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First Edition: October 20, 2014

Kaiser Health News - Mon, 10/20/2014 - 7:17am

Today's headlines include a variety of stories about the continuing national response to Ebola and the potential impact that fears of this illness might have on the midterm elections.

Kaiser Health News: What CDC Can Do To Fight Ebola
Kaiser Health News staff writer Julie Rovner reports: “The Ebola epidemic in Africa and fears of it spreading in the U.S. have turned the nation’s attention to the federal government’s front-line public health agency: The Centers for Disease Control and Prevention (CDC). But as with Ebola itself, there is much confusion about the role of the CDC and what it can and cannot do to prevent and contain the spread of disease. The agency has broad authority under federal law, but defers to or partners with state and local health agencies in most cases” (Rovner, 10/20). Read the story

Politico Pro: Dems’ Runoff Nightmare: More Obamacare Glitches
The second sign-up season for health care exchanges begins November 15 — a post-election launch that was supposed to insulate Democrats from the politics of another website meltdown. But it’s almost certain that the Senate race in Louisiana will require a runoff in December, and a January runoff is also possible in Georgia. That means residents of the two states will be checking into HealthCare.gov at the exact moment they’re considering their vote — and possibly which party will control the Senate (Cheney and Wheaton, 10/19).

The New York Times: Unable To Meet The Deductible Or The Doctor
Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring. But her new plan has a $6,000 annual deductible, ... She is skipping this year’s brain scan and hoping for the best. ... About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families (Goodnough and Pear, 10/17).

Politico Pro: Obamacare Termination Issue Could Muddle Renewals
Consumers who already have an Obamacare plan could face a messy situation early next year if they pick a different insurer for their 2015 coverage because HealthCare.gov won’t be telling companies whom to terminate. In some cases, industry sources worry, a person could be double billed for premiums because two carriers have the individual on their books on Jan. 1. Other consumers could be erroneously cut from their plans after Dec. 31 if inaccuracies in the federal exchange database lead to companies getting bad information on renewals, said one insurance official who has been briefed on the issue (Pradhan, 10/17).

Politico: Health Cancellations Ripple In Colorado
More than 22,000 Coloradans were informed in the past month that their health coverage will be canceled at the end of the year, state insurance authorities disclosed this week, a spike in cancellations already roiling the state’s fierce campaigns for the Senate and governor’s seat. Republican Rep. Cory Gardner, who’s running to unseat Democratic Sen. Mark Udall, pounced on the news as evidence that Obamacare is disrupting coverage for Coloradans ... It’s unclear, though, if Obamacare is the reason for the latest wave of canceled plans. The cancellations are nearly all the result of a decision by Humana (Cheney, 10/17).

The Washington Post: 'It's Just Maddening. There's Nothing You Can Do.'
In an obscure corner of the federal bureaucracy, there is an office that is 990,399 cases behind. ... It is bigger even than the infamous backups at Veterans Affairs, where 526,000 people are waiting in line, and the patent office, where 606,000 applications are pending. All of these people are waiting on a single office at the Social Security Administration. Social Security is best-known for sending benefits to seniors. But it also pays out disability benefits to people who can’t work because of mental or physical ailments. And it runs an enormous decision-making bureaucracy to sort out who is truly disabled enough to get the checks — and who is trying to game the systems (Fahrenthold, 10/19).

The Wall Street Journal: Lilly CEO Sees Light After A Difficult Year
Eli Lilly & Co. is deep into what Chief Executive John C. Lechleiter calls the “toughest year” in the drug maker’s 138-year history. Revenue at Lilly has plunged because of generic competition that followed patent expirations for several of its top-selling drugs, including the antidepressant Cymbalta (Loftus, 10/19).

The Wall Street Journal’s Pharmalot: Better Late Than Never: CMS Improves The Doctor Payment Website
Remember how challenging it was to navigate the new government database of payments made by drug and medical-device makers to U.S. doctors? Well, the transparency initiative just became a little easier to use – more than two weeks after the database was posted online (Loftus, 10/17).

Politico Pro: House Dems Want Approval For Surgeon General Pick
More than two dozen House Democrats are calling on the Senate to swiftly approve Vivek Murthy’s nomination to serve as surgeon general to help combat the spread of the deadly Ebola virus in the U.S. Murthy’s nomination got sidelined after Republicans and vulnerable Senate Democrats voiced reservations about the Harvard Medical School physician’s outspoken views on gun violence and public health. But the House Democrats, in a letter set to be released next week, argue that the Obama administration needs a top official in place to help with Ebola response (French, 10/17).

The Wall Street Journal’s Washington Wire: Ebola Furor Renews Sparring Over Surgeon General Nomination
The political furor over the U.S. response to the Ebola outbreak has revived debate over President Barack Obama’s stalled pick for U.S. Surgeon General. Some supporters of the administration have for the past few days been trying to shift the spotlight to opposition to Vivek Murthy, Mr. Obama’s pick for the position, which focuses on public-health issues. Dr. Murthy’s nomination met resistance in March when some Senate Democrats indicated they would not vote for him after his support for gun control drew the opposition of the National Rifle Association. Senate Democratic leaders are still not expected to bring Dr. Murthy up for a vote unless enough lawmakers change their positions to confirm him, aides said. But the public health concerns kindled by the spread of Ebola have generated new sparring over his nomination (Peterson and Radnofsky, 10/17).

Politico: POLITICO Poll: Democrats In Danger Over Ebola
Voters who intend to support Republicans in the most consequential Senate and House elections this November had significantly less confidence in the federal government’s response to the occurrence of Ebola, according to a new POLITICO poll. The survey underscores the dangers for Democrats in the midterms if the Obama administration is perceived as mishandling the government’s reaction to the virus (Shepard, 10/20).

NPR: Will Ebola Impact Midterm Elections?
Weekend Edition Sunday's new segment, "For the Record," kicks off with politics and Ebola. NPR's Rachel Martin asks NPR's Mara Liasson and Dallas columnist J. Floyd about the politics of the disease (10/19).

The Washington Post: Ebola, Islamic State Shift Dynamics For Hagan, Tillis In North Carolina’s Senate Race
For much of the year, the incumbent, Sen. Kay Hagan (D), and her allies had successfully framed the campaign as a referendum on the sharp conservative turn taken by the state legislature under the leadership of Tillis, the House speaker. But in the past few weeks, the conversation has pivoted amid alarming headlines about terrorism and a virulent epidemic, further tightening what is expected to be the most expensive Senate race in U.S. history. … For his part, he spent most of his day-long swing through the state pressing the argument that Hagan operates as an extension of Obama. He ticked off a series of issues, such as Obamacare and veterans’ care, in which he said the administration — and the senator — had failed. At every stop, he added two new items on the list: the Islamic State and Ebola (Gold, 10/19).

Los Angeles Times: Costly, Nasty Battle Rages In San Diego Race For Congress
In its third editorial endorsing Republican congressional candidate Carl DeMaio over Democratic incumbent Scott Peters, the U-T San Diego newspaper had one description of DeMaio that not even his many critics could dispute: "One of a kind." DeMaio's hard-charging style, combined with his anti-Washington pledge to "Fix Congress First," has turned the 52nd Congressional District race into one of the tightest and costliest in the country. ... Local television is filled with attack ads. Peters warns that DeMaio plans to cut student loans. DeMaio says he is a big supporter of student loans and Medicare and that Peters represents everything that is wrong with politics: officeholders who are too comfortable with the status quo (Perry, 10/18).

The Washington Post: Gubernatorial Races Poised To Make History In Two Weeks
You wouldn’t know it by following the Senate-control-centric coverage of the midterm elections emanating from Washington, but we could well be headed toward a historic gubernatorial election in 15 days. Not since 1984 have more than six sitting governors lost in any one election. But, 30 years after that gubernatorial carnage, a look at this year’s races puts 11 incumbents in various levels of peril — suggesting that history may be in the making (Cillizza, Blake and Sullivan, 10/19). 

The Washington Post: Pentagon Plans Ebola Domestic-Response Team Of Medical Experts To Aid Doctors
The Pentagon announced Sunday that it will create a 30-person team of medical experts that could quickly leap into a region if new Ebola cases emerge in the United States, providing support for civilian doctors who lack proficiency in fighting the deadly virus (Kane and Ellis Nutt, 10/19).

The Washington Post: Obama: ‘We Can’t Give In To Hysteria Or Fear’ Of Ebola
As Ebola fears have spread, some urgent-care clinics have taken steps to identify red flags, such as recent travel to West Africa, before patients ever set foot in the clinic. AFC/Doctors Express, a national chain of more than 130 urgent-care clinics, with facilities in Alexandria, Va., Woodbridge, Va., Edgewater, Md., and Towson, Md., fields some of its patient calls through a national call center that’s designed to screen symptoms before patients show up to see a doctor. On Friday, the call center developed a new Ebola fact sheet and script to ask patients about their travel history, said Glenn Harnett, the chief medical officer for AFC/Doctors Express (Jaffe and Brittain, 10/18).

The Wall Street Journal: New Ebola Guidelines For Hospitals To Require Full Body Cover
New, more stringent hospital guidelines for treating Ebola patients will require full body coverings and mandate that health-care workers be monitored while putting on and taking off protective garb, a top U.S. health official said. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health, said the new guidelines will be “much more stringent” and require that no skin be exposed (Barnes, 10/19).

NPR: Dallas Hospital Deals With Aftermath Of Ebola Missteps
Authorities in Texas are working to limit travel by health workers who may have been exposed to Ebola. Meanwhile, the hospital at the center of the first cases in the U.S. is trying to move forward (Goodwyn, 10/18).

The Wall Street Journal: Why The Work Of Dr. Nancy J. Sullivan Could Be Key To A Potential Ebola Vaccine
The world had little interest in Ebola in 1997, which is why cell biologist Nancy J. Sullivan thought she might be able to make a mark. Today, if the scientific world is to have an answer to the world’s severest Ebola outbreak, Dr. Sullivan’s work is likely to be at its center (Burton, 10/19).

Los Angeles Times: ‘Ebola Czar' Brings Decades Of Washington Experience
The man tapped to be the country’s “Ebola czar” is a veteran Washington advisor and Democratic strategist who will oversee a multi-agency response to the outbreak in West Africa and the U.S. cases, the White House announced Friday. In a change from a career spent mainly behind the scenes, Ron Klain becomes the Obama administration's point person leading a complicated and highly-visible government Ebola strategy (Hansen, 10/17).

The Associated Press: Ebola 'Czar' Knows Washington, But Not Medicine
[Klain] does have a wealth of experience managing unruly federal bureaucracies in times of crisis. The White House says that makes him the perfect candidate to shepherd the government's response to a deadly, growing outbreak. ... Under immense pressure to step up his response, Obama turned to Klain on Friday. He's being asked to synchronize an alphabet blizzard of federal agencies: the CDC, NIH, HHS, DHS, FDA and DOD, to name a few (Lederman, 10/16).

Kaiser Health News also tracked weekend headlines regarding the Obama administration’s appointment of an Ebola czar. 

The New York Times: Mental Health Issues Put 34,500 On New York’s No-Guns List
A newly created database of New Yorkers deemed too mentally unstable to carry firearms has grown to roughly 34,500 names, a previously undisclosed figure that has raised concerns among some mental health advocates that too many people have been categorized as dangerous. The database, established in the aftermath of the mass shooting in 2012 at the Sandy Hook Elementary School in Newtown, Conn., and maintained by the state Division of Criminal Justice Services, is the result of the Safe Act. ... The law, better known for its ban on assault weapons, compels licensed mental health professionals in New York to report to the authorities any patient “likely to engage in conduct that would result in serious harm to self or others" (Hartocollis, 10/19).

The New York Times: Doctor’s Letter Spells End of Job For Pregnant Employee
This month marks the first anniversary of the Pregnant Workers Fairness Act, which was signed into law by former Mayor Michael R. Bloomberg on Oct. 2, 2013. The law, which went into effect in January, represents a big step forward for working women. It requires employers to make reasonable accommodations for pregnant workers — such as providing rest and water breaks, modified work schedules and light duty – so long as the accommodations don’t cause undue hardship for the employer. Makes sense, right? It’s actually critical, particularly for low-income women who sometimes get pushed out of their jobs – and into poverty – when they become pregnant (Swarns, 10/17).

Chillicothe Gazatte/USA Today: Medicare Patients Pay More At Rural Hospitals
ECGs and nine other frequently provided outpatient services cost from two to six times more for Medicare patients at the nation's rural, critical access hospitals compared to other hospitals, according to a report by the U.S. Department of Health and Human Services' Inspector General (Balmert, 10/20). 

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Categories: Health Care

Opinion: Why America’s Ebola Fears Are Dangerously Misplaced

CommonHealth (WBUR) - Mon, 10/20/2014 - 6:33am

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

By Richard Knox

At the memorial service last weekend for the only person to have died of Ebola on American soil, the Liberian clergyman who eulogized his countryman Thomas Eric Duncan posed a question we all should be thinking hard about right now.

“Where did Ebola come from to destroy people — to set behind people who were already behind?” Methodist Bishop Arthur F. Kulah wondered.

Here’s the reality: Until the world (and especially the United States of America) refocus on the “people who were already behind” in this battle of virus-versus-humanity, no one can rest easy.

Ebola is an animal virus that has sporadically caused local human outbreaks in Africa for at least 38 years. But now it has crossed into people who live in densely populated African nations with barely functioning health systems and daily jet connections to the rest of the planet.

This is entirely predictable, as scientists who watch emerging diseases have long known. They just didn’t know which virus would be the next to terrorize the world. (SARS and HIV showed how it can happen, remember?)

Those of us who, like me, report on global public health have a sense of inevitability as we watch the Ebola crisis unfold. We always knew it would mostly affect, as Bishop Kulah so aptly puts it, “people who were already behind.”

And we knew the people least affected by this scourge — privileged denizens of wealthier countries — would overreact out of misplaced fear for themselves, rather than a reasoned and compassionate understanding about what needs to be done.

So we see the freaked-out, wall-to-wall, feedback-loop media coverage we’re experiencing now. Schools closing down in Ohio for completely unnecessary disinfection. Recriminations against hapless health workers who suddenly find themselves dealing with an exotic new threat. Politicians demanding to seal off the Mexican border to prevent Hamas terrorists from deliberately bringing Ebola into the Homeland. (Thanks, Congressman Joe Wilson of South Carolina, I’ll bet Hamas masterminds hadn’t even thought of that.) You can expect more of the same in coming weeks.

All this when the focus urgently needs to be on the real Ebola victims in Liberia, Sierra Leone and Guinea.

Let’s rewind the tape a little bit. Researchers predicted that Ebola would begin to show up in the U.S. and Europe by the end of September, based on analysis of burgeoning cases in West Africa and air traffic patterns. As events have proven, they were right on target.

The contemporary world is a porous place. It’s a fact.

U.S. public health officials knew that. And, to their credit, they began preparing for the arrival of an Ebola-infected person on our shores in the summer.

It’s not an easy thing to plan for. Where might he/she pop up — New York, Boston, Minneapolis, Dallas? What would he/she look like? Where would he/she first seek care for symptoms that mimic a hundred different disorders? Which health workers should be trained, and how, to minimize the risk of spread?

When I interviewed Boston public health and medical authorities for CommonHealth last month, I was struck by several things:

•They were taking the threat seriously.

•They were confident they could deal with it — perhaps overconfident.

•They thought (or some of them did) that a case of Ebola in Boston could be managed without much public alarm.

Fat chance, I thought.

Getting the public health messaging right is one of the trickiest aspects of the drama. People understandably have a hard time wrapping their minds around a rapidly lethal virus that’s very contagious — but only after people are showing symptoms, and only if those around them are exposed in certain ways. We simply don’t have experience with threats like this.

And Americans, who by and large lead remarkably low-risk lives by the standards of much of the world, paradoxically have very little tolerance for risk. Their anger quickly flares at authorities who they think have failed to protect them from any perceived threat.

Alas, the current Ebola crisis has shown that public health authorities whose job is to protect us from these threats were, charitably speaking, unequal to the task.

The World Health Organization has been the most distressing disappointment.

The WHO used to have a crackerjack team of infectious disease specialists who were constantly scanning the horizon for new infectious disease threats, and a staff of technical experts ready to parachute into outbreak zones to contain the danger. Now we know that budget cutbacks have decimated the WHO’s ability to respond to this very sort of crisis.

WHO Director General Margaret Chan told the head of Doctors Without Borders in early September that “it was a fantasy…to think of the WHO as a first responder ready to lead the fight against deadly outbreaks around the world,” according to the New York Times.

In other words, the world’s frontline defense against new disease threats is a paper tiger.

Just this past week, we learned that the WHO acknowledges (at least internally) that it botched its response to Ebola. A big reason, reportedly, is that Chan, the titular WHO leader in Geneva, has no control over the WHO’s regional director in Africa, a political appointee who does not report to her.

According to the internal WHO report, the WHO regional director for Africa, Dr. Luis Sambo, failed to alert Geneva to Ebola’s spread last summer.

“They didn’t do anything,” Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine and the co-discoverer of the Ebola virus, told Maria Cheng of the Associated Press (a former WHO public affairs official). “That office is really not competent.”

In this country, current ire is focused on the U.S. Centers for Disease Control and Prevention and the Obama administration for missteps in handling the first imported case of Ebola — Liberian Thomas Eric Duncan — and failing to prevent at least two Dallas nurses who cared for him from getting infected and exposing others.

It appears that the CDC over-relied on local hospital and public health officials to deal with a virus never before seen on these shores except in the highest-containment laboratories.

That over-reliance reflects CDC’s rigid culture. The agency has always insisted on deferring to state and local health authorities. Under U.S. law, they traditionally have primary responsibility for public health. The CDC acts in an advisory role — and waits to be invited in by local authorities. Clearly, that’s not the best way to deal with an unfamiliar and fast-moving global disease threat.

The CDC implicitly acknowledged as much last week when it said it would henceforth be more hands-on in coping with Ebola — sending in a SWAT team of infection-control experts to bolster the ability of a hospital and local health agency to cope.

That leaves unanswered a disturbing aspect of the Dallas episode that helped put the nation into a state of high anxiety. When Mr. Duncan first showed up at Texas Health Presbyterian Hospital in Dallas with a fever and a recent travel history to Liberia, he was sent home with an antibiotic.

It makes you wonder whether the institution, which has been characterized as the upper crust of Dallas hospitals, saw Mr. Duncan as just another black patient with unspecific symptoms and no private doctor to tend to him.

And that brings us back to Bishop Kulah’s observation that Ebola “set(s) behind people who are already behind.”

So far the world has been shockingly indifferent to the plight of West Africans who are bearing the brunt of this terrible disease. The United Nations has received just $377 million of the $1 billion it says it needs to begin to bring the burgeoning West African epidemic under control. Delay will surely increase that price tag.

Turning our backs on the problem won’t work. Dr. Jim Yong Kim, head of the World Bank, who has a deep background in public health, offers a compelling counter-argument to those who say the U.S. should just close its borders to those coming from Ebola-affected countries.

“It’s like you’re in your room and the house is on fire, and your approach is to put wet towels under the door,” Kim told NPR’s Steve Inskeep. “That might work for awhile, but unless you put the fire out, you’re still in trouble.”

Categories: Health Care

What CDC Can Do To Fight Ebola

Kaiser Health News - Mon, 10/20/2014 - 5:09am

The Ebola epidemic in Africa and fears of it spreading in the U.S. have turned the nation’s attention to the federal government’s front-line public health agency: The Centers for Disease Control and Prevention (CDC). But as with Ebola itself, there is much confusion about the role of the CDC and what it can and cannot do to prevent and contain the spread of disease.  The agency has broad authority under federal law, but defers to or partners with state and local health agencies in most cases.

Julie Rovner answers some common questions.

Q: What is the CDC?

Formally renamed the Centers for Disease Control and Prevention in 1992 to reflect its broader scope (previously it was just the Centers for Disease Control), the Atlanta-based CDC is an agency of the U.S. Department of Health and Human Services. Its mission is to promote health and prevent disease, injury and premature death. CDC’s most recent budget is just under $7 billion.

Q: What is CDC’S role in combating Ebola?         

CDC personnel have been working on the ground in West Africa to try to stop the spread of Ebola since the spring, when cases began to mount. CDC Director Thomas Frieden told a congressional hearing Thursday that the agency currently has 139 staffers in West Africa, and that more than 1,000 workers have “provided logistics, staffing, communication, analytics, management and other support functions.”

Virologist Heinrich Feldman tests blood samples for the Ebola virus in a CDC mobile laboratory near Monrovia, Liberia (Photo by John Moore/Getty Images)

In the U.S., the CDC is responsible for the procedures to screen travelers from affected countries. CDC has also developed information for hospitals to help them prepare to treat Ebola patients, guidelines for health care workers to protect themselves while caring for those infected, as well as for those handling the bodies of patients who have succumbed.

Mostly, however, CDC works with state and local agencies, as well as other federal agencies to ensure that the disease does not spread. CDC personnel, for example, work with agents from the U.S. Customs and Border Protection at ports of entry like airports. And the agency provides on-the-ground assistance, as well as funding in some cases, to state and local public health personnel.

CDC recently announced it would send “rapid response teams” to any hospital with a confirmed Ebola case within hours. That policy change came after a nurse who cared for Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Hospital was diagnosed with Ebola. The CDC has since become more assertive about sending personnel to hospitals, rather than waiting to be asked for help.

“This is a whole-of-government response, with agencies across the United States government committing human and financial resources,” Frieden testified. “We know Ebola can be stopped with rapid diagnosis, appropriate triage, and meticulous infection-control practices in American hospitals. And the United States is leading the international effort to stop it at the source in Africa.”

Q: What kind of quarantine authority does the CDC have?

Most quarantine laws are state and local. However, the CDC does have the authority and responsibility to isolate/and or quarantine individuals to prevent diseases from entering the United States, or from being spread between states. Ebola is one of the diseases specifically mentioned in an Executive Order allowing federal isolation and quarantine.

As a practical matter, however, federal quarantine is rare. The CDC says it was last used widely in the 1919 Spanish Flu epidemic, which predates the agency.

Most of the time, the CDC is invited in by state or local public health agencies for advice, guidance and expertise. State and/or local police are responsible for enforcing quarantine orders.

Q: Some history: What was CDC’s original mission?

It was originally created in 1946, as the Communicable Disease Center in the Office of Malaria Control in War Areas. Malaria was still common in the American South after World War II and much of CDC’s original work was aimed at its prevention and eradication, along with typhus and other communicable diseases.

In 1951, the CDC established the Epidemic Intelligence Service, which is the most famous part of the agency. It draws young physicians and other health professionals from around the world to investigate, track and work to contain disease outbreaks.

Q: What else does CDC do now?

In addition to tracking and working to prevent disease outbreaks, the CDC operates the national immunization program, Vaccines for Children, administers the $75 million Preventive Health and Health Services Block Grant, which provides funding for health promotion programs, and oversees much of the federal government’s biodefense efforts. It also manages the Strategic National Stockpile, a supply of emergency medicine and medical supplies to be used in cases of natural or man-made disasters. And CDC operates a broad array of programs aimed at controlling non-communicable diseases, including birth defects, injuries, and environmental health risks.

Categories: Health Care

Politics Swirl Around President's Ebola 'Czar' Pick

Kaiser Health News - Sat, 10/18/2014 - 8:35pm

News outlets covered the partisan reaction to the president's decision.

USA Today: Obama Names Ron Klain As Ebola 'czar'
President Obama tapped veteran government insider Ron Klain to coordinate his administration's efforts to contain the Ebola virus Friday. Klain, a former chief of staff to Vice Presidents Joe Biden and Al Gore, is well-known by Obama and White House aides. He was selected for his management experience and contacts throughout the government, White House spokesman Josh Earnest said. ... "He is the right person for the job," Earnest said, particularly the challenge of "integrating the interagency response." Klain's appointment marks a swift turnabout for Obama, who until Thursday had resisted calls to appoint a single official to run the government's response to Ebola (Jackson, 10/17). 

Politico: President Obama Selects Ron Klain As Ebola Czar
Klain will report to Obama homeland security adviser Lisa Monaco, who had been more informally coordinating the administration’s response, and to National Security Adviser Susan Rice. ... [Klain] was also a key member of the team that helped Obama prepare for presidential debates. He is currently president of Case Holdings, former AOL chairman Steve Case’s holding company, and general counsel of investment firm Revolution (Epstein, 10/17).

The Associated Press: Ebola 'Czar' Knows Washington, But Not Medicine
[Klain] does have a wealth of experience managing unruly federal bureaucracies in times of crisis. The White House says that makes him the perfect candidate to shepherd the government's response to a deadly, growing outbreak. ... Under immense pressure to step up his response, Obama turned to Klain on Friday. He's being asked to synchronize an alphabet blizzard of federal agencies: the CDC, NIH, HHS, DHS, FDA and DOD, to name a few (Lederman, 10/16).

CNN: GOP Slams Klain Pick As Ebola Czar
"This appointment is both shocking and frankly tone deaf to what the American people are concerned about," Pennsylvania Rep. Tim Murphy said in a written statement. ... One after another, top GOP members on Capitol Hill zeroed in on Klain's campaign experience as the wrong kind of background for the post (Walsh, 10/17).

Bloomberg: Obama Says Travel Ban For Ebola May Make Situation Worse
Obama used his weekly address to the nation to discuss Ebola, capping a week that included canceled campaign events, emergency meetings and the appointment of an administration official to coordinate response to the disease. ... Obama again sought to reassure the public that Ebola was difficult to catch and the likelihood of an epidemic was low. “I’ve met with an Ebola patient who recovered, right in the Oval Office,” he said. “And I’m fine" (Olorunnipa, 10/18).

The New York Times: Amid Assurances On Ebola, Obama Is Said To Seethe
Beneath the calming reassurance that President Obama has repeatedly offered during the Ebola crisis, there is a deepening frustration, even anger, with how the government has handled key elements of the response. Those frustrations spilled over when Mr. Obama convened his top aides in the Cabinet room after canceling his schedule on Wednesday. ... “It’s not tight,” a visibly angry Mr. Obama said of the response, according to people briefed on the meeting (Shear and Landler, 10/17).

The New York Times: Health Scare in Texas Also Sends Political Ripples
Along with dramas of disease transmission, treatment protocols and personal safety, one story line about the Ebola cases here has concerned the man who wasn’t there, sort of. Gov. Rick Perry. As national attention has obsessively focused on the three Ebola cases diagnosed here, Mr. Perry has been somewhat removed and, for a time, even absent (Fernandez, 10/16).

Politico: Rick Perry's Ebola Test
At first, Perry seemed to have everything under control. When a man in Dallas was diagnosed with the deadly virus, Perry held an Oct. 1 news conference, assuring the public that “there are few places in the world better equipped to meet the challenges posed by this case.” ... But then he left Sunday for a long-planned 7-day trip (Glueck, 10/17).

 

Categories: Health Care

Mass.gov: Gateway to All Things Massachusetts

Massachsuetts Trial Court Law Library - Sat, 10/18/2014 - 9:00am
Massachusetts' website, www.mass.gov, is a user friendly resource for a surprising variety of information related to Massachusetts.  Citizens can use the site to navigate their way to pertinent data when registering a new car, paying their state income taxes, or checking to see if they won the lottery.
But this portal can also help you to plan some hikes, select a wedding venue, or find the nearest Farmers' Market. 

So think of the Mass.gov gateway when you are searching for topics such as Asbestos Removal, Preventing Conflicts With Wildlife, Bar Exam Information  or tracking down a state agency. But also remember that you can get help planning a college education, starting a business, locating a parking spot at a transportation hub or finding directions to your closest Trial Court Law Library.
Categories: Research & Litigation

Little Green Light Donor Management CRM, 1-Year Initial Subscription

Tech Soup - Fri, 10/17/2014 - 4:36pm

Cloud-based donor management software

A Moving Story – Pic of the Week

In Custodia Legis - Fri, 10/17/2014 - 3:13pm

Hey!  Does the Law Library Reading Room think that they get to have all the fun?

Stand back Public Services Division!

We’ll see your 40,000 volume move to temporary space pending the construction of the new and improved Law Library Reading Room, and up the ante to a 2.4 million (give or take 100,000) volume move in anticipation of Collection Services Division replacing the decades old compact shelving in our closed stacks.

Sixty times the volumes, sixty times the fun, right?

Well maybe not.  Especially if you were to ask those tasked with the logistics of it all.  They just seem to sigh a lot these days.

The good news is that we’re doing it in stages.  We’re starting with our smallest space first.

And as a first step, we’re moving 1600 linear feet of older volumes of the United States Congressional Serial Set to space in the Library of Congress’ Adams Building kindly loaned to us by the Library’s Collections Access, Loan and Management Division.

Our staff loads the specially designed trucks used for transporting books over longer distances and secures the front panels so the books don’t fall out while making the trip through the Library’s underground tunnel system.

 

 

 

 

 

 

 

They then offload the books onto state-of-the-art compact shelving units in the Adams Building until they can be returned home.  All the while ensuring that the volumes are still accessible to patrons by way of the Library’s OPAC and our cracker-jack Stacks Services’ staff and contractors.

All photos by Betty Lupinacci

 

 

 

 

 

 

Categories: Research & Litigation

Investor Visas

Law Library of Congress: Research Reports - Fri, 10/17/2014 - 3:00pm
The Law Library of Congress is proud to present a new report, Investor Visas.

This report examines types of visas and visa requirements granted to people who invest in a foreign country. Austria, France, Germany, Italy, and Spain do not specify a particular amount a foreign investor must invest in the country to be considered for a visa (temporary or permanent). Australia, Bulgaria, Canada, Latvia, Lithuania, Netherlands, Portugal, and the United Kingdom specify a particular amount that must be invested in order to qualify for a visa.

Visit http://www.loc.gov/law/help/investor-visas/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. The Law Library of Congress produces reports for members of Congress and others. Learn more at http://blogs.loc.gov/law/2013/05/law-library-provides-global-legal-research/. Throughout this week there have been highlights of recent and newly published reports. Share your favorites using the hashtag #LawLibraryReport.
Categories: Research & Litigation

Outbreak On Trial: Who’s To Blame For Bringing Disease Into A Country?

CommonHealth (WBUR) - Fri, 10/17/2014 - 9:53am

Francina Devariste, 3 years old, is one victim of an ongoing cholera outbreak in Haiti that has killed 8,000 people and sickened over 700,000. (2010 photo courtesy of the United Nations)

By Richard Knox

If an international agency introduces a devastating disease to a country, should it be held accountable?

That’s the big question at the heart of a court proceeding that gets underway next Thursday. The international agency is the United Nations. The disease is cholera. And the nation is Haiti.

Four years ago this month, thousands of Haitians downstream from a U.N. peacekeeping encampment began falling ill and dying from cholera, a disease not previously seen in Haiti for at least a century.

Since then cholera has sickened one in every 14 Haitians — more than 700,000 people; and over 8,000 have died. That’s nearly twice the official death count from Ebola in West Africa thus far.

A year ago, a Boston-based human rights group sued the U.N. for bringing cholera to Haiti through infected peacekeeping troops from Nepal, where the disease was circulating at the time. The U.N. camp spilled its sewage directly into a tributary of Haiti’s largest river.

There’s little doubt that the U.N. peacekeepers brought the cholera germ to Haiti. Nor is there argument over the poor sanitary conditions at the U.N. camp.

When I visited the scene in 2012, it was plain how untreated sewage from the camp could easily contaminate the Meille River that runs alongside before it spills into the Artibonite — Haiti’s Mississippi — which provides water for drinking, washing and irrigation for a substantial fraction of the country’s population.

The smoking gun, scientifically, is a molecular analysis of the Haitian cholera bug compared to the Nepalese strain from the same time period. It showed the two differ in only one out of 4 million genetic elements.

“That’s considered an exact match, that they’re the same strain of cholera,” Tufts University environmental engineer Daniele Lantagne told me last year.

She’s one of four scientists appointed by the U.N. to investigate how cholera got to Haiti.

But next week’s proceedings, in the U.S. District Court of Judge J. Paul Oetken in New York City, will not deal with those facts, and how they point to the U.N.’s responsibility for bringing cholera to Haiti. The only issue for now is whether the U.N. can be sued — or if it enjoys absolute immunity.

At a time when nations and U.N. agencies are being criticized for not doing enough to quell the burgeoning Ebola epidemic, the cholera suit may have special resonance.

The U.N. is not commenting on the suit. “We don’t make comments on ongoing cases,” says Matthias Gillmann, a spokesman for U.N. Secretary General Ban Ki-Moon.

Gillmann says the agency hasn’t commented on the matter since it announced last year that claims for compensation filed by Haitian cholera victims “were found not receivable.”

However, the U.N. has been deploying a public relations strategy to defuse Haitians’ anger about cholera. Last July Ban Ki-Moon made what he called a “pilgrimage” to a cholera-stricken family in Haiti and said he was “very much humble and sad to have seen all this tragedy that has been affecting many Haitian people.”

Ban also said the U.N. “has a moral duty to help those people to stem the further spread of cholera,” although the agency has been able to raise only about $26 million out of the $2.2 billion it says will be needed to bring clean water and sanitation to Haiti.

The U.N.’s surrogate in this legal battle is the U.S. government. In a legal brief filed in July, U.S. Attorney Preet Bharara argued that the U.N. and its officials are totally immune from lawsuits, no matter what harm may arise from its activities, such as peacekeeping missions.

“The U.N. has repeatedly asserted its immunity,” Bharara wrote Judge Oetken. “Plaintiffs have not presented — and cannot present — any evidence to the contrary.”

Of course, the plaintiffs see it very differently. They’re represented by Dorchester-based Institute for Justice and Democracy in Haiti and its sister group Bureau des Avocats Internationaux. Their lawsuit demands that the U.N. pay for an adequate water-and-sanitation system for Haiti, the only sure way to end the cholera epidemic, and to compensate cholera victims.

Brian Concannon of the IJDH says the U.N.’s immunity is limited. He says it’s supposed to have a mechanism to compensate those injured by its actions — which might cover such things as sexual assault by peacekeeping troops, or property damage, as well as the introduction of lethal diseases.

That mechanism is called a Standing Claims Commission, which would resolve disputes over damage claims.

“The U.N. has never set up a Standing Claims Commission in 60 years of peacekeeping missions,” Concannon said in an interview.

His group petitioned the U.N. in 2012 to set up such a commission to address cholera claims. But as the secretary-general’s spokesman says, the U.N. found those claims “not receivable,” which provoked the current lawsuit.

Despite the opposition of the U.S. government, Concannon says he’s optimistic. For one thing, Judge Oetken didn’t have to schedule a hearing at all. “The safe route for the judge would be to say, ‘I’m going to defer to the government and dismiss the case,’” Concannon says. “The fact he granted our request for a hearing is a sign the court is taking this seriously.”

In addition, the judge has opened the hearing to outside “friend of the court” parties — groups of international legal experts who support the plaintiffs’ claims. “It’s unusual that the judge made such a broad invitation,” Concannon says. “We think it’s a sign he’s interested in these issues.”

Manfred Nowak, a professor of international law and human rights at Stanford University and a former U.N. Special Rapporteur on Torture, signed one of those amicus briefs. “The U.N. needs to understand,” Nowak says, “that immunity cannot mean impunity.”

Categories: Health Care

CDC, Obama Under Fire For Ebola Containment Policies

Kaiser Health News - Fri, 10/17/2014 - 9:50am

The Centers for Disease Control and Prevention Chief Thomas Frieden faced criticism Thursday on Capitol Hill over handling of the Dallas Ebola cases. Meanwhile, the White House is feeling pressure to name an "Ebola czar" to coordinate the nation's response. Also, the idea of imposing travel restrictions is gaining momentum, while Ebola is also becoming a political flashpoint.  

The Washington Post: CDC Director’s Challenge: Deadly Ebola Virus And Outbreak Of Criticism
Frieden, the 53-year-old doctor who for the past five years has served as director of the Centers for Disease Control and Prevention, is immersed in an epidemiological and political crisis. He has become the face of that crisis, and more than that, the voice. It’s a deep voice, sonorous, and he speaks slowly, deliberately, assuredly, and he declared at the end of September: “I have no doubt that we’ll stop this in its tracks in the U.S.” But his confident statements have had to compete with the onslaught of bad news, including the infection of two health-care workers in Dallas, and he is now on the defensive (Sun, Bernstein and Achenbach, 10/16).

Politico: CDC Chief Survives Trial By Fire On Hill
Tom Frieden is getting a lot of public scoldings for all of the missteps in the handling of the Dallas Ebola cases -- and there have been plenty of them. But so far, the criticisms don’t appear to be rising to the level where the director of the Centers for Disease Control and Prevention needs to worry about his job. Frieden came through a three-hour House hearing Thursday with some bruises but also with his ability to function as director seemingly intact (Nather and Norman, 10/16).

The New York Times: Obama May Name ‘Czar’ To Oversee Ebola Response
President Obama raised the possibility on Thursday that he might appoint an “Ebola czar” to manage the government’s response to the deadly virus as anxiety grew over the air travel of an infected nurse. Schools closed in two states, hospitals and airlines kept employees home from work, and Americans debated how much they should worry about a disease that has captured national attention but has so far infected only three people here (Healy, Tavernise and Goodnough, 10/16).

Politico: Obama’s Ebola Challenge
The White House playbook for handling natural disasters is clear cut: Get the president in front of the cameras early, pledge every federal resource for the recovery, make a sympathetic visit to the devastated area and never pass up an opportunity to show who’s in charge. But the strategy for dealing with a deadly infectious disease that’s unlikely to turn into an epidemic yet is still terrifying to the public? Murky, at best (Budoff Brown and Epstein, 10/17).

The Washington Post: Ebola Presents Health, Political Challenges For Obama
Cognizant of the dangers that come from going before the public without answers, Obama has emphasized the low probability that the deadly disease will become a large-scale outbreak in the United States because it is not easily transmitted. But in the wake of acknowledged errors that led to the infections of two nurses in Dallas, the White House is now engulfed in a crisis that has resurrected questions about the president’s governing style. After meeting with top aides in the Oval Office for nearly two hours Thursday night, Obama sought to address some of the criticism lawmakers have lodged against him by saying he may appoint one person, or “czar,” to oversee the federal response. But he reiterated that Americans remain safe (Eilperin, 10/16).

NPR: Health Officials Face Ebola Questions On Capitol Hill
A day after news that a second health care worker in Texas has Ebola, members of Congress grilled Centers for Disease Control and Prevent Director Tom Frieden about the federal response (10/16).

The Washington Post: Congress Presses For Ebola Travel Ban
Members of Congress sharply questioned top public health officials Thursday about banning travel from West African countries where the Ebola virus is out of control to the United States, demanding to know why the administration has not adopted that tactic. “It’s not a drill,” said Rep. Fred Upton (R-Mich.), a member of the of the House Energy and Commerce oversight and investigations subcommittee, which held Thursday’s hearing. “People’s lives are at stake, and the response so far has been unacceptable” (Berman and Berstein, 10/16).

The Wall Street Journal: U.S. Ebola Response Is Slammed By Lawmakers
President Barack Obama , after a day of withering criticism over the government’s handling of the Ebola virus, said Thursday he may name a point person to oversee the administration’s response and is open to a travel ban but isn’t planning one. His evening remarks, which sought to show a more forceful response while assuring Americans they remain safe, were the first sign the White House could adopt ideas that Republican lawmakers have emphasized in ratcheting up their attacks this week. They have called for creating an Ebola czar and for travel restrictions from virus epicenters in West Africa (Armour and Lee, 10/16).

Politico: Why A Travel Ban Wouldn’t Work
The political momentum for a travel ban on West African nations continued to swell Thursday, but health and transportation experts were uniform in saying it wouldn’t stem the spread of Ebola — and could do more harm than good. That hasn’t stopped politicians and pundits -- ranging from House Speaker John Boehner to former Obama press secretary Jay Carney -- from calling for a travel ban. The appeal is obvious: It sounds like a no-brainer to build an infectious-disease moat around the U.S., blocking some flights and barring people who come from the countries suffering the worst Ebola outbreaks (Caygle and Wolfe, 10/16).

Los Angeles Times: Dallas Hospital Shifts Blame To CDC On Ebola Protocols
The hospital's response -- its second in two days -- in part shifted responsibility to the federal Centers for Disease Control and Prevention and to the protocols the agency issued this summer to guide the handling of a patient infected by the virus, which is thought to have killed more than 4,400 people in West Africa. The hospital said the protocols changed frequently, frustrating caregivers and management (Mohan, 10/16).

The New York Times: In Cities With West African Populations, Hospitals Take Extra Steps
Hospitals in cities with large West African populations are bracing for the first patients with Ebola, a prospect that no longer seems so far-fetched, ramping up screening, protections for hospital staff, and efforts to encourage people to report symptoms and take precautions (Belluck, 10/16).

Categories: Health Care

Poll: Misconceptions, Confusion Surround Public Understanding Of Ebola's Spread

Kaiser Health News - Fri, 10/17/2014 - 9:48am

The survey, which was conducted  by the Kaiser Family Foundation (KHN is an editorially independent program of the foundation), found that 70 percent of U.S. adults say they are following news reports closely about the deadly virus. 

The Washington Post’s Wonkblog: Ebola Is Scarier When You Don’t Know How It’s Spread
As Americans are becoming increasingly fearful of Ebola, there's still some pretty notable confusion about how the deadly virus is spread, according to new polling. Even though 70 percent of U.S. adults say they're closely following news about Ebola, just 36 percent know that a person infected with the deadly virus must be showing symptoms to transmit the infection to others, according to a new Kaiser Family Foundation Tracking Poll (Millman, 10/16).

Kaiser Health News: Capsules: Many Unaware How Ebola Is Spread 
The survey by the Kaiser Family Foundation found that while nearly all adults (97 percent) know a person can become infected through direct contact with the blood or other body fluids of someone who is sick with Ebola, there are still misconceptions. (KHN is an editorially independent program of the foundation.) One third of respondents are unaware they cannot become infected through the air. About 45 percent are unaware they cannot contract Ebola by shaking hands with someone who has been exposed to the virus but who does not have symptoms (Galewitz, 10/16).

Categories: Health Care

UnitedHealth Is Bullish About Health Exchanges

Kaiser Health News - Fri, 10/17/2014 - 9:21am

During a conference call with investors Thursday, company executives suggested the online marketplaces created by the Affordable Care Act could generate profit margins in the range of 3 to 5 percent. The company wasn't a major player this year, but plans to participate in two dozen states in 2015.

Minneapolis Star Tribune: UnitedHealth Group Eyes Growth On Health Exchanges
UnitedHealth Group wasn’t a major player when the federal government and some states launched new health insurance exchanges in late 2013. It’ll be a different story this fall, however, as the Minnetonka-based insurer plans to offer insurance products in nearly two dozen states through online marketplaces that were created by the federal Affordable Care Act. During a conference call with investors Thursday, company executives suggested the new market could generate profit margins in the range of 3 to 5 percent in the long run (Snowbeck, 10/16).

The Wall Street Journal: UnitedHealth’s Profit Boosted By Lower Medical Costs
UnitedHealth Group Inc. reported better-than-expected third-quarter earnings and raised its profit forecast for the year, driven by lower medical costs. “Medical utilization remained restrained,” the health insurer said in a news release Thursday. UnitedHealth added that its medical-care ratio, a key industry metric that reflects the portion of insurance premiums used for patient care, fell to 79.7% in the third quarter from 80.6% a year earlier (Calia and Wilde Mathews, 10/16).

Reuters: UnitedHealth Says Medical Use Low And Likely To Stay
UnitedHealth Group Inc said on Thursday that patients had used medical services at low rates in the third quarter, easing worries among investors that higher admissions reported by hospitals would cost insurers more than they planned. UnitedHealth reported a net profit increase that beat Wall Street expectations and described medical use as "restrained." The portion of premiums that it spent on medical claims fell, including for the division that manages health plans sold on the new Obamacare health exchanges. Both hospitals and insurers are benefiting from increased patient volume, which appears to be related to the Affordable Care Act, Leerink Partners analyst Ana Gupte said. At the same time, UnitedHealth was clear that its costs were not rising (Humer, 10/16).

Categories: Health Care

VA Officials Leaving Jobs After Scandal

Kaiser Health News - Fri, 10/17/2014 - 9:21am

In Chicago, for instance, a Chicago-based regional chief for some VA hospitals stepped down earlier in October, around the same time as some other top officials.

The New York Times: After Hospital Scandal, V.A. Officials Jump Ship
After a national scandal erupted this year over veterans dying while waiting for care at Veterans Health Administration hospitals, Congress passed a law making it easier to fire executives who were responsible for the problems, which included systemic efforts to cover up lengthy wait times that kept patients from seeing doctors (Philipps, 10/16).

Chicago Sun-Times: Two Officials With Ties To Embattled Hines Left Hines VA
Two other top officials with ties to the Edward Hines, Jr. VA Hospital recently left their jobs -- around the same time the director of the hospital announced she was stepping down, the Chicago Sun-Times has learned. Dr. Jeffrey Murawsky, health care chief for the VA’s Chicago-based regional office, sent an Oct. 9 email that was forwarded to the Sun-Times, stating that he was resigning so he could pursue "a position outside of the Department of Veterans Affairs closer to my family in Southern Nevada." Murawsky had been nominated by President Obama to be the top health official at the Veterans Affairs Department but withdrew his name in June. There have been a slew of allegations about poor treatment at veteran’s hospitals across the country, including at Hines VA (Thomas, 10/16).

Categories: Health Care

Viewpoints: Examining The U.S. Ebola Response, Possible Solutions, Facts Vs. Fear, And The Need For Candor

Kaiser Health News - Fri, 10/17/2014 - 9:20am

The New York Times: Keeping Ebola At Bay
The Ebola cases in the United States show that American hospitals and public health officials have much to learn about effective ways to protect health care workers and the public from possible infection. Texas Health Presbyterian Hospital, the first hospital put to the test, failed to protect two nurses, who had cared for the Ebola victim Thomas Eric Duncan, from becoming infected. Perhaps more alarming are the stumbles by the Centers for Disease Control and Prevention, the lead federal agency for fighting infectious diseases (10/16). 

The Washington Post: Bipartisan Solutions, Not Blame, Can Help In Managing Ebola
The Ebola virus reached this country at the height of the 2014 campaign, so perhaps it was inevitable that the political parties would try to exploit it. To Republicans, the situation proves once again that President Obama has failed to protect Americans. In one of the milder versions of this allegation, Louisiana Gov. Bobby Jindal published an op-ed faulting Mr. Obama for spending Centers for Disease Control and Prevention resources on grants for exercise and healthy diets rather than fighting infectious disease. Some Democrats say, meanwhile, that we wouldn’t have to worry about Ebola if not for budget cuts to the CDC and the National Institutes of Health, for which the GOP alone is to blame. As one especially inflammatory TV ad puts it: “Republican cuts kill” (10/16). 

Politico Magazine: How To Stop Ebola
Like so many of the challenges we face, ending this epidemic requires proactive leadership in the form of a comprehensive strategy and focused execution. Given the rapid spread of the virus, there’s no time to waste. Here are five simple steps that will go a long way to accomplishing that goal (Sen. Rob Portman, 10/16).

The Washington Post: Fight Fear Of Ebola With The Facts
When you work in public health, you become tuned in to fear. And the fear level in the United States just ticked up a notch. All our high-tech equipment, protective gear and disease management didn’t protect two Dallas nurses from Ebola. When government officials tell us we are safe and then caregivers get sick, what does this do to trust? (Richard E. Besser, 10/15).

The Washington Post: Nothing To Fear But Panic Itself
Richard Preston, whose 1994 book “The Hot Zone” brought the Ebola virus terrifyingly to life for readers, once described how, during his research, his biohazard suit had ripped open, exposing him to a potentially fatal toxin (David Ignatius, 10/16). 

The Wall Street Journal: Who Do They Think We Are?
The administration’s handling of the Ebola crisis continues to be marked by double talk, runaround and gobbledygook. And its logic is worse than its language. In many of its actions, especially its public pronouncements, the government is functioning not as a soother of public anxiety but the cause of it. An example this week came in the dialogue between Megyn Kelly of Fox News and Thomas Frieden, director of the Centers for Disease Control (Peggy Noonan, 10/16). 

The Washington Post: On Ebola, We Need A Dose Of Candor
Let’s make a deal: We’ll all promise not to panic about Ebola if the experts — especially those at the Centers for Disease Control and Prevention — agree to get their stories straight. They should begin by giving a better explanation of why they have concluded it would be wrong to “stop the flights” arriving from the Ebola “hot zone,” beginning with the fact that there are no such flights: There is no direct commercial air service between the countries at the epicenter of the outbreak — Liberia, Sierra Leone and Guinea — and the United States (Eugene Robinson, 10/16). 

The Washington Post: Ebola Vs. Civil Liberties
Unnervingly, the U.S. public health services remain steps behind the Ebola virus. Contact tracing is what we do, Centers for Disease Control Director Tom Frieden assured the nation. It will stop the epidemic “in its tracks.” And yet nurses Nina Pham and Amber Vinson, who developed Ebola, were not even among the 48 contacts the CDC was initially following. Nor were any of the doctors and nurses who treated the “index patient,” Thomas Duncan. No one even had a full list of caregivers (Charles Krauthammer, 10/16).

Categories: Health Care

Viewpoints: Abortion And Birth Control Issues In N.C. Senate Race; Replacing Obamacare; Cancellations

Kaiser Health News - Fri, 10/17/2014 - 9:20am

The New York Times: Why North Carolina’s Senate Race Has A Wide Gender Gap
But on Wednesday in Charlotte, Kay Hagan stood without hesitation next to Janet Colm, chief executive of the Planned Parenthood Action Fund of Central North Carolina, and proudly bashed her opponent, Thom Tillis, for reducing women’s rights on abortion and birth control. … Ms. Hagan needs women to show up at the polls on Nov. 4, maybe more so than candidates in other races. She has been running even with or a few points ahead of Mr. Tillis in a swing state that is better educated and more urbanized than Louisiana, and some polls have given her an advantage of as much as 20 percentage points over Mr. Tillis among women, the biggest gender gap in any Senate race (David Firestone, 10/16). 

Politico Magazine: 4 Rules For Replacing Obamacare
The Affordable Care Act remains extremely unpopular with voters for a whole host of reasons. It has raised premiums for millions of people, forced millions more out of their insurance plans and away from the doctors that they liked and were told they could keep, and is cutting Medicare and raising taxes to pay for a massive new entitlement program. If a sizeable number of anti-Obamacare candidates win, they will rightfully believe they have a mandate from their voters to take some action (Lanhee J. Chen and James C. Capretta, 10/16).

USA Today: Obamacare Cancellations, Again: Column
Last fall, millions of Americans breathed a sigh of relief when Obamacare didn't cancel their health care plans. Now they're holding their breath once again. Hundreds of thousands of Americans will soon receive cancellation letters affecting their 2015 health care plans — and that number may quickly rise into the millions. This wave of cancellations will fall into two categories. The first group hit will be in the individual market, the same group that suffered through at least 6.3 million cancellation letters last year. They will almost certainly be joined by millions of people in the small-employer market, which has 40 million plans and will be under Obamacare's control starting next year (Tim Phillips, 10/16). 

USA Today: Web Essay: Health Reform’s Impact On Medicare
Seniors and other Medicare beneficiaries should be aware that this year – perhaps more than any year in the past – is an important one to pay attention to their Medicare coverage options during the Open Enrollment Period (Oct. 15-Dec. 7). And that’s because of the Affordable Care Act (ACA). The ACA brings with it notable changes to Medicare, from more preventive care benefits to changes in costs, and beneficiaries need to understand both the upside and downside of such changes to best evaluate their options during the Open Enrollment Period (Jennifer Cohen-Smith, 10/17). 

USA Today: Health Research Needs Boost From Bold Innovators
In 1998, I went to the doctor so fatigued I was unable to get out of bed. He sent me home diagnosed with multiple sclerosis but without so much as a treatment plan, a prescription or what I needed most: hope. Come back when it gets worse, he said, the medical equivalent of a pat on the head. In the years since, I have found other doctors and new treatments that enabled me to reclaim my life. But progress has come at an agonizing, incremental pace. The 50 million people worldwide who suffer from neurologic diseases are as frustrated as I am (Ann Romney, 10/16). 

Los Angeles Times: Why Ezekiel Emanuel Is Wrong To 'Hope' For Death At 75
Emanuel's subject is our inability to accept the inevitability of decline and death. He disavows any intention to set forth general principles either for individuals or American society: "I am not saying that those who want to live as long as possible are unethical or wrong," he writes. "I’m not even trying to convince anyone I’m right. ... And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy" (Michael Hiltzik, 10/16). 

The New England Journal of Medicine: Data Sharing, Year 1 — Access To Data from Industry-Sponsored Clinical Trials
There has been considerable interest of late in increasing the transparency of clinical trials, including increasing access to the raw data from trials sponsored by the pharmaceutical industry. Since May 2013, investigators have been able to request access to deidentified patient-level data from clinical trials sponsored by GlaxoSmithKline, subject to review and oversight by an independent review panel. As the members of this panel, we now have more than 12 months of experience with this initiative — and can report that it has been a productive and successful first step (Brian L. Strom, Marc Buyse, John Hughes, and Bartha M. Knoppers, 10/16).

The New England Journal of Medicine: Diversity Dynamics — Challenges To A Representative U.S. Medical Workforce
In an era when the proportion of the U.S. population that is nonwhite has surged to 37%, two notable trends are shaping the composition of the physician workforce: the "overwhelming majority" of medical school graduates continue to be white, and the number of black men completing medical school has been trending downward since 1997. By comparison, medical school graduates of Hispanic and Asian descent have increased in number and as a percentage of total graduates. Although the Obama administration trumpets its support for improving opportunities for minority young people — and specifically black men — it has dismayed medical educators for 3 years running by proposing elimination of the Health Careers Opportunity Program (HCOP), which aims to increase diversity in the health professions (John K. Iglehart, 10/16).

The New England Journal of Medicine: The New Diversity In Medical Education
And as we aim to translate earlier versions of diversity into something serving medicine's core missions, it's worth remembering that, as with the mother from my pediatrics rotation, I've often quickly built a rapport with a patient simply because we were both black. But all diversity, visual or not, holds value. It's not just a numbers game or an annual administrative experiment. Diversity is a process that exists outside the admissions cycle and promotional photos (Mark A. Attiah, 10/16).

The Wall Street Journal: Philadelphia School Failure
Last week the Philadelphia School Reform Commission mandated that teachers chip in between 5% to 13% toward health-care premiums on a sliding scale based on salary. Teachers will pay each month an average of $49 for single coverage and $139 for a family. Government workers on average cover 15% of their premiums while private workers pay about 25%. The teachers union calls this “union-busting.” Yet the commission, which runs the Philly schools and includes three Democrats and two Republicans, unanimously backed the cost-sharing as a last resort when unions failed to negotiate a new contract (10/16). 

Categories: Health Care

State Highlights: Calif.'s Prop. 45 Fight; Aetna Sheds Jobs After Medicaid Drop

Kaiser Health News - Fri, 10/17/2014 - 9:20am

A selection of health policy stories from California, North Carolina, Delaware, New York, Georgia, Pennsylvania, New Jersey, Florida and Kansas.

Los Angeles Times: Big Money, Complex Issues Make Prop. 45 Tough Issue For State Voters
Almost three decades ago, a small band of consumer activists persuaded California voters to slap tough new rate regulations on auto insurance. Now that same group wants to crack down on health insurance rates. And the insurance industry and its business allies are back with a multimillion-dollar war chest to fight Proposition 45 with an omnipresent media campaign. The combination of big money and complex regulatory issues makes Proposition 45 a tough issue for voters, said Larry Levitt, a senior policy analyst at the nonprofit, nonpartisan Kaiser Family Foundation, unrelated to insurer Kaiser Permanente (Lifsher, 10/16).

Charlotte Observer: Same-sex marriage In NC Has Some Employers Expanding Coverage
The legalization of gay marriage in North Carolina means more gay and lesbian individuals will now be eligible for health insurance coverage through their spouses’ employers, including Charlotte-Mecklenburg Schools. Some big companies such as Bank of America, Wells Fargo and Duke Energy have offered benefits to employees in same-sex partnerships for years. But other employers are now making changes or mulling them (McFadden and Rothacker, 10/16).

The News Journal: Dropping Aetna From Medicaid Means Job Losses
About two hundred Delaware-based health care jobs will be lost at the end of the year after the state department of Health and Social Services announced Wednesday it will no longer offer Medicaid coverage through one of its managed care organizations, Delaware Physicians Care Inc. Some employees working with Delaware Physicians Care, an Aetna health plan, will have opportunities to work in other plans in Maryland and in Pennsylvania, said Aetna spokesman Walt Cherniak. But by Jan. 1, the 202 jobs associated with the Aetna plan will be gone. About 137,000 Delaware Medicaid patients are enrolled in an Aetna Delaware Physicians Care plan, meaning those patients will have to transfer over to a Highmark or United Healthcare plan when open enrollment begins Nov. 15. Currently, 54,000 Medicaid patients are enrolled in a United Healthcare plan (Starkey and Offredo, 10/17).

The Associated Press: Binghamton Hospital Pays $3.4M To Settle Case
Federal authorities say a Binghamton hospital [in New York] has paid $3.4 million to resolve claims it improperly billed Medicare. Our Lady of Lourdes Memorial Hospital, a 242-bed facility, found billing issues and overpayments from the federal health care program for hyperbaric oxygen therapy (10/17). 

Georgia Health News: Health Data Thefts A Continuing Problem
A state agency says Georgia consumers’ personal data has not been compromised so far in the wake of a theft of a laptop computer that contained some people’s health information. The computer was stolen from the vehicle of an employee of the Department of Behavioral Health and Developmental Disabilities who was attending a Clayton County conference in August. The laptop contained health information on 3,397 individuals who receive services from the agency (Miller, 10/16).

Philadelphia Inquirer: Pa. Hospitals To Test Newborns For More Disorders
Before the end of the year, hospitals in Pennsylvania will be required to test newborns for certain rare disorders where early detection could help save lives. Gov. Corbett on Wednesday signed a bill to expand newborn screenings to include six disorders. "We owe these children and their families a fighting chance," Corbett said at a news conference in the Capitol. The bill signed by Corbett would bring to 35 the number of genetic conditions for which newborns receive screening in Pennsylvania. The law, which takes effect in 60 days, requires hospitals to add certain lysosomal storage disorders to the list of diseases for which a newborn is screened. Health-care providers will now test for Globoid cell leukodystrophy (Krabbe disease), Fabry, Pompe, Niemann-Pick, Gaucher, and Hurler Syndrome (Worden, 10/16).

The Associated Press: Crucial Ruling Due On Taj Mahal Casino’s Future
A federal bankruptcy court judge was expected to issue what the owners of Atlantic City's Trump Taj Mahal Casino Resort consider a life-or-death decision for the financially-troubled gambling hall. Trump Entertainment Resorts and billionaire investor Carl Icahn want the judge to cancel the casino's union contract, saying it can't survive without shedding costly pension and health care obligations. Trump Entertainment has threatened to close the casino by Nov. 13 if it cannot shed its pension and health care obligations to the Taj Mahal's 3,000 workers. Gross was to issue his decision at 3 p.m. Friday (Parry, 10/17).

Health News Florida: Sickest Medicaid Kids In ‘Chaos,’ Doctors Say
Florida pediatricians who care for severely disabled children say the state's overhaul of Medicaid has left  kids, parents and caregivers in turmoil. Extremely fragile children, including some with tracheostomies and feeding tubes, face barriers in access to specialty care, physical therapy, home medical supplies and other urgent needs, the pediatricians say. They say the barriers cropped up as the state Medicaid program rolled out its Managed Medical Assistance (MMA) program, which requires nearly all of the 3.6 million Floridians on Medicaid to be enrolled in HMOs or similar managed-care plans. That includes chronically ill and severely disabled children who until recently were cared for by a network of highly skilled doctors through a program called Children's Medical Services (CMS) (Gentry, 10/16).

Kansas Health Institute News Service: Malpractice Fund Stable, But Uncertainty Looms
A state fund meant to diffuse the costs of medical malpractice claims is on stable footing, but the fund's executive director said this week that legislators should not consider using reserve money for other purposes. Chip Wheelen, executive director of the Kansas Health Care Stabilization Fund, said the fund is in a key transition period due to changes in new legislation. That makes the financial future less certain. But even without those changes, Wheelen said, all the money in the fund should remain devoted to paying malpractice claims and the costs of administering the fund (Marso, 10/16).

Modern Healthcare: More Providers, Insurers Showing Appetite For Narrow Networks
A new health plan collaboration in Wisconsin between a hospital system and an insurer is the latest sign that providers and insurers are betting on narrow networks even as controversy continues over whether these plans offer adequate provider access for consumers (Herman, 10/16).

Categories: Health Care

Demographics Help Shape Lawmakers' Views On Health Law

Kaiser Health News - Fri, 10/17/2014 - 9:19am

Most of the congressional districts with the greatest numbers of uninsured people are represented by Democrats, according to The Associated Press. News outlets also report on how Georgia's gubernatorial candidates and North Dakota's congressional candidates differ on the health law.

The Associated Press: Dem Push For Health Law Rooted In Demographics
While much of America was upset about the botched rollout of President Barack Obama's health care overhaul, most Democrats in Congress were still willing to give the law a chance to work. Without the law, many of their constituents wouldn't have health insurance. ... If a community has a large concentration of people without health insurance, there is a good chance it is represented by a Democrat in Congress. Of the 50 congressional districts with the most uninsured people, all but nine are represented by Democrats(Ohlemacher, 10/16).

Atlanta Journal-Constitution: Gov. Nathan Deal and Jason Carter On Top Issues
[Jason] Carter wants to expand Medicaid under the Affordable Care Act, casting it as a fiscal necessity. … [Gov. Nathan] Deal rejects Medicaid expansion and says it would inevitably cost Georgia billions of dollars in new spending (Blustein).

The Associated Press: US House Candidates Debate Health Care Law
Two of the three candidates for U.S. House in North Dakota say they would vote to repeal the federal health care law, while the third says he'd rather fix it. The Bismarck Tribune reports that incumbent Republican Rep. Kevin Cramer, Democratic challenger George Sinner and Libertarian Party candidate Jack Seaman squared off in a debate Wednesday evening. Cramer reiterated his stance that the Affordable Care Act is a massive federal overreach and a disaster. Seaman said he also thinks the law should be repealed. Sinner said there are many parts of the law that need to be fixed, but that there are many good provisions as well (10/16).

And then there's the fact checking -

The Washington Post’s Fact Checker: Obama’s Claim That Obamacare Has Helped Produce A ‘$1,800 Tax Cut’
Remember that 2008 campaign promise touted by then-candidate Obama — that his health care law would reduce the cost of premiums by $2,500 by 2014? As we have noted, he was quickly called out by fact checkers for making a dubious claim based on shaky assumptions. Moreover, the pledge came with a large asterisk: He was not saying that premiums would drop by $2,500, but that health-care costs per person would be that much lower than anticipated. Of course, the Affordable Care Act turned out to be different from the plan Obama discussed during the campaign, and longer to implement than expected, so the White House in 2011 amended the pledge to say it would $2,000 in savings by 2019 (Kessler, 10/17).

 

Categories: Health Care

State Exchanges Gird For Round Two

Kaiser Health News - Fri, 10/17/2014 - 9:19am

Covered California hopes to enroll more than half a million new residents this year, bringing total participants to about 1.7 million. Meanwhile, more than 12,000 Oregonians could owe money at tax time because of errors computing their premium subsidies, and a study of Colorado residents finds that insurance costs and signup confusion kept many on the sidelines.

Kaiser Health News: Capsules: California’s Insurance Exchange Gears Up For Round Two 
California’s insurance exchange began mailing renewal notices this week to more than 1.1 million people already enrolled in health plans, officials announced Thursday. Consumers who want to make changes must do so by Dec. 15 for coverage effective Jan. 1, while those who want to keep their current plans will be renewed automatically. The renewals are occurring as the state’s marketplace, Covered California, gears up for the open enrollment period for new consumers. Between Nov. 15 and Feb. 15, Covered California hopes to enroll more than 500,000 new people, which would bring the total to about 1.7 million (Gorman, 10/16).

Oregonian: More Than 12,000 Oregonians Could Owe At Tax Time Under Cover Oregon Subsidy Errors
More than 12,000 people who purchased policies through Cover Oregon could owe a combined $1.12 million at tax time because of errors in subsidized premiums issued by the health insurance exchange. The vast majority of people affected are expected to owe no more than $10 per month [for the period] that their policy was in effect. That figure is not final, however, because a $10,000 consultant's study intended to settle the question did not succeed. The exchange is planning to commission a second, more in-depth study (Budnick, 10/16).

Health News Colorado: Cost, Confusion Stall Hunt For Insurance
Cost and confusion prevented many uninsured people from signing up for health coverage this year in Colorado, according to two new reports. A Rand study, Barriers to Enrollment in Health Coverage in Colorado, found that some consumers didn’t want to sign up because they opposed the individual mandate. Others were frustrated that they first had to apply for Medicaid in a cumbersome process. Still others found Colorado’s exchange website confusing. And many people said costs for insurance and co-pays seemed too high (Kerwin McCrimmon, 10/16).

Meanwhile, in other news regarding the health law's implementation -

Kaiser Health News: Administration Signals Doubts About Calculator Permitting Plans Without Hospital Benefits
Insurance consultants were shocked recently to learn that Obama administration rules allow large companies to offer 2015 worker health plans that don’t include hospital benefits. Now the administration is concerned too. Treasury Department officials are preparing to reverse course on an official calculator that permits plans without hospital coverage to pass the health law’s strictest standard for large employers, said industry lawyers who have spoken to them. These sources expect the administration to disallow such coverage by the end of the year (Hancock, 10/17).

Atlanta Journal-Constitution: Big Decision Ahead For Obamacare Enrollees
A plan to automatically re-enroll thousands of Georgians in health plans they bought through the federal insurance marketplace for 2014 may allow some to happily avoid the government’s website when open enrollment starts next month. But those who stay the course instead of taking the time to sift through new coverage options for 2015 could end up paying more for their current plans. That’s because new health plans and prices to choose from will almost certainly change the size of federal tax credits consumers can qualify for to help shrink their monthly premiums (Anderson, 10/16).

Minneapolis Star Tribune: Franken: Override ‘Hobby Lobby,’ Make Contraceptives More Available To Women
U.S. Sen. Al Franken reiterated his stance Thursday that the U.S. Supreme Court’s Hobby Lobby decision that limited access to birth control must be overridden, in a women’s health roundtable in St. Paul that focused largely in the fallout from this summer’s Hobby Lobby ruling. The ruling, in which the U.S. Supreme Court said that requiring corporations to pay for insurance coverage for contraception violated federal law protecting religious freedom. Franken told the panel of assorted women lawyers, citizens and advocates that the ruling must be overturned (Simons, 10/16).

Categories: Health Care

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