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Family Reunification Laws

Law Library of Congress: Research Reports - Thu, 08/28/2014 - 8:00pm
The Law Library of Congress is proud to present a new report, Family Reunification Laws.

This report surveys 71 foreign countries, plus the United States and the European Union, on the issue of whether their laws permit legal immigrants to bring family members into the country for purposes of residence. For many of the jurisdictions covered, the information provided focuses exclusively on family reunification for permanent residents. However, for a number of jurisdictions, information is also provided on family reunification for citizens/nationals or temporary residents.

A bibliography of selected international and comparative law sources is provided.

Visit http://www.loc.gov/law/help/family-reunification/index.php to read the entire report.

This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php.
Categories: Research & Litigation

Pennsylvania, CMS Agree On 'Healthy PA' Medicaid Exansion Plan

Kaiser Health News - Thu, 08/28/2014 - 4:05pm

The Centers for Medicare & Medicaid Services released a press statement Thursday announcing that CMS and Pennsylvania officials. have agreed to expand Medicaid in Pennsylvania.

Philadelphia Inquirer: Feds Approve Corbett's Pa. Medicaid Expansion Proposal
Ending a year-long series of negotiations, the Obama administration on Thursday approved Gov. Corbett's Medicaid expansion alternative proposal to extend health care benefits to as many as 600,000 uninsured Pennsylvanians. In what is described as a five-year demonstration project, Pennsylvania received the go-ahead to use federal funds to pay private insurers. The decision by the Department of Health and Human Services means Pennsylvania joins Arkansas and Iowa, which also received waivers to provide alternatives to Medicaid expansion under the Affordable Care Act (Worden, 8/28).

Harrisburg Patriot-News: Corbett Gains Approval To Use Obamacare Funds To Expand Health Insurance
The expanded coverage, to become available Jan. 1, is for people earning up to 138 percent of the federal poverty level, which is about $16,000 for a single person and $32,000 for a family of four. It's Corbett's version of the Medicaid expansion called for in Obamacare and now available in more than half the states. Corbett's version of the plan will use the federal funds to buy private coverage which administration officials say will give incentives toward healthy behavior and other measures intended to lead to greater self-sufficiency (Wenner, 8/28).

Pittsburgh Post-Gazette: Corbett's 'Healthy PA' Medicaid Overhaul Appoved By Federal Regulators
Mr. Corbett’s plan, submitted to the federal government in February, would not directly expand the state’s Medicaid program, but would offer federal subsidies to about 500,000 low-income Pennsylvanians to purchase private insurance. “From the beginning, I said we needed a plan that was created in Pennsylvania for Pennsylvania — a plan that would allow us to reform a financially unsustainable Medicaid program and increase access to health care for eligible individuals through the private market,” Mr. Corbett said in a prepared statement (Giammarise, 8/28).

Wall Street Journal: Obama Administration, Pennsylvania Governor Reach Deal to Expand Medicaid
The Obama administration has reached a deal with Pennsylvania Gov. Tom Corbett to expand the state's Medicaid program to half a million low-income residents under the Affordable Care Act, state officials said. The deal makes Pennsylvania the 27th state to agree to participate in a provision of the federal health law. It also marks a win for the federal government in its efforts to coax reluctant states to grow their Medicaid programs to include everyone earning up to a third more than the federal poverty level, in the wake of a Supreme Court decision in June 2012 that allowed states to opt out (Radnofsky, 8/28).

Washington Post:  Pennsylvania’s Republican Governor Expands Medicaid
Medicaid coverage for Pennsylvania adults earning below 133 percent of the federal poverty line, or about $15,500, will begin in January. Starting in 2016, adults earning above the federal poverty line will have to pay premiums worth no more than 2 percent of household income. Those adults can be dropped from the program for failing to pay premiums, but they can also receive discounts for healthy behaviors, like going for a check-up. “Like we are doing in Pennsylvania, [the Department of Health and Human Services] and CMS are committed to supporting state flexibility and working with states on innovative solutions that work within the confines of the law to expand Medicaid to low-income individuals," said CMS Administrator Marilyn Tavenner in a statement. "But, unfortunately, millions of Americans are still without Medicaid coverage because their state has yet to act" (Millman, 8/28)

Categories: Health Care

Calif. Bill Would Protect Estates Of Many Who Received Medicaid

Kaiser Health News - Thu, 08/28/2014 - 3:49pm

A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents.

Anne-Louise Vernon from Campbell, Calif. recently enrolled in Medi-Cal, but then found out the state could use proceeds from her home to recover costs of her health care. (Photo by Pauline Bartolone/Capital Public Radio)

The governor typically does not comment on bills until he receives the actual text from the legislature. His Department Of Finance, however, opposes the bill, pointing out that the recovered assets help the state provide services to others."

The bill that just passed the legislature this week, would prohibit the state from trying to recoup some of the money spent on older Medicaid enrollees for ordinary health coverage by recovering assets after they die.

Federal law requires states to recoup money spent on institutional care, such as nursing homes, by Medicaid, the state-federal health care program for low-income people. But it also allows states to recover costs from people after they die if they received basic medical services through Medicaid at the age of 55 or older. 

In California, advocates of the bill say the current law is complicating enrollment in Medi-Cal, the state’s Medicaid program, with some people refusing to sign up, and others terminating enrollment for fear of not being able to pass on their estate. The state has enrolled 2.2 million people into Medi-Cal under the Affordable Care Act.

According to Consumer Reports, California is one of 10 states that recovers funds from estates of Medicaid beneficiaries 55 and older for basic health services. The other states are Colorado, Iowa, Massachusetts, Nevada, New Jersey, New York, North Dakota, Ohio and Rhode Island.

Consumer Reports names an additional 11 states, including Washington, where Medicaid beneficiaries “don’t need to worry” because officials have decided not to pursue the asset recovery. Washington state officials had been planning to do asset recovery but backed off after a Seattle Times story last winter stirred public complaints.

Anne-Louise Vernon had been looking forward to signing up for health insurance under Covered California. She hoped to save hundreds of dollars a month. But when she called to enroll, she was told her income wasn’t high enough to purchase a subsidized plan.

“It never even occurred to me I might be on Medi-Cal, and I didn’t know anything about it," said Vernon.

She said she asked whether there were any strings attached.

"And the woman said very cheerfully, "Oh no, no, it’s all free. There's nothing you have to worry about, this is your lucky day.'” she recounted.

Vernon signed up for Medi-Cal on the phone from her home in Campbell, Calif. Just months later, she said she learned online about a state law that allows California to take assets of people who die if they received health care through Medi-Cal after the age of 55.

“So I called Medi-Cal and asked specifically, 'Does this mean what I think it means?'” she said.

It means Medi-Cal managers can take part of her estate later for health care costs she’s accruing now. Vernon said she’s panicked and worried. She doesn’t get a monthly bill – so she’s not sure what she’ll be accountable for.

“I feel as though right now, if I could go to do the doctor and I felt I knew where I stood, there are a number of appointments that I’d be making right now," said Vernon. "But I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor."

The California law has been on the books for two decades. Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it's modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publically-subsidized health coverage have no worries,” said Landsberg.

During the past 20 years, the state of California has recovered almost a billion dollars that paid for long-term care and basic health services through Medi-Cal.

Categories: Health Care

Low-Income Patients Face Hurdles To Care At Public Hospital In Miami

Kaiser Health News - Thu, 08/28/2014 - 2:58pm

With a part-time job that pays about $10,000 a year and no health benefits, Jacqueline Samuel of Miami has relied on Jackson Health System, the county's public hospital network, to manage her chronic kidney disease at reduced rates since last year.

Through Jackson's charity care program, Samuel said, she was paying about $70 to see a nephrologist each month, $50 for routine blood tests and $22 a month for four prescriptions. But in June, Samuel failed to renew her membership in the Jackson program - and that's when the trouble began.

She had an appointment for a blood test and kept it, at the suggestion of a Jackson financial assistance counselor, because her renewal application was being processed.

A few days later, Samuel got a bill for the blood test: $1,640. She couldn't pay it. She stopped going to the doctor and refilling prescriptions. "I can't see the doctor," Samuel said in early August, "unless I have the money to pay them."

Samuel, 50, said Jackson officials did not re-enroll her in the charity care program in June because - despite providing utility bills, paycheck stubs, a property tax receipt and bank statements - she did not produce signed, notarized affidavits from one of her adult sons, and from family friends in St. Kitts, attesting that they have provided her with financial support in the past.

Demanding onerous paperwork from low-income applicants is just one way that Jackson has barred eligible Miami-Dade residents from accessing the charity care program, according to administrative complaints filed this week with the Internal Revenue Service and the U.S. Department of Health and Human Services.

The complaints lodged by Florida Legal Services and the National Health Law Program, nonprofit groups that provide civil legal help to the indigent, allege that Jackson fails to meet new requirements for nonprofit hospitals under the Affordable Care Act and other laws.   

The groups say Jackson has not widely publicized its charity care program as required under the health law and has put up eligibility barriers such as "unduly burdensome verification requirements."

The complaints also say Jackson subjected uninsured patients to harsh debt-collection tactics without telling them about financial assistance, and the hospital system had failed to produce a required "community health needs assessment" to help Jackson design a charity care program.

Miriam Harmatz, a health law attorney with Florida Legal Services, said Samuel could not afford to pay $25 a page to produce the notarized affidavits Jackson wanted - documentation that Harmatz calls excessive, since state and federal officials don't request such records from people who apply for Medicaid or a subsidized health plan under the ACA.

"It bothers us that this is how they're treating people," Harmatz said. "We don't think Jackson is taking the necessary steps to ensure that people really have access."

As a county resident who meets low-income criteria, Samuel should qualify for charity care from Jackson, Harmatz said, noting that the public hospital system with a mission to treat Miami-Dade's uninsured and indigent receives more than $350 million a year in local property and sales taxes.

Jackson offers charity care on a sliding scale, with residents who earn less than the federal poverty level receiving the most generous benefits, such as free primary care visits and nominal copayments for prescription drugs.

After Florida Legal's intervention in Samuel's case, Jackson officials rescheduled a financial-assistance interview - approving her for the charity care program on Aug. 19 without requiring the notarized affidavits, Samuel said.

"I went to the doctor yesterday," Samuel said last week, noting that she qualified for the neediest category. "It's actually cheaper than the one I had first." She has not received a second bill for the $1,640 blood test.   

Jackson officials declined to comment on Samuel's case. But Myriam Torres, vice president of revenue cycle management, said "no special treatment" was given to any applicant, including Samuel.

"Maybe circumstances for that patient changed from last time to this time," Torres said, "and now the attestation is no longer needed."

Jackson officials say they request notarized affidavits to safeguard taxpayer funds, though Samuel said the hospital system had not requested the documents in 2013.

"We're not denying care," said Mark Knight, Jackson's chief financial officer. "We're merely asking for validation of what [applicants] are telling us."

Jackson officials said 29,176 individuals are enrolled in charity care. Knight said that in 2013 the program cost the hospital system $365 million for 212,294 separate medical encounters, ranging from emergency room care to doctors' visits and outpatient surgeries.   

Knight said Jackson has an obligation to screen uninsured residents for eligibility in Medicaid or other public-assistance programs, such as the Cuban Haitian Entrant Program.

"We have to ensure that those people don't have any other available venues," Knight said.

Jackson aggressively screens all uninsured patients for some form of coverage, he added. In 2013, hospital system counselors converted 29,746 previously uninsured patients to Medicaid. So far this year, Jackson has converted 22,950 uninsured patients to Medicaid.   

Knight said county residents typically have to wait three weeks to meet with a counselor and apply for charity care, but that applicants can schedule a doctor's visit or other care while waiting for the financial-assessment interview.

However, Samuel's experience suggests that those patients also risk incurring debt if their applications are denied.

"They get these really   high bills," Harmatz said. "They don't know what for. . . and they don't go back. They feel it's just going to create more medical debt."

Still, Knight noted, "Billing the patient doesn't always mean they're paying it."

As for the complaints that Jackson has failed to widely publicize its charity care program, including eligibility criteria and debt-collection policies - by not posting the information online, neglecting to post signs in emergency rooms, and failing to insert notices in debt-collection letters - Knight said that the information is available by request.

"We are looking to post those policies online," he said. "There's not any concerted effort [not to publicize the information]. It's just that we haven't historically done that."

Matt Pinzur, a Jackson spokesman, disputed the allegation that the program is not widely publicized, given that Jackson treats more uninsured patients than any hospital in the state.

While the health law requires that nonprofit hospitals make their written charity care policies widely available, it does not specify the criteria hospitals must use to determine eligibility for care.

Nor does it offer any guidance on a fundamental question that many safety-net hospitals like Jackson struggle with every day: Are some patients unable to pay, or just unwilling?   

That's not an easy question to answer, said Rick Gundling, a vice president of the Healthcare Financial Management Association, which represents healthcare finance workers.

Gundling noted that safety-net hospitals have to balance a community's health needs with their resources and mission.

"There's far more demand than they have resources to do," he said. "So they're always trying to figure out the right balance."

Jackson serves a community with the state's greatest number of uninsured residents: The U.S. Census estimates that about 744,000 people, or about 34 percent of Miami-Dade's population, lacked health insurance in 2011.

And while the debut of the ACA's health insurance exchanges in January provided almost a million Floridians with coverage - federal officials have not provided county-level breakdowns of enrollment - advocates for low-income residents say the need is still great, and probably much greater than Jackson alone can meet.   

Samuel, a night-shift custodian at Miami Dade College, is one of an estimated 800,000 Floridians, including about 165,000 in Miami-Dade, who remain uninsured in the so-called "coverage gap" because their annual income is too low to qualify for government help buying a plan under the ACA - and they are ineligible for Medicaid, the federal-state healthcare program for the poor.

Harmatz acknowledges that there is a scenario under which Florida Legal's complaints would "go away," but it's not something under Jackson's control - expansion of Medicaid eligibility to cover all Floridians, including childless adults currently excluded from the program.   

The Florida Legislature has refused to expand Medicaid, though, turning down an estimated $66 billion in federal funding over the next decade.

"If the Florida Legislature would just accept federal funding and provide healthcare coverage for low income adults," Harmatz said, "then these problems would be wonderfully diminished. All these people would be covered."   

Categories: Health Care

The National Book Festival: New Time, New Place, New Gavel Pencils

In Custodia Legis - Thu, 08/28/2014 - 1:34pm

Photograph by Andrew Weber

It is that time of year again – the National Book Festival!    This year the Festival will be taking place on Saturday, August 30th at the Washington National Convention Center.  Once again, Law Library staff are participating in the Book Festival with six staff members manning our booth.  We will have some familiar faces at our table including Elizabeth Moore, Jeanine Cali, Emily Carr and Peter Roudik as well as first timers Nicolas Boring and Dante Figueroa.  Staff will be available to talk about the Law Library’s products such as the Guide to Law Online, the Global Legal Monitor which covers legal developments around the world, and Congress.gov.  We will have handouts which list our various websites and social media outlets and we will have a new handout this year with resources for teachers and students.

Staff at the Book Festival will also be working to stoke enthusiasm for the Library’s upcoming Magna Carta exhibit opening on November 6, 2014.  And to help fire up your enthusiasm we will be giving away some of our famous gavel pencils.   This year the legend on the pencils commemorates the upcoming Magna Carta: Muse and Mentor exhibit to serve as a reminder to visit the Library this November when one of the great historical treasures of the Western World will be on view.  The 1215 Lincoln Cathedral Magna Carta starring in this exhibit will be on loan from the Lincoln Cathedral but the supporting cast of books will be drawn from the Law Library and Library’s own collections.  Nathan Dorn, who is curating the exhibit for the Law Library, will be on hand at the Book Festival to give a talk about the material he has selected from the Library’s collections.

Categories: Research & Litigation

Health Law May Benefit More Small Businesses In The Fall

Kaiser Health News - Thu, 08/28/2014 - 12:31pm

Unhappy with the choices her insurance broker was offering, Denver publishing company owner Rebecca Askew went to Colorado’s small business health insurance exchange last fall. She found exactly what she’d been hoping for: affordable insurance options tailored to the diverse needs of her 12 employees.

But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.

In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.  

SHOP exchanges were supposed to open nationwide on Oct. 1, the same day as exchanges offering health insurance for individuals. But the Obama administration postponed the SHOP launch, citing the need to fix serious technical problems with the exchanges for individuals, which it said were a higher priority.

So far, only the District of Columbia and 15 states – California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Massachusetts, Minnesota, Nevada, New Mexico, New York, Rhode Island, Utah, Vermont and Washington – have launched small business exchanges. Three more – Maryland, Mississippi and Oregon – will also start their own exchanges. 

“It’s easy to explain why (small business exchanges) have gotten off to a slow start,” said Linda Blumberg, a researcher with the Urban Institute who is tracking their development with support from health care advocates, the Robert Wood Johnson Foundation. The delay of small business exchanges in most states confused business owners in the few states that actually offered exchanges, she said.

Also, insurance companies encouraged business owners to renew their plans before the October 2013 deadline to avoid having to sign up for a new policy during the first year of the controversial ACA rollout. The Obama administration allowed even noncomplying plans to be renewed, after complaints from individuals and business owners who had received cancellation notices.

As a result, not as many businesses needed to look for new policies for their employees as was originally projected. To be successful, SHOP exchanges must attract a large pool of businesses that can exert market pressure on insurance carriers and ultimately bring down prices. Whether that will happen remains to be seen.

How It Works

The ACA offers businesses with fewer than 50 employees the opportunity to purchase health insurance coverage for their workers through a SHOP, but it does not require them to do so.

These firms comprise 5.8 million of the 6 million firms in the U.S. and employ at least 37 million Americans. More than 96 percent of larger corporations cover their employees, while only 59 percent of very small companies provide insurance for their workers. As a result, nearly half of the nation’s 47 million uninsured people are self-employed or work for a small company, according to 2012 data from the Kaiser Family Foundation.

Under the health law, a federal tax credit that can cover up to half the cost of an employer’s share of premiums is available to businesses that have fewer than 25 employees and average annual wages of less than $50,000. The federal government estimates 4 million small businesses will qualify, resulting in $40 billion in subsidies over the next 10 years.

But so far, not many companies have taken advantage of the offer, according to a report by the Government Accountability Office. In the 2010 tax year, only 170,300 businesses received a credit, amounting to just $428 million, according to the report.

“A lot of folks complained that they needed to hire an accountant to figure it out,” Blumberg said. “You couldn’t even get a rough idea whether you qualified.” Insurance brokers have also complained about how difficult it is to determine eligibility for a credit, and suggest the federal government should create some kind of easy-to-use calculator.

In Colorado, the percentage of people employed by small businesses is even higher than in much of the rest of the country. “There aren’t exactly a lot of corporate headquarters here,” said the state exchange’s chief strategy officer, Marcia Benshoof.  “Colorado is a state of small business. We have some very passionate folks here who care about this market,” she said. 

A few other states have entered partnerships with the federal government to use the federal website but plan to provide their own marketing and outreach. All states regulate the insurance companies that offer their policies on and off the exchange.

Over the past decade, insurance premiums for small firms have increased 123 percent. Currently, small businesses pay up to 18 percent more than larger businesses for health insurance, according to the Council of Economic Advisers.

The health law requires SHOP exchanges to include a feature known as “employee choice,” in which individual workers can pick from a variety of policies offered by different insurance companies, similar to the menu of health benefit options larger companies offer employees. 

“When we talk about why they should use the exchange, choice is the meaningful part of that conversation. That’s the moment of truth with employers,” Benshoof said. Besides creating goodwill, studies show that offering employees a choice of health plans often results in lower overall health care costs, because employees tend to choose the lowest-priced plans that offer the most value for their individual needs, according to the National Bureau of Economic Research.

Employee Choice 

In Askew’s case, allowing her employees to choose a health plan resulted in an overall decrease in her monthly premium bill. Two of them had chronic conditions and needed more expensive policies that covered the doctors they had been seeing for years. The rest were relatively young and healthy. 

“I set a contribution limit (from the company) based on the cost of the most expensive policy and let the staff choose the policy they wanted,” Askew said.  Out of 47 choices on the exchange, she said 10 of her employees chose a plan that was cheaper than the $300 per month per person limit she set. Overall, she will pay a total of about $400 per month less than she did last year.

Before Colorado opened its exchange, Askew, like most small employers, could qualify only for one insurance policy for all of her employees. That’s because commercial carriers set a threshold number of employees that must sign up to get a plan. As a result, companies with fewer than 50 employees usually qualify for only one plan.

In June, the Obama administration allowed 18 mostly Republican-led states using the federal exchange to temporarily opt out of employee choice, because they argued it could cause overall insurance rates to rise. Alabama, Alaska, Arizona, Delaware, Illinois, Kansas, Louisiana, Maine, Michigan, Montana, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota and West Virginia will not offer the feature until 2016 at the earliest.

A small business advocacy group, the liberal-leaning Small Business Majority, criticized the administration for putting off employee choice, which they say is critical to the exchanges’ success. Without it, state and federal small business exchanges may not offer businesses any distinguishing advantages over self-insuring or purchasing a policy outside of the exchange, said David Chase, the group’s health policy analyst.

With employee choice, he explained, carriers are selling directly to employees, giving small insurance companies a chance to compete with established carriers. That alone, Chase said, could contribute to eventually dragging down prices on the exchange.

Business Opposition

The National Federation of Independent Business (NFIB), one of the groups that sued the administration over the federal health law’s so-called individual mandate requiring nearly everyone to purchase health insurance or pay a tax fine, currently advises its member companies to consider canceling their group health policies and instead help employees apply for insurance subsidies on the individual exchange.  According to the NFIB, the total cost to business owners who are now offering workers’ coverage may be lower if they simply give employees a salary boost to purchase insurance on their own.

If a company’s average wages are low enough to qualify for the small business tax credit, chances are its workers would have incomes low enough to qualify for substantial subsidies on the individual exchange. If workers have an employer offer of affordable insurance, however, they lose their eligibility for premium tax credits.    

When it comes to health insurance, the biggest issue for small businesses is cost, according to a recent survey published in the journal Health Affairs. More than 92 percent of small firms that don’t offer employee coverage said that costs would need to be lower than they are today for them to do so. The catch for SHOP exchanges is that until a large number of businesses start purchasing policies on them, they likely will not create enough new competition to push down prices. Other features and extensive marketing will have to drive businesses there in the meantime.

In general, insurance agents and brokers, who have an equal financial incentive to help businesses purchase policies on the exchange as from the outside market, say exchanges have required nearly twice as much of their time. Colorado exchange officials admitted they were surprised that Askew had successfully navigated the exchange without the help of a broker.

“Granted I’m a lawyer,” Askew said. “But it seemed to me to be a much easier way to manage it all.”

Categories: Health Care

How to Complain to Medicare

Medicare -- New York Times - Thu, 08/28/2014 - 12:28pm
Revealed: the semi-secret phone numbers that beneficiaries are supposed to use to complain to Medicare.
Categories: Elder, Medicare

Laws on Children Residing with Parents in Prison

Law Library of Congress: Research Reports - Thu, 08/28/2014 - 10:00am
The Law Library of Congress is proud to present a new report, Laws on Children Residing with Parents in Prison.

This report provides information on select international and regional measures and the laws of 97 jurisdictions from around the world that relate to allowing children to reside in prison with an incarcerated parent. Most of the countries surveyed impose specific age limits for a child’s admission into and length of stay in prison. Additionally, most of jurisdictions surveyed require that prisons that admit children meet certain standards.

A bibliography is included.

Visit http://www.loc.gov/law/help/children-residing-with-parents-in-prison/index.php to read the entire report.

This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php.
Categories: Research & Litigation

Political Cartoon: 'Cootie Catcher?'

Kaiser Health News - Thu, 08/28/2014 - 9:32am

Kaiser Health News provides a fresh take on health policy developments with "Cootie Catcher?" by Rina Piccolo.

CBO'S LONG-TERM VIEW

The bargain price tag
On a permanent doc fix
won't last forever
-Anonymous 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

CBO: Smaller Deficits Projected As Medicare And Medicaid Spending Declines Slightly

Kaiser Health News - Thu, 08/28/2014 - 9:18am

In the Congressional Budget Office's latest forecast, reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion.

The Wall Street Journal: Deficit Forecast Trimmed As Rates Stay Low
Smaller deficits are the result of a variety of factors, including higher tax revenue and economic growth, budget cuts and new limits on government spending. The agency forecast the government would spend slightly less on Medicare and Medicaid over the next decade than it estimated earlier this year. Still, the changes were relatively minor—less than 1% of total spending on the programs. CBO expects the deficit to shrink for several years before starting a steady expansion in 2018, driven by the aging U.S. population, higher health-care costs and increasing subsidies for certain federal programs (Paletta, 8/27).

Kaiser Health News: Capsules: CBO Projects Lower Medicare and Medicaid Costs
Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday. Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast (Carey, 8/27). 

The Associated Press: US Economy Forecast To Grow By 1.5 Percent In 2014
The Congressional Budget Office on Wednesday forecast that the U.S. economy will grow by just 1.5 percent in 2014, undermined by a poor performance during the first three months of the year. The new assessment was considerably more pessimistic than the Obama administration’s, which predicted last month that the economy would expand by 2.6 percent this year even though it contracted by an annual rate of 2.1 percent in the first quarter (Taylor, 8/27).

Categories: Health Care

State Highlights: Heroin Deaths Rise In N.Y.; TennCare Computer System Delay; Colo. Races To Win $87M To Integrate Care;

Kaiser Health News - Thu, 08/28/2014 - 9:15am

A selection of health policy stories from Colorado, Minnesota, Georgia, Virginia, California, New York, Michigan and Tennessee.

The New York Times: Heroin's Death Toll Rising In New York, Amid A Shift In Who Uses It
A heroin crisis gripping communities across the country deepened in New York last year, with more people in the city dying in overdoses from the drug than in any year since 2003. In all, 420 people fatally overdosed on heroin in 2013 out of a total of 782 drug overdoses, rising to a level not seen in a decade in both absolute numbers and as a population-adjusted rate, according to preliminary year-end data from the city’s health department (Goodman, 8/28).

McClatchy: TennCare Computer System Delay Draws Federal Criticism
Just days before TennCare leaders head to court over accusations that state failures have created months-long delays in coverage, the agency’s director faced questions from lawmakers about the unfinished computer system that led to those delays. TennCare Director Darin Gordon told lawmakers Tuesday that nearly a year after the new state’s new Medicaid eligibility system was supposed to be completed, the contractors building the system have not finished even the first of four testing phases (Harrison Belz, 8/27).

Health News Colorado: Race To Win $87 Million Could Fuel Blended Physical, Behavioral Health
Integration is a hot buzzword to describe efforts to blend physical and behavioral health care. But the sad truth from experts who have been doing integration for decades is that most efforts won't work, either because managers don't know how to fully integrate their health systems or because they can't pay for it. Colorado health policy leaders are trying to strengthen and expand integration pilot programs with a jolt of federal cash. Much like "Race for the Top" funds in education, states are competing for a new pot of $700 million in federal cash to fuel innovations in health. Colorado officials are applying for $87 million and could get an answer by the end of October (Kerwin McCrimmon, 8/27).

Minneapolis Star-Tribune: Minnesota Doctors Now Must Report Dense Breast Tissue On Mammograms
The standard "all-clear" letter sent after mammograms to tell women they are cancer-free is going to contain new and potentially troubling information for thousands of Minnesota women -- the disclosure that they have dense tissue in their breasts that could cloud their cancer screenings. Minnesota mandated as of Aug. 1 that doctors notify women if their mammograms discover dense breast tissue, which can mask the presence of a tumor on an X-ray (Olson, 8/27).

Atlanta Journal-Constitution: Increased Medicaid Pay For Doctors Set To End This Year
Dr. Sean Lynch is forced to turn away as many as seven low-income patients every day, and that number could soon grow. For the past two years, Lynch and other Georgia doctors have received more money for treating Medicaid. ... But the reimbursement hike — fully paid for by the federal government for two years — is set to end on Dec. 31 unless the state opts to extend the increase with its own money (Murchison, 8/28).

Stateline: Fighting Financial Scams Aimed At Seniors
Sally Hurme figured that if anyone knew about financial scams targeted at older Americans, it would be her family and friends. After all, Hurme, an attorney and AARP project advisor, had spent two decades educating seniors across the country about fraud and how to avoid it. That's why she was so shocked when her own husband, Art, 71, became the victim of a fraud in January. The retired Army Corps of Engineers marine biologist wound up losing $3,000 in an "imposter scam" after receiving a call at his Alexandria, Va., home from a sobbing woman claiming to be his daughter (Bergal, 8/27).

Kaiser Health News: Capsules: Urgent Care Centers Opening For People With Mental lllness
Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned. L.A. County's mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are "more humane" and a smarter approach (Gorman, 8/28).

The Associated Press: Deal On Health Care Aids Port Contract Talks
Negotiators hoping to forge a new contract for dockworkers and keep hundreds of billions of dollars in cargo moving smoothly through West Coast seaports made significant progress with a tentative deal on health care benefits, a knotty issue that tied up talks for months. West Coast dockworkers already have unusually generous health benefits -- so generous, argue their employers who pay for the coverage, that the insurance plan has become riddled with fraud (8/27).

The Associated Press: Firm Allegedly Gipped Workers Out Of Jobs, $100K
Prosecutors hammered a Brooklyn contractor Wednesday with allegations he cheated workers out of $100,000 and reneged on promises of permanent jobs and health care. Contractor Anthony Miller and his firm Bael Out Enterprises were arraigned in Brooklyn Supreme Court on charges they schemed to defraud more than 70 workers and failed to obtain workers' compensation insurance (8/27).

Kaiser Health News: Health Law Spurs Focus On Faster Drug Development
Imagine if scientists could recreate you -- or at least part of you -- on a chip. That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and hefty health care costs that accompany arriving at the right treatment. Right now, at the University of California, Berkeley, researchers in bioengineer Kevin Healy's lab are working to make that happen. Funded under a provision of the health law, they're trying to grow human organ tissue, like heart and liver, on tiny chips (Hernandez, 8/28). 

Pioneer Press: Minnesota Health Care Union Vote Bucks National Labor Trend
The creation of a new bargaining unit to represent the state's 27,000 home health care workers could boost the dwindling ranks of union membership in once labor-strong Minnesota. While the percentage of Minnesota workers affiliated with unions is still above the national average, it has been steadily declining since its peak at 22 percent in 1992, according to a report by the U.S. Bureau of Labor Statistics (Woltman, 8/26).

Detroit Free Press: New Nonprofit Aims To Boost Michigan Women's Access To Health Care
A new nonprofit dedicated to informing Michiganders about the types of laws passed or being considered by the state Legislature that it sees as detrimental to women's access to health care will officially get off the ground today. Sen. Gretchen Whitmer, D-East Lansing, is the spokeswoman for the new group -- Right to Health -- that will travel the state to talk to women about obstacles to obtaining quality health care (Gray, 8/28).

Categories: Health Care

Pennsylvania Officials Say Medicaid Expansion Talks Are In Final Stage

Kaiser Health News - Thu, 08/28/2014 - 9:14am

But the state offered few details about where the negotiations with the federal government are heading. Also in news about changes from the health law in the states, the Arizona Supreme Court agreed to hear an appeal of a case that could unravel that state's Medicaid expansion.

The Associated Press: Talks On Pennsylvania Medicaid Plan Said To Be Nearing End
An announcement could be made soon on Pennsylvania Gov. Tom Corbett's plan to use billions of federal Medicaid expansion dollars under the 2010 healthcare law to subsidize private health insurance policies, a spokeswoman said Wednesday. Kait Gillis, a state Department of Public Welfare spokeswoman, said negotiations with the federal government are in the final stages, but details remain under wraps (8/27).

Arizona Republic: Arizona Medicaid Appeal To Be Heard By Court
The Arizona Supreme Court has agreed to hear Gov. Jan Brewer's appeal of an appeals-court decision that could unravel the Medicaid expansion she fought for last year. The high court has not yet set a date, but indicated it will hear Brewer's argument that about three dozen Republican lawmakers don't have the legal standing to challenge the controversial vote (Pitzl, 8/27).

Categories: Health Care

Health Law Provision Seeks To Rein In Executive Compensation At Insurance Companies

Kaiser Health News - Thu, 08/28/2014 - 9:14am

News outlets report that this little-noticed provision puts in place stricter limits regarding the amount companies can deduct from their federal tax bills. Also in the news, The Associated Press reports on ways health plans discourage sick people from enrolling and The New York Times examines the health law's efforts to expand mental health coverage.   

The Washington Post’s Wonkblog: The Obscure Part Of Obamacare That Takes On Executive Pay
We all know Obamacare is a pretty big law, with plenty of obscure provisions that don't get much attention. For one, the law targets big executive pay packages at health insurance companies -- and based on data released Wednesday, the provision is already going a long way. Companies have long been able to deduct salaries to top executives from their federal tax bills, although since the early 1990s -- in an effort to reduce excessive pay -- the government has limited the amount to $1 million (Millman, 8/27).

Marketplace: Affordable Care Act Provision Targets Some Exec Pay
A little-known provision in the Affordable Care Act (ACA) could help rein in executive compensation at health insurance companies, according to The Institute for Policy Studies. Corporations can deduct the costs of doing business from their tax bills, including the compensation of a firm’s top four executives. The deductions are capped at $1 million for each of those executives. The Affordable Care Act made the limits stricter for health insurance companies, which stood to gain business as more Americans became insured under the law (Baxter, 8/27).

Related KHN coverage: Report: Health Law Ups Taxes On Insurers With Big Pay Packages (Appleby, 8/27)

The Associated Press: 3 Ways Insurers Can Discourage Sick From Enrolling
Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling. Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul (8/27).

The New York Times: Expansion Of Mental Health Care Hits Obstacles
The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces (Goodnough, 8/28).

Meanwhile, Arkansas' governor touts lower insurance premiums --

The Washington Post: Health-Care Premiums Fall In Arkansas
Arkansas Gov. Mike Beebe's office said Wednesday that most health-care customers will pay less for their plans next year, a relief to state residents — and to the Democratic senator trying to hold onto his seat in one of the country's most expensive elections. Health-care premiums will decline about 2 percent next year, Beebe (D) wrote in a statement Wednesday. Beebe helped lead an at-times reluctant Republican legislature to expand Medicaid. In his statement, he said insurance costs nationwide "historically rise by six-to-ten percent annually." The state used federal funds to launch a private Medicaid option that has been described as a potential model for conservative-leaning states (Ferris, 8/27).

And, on the political front --

The Washington Post: Why That One Democratic Obamacare Ad Didn’t Signal A New Trend
When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it's become clear: there's little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign (Gold, 8/27).

Categories: Health Care

Obama's Plans For Vets Include Development Of Computer Chips To Stop Pain

Kaiser Health News - Thu, 08/28/2014 - 9:10am

The novel effort will be spearheaded by the Defense Advanced Research Projects Agency. Also, Sen. Bernie Sanders, I-Vt., tells American Legion convention that Congress will continue to revamp VA.

The Washington Post: New Obama Plan Calls For Implanted Computer Chips To Help U.S. Troops Health
When President Obama on Tuesday highlighted 19 executive actions he says he is taking to improve the mental health of U.S. troops and veterans, one of them centered on a particularly novel effort: The development of new computer chips designed to modulate the nervous system to help with everything from arthritis to post-traumatic stress. The project is headed by the Defense Advanced Research Projects Agency, a Pentagon agency that develops a variety of high-tech equipment for the U.S. military (Lamothe, 8/27).

Arizona Republic: Congressional Leaders Say VA Reform To Continue
Months of disclosures about potentially criminal conduct at Department of Veterans Affairs facilities in Phoenix and elsewhere will help resuscitate the agency, according to two key congressional leaders who spoke to the nation's largest veterans organization Wednesday. "The problems within the VA were not created overnight, and they are not going to be solved overnight," Sen. Bernie Sanders, I-Vt., told thousands of veterans at the American Legion's national convention. "There is much left to do" (Giblin, 8/27).

Categories: Health Care

Consumers Unable To Update Healthcare.gov Data With Deadline Looming

Kaiser Health News - Thu, 08/28/2014 - 9:10am

Hundreds of thousands of people risk losing subsidized health insurance if they don't resubmit immigration information by the end of next week, but many have been unable to comply because of glitches with healthcare.gov. Other stories look at the millions spent on healthcare.gov and at exchange developments in Connecticut, Oregon and Washington.

USA Today: Consumers Deal With Insurance Deadline, Site Glitches
Hundreds of thousands of people risk losing their new health insurance policies if they don't resubmit citizenship or immigration information to the government by the end of next week -- but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying. Consumers are being forced to send their information multiple times, and many can't access their accounts at all, immigration law experts and insurance agents say (O’Donnell, 8/28).

The Washington Post: How You End Up Spending $800 Million On Healthcare.Gov
Signed into law by President Obama on March 23, 2010, the Affordable Care Act has proven to be its own kind of jobs act, especially when it comes to the Washington-area IT community. When, in several places, the bill called for the creation of an "Internet website" to allow Americans to find and sign up for new health insurance coverage, it opened the tap on hundreds of millions of dollars that would eventually go to creating healthcare.gov's front end and back end, as well as a small universe of accompanying digital sites. On Wednesday, the office of Daniel Levinson, the inspector general of the Department of Health and Human Services, put out a report detailing the dozens of contracts that went into building out the Federal Marketplace project. And a look at each in the disaggregate paints a picture of an effort far more sweeping than even that suggested by the half-billion dollars the federal government has already paid out to implement the digital side of the health insurance law (Scola, 8/27).

Connecticut Mirror: Access Health CT’s IT Chief To Lead Agency As Interim Boss
Jim Wadleigh, the top information technology official at Connecticut’s health insurance exchange, will lead the agency on an interim basis after chief executive Kevin Counihan leaves for a top federal job next week. The exchange’'s board plans to conduct a national search to replace Counihan, but it's anticipated to take months. That means Wadleigh will be leading the agency, Access Health CT, at the start of the next open enrollment period for private health insurance, which begins Nov. 15 (Levin Becker, 8/27).

The Seattle Times: State To Offer More Health-Insurance Choices Next Year
Ninety individual health plans sold by 10 insurers will likely make their way into Washington's exchange marketplace for 2015, if the Washington Health Benefit Exchange board approves them Thursday, as expected. The Office of the Insurance Commissioner (OIC) also approved two insurers' exchange plans for small businesses, including the first to sell small-business plans statewide in Washington: Moda Health Plan (Ostrom, 8/27).

Oregonian: Cover Oregon Needs Oracle's Help To Avoid Delays In Federal Health Exchange Transition
A key portion of the work under way on the troubled Cover Oregon health exchange project -- that affecting people enrolling for the state's Medicaid program -- may not be ready as planned when the new federally-assisted exchange "goes live" in November, The Oregonian has learned. And it appears that Oregon's legal dispute with Oracle America over the exchange is not helping the matter. The new obstacles involve Oracle, which highlights an uneasy reality. Despite having accused the California software giant of lies, poor work and fraud in court, the state still needs Oracle's help (Budnick, 8/28).

Categories: Health Care

Viewpoints: Medicare No Longer 'Busting' The Budget; A 'Nightmare' Trying To Get Coverage In D.C.

Kaiser Health News - Thu, 08/28/2014 - 9:09am

The New York Times' The Upshot: Medicare: Not Such A Budget-Buster Anymore
You're looking at the biggest story involving the federal budget and a crucial one for the future of the American economy. Every year for the last six years in a row, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a report from the budget office on Wednesday morning. The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion (Margo Sanger-Katz and Kevin Quely, 8/27). 

The Washington Post's Plum Line: Yes, Obamacare Is Cutting The Deficit
Today the Congressional Budget Office released its latest economic and fiscal projections, and guess what: The news is pretty good. In fact, all the "deficit hawks" out there who are deeply concerned about too much borrowing and the terrible choices our grandchildren will confront might want to write a letter of thanks to one Barack Hussein Obama. To start things off, the CBO says the deficit this year will be $506 billion, or 2.9 percent of GDP. In 2013 it was $680 billion, so that’s a pretty steep drop. And in terms of GDP, not only is that slightly lower than the average deficit of the last 40 years (3.1 percent), it's also a 70 percent decline from Obama's first year in office, where because of the Great Recession, which brought both the need for more spending and a plunge in tax revenues, the deficit peaked at 9.8 percent of GDP (Paul Waldman, 8/27). 

The Washington Post's Plum Line: On Obamacare, Democrats Should Attack, Not Defend
Yesterday, state treasurer Doug Ducey won the GOP nomination for governor to replace Jan Brewer in Arizona. Brewer was one of eight GOP governors who accepted the expansion of Medicaid, something Ducey had opposed. Ducey's comments on the subject are vague ... when asked whether he'd repeal the expansion, he bobs and weaves. And it isn't hard to understand why. Looking at this race in combination with other close races, you see that the politics of health care have shifted profoundly in recent months. As Democrats are stroking their chins wondering whether they can turn the Affordable Care Act into a winning issue this fall, and if so how to do it, the answer is simple: Don't defend, attack (Paul Waldman, 8/27).

The Washington Post: Even A Harvard-Educated Lawyer Has 'Nightmare' With D.C. Health Insurance Site
Diana Daniels's experience with the District's health insurance Web site is the sort that gives government bureaucracy — and Obamacare — a bad reputation. The Northwest Washington mom filed her online application for medical coverage for her two teenage daughters on June 4. The process supposedly requires three weeks at most. No coverage materialized for nearly three months, despite Daniels's numerous calls to D.C. Health Link trying to sort things out (Robert McCartney, 8/27). 

The Washington Post: Early Tax Planning May Be Needed Because Of The Affordable Care Act
Having gone through tax season not that long ago, you may not want to face any issues related to your tax situation until next year. But some of you may need to do some tax planning now nonetheless. It has to do with the Affordable Care Act (Michelle Singletary, 8/26).

The Wall Street Journal: An $8.3 Billion Rebuke To The FDA
Amid this summer's M&A fever, Roche's agreement Monday to buy the San Francisco biotech InterMune deserves special notice. The tie-up is an $8.3 billion guided missile into the fortified bunker that is the Food and Drug Administration. InterMune has never turned a profit in 16 years of existence and other than its clinical expertise the company holds a single asset: an idea for treating a lethal lung disorder called idiopathic pulmonary fibrosis with no known cause, cure or approved therapy—at least in the U.S. An InterMune drug called pirfenidone that slows the progression of irreversible lung scarring is on the market in Europe, Japan, Canada and even China (8/27). 

The New England Journal Of Medicine: A VA Exit Strategy
The VHA's [Veterans Health Administration] current crisis provides an opportunity to dramatically rethink the role that the agency plays in improving access to high-quality, high-value care for its service population. To simply go on doing more of the same is to fail to recognize the challenge that the VHA's cost and population structure pose in the longer run. Just as they plan for new roles for the federal government as part of an exit strategy from a war that is winding down, politicians with longer-term views might envision a new way for the VHA to work with other federal departments and the private sector to reduce its overall and per capita costs, shed costly and unproductive assets, save taxpayers money, reduce veterans' health care expenditures, and improve veterans' outcomes (Dr. William B. Weeks and David Auerbach, 8/28).

The New England Journal Of Medicine: Updating Cost-Effectiveness — The Curious Resilience Of The $50,000-per-QALY Threshold
For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. ... Invoking thresholds, however, means acknowledging limits  ... It also suggests that more of our spending should focus on underutilized interventions with ratios below the threshold; substituting more cost-effective interventions for less cost-effective ones could improve health outcomes and save money (Peter J. Neumann, Joshua T. Cohen and Milton C. Weinstein, 8/28).

JAMA: Legalizing Medical Marijuana May Reduce Opioid Deaths
Opioid-overdose deaths increased in states across the country between 1999 and 2010, but states that legalized medical marijuana saw less-steep increases than those without, according to a study published in JAMA Internal Medicine this week. Growing use of prescription opioids over the past 2 decades to treat chronic pain has helped drive increasing rates of opioid overdoses. ... Marcus A. Bachhuber, MD, a Robert Wood Johnson Foundation Clinical Scholar at the Philadelphia Veterans Affairs Medical Center, and his colleagues analyzed opioid overdose rates in states with or without legalized medical marijuana (Bridget Kuehn, 8/26). 

JAMA: What Near-Death Experience Can Tell Us About Medical Care
In 2005, a survey was conducted examining how aggressively physicians treat patients near the end of life. Some 1500 primary care physicians and cardiologists were presented a scenario describing an 85-year-old man with severe congestive heart failure. ... Recently, the responses to this survey were analyzed by me, Ariel Stern, PhD; Jonathan Skinner, PhD; David Wennberg, MD, MPH. Although the data are nearly a decade old, there is no reason to think that answers today would be any different. Our analysis of these responses reveals the troubled state of American health care—as well as the possibilities ... No one is trying to do the wrong thing, but the consequences of unstandardized and often excessive care is wasted money and unnecessary pain. Establishing the right systems, realigning payments, and pushing for the right care can accomplish far more than many think is possible (David Cutler, 8/27).

Categories: Health Care

Longer Looks: A New Kind Of Abortion War; Foster Kids And Psychotropic Drugs

Kaiser Health News - Thu, 08/28/2014 - 9:08am

Each week KHN's Shefali Luthra finds interesting reads from around the Web.

Pacific Standard: A Tale Of Two Abortion Wars
While pro-life activists fight to rescue IVF embryos from the freezer, pregnant women in their third trimester with catastrophic fetal anomalies have nowhere to turn. ... Perhaps there is no other issue that touches on so many core dimensions of American society—legal, medical, scientific, theological, political, philosophical, biological, ethical, and ecological. What some on one side of the debate call reproductive justice, others call taking a life. What some call a person, others call a cluster of cells. This seemingly intractable split is part of the larger culture wars that have fractured the nation for decades, pitting traditionalist and progressive values against each other (Ananda Rose, 8/25).

Vox: An Interview With Healthcare.gov’s Chief Executive
Connecticut's health exchange had one of the most successful open enrollment seasons of any Obamacare marketplace this year ... It's no surprise then that the White House has now tapped AccessHealthCT executive director Kevin Counihan to run Healthcare.gov as chief executive. ... Counihan and I last spoke in June, to debrief about the first open enrollment season ... SK: How do you think the 2015 open enrollment will go? ... KC: It's going to be very complex. Not only are people going to be enrolling and going to be renewing, but there are going to have to be new determinations of what tax credits people qualify for. The education is going to be critical (Sarah Kliff, 8/26).

The Economist: Paternalism 2.0
American exceptionalism takes many forms. In the corporate world, one example is particularly odd: companies choose health insurance for their workers. Almost all firms with over 200 employees offer health coverage. Company-sponsored insurance is common for working-age Americans. In no other big and rich country is it the norm. But this form of paternalism is diminishing fast, accelerated by Barack Obama's health reform. ... Some employers are going further, asking workers to shop not only for health care, but for insurance. Workers can use their firm’s money to choose among plans from new private health exchanges. ... Eventually companies might relinquish their grip on health insurance completely (8/23).

San Jose Mercury News: Drugging Our Kids
They are wrenched from abusive homes, uprooted again and again, often with their life’s belongings stuffed into a trash bag. Abandoned and alone, they are among California’s most powerless children. But instead of providing a stable home and caring family, the state's foster care system gives them a pill. With alarming frequency, foster and health care providers are turning to a risky but convenient remedy to control the behavior of thousands of troubled kids: numbing them with psychiatric drugs that are untested on and often not approved for children. An investigation by this newspaper found that nearly 1 out of every 4 adolescents in California's foster care system is receiving these drugs — 3 times the rate for all adolescents nationwide (Karen De Sa).

The Boston Globe: Brave And Afraid, And Heading Down The Longest Road (Three-Part Series)
Mike was 33 years old. He'd been in and out of institutions for half his life, since he first got sick when he was 17. His diagnosis had changed over the years — it was schizophrenia, then bipolar disorder, then schizoaffective disorder — and his medications were in constant flux. Things stayed good for a while, then went bad again. Now Mike's medications seemed to be working, and he was saying that he wanted to stay on them — a view he didn't always take. But there had been so many days like this, so many hopeful new beginnings (Jenna Russell, 8/23-8/25).

The Atlantic: Healthcare In The Time of Grey's Anatomy
A 2005 survey by the Centers for Disease Control and Prevention found that the majority of primetime TV viewers reported learning something new about a disease or other health issue over six months of viewing. About one-third of viewers took some kind of action after learning about a health issue on TV. Many medical shows have physicians consult for accuracy, and an article in the American Medical Association Journal of Ethics notes that starting with ER in the 90s, TV shows began using more detailed medical jargon to describe conditions and procedures. But there are still inconsistencies. Treatments for patients with seizures are sometimes downright dangerous, with doctors trying to hold patients down, or put things in their mouths (they could choke) (Julie Beck, 8/26).


Categories: Health Care

Cheap, Low-Tech Devices Help Paralyzed Patients ‘Speak Their Minds’

CommonHealth (WBUR) - Thu, 08/28/2014 - 9:06am

Cathy Hutchinson, who had a brainstem stroke, is using a head mouse to type on a prototype keyboard, and has typed that she likes it. (Courtesy SpeakYourMind Foundation.)

By Suzanne Jacobs
Guest contributor

When the man started quoting Shakespeare with his eyebrow, Dan Bacher knew he was on to something.

All it took was an off-the-shelf webcam, a green sticker, and an app, and the stroke victim had regained his ability to communicate.

“Before that, what he would do is, someone would stand next to him and literally read through the alphabet, and then he would raise his eyebrow to pick a letter,” Bacher says. “He was fully dependent on someone else, and he couldn’t initiate conversation. Someone had to say, ‘Do you want to say something?’”

So Bacher, an engineer, and his colleagues put a green sticker the size of a pencil eraser on the man’s eyebrow and turned a webcam into a tracking system that could follow the green sticker and register a raised eyebrow as a mouse click. With a custom-made app, the man could then scroll through the alphabet and type on his own.

And then Shakespeare — part of a line from “Henry IV” that goes, “A good wit will make use of anything; I will turn diseases to commodity.”

“It was just like one of those wow moments, where we realized, ‘Wow, what we’re doing here really is making a difference,’” Bacher recalls. The device was just a prototype, but Bacher said he hopes to have something permanent for the patient in the coming months.

Bacher is the founder and CEO of the SpeakYourMind Foundation, a nonprofit organization based in Providence, RI, that’s developing low-cost and easy-to-use communication devices for people with neurological disorders who are “locked in,” virtually unable to move.

So far, the organization has only worked with about 12 clients and is still experimenting with prototype devices, but ultimately, Bacher says, he wants to have products that are widely available. Already, he says, people have been contacting him from around the country asking for help.

SpeakYourMind is far from the cutting edge of research on “brain-computer interfaces,” but that’s the point. Having worked in Brown University’s BrainGate Lab, one of the leading research centers for advanced brain-computer interface technology, Bacher knows all about the cutting edge, and that’s why he decided to start SpeakYourMind — to give people a simpler option, at least for now.

Brain-computer interface technology is still in its infancy, Bacher says, and the state-of-the-art eye tracking devices currently on the market aren’t always practical. They run around $15,000, and although they’re reimbursed by health insurance, the process of getting one can be arduous — visits to the neurologist and speech pathologist, lots of paperwork, having to try out different devices. Even when someone finally gets a device, he says, it’s not always smooth sailing. The devices are so complex that caregivers often can’t even set them up properly.

Bacher saw the reality of this situation after working with a number of BrainGate clinical trial participants who had tried these eye-tracking systems with little success.

“More often than not, they were collecting dust in the closet,” he says. “And so, being the engineer that I am, and pulling resources from other people around Brown, I said, ‘You know what? I’m pretty sure we can solve some of these problems using low-cost, off-the-shelf hardware and create software to really meet the need of the individual.”

Maggie Worthen, who had a brainstem stroke, is communicating with the help of her mom using our wearable eye tracker called SYMeyes. (Courtesy SpeakYourMind Foundation)

Back To First Principles

With SpeakYourMind, Bacher is taking the field back to “first principles,” he says. The idea is to find what little ability someone has, whether it’s raising an eyebrow, flexing a muscle or just moving his or her eyes, and to build a cheap and simple device that can transform that ability into a means of communication.

Alik Widge, an engineer and psychiatrist, does research with brain-computer interface technology in the Division of Neurotherapeutics at Massachusetts General Hospital. He says there’s still a ways to go before the most advanced devices are widely available, and he commends Bacher for being willing to go low-tech.

“I really think it’s an awesome project,” Widge says. “The truth about assistive technology and clinical technology in general is that there is no single best way to approach a problem. Speaking as an engineer, this is always the tradeoff that you have to do in planning out any research program — are you going to invest your time in making more advanced technology or are you going to look around for what’s on the shelf right now?”

It’s not that Bacher is against advanced devices. In fact, he says he’d recommend a state-of-the-art eye tracking device to a client if he thinks it’s the right fit, but until the devices reach the mass market, there needs to be another option.

“What we’ve learned is that for a lot of people, they don’t need all the bells and whistles. They want something simple and intuitive,” he says. “We think that simplicity and robustness more often than not will trump performance, and of course, when you factor in drastically reducing cost and being able to give much faster access to our clients, we think that’s a win.”

Aaron Loder, who has ALS, is using an eye tracker from a company called EyeTribe along with the SpeakYourMind Foundation’s newest software platform, called SYMple. (Courtesy SpeakYourMind Foundation)

At the Make-A-Thon

This spring, SpeakYourMind co-hosted an assistive technology make-a-thon at Brown University with a student group called STEAM (Science, Technology, Engineering, Art, Mathematics).

The two-day event featured a ragtag crew of 20 or so students tucked away in the back corner of a warehouse-sized engineering lab at Brown. Some were graduate students, many were undergraduates, and a few were out-of-town high schoolers. The rest of campus was quiet — empty streets, dark hallways, the occasional student here or there putting in extra hours — but these young engineers were hard at work.

At 4 p.m. on day two, the students, divided into teams, would have to present what they had been working on all weekend (and in a few cases, all semester) to a panel of judges. The projects were all different, but they all had the same goal — to restore the ability to communicate autonomously to those who had lost it — and the same scrappy, low-tech approach as SpeakYourMind.

Bacher was bouncing between groups to check on their progress and offer advice. One team was reverse-engineering Facebook so someone who was locked in could use an eye-tracking device to click through the website with just his or her eyes. Another group was developing a custom e-mail service that people could use by simply hitting the space bar as things on the screen they wanted to click were highlighted. Yet another group designed a new wheel-like onscreen keyboard for eye trackers and another a program for writing music with eye trackers.

And then there was Owen and Valay. Owen Duke, a high school student from New Hampshire, heard about SpeakYourMind from his dad, who had heard Bacher give a lecture. Intrigued, Duke got in touch with Bacher and the two of them started brainstorming a device for one of the organization’s clients — a man in New Jersey who had a brain injury and could only communicate by controlling which way his arm fell when someone lifted it up and dropped it.

The man clearly had some muscle activity in his arm but not enough to lift it on his own, so the question was: what kind of device could allow him to communicate using that muscle without needing the help of others?

Duke had an idea: he would attach a muscle sensor to an ace bandage and wire it to a microcontroller, making a kind of custom wearable device that would wrap around the man’s arm and pick up on his flexing.

He brought the device to the make-a-thon, where he teamed up with Brown University graduate student Valay Shah. Shah was working on software that turned his laptop camera into a tracking system. Inspired by another client who could both flex his arm and move his face, Shah used the tracking system to follow a small green sticker he had on the tip of his finger. The two components together were a makeshift mouse — the green dot for navigation and the muscle sensor for clicking.

When it was time to present, the duo made their way in front of the judges, awkwardly moving in lockstep so as not to detach the sensor around Duke’s arm from the laptop in Shah’s hand. The device was a crude prototype, but it worked, and the judges loved it.

It was a perfect demonstration of what SpeakYourMind is all about: finding an easy way to meet the needs of an individual, not in 20 years, but today.

“Right now, we’re actually learning just as much from our clients as we hope they’re benefiting from what we’re creating,” Bacher says. “A lot of what we’re doing now is we’re visiting our clients, and we’re testing. You know, we’re changing settings; we’re adding new features, and we’re testing things out.”

The ultimate goal, he says, is to “go from prototype to product and really get these things out there, to try to maximize our impact and help as many people as possible.”

Categories: Health Care

First Edition: August 28, 2014

Kaiser Health News - Thu, 08/28/2014 - 7:14am

Today's headlines include reports about the Congressional Budget Office's latest projections regarding Medicare and Medicaid spending.

Kaiser Health News: Health Law Spurs Focus On Faster Drug Development
Kaiser Health News staff writer Daniela Hernandez reports: “Imagine if scientists could recreate you---or at least part of you---on a chip. That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and hefty health care costs that accompany arriving at the right treatment. Right now, at the University of California, Berkeley, researchers in bioengineer Kevin Healy's lab are working to make that happen. Funded under a provision of the health law, they're trying to grow human organ tissue, like heart and liver, on tiny chips” (Hernandez, 8/28). Read the story, which also ran in Wired.

Kaiser Health News: Capsules: CBO Projects Lower Medicare and Medicaid Costs; Urgent Care Centers Opening For People With Mental lllness
Now on Kaiser Health News’ blog, Mary Agnes Carey reports on the CBO’s latest projections for Medicare and Medicaid: “Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday. Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast” (Carey, 8/27). 

Also on Capsules, Anna Gorman reports on how urgent care centers are opening to treat people with mental illness: “Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned. L.A. County’s mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are “more humane” and a smarter approach” (Gorman, 8/28). Check out what else is on the blog.

The Associated Press: 3 Ways Insurers Can Discourage Sick From Enrolling
Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling. Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul (8/27).

The Washington Post: Health-Care Premiums Fall In Arkansas
Arkansas Gov. Mike Beebe’s office said Wednesday that most health-care customers will pay less for their plans next year, a relief to state residents — and to the Democratic senator trying to hold onto his seat in one of the country’s most expensive elections. Health-care premiums will decline about 2 percent next year, Beebe (D) wrote in a statement Wednesday. Beebe helped lead an at-times reluctant Republican legislature to expand Medicaid. In his statement, he said insurance costs nationwide “historically rise by six-to-ten percent annually.” The state used federal funds to launch a private Medicaid option that has been described as a potential model for conservative-leaning states (Ferris, 8/27).

The Washington Post’s Wonkblog: The Obscure Part Of Obamacare That Takes On Executive Pay
We all know Obamacare is a pretty big law, with plenty of obscure provisions that don't get much attention. For one, the law targets big executive pay packages at health insurance companies — and based on data released Wednesday, the provision is already going a long way. Companies have long been able to deduct salaries to top executives from their federal tax bills, although since the early 1990s — in an effort to reduce excessive pay — the government has limited the amount to $1 million (Millman, 8/27).

USA Today: Consumers Deal With Insurance Deadline, Site Glitches
Hundreds of thousands of people risk losing their new health insurance policies if they don't resubmit citizenship or immigration information to the government by the end of next week -- but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying. Consumers are being forced to send their information multiple times, and many can't access their accounts at all, immigration law experts and insurance agents say (O’Donnell, 8/27).

The New York Times: Expansion Of Mental Health Care Hits Obstacles
The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces (Goodnough, 8/27).

The Washington Post: How You End Up Spending $800 Million On Healthcare.Gov
Signed into law by President Obama on March 23, 2010, the Affordable Care Act has proven to be its own kind of jobs act, especially when it comes to the Washington-area IT community. When, in several places, the bill called for the creation of an "Internet website" to allow Americans to find and sign up for new health insurance coverage, it opened the tap on hundreds of millions of dollars that would eventually go to creating HealthCare.gov's front end and back end, as well as a small universe of accompanying digital sites. On Wednesday, the office of Daniel Levinson, the inspector general of the Department of Health and Human Services, put out a report detailing the dozens of contracts that went into building out the Federal Marketplace project. And a look at each in the disaggregate paints a picture of an effort far more sweeping than even that suggested by the half-billion dollars the federal government has already paid out to implement the digital side of the health insurance law (Scola, 8/27).

The Washington Post: Why That One Democratic Obamacare Ad Didn’t Signal A New Trend
When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it's become clear: there's little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign (Gold, 8/27).

The Wall Street Journal: Deficit Forecast Trimmed As Rates Stay Low
Smaller deficits are the result of a variety of factors, including higher tax revenue and economic growth, budget cuts and new limits on government spending. The agency forecast the government would spend slightly less on Medicare and Medicaid over the next decade than it estimated earlier this year. Still, the changes were relatively minor—less than 1% of total spending on the programs. CBO expects the deficit to shrink for several years before starting a steady expansion in 2018, driven by the aging U.S. population, higher health-care costs and increasing subsidies for certain federal programs (Paletta, 8/27).

The Associated Press: US Economy Forecast To Grow By 1.5 Percent In 2014
The Congressional Budget Office on Wednesday forecast that the U.S. economy will grow by just 1.5 percent in 2014, undermined by a poor performance during the first three months of the year. The new assessment was considerably more pessimistic than the Obama administration’s, which predicted last month that the economy would expand by 2.6 percent this year even though it contracted by an annual rate of 2.1 percent in the first quarter (8/27).

The Washington Post: New Obama Plan Calls For Implanted Computer Chips To Help U.S. Troops Health
When President Obama on Tuesday highlighted 19 executive actions he says he is taking to improve the mental health of U.S. troops and veterans, one of them centered on a particularly novel effort: The development of new computer chips designed to modulate the nervous system to help with everything from arthritis to post-traumatic stress (Lamothe, 8/27).

NPR: Life After Ice Buckets: ALS Group Faces $94 Million Challenge
The ALS ice bucket challenge continues to bring in huge donations this summer for efforts to cure and treat what's commonly known as Lou Gehrig's disease. As of today, the viral campaign has raised more than $94 million for the ALS Association. That's compared with $2.7 million raised by the group during the same time last year. Now the association faces a challenge of its own: figuring out the best way to spend all that money (Fessler, 8/27).

The New York Times: Heroin’s Death Toll Rising In New York, Amid A Shift In Who Uses It
A heroin crisis gripping communities across the country deepened in New York last year, with more people in the city dying in overdoses from the drug than in any year since 2003. In all, 420 people fatally overdosed on heroin in 2013 out of a total of 782 drug overdoses, rising to a level not seen in a decade in both absolute numbers and as a population-adjusted rate, according to preliminary year-end data from the city’s health department (Goodman, 8/28).

The Associated Press: Deal On Health Care Aids Port Contract Talks
Negotiators hoping to forge a new contract for dockworkers and keep hundreds of billions of dollars in cargo moving smoothly through West Coast seaports made significant progress with a tentative deal on health care benefits, a knotty issue that tied up talks for months. West Coast dockworkers already have unusually generous health benefits — so generous, argue their employers who pay for the coverage, that the insurance plan has become riddled with fraud (8/27).

The Associated Press: Firm Allegedly Gipped Workers Out Of Jobs, $100K
Prosecutors hammered a Brooklyn contractor Wednesday with allegations he cheated workers out of $100,000 and reneged on promises of permanent jobs and health care. Contractor Anthony Miller and his firm Bael Out Enterprises were arraigned in Brooklyn Supreme Court on charges they schemed to defraud more than 70 workers and failed to obtain workers' compensation insurance (8/27). 

 

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