would have to limit co-payments and provide the wraparound services for Medicaid-eligible enrollees for the federal government to approve his alternative, but he said he still thinks his overall plan is “workable.”

What’s next?

Haslam’s plan is modeled on a plan by Arkansas, which also wants to use federal matching dollars to pay commercial insurance premiums for those eligible for the Medicaid expansion. But while Arkansas got legislators’ approval before approaching the federal government, Haslam has taken the opposite approach, presenting his plan to CMS first.

Haslam did not ask state legislators to vote on whether to take the federal Medicaid expansion funds this session, though he said he has not ruled out calling a special legislative session later this year to meet federal deadlines for the health exchange enrollment starting in October.

The Medicaid expansion is the only provision in the ACA that provides insurance coverage specifically to those between 101 percent and 138 percent of the federal poverty guideline. If Haslam fails to reach an agreement with the federal government, or does not opt to accept the federal Medicaid expansion plan (which he could still do), that population likely would remain uninsured.

However, the latest word among hospital executives and advocates is that an agreement could be near.

“I think (Health and Human Services) Secretary (Kathleen) Sebelius is really eager to find some alternative plans that meet the goals of the ACA but do so in creative ways and allow states to create plans beneficial to those individual states,” said Jerry Askew, senior vice president for governmental relations for Tennova Healthcare.

Through Tennova’s parent company, Health Management Associates, Askew works with hospitals in seven states. All of them, except those in Kentucky and West Virginia, have said no to the expansion.

“They’re all trying to figure out what to do. It’s really interesting to watch how the state is to meet their individual objectives,” Askew said. As for Tennessee, he added, “It is fair to say that the governor’s plan is being built on principles that the majority in the Legislature would agree with. But it’s not a given. It’s a lot of hard work.”

Consumer-advocate groups and hospitals were in favor of the expansion, especially since hospitals stand to lose money on uncompensated “charity” care that would have been partially covered, at least, if more people were insured through Medicaid. The Tennessee Hospital Association has said the state stands to lose 90,000 jobs and nearly $13 billion.

Having that population continue to go uninsured also means higher costs in the long run, Myers said, as studies have shown that those without insurance are less likely to get preventive or early care.

“When you are resorting to getting care only when it becomes so bad you can’t stand it, and you’re in the emergency room, it’s causing a major human toll,” she said. “We know that intervention on the earliest point of the illness trajectory is the most cost-efficient. The true measure of whether we’re successful in what we’re doing in health care is in whether people have long, happy, productive lives.”

Business writer Carly Harrington contributed to this report.

 © 2013, Knoxville News Sentinel Co.

The death of the Murphy Bill: On being the national spokesman
Larry Drain


The Murphy Bill as we know is dead.  The Republican leadership in the House announced a change in strategy.  They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.

It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so.  It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.

Part of the problem was Murphy himself.  He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform.  He wasnt.  Being a psychologist certainly didnt qualify for the role.  Neither did being a member of the House of Representatives.  It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered.  In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.

He didnt understand that leadership was built or that it was a two way street.  He alienated people who had lived mental health reform their entire adult lives.  He thought it was about them joining him and never seemed to know it was the other way around.  And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.

He was naive.  The only people who believe federal laws change everything are federal lawmakers and most of them know better.  To say that his law was going to prevent the next shooting was simply ego.  He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.

Mental health reform is an ongoing effort by many, many people with different values and priorities.  Sometimes it is its own worst enemy.  People who cant stand each other have a hard time standing together for anything.  Murphy I hope has to some degree taught people they can find unity despite their differences.  And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.

He may indeed try again.  He probably will.  Dr.  Torrey most surely will.  He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.

Thanks for the support
by Larry Drain, hopeworkscommunity

The following organizations have offered support of "Dear Governor Haslam".  They have put links to this site or printed the letters on their websites.  I really appreciate it.  I invite you or your organization to do the same.


Tennessee Health Care Campaign.
Tennessee Citizen Action.
Tennessee Disability Coalition.
Tennessee Chapter Depression and Bipolar Support Alliance.

AGAIN THANKS.

WRITE GOVERNOR HASLAM TODAY

hopeworkscommunity | June 1, 2014 

Murphy misunderstandings

byLarry Drain, hopeworkscommunity

Rep.  Murphy has not went gently into the good night.  Dr. Torrey will never go gently into the good night.  They are trying it sounds like to provide cpr to their bill. Rather the things that didnt work the first time will work on second effort is anyone's guess.  I think sometimes it is really hard for annointed national spokesmen to realize they are not and never were.

But this post is not about that.  It is about a fundamental misunderstanding of the American mental health system that was part of the reason that may have doomed the Murphy Bill from the start.

Murphy seemed to believe we were doing far too much for too many.  He thought people who were doing better in the system were robbing those who were doing poorly of help and resources. And he thought if resources were properly allocated things would be okay. Using terms like "worried well" he seemed to want to pit one group against another or at least give worried family members someone to blame. Somehow, I never really understood how, he seemed to think that this misallocation of resources was the fault of Samsha. It was us against them, with guys in black hats, just lacking an afternoon channel from being great soap opera. People were getting rich, famous and powerful off the worried well and just abandoned those in serious need. It had drama, moral outrage, and more than a little passion. It just lacked truth.

Anyone who had watched or been part of the last few years would tell you that state after state year after year had cut their mental health budgets to the bone. In some places there was only skin. The bone had long since disappeared. It was not that too much was done for too many. Too little was done for everyone. Many people lacked insurance and couldnt even access the services that were there. It wasnt misallocation of funds. It was abandonment. Never, not once, have I ever heard anyone touting the Murphy bill ever acknowledge this.

The baggage from Dr. Torrey obscured their vision. No state bought his love affair with psychiatric hospitals. It was too little bang for way too much bucks. No one believed. It was a cash cow around their necks that threatened to bankrupt their community systems. There was little or no proof it worked. When insurance companies basically stop paying for a service that service is on borrowed time. No one drank the kool aid any more.

There will probably always be psychiatric hospitals. But they will never be the centerpiece of the mental health system again. Putting your money into backline services, what you do when things go wrong, destroys your ability to keep things from going wrong. There was never any conspiracy. People just decided what they thought mattered and all of Dr. Torrey's pr and marketing campaigns just didnt change that. In the end I dont think federal law can bring back psychiatric hospitalization as the gold standard of mental health care. The truth is that even people with "severe mental illness" can and do make it in their communities with effective support and services.

The notion that one group of people needing help was more worthy than another and that they were in competition just seemed like such a mean and stupid notion. It completely just ignored the reality of the bloody battle for funding that is the reality for so many states. It was a pseudo explanation for the fact that state after state just said "Dr. Torrey we dont buy what you say and your way will not increase the amount of services for people with severe needs but radically decrease it."

Count me cynical. Count me way cynical. Murphy lost because it was never about a battle for the "severely mentally ill." It was a battle for Dr. Torrey and a vision found lacking a long time ago.

hopeworkscommunity | June 11, 2014

Gun Violence Killed At Least 80 People The Week Prior To Elliot Rodger's Rampage

Sam Stein, Jason Cherkis05/28/14 12:00 AM ET

WASHINGTON --The Memorial Day weekend saw a community eviscerated by gun violence that left several dead and many more injured. But it wasn't UC Santa Barbara that witnessed this particular round of bloodshed. It was New Orleans. By weekend's end, the city had seen 19 people shot, four fatally. On Friday, a fight broke out at a high school graduation party that resulted in one person being killed and seven wounded. On Sunday, three men were shot with an assault rifle. That night, a murder took place at a Cajun seafood joint. On Monday morning, a triple shooting happened right outside a hospital, where people sitting in a car were hit with bullets in their backs, arms and legs. All survived. That same day, a 17-year-old died after being shot multiple times. Even earlier, a man riding his bike was shot under an overpass. The day ended with ahomicide in the Lower Ninth Ward. Outside of New Orleans, the U.S. was pocked with bad news. In the week prior to Elliot Rodger's shooting spree in Isla Vista, there were at least 80 gun-related deaths across the country, according to a Huffington Post analysis of local news reports. That these shootings failed to garner the national attention that the one in Isla Vista did shouldn't shock anyone who has followed the gun control debate. High-profile instances of gun violence are more likely to grab the spotlight than the everyday scourge of gun-related killings. And certainly, the shooting of three (and stabbing of three others) by the 22-year-old son of a Hollywood director who happened to leave a dark, depressing trail of self-made YouTube videos qualifies as high-profile. But instances such as the one at UC Santa Barbara are rare in respect to gun-related homicides. In fact, FBI data shows that there were 900 people who died in mass shootings from 2006 through 2012. By contrast, firearms were used in 11,078 homicides in 2010 alone,according to the U.S. Centers for Disease Control and Prevention. And for those on the frontline of the gun control debate, it's a bit of a head-scratcher as to how the press tends to cover instances of violence. "There's a grim calculus in the heads of journalists about what makes a shooting newsworthy," said Mark Glaze, executive director of the Bloomberg-backed Everytown for Gun Safety. "The total number killed and injured tends to be variable one. The role of young people as perpetrators or victims is a close number two." Glaze argued that press coverage was actually becoming more comprehensive, with reporters "actually paying more attention to the 33 daily gun murders in America than they did five or 10 years ago." That may be true. But, unlike with Rodger's killing spree, there was no national news coverage for the killings in New Orleans. Indeed, unless the shooting involved an athlete or a TV star, the only media that covered gun-related killings the week before Rodger took up arms was in the communities affected. Below are the local stories that The Huffington Post found from the week prior to Rodger's rampage. Alabama:

• Christopher George Handley was shot to death on May 20.
• James Madden was shot to death on May 17.
• Hassan Johnson, 20, was killed on May 19.
• 34-year-old Michael Thornton was killed May 18.

Arizona:

• Ramon Garcia was shot to death on May 17.
• Charla Faust was shot to death on May 20.
• Faustino Solis Garcia, 23, and Kassandra Medina, 20, were shot to death on May 21.

Arkansas:

• Douglas Cloyes, 72, was killed in a domestic disturbance on Sunday.
• James Green, 56, was chased out of his apartment and fatally shot on Sunday.

California:

• A shooting at a barbershop left one dead and three injured
• Sunday night.Derrick Whitfield, 23, was shot to death at the Potrero Hill housing complex on May 21.
• Gail Temple, 75, died from a gunshot wound on May 16.
• April Jace, 40, was shot to death on May 20, reportedly by her husband, actor Michael Jace.
• A 26-year old mom was killed by stray bullet in Compton on Tuesday.
• Anthony Johnson, 28, was shot to death on Monday.
• A man shot in Oakland on Monday became the city's 31st homicide of the year.
• Leonicio Banuelos was shot to deathon Saturday.
• Janet Jimenez, 17, "was riding in a carlate Friday with friends when someone fired into the vehicle, striking her in the upper torso and killing her."
• A Stockton, California, shooting and fire left one dead on Sunday.
• A 69-year-old was shot dead by an armed robber on May 16 while hiking with his 76-year-old companion.
• There was a triple shooting in San Bernardino on May 16 that resulted in the deaths of 21-year-old David Lawler, his 20-year-old half brother Terry Freeman and cousin Kavin Johnson.
• Alex Gines, 23 was shot to death on May 17.
• A woman shot to death in Hyde Park in Los Angeles on Monday.

Colorado:

• Marcus Anthony Armstrong, 44, was shot to death on May 19.

Florida:

• Clausell Stevens, 23, was shot to death on May 18.
• Alex Mazzan, 20, was shot to death on May 19.
• Frank Carl Jones III was shot to death on May 18.
• Victor Navarro, 24, was shot to deathat a barbershop after demanding Xanax and brandishing a weapon.
• Terrell Williams, 30, was reportedlyshot to death while in passenger seat of the truck that was not his.

Georgia:

• Marshal Tucker, 48, was found deadof a gunshot late Monday night.

Illinois:

• Juwan Williams, 18, was shot on May 18 and died two days later.
• Kayshaun Hall, 17, was shot to death May 19.
• Leonard Goldman, 29, was shot to death on May 19.
• Lewis Jenkins, 38, was shot to death on May 21.
• Brian McKinney, 20, was shot to death on May 22.
• Robert Waldon, 18, was shot to death on May 22.
• Kevin Diaz, 14, was shot to death on May 22.

Indiana:

• Two men were shot to death at the front door of a home in Indianapolis late Monday night.

Kentucky:

• Crystal Parker, 25, died from an apparent gunshot wound on May 19. Police arrested and charged her estranged boyfriend.

Louisiana:

• Early Tuesday morning or late Monday night, a 16-year-old male was shot dead in Tangipahoa Parish.

Maryland:

• James Lee Butler, 28, was shot (multiple times) and killed on Saturday.
• Davon McLaurin Sr., 37, was shot dead on Wednesday morning.
• John Jackson III, a 40-year-old father of two, was shot to death late last week.
• Rodolfo Miguel Cervantes, 31, wasfound dead on Friday afternoon.

Massachusetts:

• Shannon Richardson, 25, was shot several times while walking a streeton Wednesday. Taken to a hospital, he was later pronounced dead.

Michigan:

• Johnny Clyburn, an active duty Air Force sergeant, was shot to death on Tuesday morning. The suspect was a 19-year-old man who was the son of the women he was scheduled to marry.

Mississippi:

• A man was shot inside a Ford F-250 pickup truck late last week and died of a gunshot wound to the neck.

Missouri:

• Darrah Lane, 17, and Leon Davis, 27,were found shot to death in a car on May 21.

Nevada:

• An adult male died from apparent multiple gunshot wounds near the Desert Inn Road on May 22.
• An aspiring rapper named "Hollywood Will" died from a shot in the chest during a fight at a party in the Palms Hotel Casino on Thursday.

New Mexico:

• Jose Mesa, 27, was shot to death on Sunday. Police arrested 61-year-old Enrique Carmona.

New York:

• Lamont Smith, 45, was fatally shotnear a school on May 21.

North Carolina:

• Markee Watson, 26, was shot just after 4 a.m. on May 17. Medicspronounced him dead on the scene.
• Gary Lane Jr., 36, was shot and killedearly Saturday morning.

Ohio:

• 50-year-old Tyrone Hilton was fatally shot in the head and his 28-year-old son Lamont Quarterman, was shot in the arm. A young girl witnessed the shooting, which happened on Sunday.
• A 28-year-old man was found with gunshot wounds to the chest by police on Monday. He died from his injuries in the hospital.
• 21-year-old Raheem Stenson wasshot just before midnight on March 17.

Oklahoma:

• Jesse Lee Taylor, 24, was shot to death on May 18.

Pennsylvania:

• Tezjuan Taylor, 20, was fatally shot outside a Sunoco gas station early Saturday morning.

South Carolina:

• Mitzi Larson was shot to death the day after her 42nd birthday on May 17. Her husband has been charged with the murder.
• Tyrone Moore Jr., 21, brother of an NFL star, shot to death May 17outside a nightclub.
• Shamoray Antonio Robinson, 18, was shot to death on May 18 following an argument at a party.

Tennessee:

• 26-year-old William Brock was fatally shot by his 67-year-old father, Ralph, on Sunday in what was described as a domestic dispute.
• Michael Richard, 47, was killed by the man with whom he was walking on May 23, law enforcement officials allege.

Texas:

• Two people were shot to death on May 19. The victims were identified as Dylan Headrick, and Rudy Hernandez III
• William Hill, 29, was shot to death at a shopping center on Wednesday.
• A man was shot to death at a northwest Houston hotel on Thursday morning.
• Jennilynn Montana, 6-year-old girl,was fatally shot Sunday.

Virginia:

• 18-year-old Elijah-Juan Zaire Vanness of Hampton, Virginia, was shot to death on May 16.

Washington:

• Monique V. Williams, 29, was found dead on Monday in what police suspect is a murder-suicide involving her boyfriend.

Washington, D.C.:

• Simwone Keith Milstead, 36, was shot to death on May 17.
• Antwone Dwayne Tolson, 19, was shot and killed on May 19.
• Ronnell Daniels, 40, was shot and killed on May 19.

Wisconsin:

• A 34-year-old man from Milwaukeewas shot dead on May 17 after what police suspect was a fight.
• One person was shot to death on Saturday in Plover, Wisconsin.

Helping me through my depression

Blogger, Kelley Baker, shares hints her family uses to help her through depression.

 

By Kelley Baker

 

Most of the time, I’m the one you call when you want someone to cheer you up. I like to dance. I love rock concerts, farmers markets, dogs and children. But there’s another side to me: I have been living with clinical depression since I was a child.

Thanks to treatment, coping tools and lifestyle changes—working from home, eating a natural diet—I am better now than I have ever been. Still, every so often I feel the depression returning. I have described it to my husband as a demon eating my brain.

I know it’s confusing for him as one day I seem fine and the next I am sad, distant, or even angry and pushing him away. And I know he wants to help me, but sometimes it’s hard for family members and friends to know what to do.

I had to learn how to be more open with my husband about how I’m feeling and what I need from him. These are some of the things I’ve shared with him:

Help keep clutter at bay. A person spiraling into depression may feel like they are slowing down while the world around them speeds up. The daily routine feels overwhelming: The mail stacks up, dishes pile up in the sink, laundry goes undone. It feels more and more impossible to keep up. Getting extra help with kitchen chores and other mundane tasks keeps things under control so everyone in the house is happier.

Pitch in on meal plans. People who are depressed tend to either eat too little or overeat—usually going for something less than nutritious. Plus, driving through the pick-up lane at a fast food restaurant or ordering a pizza feels so much more manageable than fixing a meal. Having someone make a healthy meal not only contributes to my physical and mental well-being, but also eases my “mom guilt” over what my kids are eating.

A simple ‘Do you want to tell me what you’re feeling?’ makes me feel less alone.

Ask how I’m feeling. If I am able to articulate what I am going through, it helps my husband understand what I am dealing with—and sometimes it helps me understand better, too. Unfortunately, I won’t talk about what I’m going through unless someone asks me. I don’t want to impose, or I don’t think they care. A simple “Do you want to tell me what you’re feeling?” makes me feel less alone.

Encourage self-care. A lot of things fall by the wayside during a depression, including personal appearance. Brushing your teeth and taking a shower just don’t seem to matter—much less getting a haircut or going to the dentist. It all just seems too hard. That attitude can snowball quickly into greater feelings of worthlessness: “Now I’m such a mess, no one could ever love me.” Hearing something like, “I’m going to do the dishes, why don’t you go enjoy a bubble bath?” is often what I need to make me feel okay about doing something self-loving.

Offer a hug. Studies show that a sincere hug lasting longer than 20 seconds can release feel-good chemicals in the brain and elevate the mood of giver and receiver. The fact that people who are depressed often don’t want to be touched can make this tricky, but a hug from the heart, with no expectation of anything further, just may help.

Offer reassurance. Along with the feelings of worthlessness, anger and even guilt that are part and parcel of depression, there’s often fear of ending up alone because really, who would want to put up with these episodes forever? Being reassured I won’t scare away my family because I have an illness takes a huge weight off my mind.

Give a reality check. A never-ending loop of painful, destructive thoughts—“I’m unlovable, I’m a failure, I’m ugly, I’m stupid”—loop through the mind of someone with depression. When my husband reminds me how hard I worked to get a teaching credential, or tells me I’m a great mom or that he loves me, it helps me keep those kind of thoughts in check.

Remember the good. When I’m depressed, I sometimes forget that I was ever happy. Looking at pictures of vacations with my family, watching home movies, hearing things from my husband and kids that they like about me, reminds me that while I may feel sad or numb right now, I’ll get through it.

Why Can’t Doctors Identify Killers?

by hopeworkscommunity

This article is remarkably absent much of the bs in so many reports about the tragedy in California.  It is nice to hear from someone who is not trying to tell you that someone died because their particular law was not passed soon enough.  Very good job I think.  Thanks Dr.  Friedman.
http://mobile.nytimes.com/2014/05/28/opinion/why-cant-doctors-identify-killers.html?emc=edit_tnt_20140527&nlid=59240565&tntemail0=y&_r=0&referrer=

hopeworkscommunity | May 27, 2014

Will you speak???

by hopeworkscommunity

The opposition to Medicaid expansion is loud, organized, powerful, aggresssive and persistent.  Many people believe that the fight is over with in Tennessee. They point to the opposition in the legislature and wonder how they can make a difference. Expansion seems like such a no brainer in so many ways. I cant remember when the state of Tennessee had a chance to do something with the ability to help so many people so much. Yet it seems so far away.

It will take people who believe in it speaking up, speaking a lot, and speaking a lot more. Silence will only confirm what is. If what you say matters, saying nothing matters even more. Will you speak up??

There is no assurance it will make a difference. There is no promise you will be heard. The only promise is what will happen if you dont.

We need each other. Badly. Speak out. Write. Call. Email. Do something and then support someone else in doing the same. Vote each and every day the matters of your heart.

If are voice is to matter then what we do must matter.

Speak today for Medicaid expansion. Speak tomorrow and the day afterward. And continue speaking until you are heard and make a difference. If you dont speak for the people in need now who will speak for you in need.

Tomorrow will be my 13th letter to Governor Haslam. The day after that will be the 14th. Please join me. Contact Governor Haslam today.

hopeworkscommunity | May 29, 2014