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When Muscular Dystrophy Is Personal — And Global

CommonHealth (WBUR) - Thu, 09/18/2014 - 5:13pm

Chris Chege (courtesy Romana Vysatova)

By Fred Thys
Guest Contributor

Every once in a while, I’m grateful I live in such a medically-minded town, with many deep thinkers trying to figure out treatments and cures for some very tough diseases.

I felt this way over the summer, at a conference in Boston on Facioscapulohumeral Muscular Dystrophy, a genetic disorder that affects 1 in 8,333 people and has no treatment. I did not attend the meeting due to some theoretical interest in the topic; for me, it’s personal.

My mother and grandmother suffered from the condition, and so does my brother. It causes gradual loss of muscle function, notably in the face, and in the muscles that mobilize the shoulder blades and the upper arm, but also in the legs.

My brother first developed symptoms when he was 15, and found that he could no longer run as fast as his high school soccer teammates. Since the age of 43, he has been confined to a wheelchair or scooter, unable to walk or stand.

But at the conference in August, I also realized that this illness with such a profound impact on my family, also has a global reach. Indeed, in regions like Africa, the condition is only just beginning to be acknowledged.

Enter: Chris Chege

I first saw Chege sitting on a tall stool at the back of the room with his wife. Their presence proved that the condition affects Africans, too, something that isn’t widely acknowledged. Chege and his wife had traveled to Boston from their home in Thika, in central Kenya, 30 miles Northeast of Nairobi.

An interview with Chege pointed to one possible reason that conference room was full, mainly, of white people: most people with the condition in Africa may not have been diagnosed with it yet.

But Chege said he sees others with FSHD in Kenya. He said he can tell.”By the way they walk,” he said. “I see them on national television when journalists go to their homes to interview them.”

The television journalists, Chege says, report that the families he sees on television with the symptoms of FSHD are bewitched.

“The way they walk I can tell that’s muscular dystrophy,” he said.

His own condition was a mystery to him for nearly twenty years.

When he was a teenager, he first realized that he could not keep up with other people. “Back home, my father was a farmer,” Chege said. “We used to pick coffee berries from our farm. Once we pick the coffee berries, we have to take them to a processing machine, and you take what you pick.”

Chege would have to carry 45 lbs of coffee berries at a time. One day, he found that he was unable to carry so many berries. “I used to receive a lot of beatings from my father and my mother because they thought I was just lazy,” he said.

Chege decided on his own to see a doctor, who gave him medication that produced “a lot” of side effects on him, he said.

There are no medications approved anywhere for the treatment of FSHD.

It was not until the year 2000, at the age of 34, that he was diagnosed with muscular dystrophy.

“Life is very harsh having a muscular dystrophy condition, because in my town, it’s very hilly, so walking around is quite difficult, and if I have to walk around, I have to have somebody to help me, and you see, almost everybody is busy,” he said.

So most of the time, Chege said, he sits at home.

“It’s actually very, very harsh in Africa,” he said.

Chege and his wife have two boys, 16 and 10. “The way they behave during their daily activities, she senses they may be affected also,” he said

Chege found out about the FSH Society’s biannual conferences that bring together patients, their families, and researchers.

Peter Jones was one of the researchers at the conference who met with Chege. Jones is conducting research at the University of Massachusetts Medical School. The genetic sequence that causes FSHD, known as 4q35 D4Z4, is present in healthy people as well as people affected by the disorder. In healthy people, the sequence is suppressed. For some reason, in people affected by FSHD, the suppression mechanism doesn’t work. Jones is trying to figure out why.

“I decided to come to this conference in Boston to meet other patients who have the same condition and also to learn more about this condition and also to meet the scientists, the doctors and to gather more information so that I can be able to educate others back home,” Chege said.

But the trip to Boston was expensive. He had to sell some of his land in order to travel to the conference.

“Most of my friends, family members, thought I was mad,” he said. “To me, knowledge is more than those properties.”

He was not able to afford bringing the entire family, so the boys stayed in Kenya.

Chege said because his wife was able to attend the conference, she has gained understanding into his condition.

“I don’t regret disposing some of my properties to come here,” he said.

At the conference, he said, researchers offered to test him. He had a discussion with a physiotherapist who taught him what he could do on his own at home.

Before coming to Boston, Chege said he was not aware that any research on FSHD was being done in Africa; in fact, research is currently underway in South Africa.

But Chege would like to return to the U.S. in two years to attend the next conference on FSHD, only next time, he hopes to bring his sons along as well.

Categories: Health Care

Much Does That X-Ray Cost? You Can Find Out In New Hampshire

Kaiser Health News - Thu, 09/18/2014 - 2:45pm

When Anthem Blue Cross Blue Shield became embroiled in a contract dispute with Exeter Hospital in N.H. in 2010, its negotiators came to the table armed with a new weapon: public data showing the hospital was one of the most expensive in the state for some services.

Local media covering the dispute also spotlighted the hospital’s higher costs, using public data from a state website.

When the dust settled, the insurer had extracted $10 million in concessions from Exeter. The hospital “had to step back and change their behavior,” said health policy researcher Ha Tu, who studied the state’s efforts to make health care prices transparent.

New Hampshire is among 14 states that require insurers to report the rates they pay different health care providers —and one of just a handful that makes those prices available to consumers.  The theory is that if consumers know what different providers charge for medical services, they will become better shoppers and collectively save billions.

In most places, though, it’s difficult, if not impossible to find out how much you will be charged for medical care. And with more people enrolled in high-deductible insurance plans, there is a growing demand for accurate price information.

In response, some hospitals are putting some prices on their websites—usually list prices, which are much higher than what most people would actually pay. Some insurers also provide enrollees with cost estimates, while free websites, such as Healthcare Bluebook and Fair Health, offer some cost information.

Still, in many cases, the data is limited or is restricted to enrollees in specific health plans. That’s why business groups in almost two dozen additional states have sought laws to require insurers to report what they pay providers.

But even in New Hampshire, which pioneered price disclosure, it is not entirely clear what role those efforts have played in reducing health care spending or changing consumer behavior.

“It’s an important component, but it’s not a silver bullet,” said Mark Whitney, a vice president at Exeter Health Resources, the hospital’s parent company.  Overall, “premiums didn’t drop, the overall cost of health care didn’t necessarily drop.”

Consumers Find Prices Online

New Hampshire’s HealthCost website, which launched in 2007, shows median prices paid by insurers for 40 procedures, including emergency room visits, mammograms and outpatient knee surgeries. Prices are shown for every hospital, as well as for many freestanding surgical facilities and imaging centers, where patients go for tests such as X-rays.

For those with insurance, the website lists the potential cost to patients based on their plan deductible -- as well as to their insurer. Outpatient knee surgery covered by an Anthem plan with a $1,000 deductible, for example, could cost $3,557 at the lowest-cost outpatient facility or as much as $8,962 at the most-expensive hospital, with the patient paying a portion ranging from $731 to $1,793.

Uninsured consumers can also see what they might pay, including any charity programs that might apply. That same surgery could cost an uninsured patient, who doesn’t benefit from the special rates negotiated with insurers, $6,782 to $17,426.

At the very least, many experts say price transparency efforts help consumers ask smarter questions on what their care might cost, said Rachel Verville, a vice president of the Elliott Health System in Manchester.

For example, many consumers don’t realize that a test performed in a hospital might cost two or three times more than in an outpatient facility or a doctor’s office.

Incentivizing Consumers

But experts say that price information does not change consumer behavior by itself. In New Hampshire and other states, change occurred only when insurers or employers created financial disincentives for consumers who choose higher-priced providers for tests and elective procedures.

“What we found is transparency in the absence of some incentive to shop doesn’t get very far,” said Maribeth Shannon, a director at the California Healthcare Foundation, a nonprofit think tank.

For instance, the California Public Employee Retirement System, which covers more than 1.3 million employees and retirees, decided it would pay a maximum of $30,000 for joint replacement surgeries, listing 41 hospitals statewide that met that price.

Patients could choose to go to hospitals that charged more, but they would have to pay the price difference, which could run into thousands of dollars. Many consumers picked the lower-priced hospitals.

But researchers found the biggest savings resulted from hospitals lowering their prices voluntarily for fear of losing business. An analysis of the California effort found that CalPERS saved an estimated $5.5 million in 2011 and 2012, with 85 percent of the savings coming from hospitals lowering prices.

New Hampshire saw similar effects.

In 2009, Anthem rolled out plan in which patients who chose lower-cost labs or surgery centers got free lab tests – and out- of-pocket costs for surgery as low as $150, with no deductible.

If they went to the higher priced labs or hospitals, however, they had to pay their annual deductible, which in New Hampshire averages $3,000 a year, before their coverage kicked in.

“That could mean a difference of several thousand dollars,” said Denise McDonough, Anthem’s regional vice president of sales.

New Plan Designs Take Hold

Such plans have drawbacks for enrollees in sparsely populated areas, who may have to travel long distances to find a low-cost facility.

Nonetheless, that design is now standard for Anthem’s small business plans in New Hampshire, according to a report by researcher Tu for the California HealthCare Foundation.

What’s more, some hospitals came to Anthem seeking to be paid less so that they could be included among the low-cost providers, said Bob Noonan, also an Anthem regional vice president.

A similar discount program for consumers who use low- price facilities was soon offered by Harvard Pilgrim Health Care, another insurer in the state.

Both insurers say that in recent years, hospitals have sought smaller price increases than they had in the past and that overall medical inflation in the state has slowed— although neither attributes that primarily to price transparency.

Still, “that data was the first step,” said Beth Roberts, senior vice president at Harvard Pilgrim. “All that momentum and disclosure helped us have more effective contract negotiations.”

Whether New Hampshire’s experience would translate to other, more populous states is unclear. 

Hospitals in smaller markets “really care what others in the community think of them, so that helps explain the pressure on Exeter,” said Tu, who works for the nonpartisan Mathematica Policy Research.

Moreover, cost information needs to be paired with information on the quality of care, if it is going to be really meaningful to consumers, she said.

Right now, none of the state websites providing price information to consumers include quality data, although those in Colorado and Maine link to other sites that provide that information.

There is another potential downside to transparency efforts: They can spur even struggling hospitals to cut prices, pushing them over the financial edge.

“They have to be prepared for some hospitals losing financial viability and going out of business,” Tu said.

And even with such efforts, consumers can still encounter roadblocks to choosing more cost-effective care.

Jo Porter, deputy director for the Institute for Health Policy and Practice at the University of New Hampshire, is the epitome of a well-informed consumer.

When her husband broke his toe last winter, and his doctor wrote a prescription for an X-ray at the local hospital, the couple checked the state website for prices. When they saw they could get it for $400 less at a nearby outpatient facility, that’s where they went.

But when a specialist asked for another X-ray six weeks later, the doctor’s computer would not allow him to write a prescription for that same facility. Eventually, the order was sent the old fashioned way, by fax.

“We not only have to get to place where consumers feel empowered to make these decisions,” Porter said, “but also one where the system works, too.”

Categories: Health Care

Good Potato, Bad Potato: War Over Starchy Spud Continues

CommonHealth (WBUR) - Thu, 09/18/2014 - 12:22pm

Hideya HAMANO/flickr

By Alvin Tran
Guest Contributor

Potatoes, it turns out, are political.

At least in the cutthroat world of food and nutrition where, increasingly, what we eat is a highly partisan, hotly debated and frustratingly gridlocked battle pitting health policy types against one another.

Here’s where the potatoes come in:

On one side of the battle, you’ll find politicians, farmers and advocates lobbying for potatoes to become a part of the federal Special Supplemental Nutrition Program for Women, Infants, and Children, saying they are cheap and potentially nutritious. On the other, you’ll find researchers, including many doctors from the Institute of Medicine, steering patients away from potatoes and saying that Americans are currently consuming too much of the starchy vegetable.

As a doctoral student in nutrition, I often find myself caught in the crossfire of such food battles, whether they’re over the health benefits of dark chocolate, red wine, coffee or my current fixation: potatoes. All too often, friends, family members and even strangers on the bus beg for a little simplicity: they just want to know if certain foods are “good” or “bad.”

Unfortunately, things are rarely so simple and, like many foods that have become mired in controversy, nuances around the relative benefits or ills of potatoes have been obscured in the rhetoric.

Some specifics:

For starters, potatoes contain a large amount of carbohydrates and they have a high glycemic load – meaning they are quickly digested. Foods that have high glycemic loads generally cause blood sugar and insulin levels to rapidly spike and may cause a person to feel hungry again shortly after eating a meal.

According to The Nutrition Source, a publication of the Harvard School of Public Health that acts as a source of research-based nutrition information, previous research studies have linked diets high in potatoes and other rapidly digested carbs to chronic health outcomes, including diabetes and heart disease.

The findings from a new study, published early September, suggested that a low-carb diet, compared to one that is low-fat, may be more effective for weight loss and in reducing the risk of heart-related health problems.

Nutrition researchers, however, have raised concerns over the study’s findings. For example, in a recent opinion piece in The New York Times, David L. Katz, a nutritionist and the founding director of the Yale University Prevention Research Center, is quoted saying that diets focused on eliminating solely one item, such as carbs, aren’t always good and can actually be harmful: “Our fixation on a particular nutrient at a time has been backfiring for decades…”

So, that leaves us all with an important question: can potatoes actually be incorporated into a healthy meal?

Joan Salge Blake, a clinical associate professor at Boston University and spokesperson for the Academy of Nutrition and Dietetics, says yes.

“It’s what you do with the spud. The spud itself – the way nature made it – is quite nutritious,” Blake explained. She adds that Americans need to do a better job in preparing the potato without having to deep fry them or eat them as chips. “They are a very inexpensive way to get good nutrients in our diet,” she said.

Vitamin C and potassium are two examples of nutrients found in potatoes, but are also found in many other food sources, including broccoli.

Over at the Friedman School of Nutrition Science and Policy at Tufts University, Alice H. Lichtenstein, DSc, a senior scientist for the school’s Nutrition Research Center on Aging, advises Americans to focus on two things when it comes to eating potatoes: their form and frequency.

If a person is going to have a moderately sized baked potato once a week, Lichtenstein doesn’t see a problem, as long as they aren’t adding sour cream and butter. If the same person is eating French fries or potato chips everyday as a snack – this probably isn’t such a good idea as these two forms of potatoes are generally high in sodium and calories, Lichtenstein added.

And, if you’re wondering if you can replace white potatoes with sweet potatoes, you may want to go easy on the portions. According to the Nutrition Source, while sweet potatoes are packed with more vitamin A and fiber, they have a similar glycemic load to white potatoes.

Lichtenstein adds, however, that sweet and white potatoes are completely different foods and shouldn’t be compared to another. She says that due to their taste and color, sweet potatoes can be more appealing to children than white potatoes.

But unlike white potatoes, sweet potatoes and orange yams are included as part of the Special Supplemental Nutrition Program for Women, Infants, and Children program, also called WIC.

So, what’s the deal with potatoes being excluded from the WIC program?

In short: The decision was a result of a 2005 Institute of Medicine study that aimed to improve the quality of the diet of WIC participants. The committee members who evaluated the WIC food packages at the time chose to exclude white potatoes, stating Americans did not need encouragement to consume the maximum recommendation of one serving of potatoes a day.

NPR’s The Salt blog explains:

“Back in 2007, the USDA ruled that women and children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, couldn’t buy potatoes with the program’s vouchers. Instead, the nearly 9 million WIC participants, who have to be poor and at risk of under- or malnutrition to enroll in the program, are given a monthly benefit ($10 for women and $6 for children) to buy any fruit or vegetable except white potatoes.

This month, industry groups persuaded some members of the House Appropriations Committee to introduce an amendment to change that — by permitting states the option to include potatoes in their WIC programs. The potato lobby is also hoping to change the final WIC rule on what foods are eligible for the WIC benefit. USDA is taking comments on it until June 29.”

“Whatever nutrients we are getting from potatoes, we’re getting plenty of those,” said Marlene B. Schwartz, PhD, the director for the Rudd Center for Food Policy and Obesity at Yale University. “The biggest problem is that people simply consume too much potatoes. And they do so by eating a lot of French fries,” Schwartz added, clarifying that her issue isn’t necessarily with the potatoes themselves but the many forms they exist in and are frequently consumed as – she particularly calls out French fries.

“Potatoes are a victim of their own success,” Schwartz said, adding that she thinks the potato industry has probably benefited tremendously by having their products processed and sold frozen to restaurants and schools around the country.

Lichtenstein, however, says that it would be difficult to justify the complete elimination of potatoes. “Anytime we vilify one specific food or put undo focus on it, we sort of create a less than optimal food environment,” Lichtenstein said.

“It all goes back to preparation and frequency,” Lichtenstein restated in a phone interview. She adds that it all comes down to energy balance: “You can consume the highest quality diet but if you consume it in excess of energy needs, you’re not going to realize the benefits from it.”

What’s the final verdict when it comes to potatoes?

It’s personal: The decision of whether or not we should include a spud on our dinner plates tonight – I believe – is up to us.

Alvin Tran studies nutrition as a doctor of science student at the Harvard T.H. Chan School of Public Health. He is on Twitter: @alvinhtran.

Categories: Health Care

Expert Panel: End-Of-Life Care In U.S. Needs Improvement

Kaiser Health News - Thu, 09/18/2014 - 10:07am

The 21-member Institute of Medicine panel concluded in its new report that incentives exist within the health system that often run contrary to dying patients' wishes. More conversations and planning are among the recommendations. 

The New York Times: Panel Urges Overhauling Health Care At End Of Life
The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday. The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change (Belluck, 9/17).

Kaiser Health News: Dying In America Is Harder Than It Has To Be, IOM Says
The report suggests that the first end-of-life conversation could coincide with a cherished American milestone: getting a driver's license at 16, the first time a person weighs what it means to be an organ donor. Follow-up conversations with a counselor, nurse or social worker should come at other points early in life, such as turning 18 or getting married. The idea, according to the IOM, is to "help normalize the advance care planning process by starting it early, to identify a health care agent, and to obtain guidance in the event of a rare catastrophic event" (Gold, 9/17).

The Washington Post’s Wonk Blog: It’s Time To Bury The ‘Death Panel’ Myth For Good. Is This The Way To Do It?
Behind all the charts and policymaking lies an uncomfortable truth about health care: We are all going to die someday, and the health-care system's ultimate challenge is to make that certainty as painless and as peaceful as possible. A rational and responsible national conversation about preparing for death and end-of-life care has been virtually impossible over the past five years because of the "death panel" myth that erupted during the heated health-care debate of 2009. But a new report from independent experts at the Institute of Medicine may revive the conversation about preparing patients for the end (Millman, 9/17).

The Wall Street Journal: End-Of-Life Care In U.S. Is Lacking, Report Says
End-of-life conversations with medical providers should be covered by insurers and Medicare, said the report by the Institute of Medicine, an independent organization and the research branch of the National Academy of Sciences. One impetus behind the study was concerns raised in 2009 about "death panels," a term that sprung up during political debates about what became the Affordable Care Act (Armour, 9/17).

The Associated Press: Study: Americans Endure Unwanted Care Near Death
The “Dying in America” study released Wednesday was done by a panel of 21 experts. It finds that people repeatedly stress a desire to die at home, free from pain, but often the opposite happens. The authors blame a medical system ruled by “perverse incentives” for aggressive care, inadequate physician training and too few conversations about end-of-life wishes (9/17).

Reuters: U.S. Needs Better End-Of-life Care, Which Might Cut Costs – Study
The United States needs to improve its medical care for people nearing death, a move that might cut rising healthcare costs, an Institute of Medicine (IOM) study said on Wednesday. The 507-page "Dying in America" study is aimed at opening a debate on how the U.S. healthcare system treats Americans nearing death and urges comprehensive care to improve the quality of life in their final days. The study was spurred by allegations that under the 2010 Affordable Care Act doctors who would advise patients about end-of-life issues would be part of "death panels" that would judge who would live and who would die. The proposal never became law (Simpson, 9/17).

San Jose Mercury News: Institute Of Medicine Urges Reforms To Improve Care For Dying People
An influential national institute has prescribed a powerful cure for America's approach to dying, saying that today's health care system is ill-equipped to provide the comfort and care so cherished in our final days. The long-awaited report released Wednesday by the Institute of Medicine recommends that regular end-of-life conversations become part of patients' primary care, starting at age 18 and that doctors should be paid for time spent on these discussions -- a controversial initiative eliminated from President Barack Obama's health care law (Krieger, 9/17).

Politico Pro: IOM Report Urges Better End-Of-Life Care
It’s time to put the damaging “death panel” debate away for good and push the American health care system to provide high-quality end-of-life care that matches what dying people want for themselves and their families, a panel convened by the Institute of Medicine said Wednesday. “The time is now,” said IOM President Victor Dzau, introducing the far-reaching recommendations of a report titled “Dying in America.” The 500-page report stresses better education about end-of-life care for a breadth of medical professionals — not just specialists in palliative care or hospice — and far more integration of medical and social services for patients and family caregivers. It says good care needs to be available and accessible 24/7 (Kenen, 9/17).

Categories: Health Care

Competition Among Health Exchange Plans Curbing Prices, Says Humana Exec

Kaiser Health News - Thu, 09/18/2014 - 10:06am

Also in the news, data from Connecticut's exchange shows who purchased new coverage and if they have used it, and more on the staggered launch planned for Maryland's online marketplace.  

Reuters: Humana CEO Says New Competition Curbs Obamacare Plan Prices
President Barack Obama's landmark healthcare law will begin enrolling customers for 2015 benefits in mid-November. Now in its second year, Obamacare is attracting health insurers to offer plans in more states after over 8 million people enrolled for coverage in 2014. The country's largest insurer, UnitedHealth Group Inc, sold Obamacare plans in only a few states in 2014. But for 2015, it will sell plans in about two dozen states. Aetna Inc, Cigna Corp, WellPoint Inc and Humana have said they would stick to most of their markets. ...  Humana will sell plans in 15 states for 2015 and has asked for premium rate increases of 3 percent to the 20 percent range, depending on the market. Last year, large insurers were hesitant to enter the new marketplace, concerned by conservatives' political opposition as well as federal regulations that required that the plans be available to any individual regardless of age or health status (Humer, 9/17).

CT Mirror: Exchange Says Obamacare Helped Close Racial, Ethnic Coverage Gaps
Black and Hispanic Connecticut residents were more likely than others to be uninsured before the rollout of the federal health law, and new data suggest that the first sign-up period for coverage under Obamacare made a dent in that disparity. The data, based on a survey of people who signed up for coverage through the state’s health insurance exchange, also show that close to three-quarters of enrollees have used their coverage to obtain medical care. Among those who bought private insurance through the exchange, 76 percent said they have a primary-care physician, as did 66 percent of Medicaid enrollees (Levin Becker, 9/17).

Baltimore Sun: Staggered Launch Could Help Md. ‘Kick The Tires’ Off Its New Heath Exchange Website
A day after Maryland committed to a gradual launch of its health exchange, state officials are still working out some key details — including where the opening day sign-up will be held — but experts say it could be a way to avoid a repeat of last year's botched rollout.  Several health experts said the approach that limits enrollment in the first few days could allow Maryland to "kick the tires" on its new website. "It's a controlled way to open enrollment," said Karen Pollitz, senior fellow at the Kaiser Family Foundation. "They can work with a controlled number of people for the first couple of days to see how this works in practice. I'm assuming there is some plan at the end of the day when people gather in a room and compare notes and say we need to fix this or that." But Leni Preston, chair of the Maryland Women's Coalition for Health Care Reform, said she feared that a staggered approach might confuse consumers (Cohn, 9/17).

Categories: Health Care

FTC Wary Of Growing Number Of Hospital Mergers

Kaiser Health News - Thu, 09/18/2014 - 9:37am

The agency is "raising a lonely but powerful voice" against the trend, The New York Times reports. Also in the news are reports about a big insurer and seven hospital groups creating a new health system in the Los Angeles area and the shift from doctors' offices to retail outlets for vaccinations.

The New York Times: F.T.C. Wary Of Mergers By Hospitals
As hospitals merge and buy up physician practices, creating new behemoths, one federal agency is raising a lonely but powerful voice, suggesting that consumers may be victimized by the trend toward consolidation. Hospitals often say they acquire other hospitals and physician groups so they can coordinate care, in keeping with the goals of the Affordable Care Act. But the agency, the Federal Trade Commission, says that mergers tend to reduce competition, and that doctors and hospitals can usually achieve the benefits of coordinated care without a full merger (Pear, 9/17).

The New York Times: Hospitals And Insurer Join Forces In California
In a partnership that appears to be the first of its kind, Anthem Blue Cross, a large California health insurance company, is teaming up with seven fiercely competitive hospital groups to create a new health system in the Los Angeles area. The partnership includes such well-known medical centers as UCLA Health and Cedars-Sinai (Abelson, 9/17).

The Associated Press: Drugstores, Retailers Dive Deeper Into Vaccines
Walgreen provided enough flu shots last season to protect a population roughly twice the size of Los Angeles. CVS doled out more than 5 million, or double its total from a few years ago. And Wal-Mart, the world's largest retailer, offers flu shots at more than 4,200 of its U.S. stores that have pharmacies. The nation's biggest drugstores and other retailers are grabbing larger chunks of the immunization market, giving customers more convenient options outside the doctor's office to protect themselves against the flu, pneumonia and other illnesses. In fact, nearly half of all flu vaccines provided to adults are now administered in non-medical settings like drugstores or worksite clinics. But this push by retailers muscles into an area of health care that was once largely the domain of the family doctor. And that stirs some concern from doctors who want to stay tuned into the health of their patients and keep track of who has received a vaccine (Murphy, 9/17).

Categories: Health Care

Medi-Cal Patients, Advocates Sue Calif. Over Application Wait

Kaiser Health News - Thu, 09/18/2014 - 9:37am

The lawsuit alleges that hundreds of thousands of people are going without health care as a result.

Kaiser Health News: Capsules: Lawsuit Accuses Calif. of Denying Care to Medi-Cal Applicants
California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups (Gorman, 9/18).

The Associated Press: Medi-Cal Patients Sue Over Application Backlog
Medi-Cal patients and health care advocates filed a lawsuit against the state Wednesday for leaving hundreds of thousands of low-income and disabled people waiting months for care. The suit filed in Alameda County Superior Court aims to get the California Department of Health Care Services to process applications within a required 45-day time frame. One plaintiff, 68-year old Frances Rivera of Visalia, said she lost her adult son, Robert, who died from a pulmonary embolism while waiting to hear back about his Medi-Cal application. The application was approved two months after he died. Medi-Cal is the state's version of Medicaid, the state-federal health insurance program for poor, disabled and low-income people. The program's ranks have swelled nationwide under President Barack Obama's Affordable Care Act, which allows more people to qualify in the states that decided to expand it  (Lin, 9/17).

Categories: Health Care

After Health Stock Scandal, Lawmakers Plan Bill Regulating 'Political Intelligence'

Kaiser Health News - Thu, 09/18/2014 - 9:37am
Elsewhere, advocates for the Children's Health Insurance Program express optimism that the program will be renewed, and scrutiny of the VA continues.

The Wall Street Journal: Lawmakers Plan To Introduce Bill Regulating 'Political Intelligence'
Lawmakers plan to introduce legislation in the House on Thursday that would for the first time shed light on the political-intelligence industry. … A spokeswoman for Mr. Grassley said that he was still interested in pursuing regulations on the issue, and is "looking for the right time and vehicle, as usual with legislation." Mr. Grassley's push for regulations became more complicated last year when one of his former aides ended up at the center of a high-profile investigation by the Securities and Exchange Commission into the political-intelligence industry. The aide, Mark Hayes, sent an email to a Washington research firm correctly predicting a major change in government funding for private health-insurance firms. That prediction was relayed to more than 100 Wall Street firms and prompted a big rally in health-insurance stocks in the moments before the policy change was officially announced by the government (Mullins, 9/17).

The Hill: Advocates Claim Momentum Following CHIP Hearing
Advocates for children are claiming momentum after senators held an initial hearing on financing the Children's Health Insurance Program (CHIP) past September 2015.  First Focus, a bipartisan advocacy group based in Washington, D.C., emphasized that CHIP has the "same strong bipartisan support among lawmakers as among voters."  The hearing in the Senate Finance Subcommittee on Healthcare comes amid debate over how much money to provide for CHIP given the new coverage options available to families under ObamaCare (Viebeck, 9/17).

CNN: Lawmakers, Whistleblowers Heatedly Hammer Away At VA Inspector's Report
A bipartisan group of lawmakers and two whistleblowers harshly grilled and criticized the top watchdog of the Department of Veterans Affairs for a recent report that could not conclude whether long wait times at the Phoenix VA might have caused veterans' deaths. Acting Inspector General Richard Griffin faced a barrage of questions at a hearing before the House Committee on Wednesday. At issue was a VA report released in August that stated investigators could not "conclusively" link the deaths of 40 veterans to health care delays (Devine and Bronstein, 9/17).

Seattle Times: VA Gets Earful From Vets At Town Hall
David Winter is a Gulf War Veteran who depends on the Puget Sound VA to treat his post-traumatic stress disorder, neck pain and other ailments. In a town-hall meeting Wednesday evening called by the Department of Veterans Affairs, he spoke in stark detail about his difficulties trying to see his health providers and to get medications in a hospital system struggling under an expanding patient load. Though he was supposed to have a 20-minute PTSD counseling session once every six weeks, he’d been to only three this year. “The last time I went, I was told: ‘Don’t call us, we’ll call you,’ ” Winter recalled. He says they never did call. The Wednesday meeting in South King County is one of a series of town halls the VA is hosting around the nation to reach out to veterans in the aftermath of scandals that included manipulations of waiting times for veterans seeking medical care (Bernton, 9/17).

Categories: Health Care

Census Shows Health Insurance Coverage Winners, Losers

Kaiser Health News - Thu, 09/18/2014 - 9:36am

Among the 25 biggest cities, uninsured rates last year ranged from almost 25 percent in Miami and 23 percent in Houston to just more than 4 percent in Boston and 7.5 percent in Pittsburgh, according to Census data.

Politico Pro: Census Survey Shows Big Gaps In 2013 Uninsured Rates
The government agency known for its impartiality is pointing out some winners and losers when it comes to health insurance coverage in the United States. Among the 25 biggest cities, uninsured rates last year ranged from almost 25 percent in Miami and 23 percent in Houston to just more than 4 percent in Boston and 7.5 percent in Pittsburgh, according to the American Community Survey released Thursday by the Census Bureau. The survey offers a trove of poverty, income and insurance data on households in all metropolitan areas with a population of more than 65,000. The most insured metro area surveyed was Pittsfield, Mass., with just 2.1 percent of its population lacking health coverage in 2013 (Norman, 9/18).

Dallas Morning News: Census Shows Small Gains In Coverage Of Uninsured In Dallas Area
The percentage of Texans without health insurance fell statewide and in the Dallas-Fort Worth area in 2013 -- before the official launch of the Affordable Care Act -- according to data released Thursday by the Census Bureau’s American Community Survey. The percentage of uninsured Texans has fallen every year since 2009, according to the ACS, from 23.8 percent to 22.1 percent in 2013 (Young, 9/17).

Related KHN coverage: CDC Survey Finds Drop In Uninsured (Rau, 9/17).

Categories: Health Care

Virginia Lawmakers Expected To Return To Debate Over Medicaid Expansion

Kaiser Health News - Thu, 09/18/2014 - 9:35am

The topic will come up during a special session of the Virginia House of Delegates, which is dominated by Republican lawmakers who are on record opposing the approach. A poll released Wednesday, however, found the majority of Virginians support the expansion.   

The Washington Post: Va. House Of Delegates Plans To Vote On Medicaid Expansion
Republican leaders of Virginia’s House of Delegates, who have staunchly opposed Medicaid expansion all year, plan to put the question to a floor vote as early as Thursday in a special legislative session. The GOP-dominated chamber is widely expected to shoot down the proposed $2 billion-a-year expansion, although a few conservative legislators have expressed fears that the measure might defy expectations and pass — just as a then-record tax hike did when Democrat Mark R. Warner was governor a decade ago (Vozzella, 9/17).

The Associated Press: No Medicaid Action Expected In Special Session
There will be plenty of talking but probably not much action when Virginia state lawmakers reconvene to discuss whether the Medicaid program should be expanded. Both the state House and Senate are set to meet Thursday at noon at the Capitol. Republican leaders said they're holding a special session to discuss Medicaid expansion because they promised they would. But they've indicated on several occasions that they still oppose expansion (9/18).

Richmond Times-Dispatch: Lawmakers Return To Consider What's Best For Virginians' Health
The answer to improving health care in Virginia may lie on the other side of East Broad Street from the Capitol, where lawmakers return today for a special session to discuss whether to expand coverage of uninsured Virginians with federal funds under the Affordable Care Act. Across from the Capitol, the Virginia Commonwealth University Health System is conducting a 14-year experiment that it says has reduced inappropriate use of emergency rooms and hospitalization, improved health outcomes for uninsured residents of the Richmond region, and dramatically reduced the cost of care (Martz, 9/18).

The Washington Post: Poll Finds Solid Support For Medicaid Expansion In Virginia
A solid majority of Virginia voters support expanding Medicaid to an additional 400,000 Virginians, according to a new poll. Released Wednesday, the day before the General Assembly is due to reconvene in Richmond to consider expanding the health-care program for the poor and disabled, the Christopher Newport University survey found that 61 percent of voters support expansion under the Affordable Care Act and 31 percent oppose it (Vozzella, 9/17).

Categories: Health Care

Viewpoints: Many Beneficiaries Of Health Law Don't Vote; Reboot For Healthcare.gov

Kaiser Health News - Thu, 09/18/2014 - 9:35am

The New Republic: The Strategy That Might Have Beaten Mitch McConnell
For starters, my strong hunch from my own reporting in the region over the past couple years—including several trips to Kentucky for a new book on McConnell—is that the Democrats' biggest problem in Appalachia and the Upland South is not that the people who are benefitting from Obamacare or would stand to benefit from it if their states fully implemented the law are voting against their own interests, for Republicans. It is that many of those people are not voting at all. Remember, the vast majority of Obamacare's beneficiaries in states like Kentucky that expanded Medicaid are poor, with incomes below 138 percent of the poverty level, the threshold up to which Medicaid coverage is to be expanded under the law. And poor people famously vote at far lower rates than everyone else (Alec MacGillis, 9/17).

The Wall Street Journal: Why A GOP Senate Majority Is Still In Doubt
There is also evidence there are limits to the efficacy of the Democrats' "war on women" narrative. Recent American Crossroads focus groups among swing women voters found they resent being treated as single-issue abortion voters, considering it condescending. They want candidates from both parties to talk about broader concerns like jobs, the economy, health care, energy, government spending and national security, and they are more than open to the GOP message. However, women do view attacks on Republicans over social issues as a way to determine whether a candidate is outside the mainstream. If GOP candidates address these concerns in a reasonable fashion, they undermine the Democrats' anti-women meme and can pivot successfully to larger issues. That's why Planned Parenthood has reacted with such fury to Republican Senate candidates in Alaska, Colorado and North Carolina saying they support making contraceptives available over-the-counter (Karl Rove, 9/16). 

The New Republic: How To Reboot Healthcare.gov
This year, healthcare.gov and the state exchanges all need to raise their game. While 8 million people signed up for private health plans via Obamacare last year, an estimated 8 million people eligible for subsidized private plan coverage remain uninsured. This isn’t a surprise. Experts, like those at the Congressional Budget Office, have always predicted it would take several years before the law reached all of the people it could. Even so, it's hard not to be disturbed by polls showing widespread ignorance of how the Affordable Care Act works and how to take advantage of it (Andrew Sprung, 9/17).

The New York Times’ The Upshot: With New Health Law, Shopping Around Can Be Crucial
If you bought health insurance at an Affordable Care Act marketplace this year, it really pays to look around before renewing your coverage for next year. The system is set up to encourage people to renew the policies that they bought last year — and there are clear advantages to doing so, such as being able to keep your current doctors. But an Upshot analysis of data from the McKinsey Center for U.S. Health System Reform shows that in many places premiums are going up by double-digit percentages within many of the most popular plans (Margot Sanger-Katz and Amanda Cox, 9/17).

The New York Times’ The Upshot: San Francisco Official Says He Takes Truvada To Prevent H.I.V., And More Gay Men Should, Too
Scott Wiener, a member of the San Francisco Board of Supervisors, made an unusual public announcement on Wednesday: He takes Truvada, a daily antiviral pill, to greatly reduce his risk of contracting H.I.V. (Josh Barro, 9/17). 

The Wall Street Journal's The Experts: Hospitals Must Invest In Preventing Medical Errors
Investors seem reluctant to back manufacturers of products that protect patient safety, such as fabrics that resist bacterial infection, devices that prevent wrong intravenous (IV) dosing and furniture that hinders falls. This seems counterintuitive, since medical mistakes present an overripe market for such innovation (Leah Binder, 9/17). 

The Wall Street Journal: Calling In The Military To Fight Ebola
This week President Barack Obama announced that the U.S. military would dramatically scale up its engagement in the response to the Ebola outbreak in West Africa, the worst ever such outbreak to occur. ... It might strike some as odd that the military is being called on to address a disease outbreak that poses little direct threat to the U.S. But the Department of Defense actually has a long history of engagement in global health activities, ranging from developing drugs and vaccines for diseases (including Ebola) to helping countries build their surveillance and health-care systems, and bolstering their ability to handle dangerous pathogens (Drew Altman, 9/17).

The New York Times’ The Upshot: How Insurers Are Finding Ways To Shift Costs To The Sick
Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs (Charles Ornstein, 9/17). 

Los Angeles Times: Dave Jones For State Insurance Commissioner
The two candidates running for state insurance commissioner present a stark contrast. The incumbent, Democrat Dave Jones, has used his regulatory authority to push insurers to slow the growth of premiums for auto, home and other property and casualty insurance. His challenger, Republican state Sen. Ted Gaines of Roseville, isn't convinced that the insurance commissioner should have the power to pass judgment over premiums. Gaines is an insurance agent, and that job may give him valuable insights into the industry. But Jones is the only sensible choice to oversee it (9/17). 

Journal of the American Medical Assocation: The Pioneer Accountable Care Organization Model: Improving Quality And Lowering Costs 
The Pioneer accountable care organization (ACO) model was one of the earliest models sponsored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and has arrived at a critical juncture in its evolution. ... The Pioneer model continues to mature, fueled by rapid cycles of measurement, reporting, learning, and refinement made possible by the close collaboration CMS has formed with participating ACOs. ... CMS will evaluate whether these Pioneer ACO results warrant expansion nationally. Early success in the Pioneer model suggests that in the long term, accountable care will offer patients the improved outcomes they deserve and ACOs the sustainable business model they need to stay focused on delivering high-value care (Hoangmai H. Pham, Melissa Cohen and Patrick H. Conway, 9/17).

Categories: Health Care

State Highlights: L.A.'s New Mental Health Program; N.Y. Nurses Push For More Staff

Kaiser Health News - Thu, 09/18/2014 - 9:35am

A selection of health policy stories from California, North Carolina, New York and Texas.

Los Angeles Times: Mental illness Program Could Transform L.A. County Justice System
The $756,000 initiative marks one of the county's most significant attempts to find a better way to treat people who have mental illness and wind up in the criminal justice system by offering them transitional housing, medical treatment and job-hunting help. Officials say the pilot program will start in Van Nuys and initially help 50 people at a time, but it is expected to spread throughout the county and could accommodate up to 1,000 people at once (Gerber, 9/17).

The Associated Press: North Carolina Reviews Options For Medicaid Expansion
North Carolina's health secretary said Wednesday her agency is collecting information for Gov. Pat McCrory to offer him possible ways to expand Medicaid coverage to more people under the federal health care overhaul. The Republican-led General Assembly and McCrory declined to accept expansion last year because they said the state Medicaid office consistently faced shortfalls in the hundreds of millions of dollars. A state audit and other troubled operations led McCrory to call the $13 billion program "broken." But Health and Human Services Secretary Dr. Aldona Wos told a legislative committee the agency's financial and structural improvements make offering credible options doable (Robertson, 9/17). 

The Associated Press: New York Nurses Press For Higher Staffing Levels
About 700 nurses and supporters rallied Wednesday outside the offices of the Greater New York Hospital Association to press for higher staffing levels at hospitals. The demonstration by the New York State Nurses Association was intended to rally support for a bill in the state legislature that would set minimum staffing levels for nurses. Advocates say required staffing of one nurse for every two intensive-care patients and 1-to-4 ratios in regular medical-surgical units would improve patient care and reduce deaths. But hospital administrators have said the ratios would cost them and nursing homes about $3 billion annually. In a statement Wednesday, the hospital association said that "rigid" nurse staffing ratios would undermine patient care decisions and "deny hospitals the workforce flexibility they need to respond to emergencies” (Matthews, 9/17). 

San Jose Mercury News: Californians Mostly Aware They Have Mental Health Benefits
Most Californians are aware that their health care plans offer mental health services -- aimed at treating ailments ranging from depression to drug abuse to alcoholism -- and they believe such services help people lead productive lives, according to a new Field Poll. But the survey also revealed a lack of understanding about the breadth of mental health assistance available. The poll, done for the California HealthCare Foundation, also showed that many Californians are reluctant to seek mental health counseling or help with substance abuse even if pursuing those services would not hurt them financially. With the advent of the Affordable Care Act, commonly called Obamacare, the poll's basic purpose was to find out if the public had a general understanding of the broad scope of coverage now required by the law, Field Poll Director Mark DiCamillo said (Early, 9/17).

The New York Times: New York City Council Hears Push For Benefits By Jazz Veterans
Unlike Broadway pit musicians and symphony orchestra players, who receive pensions, health insurance and other benefits through their unions, many jazz musicians receive no such benefits. For the last few years, the union has argued that owners of clubs -- namely Birdland, the Blue Note, Dizzy’s Club Coca-Cola, Iridium, Jazz Standard and the Village Vanguard -- reneged on a promise they made in 2006 to pay pension benefits in return for a sales-tax break passed by the Legislature. But the union and the clubs never reached a formal agreement (Schlossberg, 9/17). 

Kaiser Health News: When A Hospital Closes
In a scenario playing out in rural areas across the country, the closing has left local doctors wondering how they will make sure patients get timely care, given the long distances to other hospitals, and residents worrying about what to do in an emergency and where to get lab tests and physical therapy. "Half of them aren’t going anywhere," Dr. Charles Boyette said about people who already seem reticent about driving farther for medical treatment. "They’re taking a chance on if they’ll be alive or dead after the emergency passes. The disaster has already started" (Gillespie, 9/18).

Dallas Morning News: Texans At Risk Of Big Unexpected Bills After Hospital Stay, Report Says
Some Texans with private health coverage are susceptible to a nasty surprise after a hospital stay -- bills for thousands of dollars -- according to a new report. Consumer protections against “balance billing” are inadequate, despite a new regulation last year by the Texas Department of Insurance, the Center for Public Policy Priorities found. Most Texans with private insurance have preferred provider organization policies, or PPO plans, the center-left think tank’s study says. Patients save money if they obtain treatments from providers within a specified network -- those that have reached agreement on reimbursements and signed contracts with the insurer. But at hospitals, many doctors and labs are not “in network,” even though the hospital itself may be (Garrett, 9/15).

Categories: Health Care

States' Customized Efforts To Expand Medicaid Could Complicate Reform

Kaiser Health News - Thu, 09/18/2014 - 9:35am

Some conservative states have won concessions from the administration in exchange for moving forward on expansion, and other states are carefully weighing those choices.

California Healthline: More States Are Exploring Alternative Medicaid Expansion Plans. What Does That Mean For Health Reform?
Pennsylvania's now in. Indiana might be next. Is the tide turning on Medicaid expansion? Recent moves by previously entrenched states indicate that might be the case. However, what does it mean for Medicaid nationwide when more states are choosing alternative plans? The Affordable Care Act calls for Medicaid to be expanded to cover residents with annual incomes up to 138% of the federal poverty level and eliminates categorical eligibility. However, a Supreme Court ruling in 2012 made it optional for states to participate in the expansion. Some states that have been hesitant to increase program eligibility under the law now are looking at alternative ways to expand health coverage to low-income residents (Stuckey, 9/17).

However, Medicaid programs are also under review in states that are not expanding.

New Orleans Times-Picayune: Lawmakers Call For More Complete Information On Medicaid Privatization Program Going Forward
Lawmakers told officials with the Department of Health and Hospitals on Wednesday they needed to provide more complete information going forward about Bayou Health, Gov. Bobby Jindal's Medicaid privatization program. The Legislative Audit Advisory Council heard testimony from DHH and the Legislative Auditor's Office about an audit that raised a number of questions about the program. Auditors testified 74 percent of the transparency report was based on self-reported data with no corroborating documentation. ... A law passed in 2012 asked for the report to see if the state was saving money by switching from the old Medicaid system to Bayou Health. DHH claims it saved the state about $136 million during the 2013 fiscal year, but the audit could not verify that information (Avery, 9/17).

AL.com: Alabama One Of Three States Picked By National Governors Association For Medicaid Reform Program
The National Governors Association has chosen Alabama as one of three states to take part in a year-long policy academy on Medicaid reform. Gov. Robert Bentley's office announced that Alabama was chosen, along with Nevada and Washington. State Health Officer Don Williamson will lead a team of six who will meet with NGA staff and other experts about Alabama's proposed regional care organizations (Cason, 9/17).

Categories: Health Care

Many See Health Law Coverage As Affordable, Survey Finds

Kaiser Health News - Thu, 09/18/2014 - 9:34am

That's most true among low-income consumers who receive subsidies to help pay their premiums, according to the Commonwealth Fund survey.  

Marketplace: How Affordable Is The Affordable Care Act?
A survey out on Thursday suggests many Americans who signed up for health insurance under the Affordable Care Act (ACA) find their coverage affordable. That’s particularly true for people with low incomes who are paying less than $125 a month in premiums, similar to people that get coverage at work. To be sure, there were good deals for consumers in the first year of the ACA (Gorenstein, 9/18).

Politico Pro: Commonwealth Fund Survey: ACA Plans Seen As Affordable
Seventy percent of the people getting health coverage through the ACA insurance exchanges believe they could now afford care if they get sick, according to a Commonwealth Fund survey released Thursday. Generally, the people in the exchanges find premiums affordable, although that’s particularly true of lower-income people who are more heavily subsidized (Norman, 9/18).

In other news about the health law and its implementation -

Bloomberg: U.S. Health System Among Least Efficient Before Obamacare
The U.S. health-care system was among the least efficient in the developed world two years before major changes from Obamacare began to go into effect. America’s health-care system ranked 44th of 51 nations assessed by Bloomberg, in terms of per person spending, life expectancy and health-care cost as a percentage of the economy. It’s an improvement from 46th of 48 last year, yet Serbia, Turkey and China still scored better. Singapore, with the top ranking, spent $2,426 per person and had a life expectancy of 82.1 years in 2012, the most recent year for which data are available. In comparison, the U.S. shoveled cash into health care -- $8,895 per person, per year -- and Americans are expected to live for 78.7 years (Edney, 9/18).

The Fiscal Times: Obamacare Has a Long Way to Go, ACA Experts Say
When it comes to the president’s health care law, there’s very little that Republicans and Democrats agree on—but one idea that seems to unite analysts, experts and lawmakers across the political spectrum is that Obamacare has done very little to actually improve health care.  “The U.S. healthcare system was always dysfunctional. The Affordable Care Act has just provided more access to that dysfunctional system,” iVantage chief Donald Bialek said during an ACA debate at The Economist’s health care forum in Boston on Wednesday. Bialek, for his part, was on the side defending the health care law (Ehley, 9/17).

Also, in regard to challenges to the health law's contraception mandate --

Politico Pro: Religious Groups’ Contraceptive Cases Nearing High Court
Lawsuits challenging whether religious schools and other nonprofits have to abide by Obamacare’s contraceptive coverage requirement are moving toward an expected Supreme Court showdown. Last month, in an effort to end the legal battles, the Obama administration released new rules on how religious nonprofits have to abide by the requirement. But organizations have told one court that even the updated rules are untenable (Haberkorn, 9/17).

Categories: Health Care

Health Law's Ripple Effects On Hospitals, Schools, Uninsured

Kaiser Health News - Thu, 09/18/2014 - 9:33am

The Kansas City Star reports that some uninsured patients fall through the cracks as hospitals cut back on charity care to persuade people to sign up for coverage. Some schools, meanwhile, are turning to private substitutes to avoid having to pay for their health coverage next year. In Colorado, Denver Health is back in the black, partly due to a dramatic decrease in uninsured patients.

Kansas City Star: Patients Fall Through Cracks As Hospitals Cut Back Charity Care
Stephen Maxwell had struggled for years with a bad back, but what he felt in December was something new. A pop, pop, pop in his spine left Maxwell, 45, in constant, inescapable pain that’s made it impossible for him to work or even get a full night’s sleep. In January, Truman Medical Center, the hospital he has relied on for care, rolled back its financial assistance program. Truman used to provide free or discounted care for uninsured people making up to 400 percent of the federal poverty level — $46,680 for an individual. Now, only those making less than 200 percent qualify for the help. The change was intended to motivate people to sign up for health insurance plans through the Affordable Care Act. Maxwell didn’t get the message in time (Bavley, 9/17).

Kansas City Star: Kansas Schools Turn To Private Substitutes To Avoid Providing Health Insurance
Budget concerns and the advent of new health insurance requirements next year have caused some of the bigger school districts in the Kansas City area to rethink one of their largest logistical problems — the hiring of substitute teachers. The result: privatization. Substitutes at Lee’s Summit, Hickman Mills, Kansas City and North Kansas City schools — who had been hired and paid by public school districts in the past — are now employed by Kelly Educational Staffing, an arm of one of the country’s largest temporary employment agencies. The change, which has happened in just the past two years, is part of a nationwide trend as districts look at how to keep expenses low and prepare for the new federal health insurance law known as the Affordable Care Act. District officials say the change allows them to find more high-quality substitutes — especially long-term ones — without incurring the extra costs of health insurance that will be required next year (Hammill, 9/17).

Health News Colorado: Denver Health Regains Financial Footing
Denver Health is back in the black after a tough year in 2013. The return to financial health is a result of a boost in payments from the City of Denver to the safety net health system, reforms under the Affordable Care Act and aggressive job cuts last year — some of which have been restored this year. Since the beginning of 2014, Denver Health has seen a dramatic conversion of patients who were once uninsured and now have health coverage through Medicaid, the government health insurance program for low-income people and the disabled. Last year, more than one of every four Denver Health patients was uninsured. That percentage has shrunk from 27 percent in 2013 to about 14 percent this year. At the same time, about half of Denver Health’s patients now have Medicaid, up from 36 percent last year (Kerwin McCrimmon, 9/17).

Categories: Health Care

Political Cartoon: 'Indestructible Deductible?'

Kaiser Health News - Thu, 09/18/2014 - 9:32am

Kaiser Health News provides a fresh take on health policy developments with "Indestructible Deductible?" by John Deering.

And here's today's health policy haiku:

HOPING FOR A BETTER ENDING

Care at end of life
leaves much to be desired,
says the IOM.
-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

Longer Looks: Lithium In The Water; Controlling Cancer; Recovering From Brain Injury

Kaiser Health News - Thu, 09/18/2014 - 9:32am

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

The New Yorker: Is It Possible To Control Cancer Without Killing It?
There are many kinds of cancer, but treatments have typically combatted them in one way only: by attempting to destroy the cancerous cells. Surgery aims to remove the entire growth from the body; chemotherapy drugs are toxic to the cancer cells; radiation generates toxic molecules that break up the cancer cells’ DNA and proteins, causing their demise. A more recent approach, immunotherapy, coöpts the body’s immune system into attacking and eradicating the tumor. The Agios drug, instead of killing the leukemic cells—immature blood cells gone haywire—coaxes them into maturing into functioning blood cells. ... at least some cancer cells might be redeemable: they still carry their original programming and can be pressed back onto a pathway to health (Dr. Jerome Groopman, 9/15).

Modern Healthcare: ACA Open Enrollment For 2015 Causing Anxiety For Plans, Providers
During the 2014 open enrollment for Obamacare coverage, Mary Denson, 21, a student at Columbia (Mo.) College, qualified for a federal premium subsidy that reduced her premium contribution for buying health insurance to less than $20 a month. But she fears that when she renews her coverage for 2015, she won't have enough income from her nanny job to reach the subsidy income threshold of 100% of the federal poverty level and continue qualifying for premium tax credits. .... The sole focus during the 2014 open enrollment period was on signing up as many people like Denson as possible in exchange and off-exchange individual-market plans. But when the three-month open enrollment period for the second year ... opens on Nov. 15, the task for health plans, insurance brokers and thousands of enrollment workers at hospitals, clinics and community organizations will be more complex (Paul Demko, 9/13).

The Washington Post: After Traumatic Brain Injury, A Young Man’s Astounding Recovery
On Nov. 8, 2012, my son Dylan — two months into his junior year at Tufts University — was struck by a car in a crosswalk. His head punched a hole through the car's windshield, and he suffered a traumatic brain injury so severe that doctors initially warned he might be permanently disabled. ... his luck changed in time to save his life. Because the accident occurred at 8:30 p.m. rather than in the middle of Boston’s rush hour, he was brought to a hospital within a half hour — and not just any hospital. It was Massachusetts General, ... The speed of triage was impressive, but the results of that scan were devastating. Dylan’s brain injury was rotational, meaning hisFortunately, Dylan’s neocortex, the brain’s seat of higher-level processing, was mostly uninjured. And he had one other thing going for him, doctors said: his youth (Rebecca Hubert Williams, 9/15).

The New York Times: Should We All Take A Little Bit Of Lithium?
Lithium is a naturally occurring element, not a molecule like most medications, and it is present in the United States, depending on the geographic area, [in water] at concentrations that can range widely, from undetectable to around .170 milligrams per liter. This amount is less than a thousandth of the minimum daily dose given for bipolar disorders and for depression that doesn’t respond to antidepressants. ... Evidence is slowly accumulating that relatively tiny doses of lithium can have beneficial effects. They appear to decrease suicide rates significantly and may even promote brain health and improve mood (Anna Fels, 9/13). 

New York Magazine: My Year As An Abortion Doula
Women have historically supported other women through the process of childbirth, so the work of birth doulas is nothing new. But when birth doulas Lauren Mitchell and Mary Mahoney sought to bring those support practices into abortion clinics, they met immediate resistance. "To imply that women getting abortions would need something as touchy-feely as support was not accepted," Mitchell explains. Some birth doulas were reluctant to consider the needs of women terminating pregnancies as at all similar to their patients carrying them to term. And many pro-choice doulas, doctors, and nonprofits were unwilling to acknowledge how difficult and painful many women find abortion (Alex Ronan, 9/14).

Pacific Standard: Gambling With America’s Health
A debate over the social and health costs of legal gambling has largely been sidelined even as availability has expanded dramatically in the last 25 years. This is not because of a lack of merit, say experts and activists, but because of the political power of the gambling industry. They allege that the industry has employed tactics in the same spirit as those of tobacco companies, which for many years misled consumers about the addictive properties of cigarettes and advertised to young people and other vulnerable consumers. According to Les Bernal, the national director of Stop Predatory Gambling, a Washington, D.C.-based non-profit, “This is one of the biggest public health issues in America today that no one has been paying attention to” (Elaine Meyer, 9/15).

Aeon Magazine: How Mathematics Can Make Epidemics History
When Ronald Ross tipped over the water tank outside his bungalow in Bangalore, it began a lifelong battle against mosquitoes. It was 1883 and Ross, only two years out of medical school, was the British Army’s new garrison surgeon. Overall, he was happy with the posting – he considered the city, with its sun, gardens and villas, to be the best in southern India. He was less enthusiastic about the mosquitoes. Having arrived to find his room filled with the sound of buzzing wings, he decided to hunt down and destroy their breeding ground in pools of stagnant tank water. ... The longer Ross spent in the region, the more he began to suspect that those mosquitoes transmitted malaria .... Ross’s work, which won him a Nobel Prize in 1902 and a knighthood in 1911, set the stage for a new mathematical way of thinking about disease outbreaks from bubonic plague to influenza (Adam Kucharski, 9/16). 

Categories: Health Care

Photos from the Scottish Independence Referendum Campaign

In Custodia Legis - Thu, 09/18/2014 - 8:23am

My friends and I were fortunate to be in Scotland during the run-up to today’s vote on the Scottish independence referendum. We read several articles about the referendum, but only began to grasp the various arguments for and against it after paying a visit to the respective campaigns.  After taking a bike tour of Edinburgh, we found we were only steps away from the local “Yes” campaign office,  where we met with a group of staff members who had just returned from distributing literature at a local college. After arriving in Glasgow, we stopped by a “Better Together” campaign headquarters and met with a group of staff members who took time away from manning a phone bank to talk with us. Regardless of your position on the referendum, I hope you enjoy the evidence of political engagement represented by the photographs of this campaign.

Photos of campaign material associated with the Scottish independence referendum

Categories: Research & Litigation

Massachusetts State Undergraduate and Law School Degree in 6 Years

Massachsuetts Trial Court Law Library - Thu, 09/18/2014 - 8:00am
Fitchburg State University and the University of Massachusetts Law School have signed an agreement making it possible for motivated students, set on a career in law, to complete both degrees after three years spent studying at each institution.  Qualified students are guaranteed admission to UMASS Law and spend their senior undergraduate year in law school.

Many students will not be ready to commit to a career as they begin undergraduate school.  Besides the obvious cost savings, there are other factors to consider when deciding on an accelerated J.D. program. Interested candidates should look carefully into what being a lawyer is really all about. 

Introduction to the Study and Practice of Law in a Nutshell, is a lighthearted, but informative resource for those contemplating law school and a legal career.
Categories: Research & Litigation

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