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Health Care

Fla.'s Gubernatorial Candidates At Odds Over Medicaid Expansion

Kaiser Health News - Mon, 10/13/2014 - 9:24am

Charlie Crist, the Republican-turned-Democrat, says he will consider using an executive order to expand the program for low-income Floridians.

The Miami Herald: Rick Scott, Charlie Crist Split On Medicaid Expansion
As he gains momentum in the race for governor, Charlie Crist is driving a conversation on Medicaid expansion. The Republican-turned-Democrat has become such a fervent supporter of the policy that he said he would consider using an executive order to get it done (McGrory, 10/12).

The Associated Press: Scott, Crist Weigh In On Medicaid Expansion
If former Florida Gov. Charlie Crist gets his old job back, he promises to expand Medicaid to roughly 1 million low-income residents by calling a special session of the Legislature or through an executive order. If Gov. Rick Scott is re-elected, the decision will be once again left to the Legislature with little meddling from him. The debate over Medicaid expansion, a key part of President Barack Obama's health law, has been contentious in the campaign leading up to the Nov. 4 election. The Sunshine State has one of the highest uninsured rates in the country. That pent-up demand was clear as nearly 1 million Floridians bought private insurance through the federal health marketplace when it opened a year ago. But another million fell into a gap: too poor to qualify for tax credits in the marketplace, yet earning too much to qualify for Medicaid (Kennedy, 10/12).

Categories: Health Care

State Highlights: Md., Minn. See Small Business Health Insurance Rate Changes

Kaiser Health News - Mon, 10/13/2014 - 9:24am

A selection of health policy stories from Maryland, Minnesota, Texas, the District of Columbia, Virginia, Colorado, Arizona, Pennsylvania and Maine.

Baltimore Sun: State Approves Rates For Small Business Health Insurance
Some small businesses in Maryland will see a small drop in health insurance premiums next year, while others will pay as much as 11 percent more to cover their workers, according to rates released by state regulators Friday. The rates, which go into effect in January, only apply to small firms with up to 50 employees, and not to large or self-insured firms or individuals buying coverage on the state's health insurance exchange. Evergreen Health Cooperative sought no rate increase, and Aetna Health Inc. will raise rates only slightly, according to the rate information released by the Maryland Insurance Administration. Some UnitedHealthcare premiums will drop by about 2.5 percent (Cohn, 10/10).

Minneapolis Star-Tribune: Premium Spikes Catch Up With Small Businesses
Many small businesses in Minnesota are seeing big changes in their premiums this fall as they renew health insurance policies before the year’s end. Some face increases of 40 percent or more. But others are enjoying discounts of up to 30 percent, insurers say -- thanks to the adoption of new rules under the federal health law. The rules mean that small businesses will no longer benefit from premium discounts -- or suffer from premium surcharges -- based on the health of employees. With a move to what’s called “community rating,” groups that used to get discounts are seeing big premium increases, while those that were paying surcharges are seeing big savings (Snowbeck, 10/13).

The Wall Street Journal's Pharmalot blog: Texas AG Lawsuit Claims AstraZeneca Improperly Marketed Seroquel 
The Texas Attorney General has filed a lawsuit against AstraZeneca that alleges the drug maker illegally marketed its Seroquel antipsychotic pill for unapproved uses, paid kickbacks to physician and state health officials, and subsequently caused the state Medicaid program to overpay for the medicine (Silverman, 10/10).

The Washington Post/Kaiser Health News: Medicare Penalizes Washington-Area Hospitals For Readmissions
Every general hospital in the District of Columbia and its Virginia suburbs has been fined for having too many Medicare patients readmitted within a month for additional treatment, federal records show (Rau and Gillespie, 10/10).

The Associated Press: Colorado Health Officials Announce Privacy Breach
Colorado health officials say they accidentally violated the medical privacy of about 15,000 people in a recent postcard mailing. The postcards were mailed as part of a survey sent to people receiving behavioral health services through Medicaid or the Department of Human Services' Office of Behavioral Health. The breach was announced Friday. State officials say that no financial information or Social Security numbers were disclosed. Instead, the information was protected health information. Whether someone receives behavioral health care services is considered protected private medical information (10/10).

Arizona Central Republic: County Hospital At Heart Of Contentious Debate
The Maricopa Integrated Health System is a safety net for the county's poor and underserved residents. It primarily caters to those who have nowhere else to go. But it operates a burn center that treats some of the most desperate patients from across the Southwest. Its hospital is a Level 1 trauma center and a teaching institution for medical students and other health-care professionals. Maricopa County residents pay for these facilities through their secondary property taxes. The special health-care district also receives federal and state funds. Next month, county taxpayers will be asked in Proposition 480 to approve $935 million in bonds that would be spent to expand and renovate the aging system and increase capacity to serve the county's mentally ill (Lee, 10/10).

CBS News: A Harsh Financial Lesson For Philly Teachers
In a surprise move, the state-appointed body that oversees the Philadelphia School District decided last week unilaterally to void its contract with the teacher's union after failing to reach an agreement over whether teachers should pay more for their health care costs. It's the latest battle over the contentious national issue of health care costs (Berr, 10/13).

NPR: A Benefit For Rural Vets: Getting Health Care Close To Home
Army veteran Randy Michaud had to make a 200-mile trip to the Veterans Affairs hospital in Aroostook County, Maine, near the Canadian border, every time he had a medical appointment. Michaud, who was medically retired after a jeep accident in Germany 25 years ago, moved home to Maine in 1991. He was eligible for VA medical care, but the long drive was a problem (Lawrence, 10/13).

Categories: Health Care

Viewpoints: Ebola Myths; Sen. McCain's 'Opportunistic Alarmism'; Gov. Jindal On CDC's Misspent Resources

Kaiser Health News - Mon, 10/13/2014 - 9:24am

The Washington Post: Five Myths About Ebola
Hubris is the greatest danger in wealthy countries — a sort of smug assumption that advanced technologies and emergency-preparedness plans guarantee that Ebola and other germs will not spread. It was hubris that left Toronto’s top hospitals battling SARS in 2003, long after the virus was conquered in poorer Vietnam. It was hubris that led the World Health Assembly in 2013 to cut the WHO’s outbreak-response budget in favor of more programs to treat cancer and heart disease. And it is hubris that causes politicians to routinely slash public health budgets every time the microbes seem under control, only to cry out in desperation when a new epidemic appears (Laurie Garrett, 10/10).

The New York Times: How To Quarantine Against Ebola
One feature of the tragic case of Thomas Eric Duncan, the first traveler known to have carried the Ebola virus into the United States, rankles me as a physician: Even if every system in place to identify suspected carriers had been working perfectly, he may have still set off a mini-epidemic in Dallas (Siddhartha Mukherjee, 10/12).

Los Angeles Times: Why Don't We Have An Ebola 'Czar,' Sen. McCain? Because Of The NRA
Donning the mantle of the nation's scaremonger-in-chief, Sen. John McCain, R-Ariz., appeared Sunday morning on CNN to weigh in on the latest Ebola news. ... Prompted by [CNN's Candy] Crowley, McCain complained, "We were told there would never be a case of Ebola in the United States and obviously that's not correct." He said, "There has to be some kind of czar" to manage the disease in the U.S. "I'd like to know who's in charge, among other things." These statements are evidence as good as you'll ever find of the viral outbreak of fatuous misinformation and opportunistic alarmism that has reduced governing in Washington to a bedridden wreck. Let's unpack them (Michael Hiltzik, 10/12).

Politico: The Facts About Ebola Funding
In a paid speech last week, former Secretary of State Hillary Clinton attempted to link spending restraints enacted by Congress—and signed into law by President Obama—to the fight against Ebola. Secretary Clinton claimed that the spending reductions mandated under sequestration "are really beginning to hurt," citing the fight against Ebola: "The CDC [Centers for Disease Control and Prevention] is another example on the response to Ebola—they’re working heroically, but they don't have the resources they used to have." Her argument, like those made by others, misses the point. In recent years, the CDC has received significant amounts of funding. Unfortunately, however, many of those funds have been diverted away from programs that can fight infectious diseases, and toward programs far afield from the CDC’s original purpose. Consider the Prevention and Public Health Fund, a new series of annual mandatory appropriations created by Obamacare (La. Gov. Bobby Jindal, 10/12).

USA Today: What Ebola Error In Dallas Shows
Diagnostic errors — such as when a patient seeks attention and is turned away because of a failure to collect or appreciate a crucial piece of information — are the most common type of medical mistake. They contribute to up to 80,000 deaths a year in the U.S. Errors of this type can be fatal, such as when the error involves a missed heart attack, stroke, or serious infection. But in an Ebola outbreak, the consequences can be much more severe because they can affect so many more people (Robert Wachter, 10/12). 

On other health care topics -

USA Today: Obamacare Is In Hiding Until After The Election
The second Obamacare open enrollment is scheduled to begin on November 15th and end on February 15th. Instead of learning critical lessons from the mistakes of the first open enrollment fiasco, the Obama administration appears to be trying to silence potential critics (Robert Laszewski, 10/12).

The Hill: Both Parties Are Keeping Americans In The Dark About Healthcare Reform
Substantial majorities of Americans say they want specific health insurance reforms. According to pollsters, most Americans want rules to keep insurance companies from refusing to cover sick people or charging them more. They want government to help make insurance accessible and affordable for small businesses and families. Most applaud free preventive care — including contraception — as well as improvements in Medicare prescript. Here's the irony: Most Americans do not know these changes are actually included in the Patient Protection and Affordable Care Act (ACA) that has been law since 2010 (Theda Skocpol and Colleen Grogan, 10/13).

The Washington Post: Tendon Surgery Sheds Light On The Lack Of Clarity In Some Out-Of-Network Pricing
Spurred on by competition on the new Affordable Care Act exchanges, health insurers are moving to pare down their provider networks .... Docs are busy selling out their practices to hospitals that can negotiate better rates for their services .... And together, hospitals and large medical groups are joining "accountable care" networks in which, like insurers, they agree to provide all of a family's medical needs for a fixed annual fee. It's one reason — perhaps a big reason — why medical costs have begun to level off in recent years. But it’s not without its trade-offs (Steven Pearlstein, 10/11).

Los Angeles Times: The 5 Rules On How To Kill A Consumer-Friendly Initiative
There are six statewide measures before voters on Nov. 4, but it's the battle over Proposition 45 where the techniques of anti-consumer influence are most openly exposed for examination. ... The measure would allow the state insurance commissioner, an elected official, to set health insurance rates. This is a power that the insurance commissioner already has over auto and property/casualty insurers, and that insurance regulators have over health insurance in 35 states and the District of Columbia. Proposition 45 is abominated by the insurance industry, which has provided virtually all of the $37 million collected to fight the initiative. The measure's backers have collected or spent about $3.6 million (Michael Hiltzik, 10/10).

Bloomberg: Midterm Voters Drown In Dark Money
Crossroads GPS has assailed the Democratic Senator Mark Udall for shortchanging Colorado residents with his votes on health insurance; Patriot Majority USA has gone after the Republican Senate candidate in Arkansas, Tom Cotton, as being a supposed shill of the insurance industry and opposing a farm bill. This is standard fare in the American midterm elections, where spending could exceed $5 billion and outside groups specialize in attack ads. ... This is dark money, which allows both sides to set up supposed social welfare organizations that are a front for political partisans (Albert R. Hunt, 10/12).

The Washington Post: Stem-Cell Research's Potential Worth Supporting
On Thursday, a group of Harvard researchers announced that they had effectively cured diabetes in lab mice using human embryonic stem cells. The team painstakingly exposed stem cells to various chemicals until they figured out which ingredients to use and in which order, finally inducing undifferentiated stem cells to become beta cells, which specialize in detecting rises in blood sugar and releasing insulin in response. Beta cells are nature’s natural insulin pumps, but they are much better at finely tuning blood sugar than artificial insulin delivery methods. The Harvard scientists transplanted the beta cells they created into diabetic mice, which were asymptomatic within 10 days. This dramatic result is particularly promising for victims of type I diabetes (10/11).

The New York Times: The Last Right
On Nov. 1, barring the medically unexpected or a change of heart, a young woman named Brittany Maynard will ingest a lethal prescription and die by suicide. Maynard is 29, recently married and is suffering from terminal brain cancer. After deciding against hospice care — fearing, she wrote in a CNN op-ed, a combination of pain, personality changes, and the loss of basic mental and physical functions — she and her husband moved from California to Oregon, one of five states that permit physician-assisted suicide. ... The future of the assisted suicide debate may depend, in part, on whether Tippetts’s case for the worth of what can seem like pointless suffering can be made either without her theological perspective, or by a liberalism more open to metaphysical arguments than the left is today (Ross Douthat, 10/12).

Toledo Blade: Tighten Medicaid Rules
A new report by the U.S. Department of Health and Human Services proposes improvements that states could make to their Medicaid systems, many of them without raising costs. Ohio Medicaid officials should pay attention. In some respects, Ohio’s Medicaid rules are among the strongest in the country. ... But in other areas, Ohio falls woefully behind. A patient’s maximum wait time to see a primary care physician is 42 days, one of the highest limits in the country. For specialists, there is no maximum wait time, even if the need is urgent. Ohio also has no maximum ratio of Medicaid patients to provider. Both of these standards must improve if the state is serious about guaranteeing access to care for Medicaid enrollees, especially now that Gov. John Kasich has expanded Medicaid eligibility under the federal Affordable Care Act (10/13).

Categories: Health Care

Obamacare Premium Increases Likely In States With Key Senate Races

Kaiser Health News - Mon, 10/13/2014 - 9:21am

Politico reports that this could be bad news for Democrats who are running in Louisiana and Iowa -- both locations are experiencing double-digit rate hikes for individual health plans. In other news, Va. Senate candidate Ed Gillespie, a Republican, unveils a plan to replace the health law if it were to be repealed, and the New York Times take a close look at one Florida congressional contest.  

Politico: An Obamacare October Surprise?
Obamacare premiums aren’t rising everywhere. They just have a way of finding the states with the biggest Senate races. And that could be very bad timing for Democrats in two of the party’s key contests. Double-digit rate hikes for individual health insurance plans have become an issue in the Louisiana and Iowa Senate races over the past week, where the Republican candidates are hammering their Democratic opponents for the steep premium increases on the way next year for some customers under the Affordable Care Act (Nather, 10/12).

The Washington Post: Ed Gillespie, Senate Candidate In Va., Unveils Alternative To Affordable Care Act
Virginia Senate candidate Ed Gillespie unveiled a health-care reform proposal Friday, offering an alternative to a law he would like to see repealed. Gillespie, a former Republican National Committee chairman who is challenging Sen. Mark R. Warner (D), has made opposition to the unpopular Affordable Care Act a cornerstone of his campaign. ... His plan would end the individual mandate to buy health insurance, the health-care exchanges and all of the law’s industry regulations. In their place, he would offer tax credits that increase with age and family size. ... In addition, under Gillespie’s proposal, family plans would no longer be required to cover young adults until age 26 (Weiner, 10/10).

Richmond Times-Dispatch: Gillespie Unveils Health Care Plan That Focuses On Tax Credits
Ed Gillespie, the Republican nominee for U.S. Senate, on Friday rolled out his long-awaited proposal for comprehensive health care reform to replace the Affordable Care Act — a plan that he said would reduce insurance premiums, enhance access to doctors, and increase the number of people with private insurance by 6 million more than Obamacare will (Schmidt, 10/10).

The New York Times: In Florida, A Chance For Democrats To Win One Back
But in an election season full of dire predictions for Democrats, the party is pinning one of its few genuine chances to reclaim a House seat on a little-known northwest Florida woman with a well-known name. Voters know her just as Gwen, but it is her last name, Graham, that resonates — a marquee Florida brand brimming with centrist political currency. And her father, Bob Graham, who was a popular longtime United States senator and governor, is usually by her side these days, chewing on pork at a fund-raiser, gobbling peanuts at a rally and extolling his eldest daughter’s pledge to put people before party as a Graham Democrat. … But Mr. Southerland, the 49-year-old co-owner of his family-run funeral home chain who co-founded a Panama City Tea Party group, has three powerful forces on his side: voters’ antipathy to President Obama, their deep-rooted opposition to his Affordable Health Care law and the growing inclination to vote Republican (Alvarez, 10/12).

Categories: Health Care

Political Cartoon: 'Bill Of Goods?'

Kaiser Health News - Mon, 10/13/2014 - 9:20am

Kaiser Health News provides a fresh take on health policy developments with "Bill Of Goods?" by Chris Wildt.

And here's today's health policy haiku:

THERE ARE STILL HEALTH POLICY HEADLINES

It's Columbus Day.
For some, that's a holiday.
If not, read what's news.
-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

Boston Patient Not At High Risk For Ebola, Health Officials Say

CommonHealth (WBUR) - Mon, 10/13/2014 - 7:50am

Beth Israel Deaconess Medical Center in Boston was temporarily shut down after a patient was brought in Sunday with Ebola-like symptoms. (Steven Senne/AP)

A man who travels frequently to Liberia caused a stir Sunday afternoon when he arrived at a Braintree clinic with Ebola-like symptoms. But doctors and public health officials say that the man is not considered at high risk for the often deadly virus. His case did, however, give us the first public look at how nurses, EMTs, hospital staff and others have prepared to respond when there is an Ebola alert.

WBUR’s Martha Bebinger spoke with WBUR’s Bob Oakes on Monday with more on the story.

Bob Oakes: How did this man, who has not been identified, become the focus of police escorts, press conferences and numerous statements on Sunday?

Martha Bebinger: The man called his primary care practice, Harvard Vanguard, in Braintree Sunday morning, complaining of a headache, muscle aches and some other problems. He was given an appointment in the afternoon. The man went to the Harvard Vanguard pharmacy to pick up a prescription for something else, then left.

But after that first call, Harvard Vanguard reviewed his medical record and noticed that the man traveled frequently to Liberia. The office staff then called the patient and “intercepted” him as he was coming in. They asked him to wait in his car while they called for an ambulance. The Harvard Vanguard office was closed for a period of time, while they disinfected surfaces in the pharmacy they believe he touched, and then reopened.

The man waited, cooperatively, we’re told, in his car, sort of a self-quarantine, until an ambulance arrived. What kind of precautions were in place there?

Brewster ambulance completed their Ebola response training about a week ago. Brewster’s director of training, Jeff Jacobson, says the company was on the scene in 15 minutes with two ambulances, one that had been sealed inside with plastic and three EMTs wearing hazardous materials suits.

“Once the patient is removed from the ambulance and into the hospital, two more folks get into the level B suits and remove all the plastic, put in sealed containers, then the vehicle is disinfected, following the Centers for Disease Control recommendations,” Jacobson said.

In all, Jacobson estimates there were 40 responders, including police, firefighters, local public health and Harvard Vanguard personnel.

Forty personnel arrived? And were all of those responders trained in Ebola safety practices?

I heard both yes and no. Only people who may come in contact with the patient or his body fluids need to wear gloves and protective gear. But I also heard there was a call Sunday, after this incident, on which some participants felt the response was too much while others thought that a maximum effort is warranted as responders test and adjust their reaction to Ebola.

The ambulance took the patient to Beth Israel Deaconess Medical Center, where I imagine there were a few nervous staff members. Earlier Sunday, the CDC confirmed that a nurse who treated a man who died from Ebola in Dallas has come down with the virus.

Yes, we did get word of the first case transmitted in the United States on Sunday, but Dr. Kenneth Sands, chief quality officer at Beth Israel Deaconess, said the staff there were ready to deal with Ebola. Sands said the Braintree patient was placed in a special unit with a barrier, a separate ventilation system and safety features for doctors and nurses.

“We felt very good about our plan, despite the results in Dallas, so we are implementing the plan we have had in place for a couple of months and we feel comfortable that it is working in a way that protects our patients and our staff,” Sands said.

The man remains in isolation at Beth Israel Deaconess. How have doctors there and public health officials determined that he is not a high risk for Ebola?

Doctors at Beth Israel Deaconess have not explained why they reached that conclusion, but there are clues from Harvard Vanguard, where the man checked in earlier Sunday. While the man had a headache and muscle aches, which could be early signs of Ebola, or many other things, he did not mention a high fever, vomiting or diarrhea, said the chief of infectious disease at Harvard Vanguard, Dr. Ben Kruskal.

“He lacks all of the more typical symptoms. And the time frame from his return from Liberia to now is on the rather long side of the incubation period for Ebola,” Kruskal said.

It’s been about two weeks since the man returned from Liberia, which is, apparently a little late for the first signs of infection to emerge.

We haven’t had any confirmed cases of Ebola in Massachusetts, but if someone does suspect they have the virus, what should they do?

Interesting, the CDC website says “seek medical care immediately,” but don’t go anyplace besides a health care facility. Now some local doctors are revising that guidance. Kruskal says if you think you may have Ebola, make your first move from home — call your doctor or hospital.

“A lot of people are feeling anxious, and if anybody actually did have Ebola, rushing into the hospital without stopping to figure out the right way to do it would not be a particularly helpful thing. It would probably expose a lot of people needlessly,” Kruskal said.

Advice about Ebola will likely be refined as officials review treatment of suspected cases of Ebola. There have been a number of them, this one the most public. So far, none have been confirmed and we’ll hope that continues to be the case.

Further reading: The Ebolacoaster: Boston Prepares Intensively for What-Ifs

Categories: Health Care

First Edition: October 13, 2014

Kaiser Health News - Mon, 10/13/2014 - 7:11am

Today's headlines include previews of what might happen during the health law's second open enrollment period, as well as the latest developments related to Ebola.  

Kaiser Health News: Got Insurance? You Still May Pay A Steep Price For Prescriptions
Kaiser Health News staff writer Julie Appleby reports: “Even with insurance, some patients are struggling to pay for prescription drugs for conditions such as cancer, arthritis, multiple sclerosis or HIV/AIDS, as insurers and employers shift more of the cost of high-priced pharmaceuticals to the patients who take them. Increasingly, health plans – even those offered to people with job-based coverage--require hefty payments by patients like Grooms. In some plans, patients must pay 20 to 40 percent or more of the total cost of medications that insurers deem to be specialty drugs and place in the highest tiers of patient cost sharing” (Appleby, 10/13). Read the story, which also ran in USA Today

The Wall Street Journal: Prepare For Health-Plan Enrollment
The second year of the Obama administration’s health-insurance program starts Nov. 15, with new deadlines, prices and options for the millions of Americans who have obtained coverage under the law—and, for the uninsured, opportunities to get coverage (Johnson, 10/11).

Politico: New Strategy: Underselling Obamacare For Year 2
The Obama administration vastly oversold how well Obamacare was going to work last year. It’s not making the same mistake this year. Gone are the promises that enrolling will be as easy as buying a plane ticket on Orbitz. ... Officials say the site won’t be perfect but will be improved. They refuse to pinpoint how many people they plan to enroll, instead describing general goals of reducing the number of uninsured and providing a positive “customer experience” — not exactly metrics that can be immediately judged (Haberkorn, 10/12).

The Associated Press: California Gives No-Bid Health Pacts
California’s health insurance exchange has awarded $184 million in contracts without the competitive bidding and oversight that is standard practice across state government, including deals that sent millions of dollars to a firm whose employees have long-standing ties to the agency’s executive director. Covered California’s no-bid contracts were for a variety of services, ranging from public relations to paying for ergonomic adjustments to work stations, according to an Associated Press review of contracting records obtained through the state Public Records Act (10/12).

The Wall Street Journal: Medicaid Backlogs Could Worsen As Health-Law Sign-Ups Resume
Hundreds of thousands of people who signed up for Medicaid months ago still don’t have coverage, a problem that could worsen when insurance sign-ups under the Affordable Care Act restart next month. California and Tennessee are facing lawsuits from residents who say they have seen long delays for coverage after signing up for Medicaid, the federal-state health program for the low income and disabled. Some say they have been waiting since late 2013 (Armour, 10/12).

Politico: An Obamacare October Surprise?
Obamacare premiums aren’t rising everywhere. They just have a way of finding the states with the biggest Senate races. And that could be very bad timing for Democrats in two of the party’s key contests. Double-digit rate hikes for individual health insurance plans have become an issue in the Louisiana and Iowa Senate races over the past week, where the Republican candidates are hammering their Democratic opponents for the steep premium increases on the way next year for some customers under the Affordable Care Act (Nather, 10/12).

The Washington Post: Ed Gillespie, Senate Candidate In Va., Unveils Alternative To Affordable Care Act
Virginia Senate candidate Ed Gillespie unveiled a health-care reform proposal Friday, offering an alternative to a law he would like to see repealed. Gillespie, a former Republican National Committee chairman who is challenging Sen. Mark R. Warner (D), has made opposition to the unpopular Affordable Care Act a cornerstone of his campaign. ... His plan would end the individual mandate to buy health insurance, the health-care exchanges and all of the law’s industry regulations. In their place, he would offer tax credits that increase with age and family size. ... In addition, under Gillespie’s proposal, family plans would no longer be required to cover young adults until age 26 (Weiner, 10/10).

The Miami Herald: Rick Scott, Charlie Crist Split On Medicaid Expansion
As he gains momentum in the race for governor, Charlie Crist is driving a conversation on Medicaid expansion. The Republican-turned-Democrat has become such a fervent supporter of the policy that he said he would consider using an executive order to get it done (McGrory, 10/12).

The New York Times: In Florida, A Chance For Democrats To Win One Back
But in an election season full of dire predictions for Democrats, the party is pinning one of its few genuine chances to reclaim a House seat on a little-known northwest Florida woman with a well-known name. Voters know her just as Gwen, but it is her last name, Graham, that resonates — a marquee Florida brand brimming with centrist political currency. And her father, Bob Graham, who was a popular longtime United States senator and governor, is usually by her side these days, chewing on pork at a fund-raiser, gobbling peanuts at a rally and extolling his eldest daughter’s pledge to put people before party as a Graham Democrat. … But Mr. Southerland, the 49-year-old co-owner of his family-run funeral home chain who co-founded a Panama City Tea Party group, has three powerful forces on his side: voters’ antipathy to President Obama, their deep-rooted opposition to his Affordable Health Care law and the growing inclination to vote Republican (Alvarez, 10/12).

The New York Times: U.S. Finds Many Failures In Medicare Health Plans
Federal officials say they have repeatedly criticized, and in many cases penalized, Medicare health plans for serious deficiencies, including the improper rejection of claims for medical services and unjustified limits on coverage of prescription drugs (Pear, 10/12).

The Washington Post: State Allows Employee Health Insurance To Cover Transgender Services
The State Department, which has been on the leading edge of policies affecting lesbian, gay, bisexual and transgender federal employees, is eliminating the “transgender exclusion” from the agency’s largest health insurance program. Insurance policies under the Federal Employees Health Benefits (FEHB) program generally exclude services “related to sex reassignment” (Davidson, 10/12).

NPR: A Benefit For Rural Vets: Getting Health Care Close To Home
Army veteran Randy Michaud had to make a 200-mile trip to the Veterans Affairs hospital in Aroostook County, Maine, near the Canadian border, every time he had a medical appointment. Michaud, who was medically retired after a jeep accident in Germany 25 years ago, moved home to Maine in 1991. He was eligible for VA medical care, but the long drive was a problem (Lawrence, 10/13). 

The New York Times: Harvoni, A Hepatitis C Drug From Gilead, Wins F.D.A. Approval
The first complete treatment for hepatitis C that requires taking only a once-a-day pill won approval Friday from the Food and Drug Administration. The drug, called Harvoni from Gilead Sciences, could shorten the duration of treatment and provide the first all-oral regimen for many patients. The new drug also appears to be a bit less expensive for some patients than Gilead’s existing blockbuster hepatitis C drug, Sovaldi, which has become the poster child for those complaining that the cost of medicines is out of control. Sovaldi costs $1,000 a pill, or $84,000 for a typical 12-week course of treatment, but it must be used with other drugs. Harvoni is even more expensive at $1,125 a pill, or $94,500 for a 12-week course of treatment (Pollack, 10/10).

The Wall Street Journal: Gilead Gets U.S. Approval To Sell New Hepatitis C Drug
Gilead Sciences Inc. won U.S. approval Friday to begin selling the first pill that promises to cure most hepatitis C patients without requiring other medicines, but its near $100,000 cost will likely further inflame tensions between drug companies and health insurers over spiraling prices. ... The escalating price for treating hepatitis C, which affects more than three million Americans, has been a sore point for health insurers and drug-benefit managers facing a mounting dilemma: how to balance use of a medicine that can prevent tens of thousands of deaths without breaking the bank (Rockoff, 10/10).

The Associated Press: Nursing Home Chain To Pay $38M In US Settlement
A nursing home chain has agreed to pay $38 million to resolve allegations that it billed Medicare and Medicaid for substandard care at nearly three dozen facilities around the country, the Justice Department said Friday. A federal investigation into Extendicare Health Services Inc. accused the company of failing to provide appropriate care, follow safety protocols or maintain enough skilled nurses. Those lapses in some cases resulted in head injuries to residents, falls, bed sores and fractures and cases of malnutrition, dehydration and infection, the government said (Tucker, 10/10).

The New York Times: Chain To Pay $38 Million Over Claims Of Poor Care
One of the nation’s biggest nursing home chains, Extendicare, has agreed to pay $38 million to resolve federal claims that it inappropriately billed for physical therapy and provided such poor care to residents that it was effectively worthless, the Justice Department said on Friday. The settlement with Extendicare, which owns about 150 homes in 11 states, is the largest settlement in the department’s history involving a nursing home chain accused of providing substandard care to residents (Thomas, 10/10).

The Wall Street Journal: Extendicare To Pay $38 Million In Medicare, Medicaid Billing Settlement
A U.S. nursing home chain has agreed to pay $38 million to end a government investigation into whether it billed Medicare and Medicaid for poor care of elderly residents. ... The company denied engaging in illegal conduct and agreed to the final settlement without any admission of wrongdoing. The company also agreed to be subject to a compliance program to monitor resident care. U.S. investigators said Extendicare Health understaffed nursing homes, alleging that in some instances it failed to provide adequate catheter care and failed to follow procedures to prevent bed sores and falls (Armour and Barrett, 10/10).

The Washington Post: U.S. Ebola Victim’s Medical Records Reported Contradictory 
On the other side of the city, at the Dallas/Fort Worth International Airport, a special Homeland Security Committee held a field meeting Friday in which Rep. Michael McCaul (R-Tex.), chair of the committee, tried to reassure the public. “Blind panic won’t help us stop (Ebola) from spreading,” he said, “and fear-mongering will only make it harder to do so. . . . The situation here at home is far different than what is happening in West Africa.” Some experts, however, say the United States and other western countries are hardly immune to a potential public health crisis. “Hubris is the greatest danger in wealthy countries,” wrote Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, in Friday’s Washington Post (Ellis Nutt, 10/10).

The Wall Street Journal: Ebola Virus: Texas Health Worker Tests Positive, CDC Confirms
Officials gave few details of how they believe she contracted the virus. CDC Director Tom Frieden called the infection a result of a “breach in protocol” at the hospital and said more cases may emerge. “Unfortunately, it is possible in the coming days that we will see additional cases of Ebola,” Dr. Frieden said in a news conference. “This is because the health-care workers who cared for this individual may have had a breach of the same nature.” The infection is the first transmitted in the U.S. and the second outside of West Africa, following that of a nurse’s aide in Spain who had cared for a missionary repatriated from Sierra Leone. The missionary died. The latest case has prompted a wider search for those possibly exposed (McKay, Bustillo and Beck, 10/13). 

The Washington Post: Health Worker Who Treated Dallas Patient Tests Positive For Ebola
The case raises new doubts about whether hospitals around the country, aside from a handful of highly-specialized facilities, are truly prepared to safely deal with the Ebola virus, and whether front-line nurses and doctors have received adequate training in diagnosing and treating the disease. The incident also seems certain to intensify fears about how easily the disease can spread, even though Ebola is transmitted only through bodily fluids and only after a patient begins showing symptoms (Dennis, Phillip and Sun, 10/12).

Los Angeles Times: Ebola Safeguards Are Being Taken, Southland Health Officials Say
So far, there have been no confirmed or suspected Ebola cases in Los Angeles County, and officials say they do not expect a major outbreak. But some on the front lines, alarmed by the death last week of a nurse in Spain who contracted the virus from a patient, are concerned that efforts to prepare healthcare workers aren't going far enough. On Sunday, officials reported a healthcare worker who treated Duncan has contracted Ebola. … Public health authorities in Los Angeles County are rolling out Ebola guidelines based on recommendations from the U.S. Centers for Disease Control and Prevention, which call for providers to don protective gear — goggles, gloves, masks and gowns — when working with a suspected Ebola patient; to isolate suspected Ebola cases in a room with its own bathroom; and — perhaps most key — to immediately ask patients with symptoms such as vomiting, nausea and fever if they have traveled to West Africa or been in contact with someone who has (Brown, 10/12). 

The Washington Post: Ebola Screening To Begin At Dulles, 3 Other Gateway U.S. Airports Thursday
Thomas Frieden, director of the Centers for Disease Control and Prevention, said Sunday that enhanced screening of international travelers for Ebola is likely to begin Thursday at Dulles International Airport and three other gateway airports (Halsey III, 10/12). 

Los Angeles Times: For Abortion Foes, A National Strategy Built At The State Level
The numbers have changed little over the decades: A majority of Americans support abortion. But across the country, the antiabortion movement has recorded major success in the last four years, part of a well-funded national strategy to legislate abortion out of existence state by state. Legislatures, many stocked with new Republican majorities, have passed laws that, if upheld, would drastically reduce access to abortion for millions of women (Semuels and La Ganga, 10/12).

The Wall Street Journal's Pharmalot blog: Texas AG Lawsuit Claims AstraZeneca Improperly Marketed Seroquel 
The Texas Attorney General has filed a lawsuit against AstraZeneca that alleges the drug maker illegally marketed its Seroquel antipsychotic pill for unapproved uses, paid kickbacks to physician and state health officials, and subsequently caused the state Medicaid program to overpay for the medicine (Silverman, 10/10).

The Washington Post/Kaiser Health News: Medicare Penalizes Washington-Area Hospitals For Readmissions
Every general hospital in the District of Columbia and its Virginia suburbs has been fined for having too many Medicare patients readmitted within a month for additional treatment, federal records show (Rau and Gillespie, 10/10).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

Categories: Health Care

Got Insurance? You Still May Pay A Steep Price For Prescriptions

Kaiser Health News - Mon, 10/13/2014 - 5:09am

Sandra Grooms recently got a call from her oncologist’s office. The chemotherapy drugs he wanted to use on her metastatic breast cancer were covered by her health plan, with one catch: Her share of the cost would be $976 for each 14-day supply of the two pills.

"I said, 'I can't afford it,' " said Grooms, 52, who is insured through her job as a general manager at a janitorial supply company in Augusta, Ga. "I was very upset."

Even with insurance, some patients are struggling to pay for prescription drugs for conditions such as cancer, arthritis, multiple sclerosis or HIV/AIDS, as insurers and employers shift more of the cost of high-priced pharmaceuticals to the patients who take them.

Increasingly, health plans – even those offered to people with job-based coverage--require hefty payments by patients like Grooms.  In some plans, patients must pay 20 to 40 percent or more of the total cost of medications that insurers deem to be specialty drugs and place in the highest tiers of patient cost sharing. There is a limit: Most health plans have an out of pocket maximum, which is often several thousand dollars.

The trend is controversial, prompting a civil rights complaint in Florida, legislative action in a few states and debate over how to slow the rapid rise of spending on prescription drugs without hurting consumers or stifling development of new treatments.

Proponents say the high-priced drug tiers encourage patients to select lower-cost medications, just as similar efforts in the past decade led to a dramatic rise in the use of lower-cost generics.

Brendan Buck, spokesman for the industry group America’s Health Insurance Plans, said insurers rely on cost sharing tiers in their policies "as a way to keep premiums down for consumers and promote more cost-effective health care choices."

In some cases, drugs placed in the highest tiers have equally effective alternatives that are in a lower cost tier, he said, adding that high drug prices have spurred the use of specialty tiers: "If a drug maker is concerned that its treatment is on a higher tier than they would like, the solution is to lower the price."

Skeptics say it remains unproven whether requiring consumers to pay more will actually result in lower overall medical costs.  Many patients facing life-threatening diseases will choose the expensive drugs anyway, some studies have shown, even if there is a less pricey alternative.

Meanwhile, some patient advocates fear such payments are simply a way for insurers to skirt the health law’s rules requiring them to accept all enrollees, including those with medical conditions. While not rejecting anyone, they can discourage patients with health problems from enrolling if they set high payments for drugs for specific medical conditions.

"We will wind up with a race to the bottom where plans will design benefits to shift the greatest burden of cost to those with the greatest health needs," said Wayne Turner, staff attorney at the National Health Law Program, which advocates for low-income individuals.

Along with another advocacy group, the AIDS Institute, the law program has filed an administrative complaint with the Department of Health and Human Services’ Office For Civil Rights, focused on four Florida insurers that put all HIV/AIDS drugs, including generics, into a category with the highest patient cost sharing.

"This amounts to discrimination based on disability," said Turner, something federal law prohibits.

For Grooms, a solution came when her oncologist selected a different drug – an intravenous medication – for which her share of the cost is $100 a month.

While she's relieved, she said requiring huge payments by consumers sharply affects "middle class people who are working and trying to make a living, even though they may be living with a serious illness."

$10,000 A Month For A Cancer Drug

Driving the increasing use of such drug tiers and other cost-control efforts are a growing number of high-priced treatments that offer the hope of curing or managing debilitating diseases.

A new Hepatitis C drug, for example, costs $84,000 per 12-week treatment, and the average cost of brand-name cancer drugs has doubled to $10,000 for a month’s supply in the past decade, according to a May report from the IMS Institute for Healthcare Informatics. Drugs for severe arthritis and multiple sclerosis can costs tens of thousands per year.

Responding to the increased use of such drugs and their rising prices, employers and insurers have changed their policies. Many already require patients to first try other drugs before moving to specialty medications, a practice called "step therapy." About 20 percent of workers insured through their jobs – and many of those who buy their own insurance through the new federal health law – have multiple tiers of drug-payment categories, with patient costs going up in each consecutive tier. 

Insurers often place into the higher tiers specialty drugs, which have no standard industry definition, but are generally the most expensive products. Many do not have lower cost alternatives.

Ninety-one percent of 600 insurance plans sold to individuals through the new health law marketplaces this year had four or more tiers, according to a study by Avalere Health, a private research firm. It produced the report last December for the pharmaceutical industry’s lobbying group.

In addition, more than 60 percent of the most popular level of coverage purchased through those markets, the silver-level plans, place all medications for multiple sclerosis, rheumatoid arthritis, Crohn’s disease and certain cancers in their highest-cost sharing tier, according to an Avalere report this year.

"The plans definitely think it's a way to contain costs by shifting them to consumers," said Caroline Pearson, vice president of Avalere.

Advocacy groups for patients are urging some states and Congress to cap how much workers would have to pay.

"Is it fair that because you need that type of benefit that you have to pay that much more out of pocket than someone else?" asks Kim Calder, director of health policy at the National Multiple Sclerosis Society.

Calder said it would be better to spread the cost of such drugs to everyone through increases in premiums.

Lawmakers in nine states have debated ways to limit the consumer costs, but only three have passed legislation. Delaware, Louisiana and Maryland each cap the out-of-pocket cost of specialty-tier drugs at a maximum of $150 for a 30-day supply, according to a report by researchers at the Georgetown Health Policy Institute.

But the effect on overall consumer costs is uncertain.  Capping monthly costs for prescriptions could simply lead insurers to raise premiums or the annual deductibles, the amounts consumers pay before most coverage kicks in.

Looking For An Alternative

Even as new specialty treatments offer promise for many patients, they pose a dilemma for benefit administrators like Judith Muck, executive director of the Missouri Consolidated Health Care Plan.

Specialty drugs account for only 1 percent of all prescriptions filled by the nearly 100,000 state workers and retirees covered by the plan, but they accounted for 28 percent -- $66 million -- of drug spending over a recent 18-month period.

"Specialty drugs are life changing for individuals who take them and can be life-saving," says Muck. "Our goal is to find a way to pay for them."

Muck rejected the idea of creating a specialty tier in the plan’s drug benefit. Instead, the plan is considering options including treating some patients needing high-priced intravenous drugs at doctors’ offices rather than more expensive hospitals, which could save $428,000 a year, and negotiating with hospitals that charge higher-than-average prices, which could save $400,000 a year.

Other insurers are trying different methods. WellPoint, one of the nation’s largest insurers, will pay oncologists a bonus of $350 a month per patient for sticking with specific, less-costly, chemotherapy regimens.  Florida Blue has created cancer-specific "accountable care organizations" that reward doctors if the new organizations save money while hitting quality targets.  

While some critics of the drug industry have called for more direct government influence on prices drug makers can charge, that idea is still seen as a political nonstarter.

"At the end of the day, that undermines innovation," said Bradford Hirsch, an adjunct professor at Duke Medical School and medical director at the health economics and outcomes division of U.S. Oncology, a network of cancer treatment centers.

This story was updated to add a reference to insurance plans' maximum out-of-pocket limits.

Categories: Health Care

Photos: Honk Music Festival Parade From Somerville To Cambridge

CommonHealth (WBUR) - Sun, 10/12/2014 - 9:30pm

Thousands of people lined Elm Street in Somerville to Massachusetts Avenue in Cambridge to see the exhilarating parade at the ninth annual “Honk! Festival of Activist Street Bands.” (Read our oral history of the festival here.)

Some 70 groups marched in the parade, including bands from Somerville, Vancouver, Seattle, Madison, Los Alamos, Paris, Austin, New Orleans, Atlanta, New York, Moscow. Also participating were Veterans for Peace and activists agitating for “People over profit$,” prison reform, “immigrant justice,” a $15 minimum wage, and “No spy drones.”

Greg Cook is co-founder of WBUR’s ARTery. Be his friend on Twitter @AestheticResear and on the Facebook.

Categories: Health Care

An Oral History: How The Honk Music Fest Began Here And Spread Around The World

CommonHealth (WBUR) - Sat, 10/11/2014 - 11:59am

“A lot of people, I would say a majority of people even, who are big Honk fans just happened onto it.”—Trudi Cohen

The Honk! Festival of Activist Street Bands began with the Second Line Social Aid & Pleasure Society Brass Band, a raucous, renegade gang of Somerville horn players who dress all in reds. They had an inkling that there were others like them around the country and put out a call to come play together. A dozen brass and drum bands—hailing from as far away as San Francisco, Vancouver, Chicago and Brooklyn—arrived to perform on sidewalks and plazas around Davis Square for the first Honk in 2006.

The next year Honk added a parade from Davis Square to Harvard Square. Somerville Mayor Joseph Curtatone marched at the front—well, at least to the Cambridge line. The largest Honk in 2012 showcased 34 bands with 600 musicians. It attracts some 10,000 revelers.

It’s become an infectious street party as the ninth annual Honk Fest takes place in Somerville this weekend, with bands performing for free from 12:30 to 9 p.m. Saturday around Davis Square and parading from Somerville to Cambridge at noon Sunday and then performing at the Harvard Square Oktoberfest from 2 to 6 p.m. Sunday. (Update: See our photos of the 2014 Honk parade here.)

Honk is the rare Boston area cultural invention that’s so successful that it’s been copycatted in New York, Seattle, Providence, Austin, and Detroit. And there are plans to debut Honk festivals in Australia and Brazil in 2015.

How did it begin? What has made it so contagious? In the oral history below, we begin to answer some of these questions.

“Would you like to get together?”
Trudi Cohen, drummer in the Second Line Social Aid & Pleasure Society Brass Band in Somerville and one of the co-founders of Honk here: “Our band got started in 2003 doing some anti-war protests with Bread and Puppet [Theater] actually. It was an ad-hoc group of people. Various people knew each other, but we didn’t all know each other. After one march in particular, we thought ‘This is really exciting, why don’t we stick together.’ That was the beginning of our band.”

“About three years later we had this thought that there were probably other bands that had formed similarly with this idea of lending music to the politics of the moment. We started looking around to see who they might be. Hungry March Band had been around for a while. John [Bell, her husband] and I knew them from New York. And, of course, the Bread and Puppet Band was a big part of our inspiration. [The couple has performed with the experimental, political, theater troupe since the 1970s.] Then we found the Brass Liberation Orchestra in Oakland, California. So we just sort of sent out this message: ‘Would you like to get together and have some sort of convergence of activist bands?’ And we got a very positive response. And when the BLO people from California told us they were coming, we said, ‘Oh, we have a festival.’”

“There were 12 bands the first year and it took us completely by surprise how great it was, how much all the musicians who participated enjoyed it and how much the public enjoyed it. We had approached Rob Gregory, who is one of the owners of Redbones [restaurant in Somerville], to just run this idea by him about whether doing it in Davis Square would make sense. You know, he’s a visionary. So he was like, ‘This is perfect. This is exactly what Davis Square needs to preserve its image as a spontaneous, creative place.’ He got Davis Square businesses to back it. So that took us by surprise too because he believed in it more than we did in a way. It was like a combination of this great good will of the musicians who came and having the support of the community and then having it just be a really cool event that gave it its birth.”

The first Honk festival debuted in fall 2006. A dozen bands—hailing from as far away as San Francisco, Vancouver, Chicago and Brooklyn—performed around Somerville’s Davis Square.

Cohen: “There had just been at Bread and Puppet [in Glover, Vermont] this ‘Radical Cheese’ gathering of political puppeteers, the puppetistas. I really think that for me and John at least, our roots in this street band culture, which is a big part of our Bread and Puppet experience and also having just, maybe a year or two before that had this experience of being together with puppeteers from around the country, talking about what we do and also showing each other our work, I think that was a lot of the seed of the idea [for Honk]. But it’s really hard to say that because I don’t want to take credit for it. It was really a collective idea. But I know for me personally those were very important influences.”

Somerville as the ideal location
Jason Fialkoff, plays trombone in the Minor Mishap Marching Band and helps organize Honk TX in Austin: “I’m a transportation planner, I’m a bicycle and pedestrian specialist, I’m big on how you can transform public space. To show up in Davis Square and to see how by programming 20 bands in normal everyday spaces like parking lots and squares and parks that an entire town can just completely come to life and have its own pulse. The city just comes to life in a way it never does.”

Reebee Garofalo, plays snare drum in Second Line Social Aid & Pleasure Society Brass Band and a Honk organizer since the second Honk: “The mayor loves it. The city has been very supportive. The way Somerville is developing generally, I think the whole atmosphere of Honk fits into the kind of hip reputation that the city as a whole has been getting and cultivating. We are now the coolest place in the world. And I think the Honk Festival plays some role in that reputation.”

“Here [at Davis Square] you have this self-contained area that has all these fabulous nooks and crannies that are available for performance that are about a half a block from each other and they’re still sonically isolated. It’s ideal. A major public transportation hub is right in the middle of the place. You take the Red Line and you come up out of the ground into the middle of a festival. You’ve got a completely supportive business community beginning with Rob Gregory of Redbones mobilizing everybody else to be supportive. And the businesses jumping on board very quickly because they see the payday they get out of doing it. So it’s a really magical place. In traveling to other cities, we’ve learned just how magical it is because it’s hard to duplicate that constellation of variables that we have in the square elsewhere. You won’t find that in Seattle and you won’t find that in the sprawl of Austin. But to their credit they’ve developed in different ways that take advantage of the aspects of their communities in a really good way.”

Cohen: “We had just moved her from New York. When Honk happened and it was so successful and exciting, it really struck me that would be extremely hard to do it in New York. There aren’t neighborhoods that could support the event. Or the infrastructure of the city is so vast that it’s really hard. I know in Austin they’re up against a big city government every time they need a permit for something. And in Detroit, where there’s no money at all, they couldn’t do anything without paying for it. In Somerville and Cambridge, we’re just getting bestowed with municipal services all time. Not only that, in the first years at least, the businesses were all supportive and we were in their community, we were part of it. For me that was really particular to Somerville and really hard to duplicate elsewhere. The fact that the character of the festivals is different in different places is inevitable. … People love their community here, they want it to be known as a welcoming and happy place. So anything that reinforces that it seems like they like it.”

Garofalo: “The Honk festival proceeds as if it’s a normal day in Davis Square that just happens to have 550 musicians and 10,000 participants milling around. We don’t close any streets. We don’t allow any outside vendors. We drive all the business to local businesses. All of the local business say they have their biggest payday of the year on Honk Saturday. So the notion that what we’re promoting here is what a normal day might look like is a statement about reclaiming public space as public and some sort of statement about what sort of sounds and images and activities are acceptable in public. … We don’t use any stages [except for the Harvard Square Oktoberfest stage]. We don’t use any electricity. We don’t use any sound reinforcement at all. So there is virtually no distance between artist and audience. And in fact there are moments when you can’t tell who’s who without the playbook. … It not only lowers cost, it also facilities performance. There is no set up, there are no sound checks. One band marches out of the performance venue while another band is marching in. The one stage that we actually use is the main stage at Oktoberfest in Harvard Square. We’re going to have 28 bands perform on that stage in a four-hour period. You couldn’t do that with electric bands.”

A movement that didn’t know it was developing
Garofalo: “We provided a convergence for a movement that was developing and didn’t know it was developing. One of the most striking things about the first couple of Honk festivals is the extent to which the bands didn’t know the others existed. Most of the bands who responded to the call for the first Honk festival thought they were the only band of its kind.”

Cohen: “I don’t think we knew either actually. And many more bands are forming all the time. And there’s a whole hipness to this pseudo marching band genre. There’s Mucca Pazza and MarchForth [Marching Band] that are really exploiting that image professionally. I don’t think we knew that that was going to happen. What Cheer? [Brigade], they came to our first festival as a brand new band. They had no idea that they were going to hit this punk scene by combining street music with I don’t know what. They’re hugely popular. I don’t think we could have anticipated it as a genre. … And maybe it affected the moment too. Not to toot our own horns. By bringing all these people together and saying, yes, we are a thing, maybe that helped strengthen it.”

Honk spreads to New York in 2007 and Providence in 2008
Cohen: “I’ve spent my adult life trying to convince people that they want to see theater. It’s so hard to get support for the theater things I do. Honk is this charmed thing. Everybody wants to support it. Everybody wants to have a piece of it. It’s crazy and a little scary.”

“We can’t get any bigger. We started to get bigger and it was really painful in many, many ways. So last year we did a very drastic cutting back of how many bands we invited and that was super hard to do. And this year we’re holding it at that lower number. I think it’s 28 bands this year. There was no place to put everybody. … A way that it can grow is by having it happen in other places. … To us, it’s a great way to expand without us having to do more.”

Garofalo: “Very quickly the Honk Festival became sort of a mini Honk tour that made stops in Providence and New York. Because a lot of bands flying in fly in through New York, especially foreign bands, providing a mini tour that gets you from here back to New York happened kind of naturally.”

Avi David, bass drummer in the Extraordinary Rendition Band and an organizer of Pronk, the Providence Honk Festival: “The first year it was very small and informal. It was just a handful of bands coming back to Providence after Somerville. And it’s sort of grown to have a little more structure every year.”

Pronk, which takes place on Oct. 13 this year, now has 14 bands, about 10 are bused down from Somerville for performances in India Point Park and a parade. Then four or five bands are bused down for Honk NYC to join some 12 other bands for a festival from Oct. 13 to 18 this year.

David: “I think a big part of it is the spontaneity. Every year I’m blown away by how spontaneous the whole thing feels. It’s a very do-it-yourself festival. People are making crazy instruments, crazy costumes for themselves. It’s a decidedly, intentionally non-corporate festival. You don’t see these massive advertisements on radio and television. I mean, you see the internet stuff and the Kickstarters. But it’s all through grassroots organizing. So it’s not pitched as the Hot 106 or 108 festival of the fall. There’s something very charming about the idea of such a cool and exciting and chaotic and spontaneous festival that just feels like it appears and then it disappears. It’s like if you blink and eye you can miss the whole thing. At the same time, if you’re there, it feels like you’re in the center of the universe.”

Activist street bands
David: “The thing that really gets me is it’s not just a normal music-focused festival. It has a very deep tie to social activism and this notion that art should be used to provoke social change, that artists and musicians should be working together and try and use this incredible power as artists and musicians we have to do something positive for society. Not just to bring people together, but highlight the hard work of the local organizations, nonprofits and activists where we all live and support them in their efforts. Playing with ERB for many years, it’s just been this incredible community that we’ve discovered all around the U.S. of people basically doing the same thing that we’re trying to do.”

Cohen: “People don’t actually know what activism is or why this has any activist component at all. It’s a lot of fun and that’s what people are mainly seeing. Should we be doing more to hit them over the heads that these are not just club bands, but they’re bands that have motivating principles? We talk about that: How can we make it more obvious what we’re about? But, you know, fun is a big part of it too. Having fun with people outdoors is a great thing. Just bringing people together is a great thing. So in some ways we can’t worry too much about it. But on the other hand, we’re trying a lot more to make it obvious that this is a different festival than, for example, Honk TX or Crash Detroit or Honk Fest West, that we really want it to be about the activism. So this year we’re doing these direct action things, which is quite an experiment and it’s really exciting.”

Garofalo: “This year we’ve added a day of action which entails six bands going down to Downtown Crossing at 3 o’ clock in the afternoon [yesterday] and targeting half a dozen different low-wage sites in the fight for the $15 minimum wage.”

“There is a way in which just playing in the street is itself a political statement that sort of reclaims public space in a way that is different from the way most people imagine. But often times the music is intentionally political.”

Cohen: “We’re very proud to say that everything is free. The accessibility idea, that it’s for everyone, to me that’s a very exciting component. If we truly believe that street bands can change the world or can be a useful tool for supporting causes and organizations that we believe in, then the value of them is that they can speak to everyone, that they can get those ideas in a free and open way.”

We say no a lot
Cohen: “The thing about commercialism, that’s really important to us. We really don’t want it to be bought by anybody. Everybody who gives money, if they give $5,000 or if they give $50, they get acknowledged the same way. We don’t have vendors at the festival itself. We don’t want it to be about commerce. We want it to be free and open and it’s about the music exclusively. … We say no a lot. The Harvard Square Business Association felt like they could get support for the parade from Nantucket Nectars. This is quite a number of years ago. It’s a local product, it’s a good product. They weren’t going to have signs, they were just going to have T-shirts and hand out samples. We said no. Then they said, ‘What kind of sponsorship would you accept?’ So we had a meeting about this. And we ended up saying, ‘None.’ We don’t want any. If they want to give us some money we’ll take it and put it in the program. I’m kind of proud of that because I feel that it’s really hard to hold onto that.”

Garofalo: “For the most part, the bands do not receive a fee for performance. To the extent possible, we try to defer travel expenses for as many bands as we can. The question we ask bands is: ‘What would it take to get you here?’ And bands are surprisingly honest about not inflating those figures. They tell us what it would take to get them here and we try and approximate that amount to the extent that we can. I think the bands sort of trust the process because they know that our budget is a zero-sum game. Whatever money we raise goes to them.”

Cohen: “We’ve had some conversations about whether we want to protect it and copyright the word or whatever because we don’t want the Pepsi Cola Honk Festival happen somewhere. But we never really went anywhere with it.”

Garofalo: “It’s completely noncommercial. … I think that has given us a certain leeway to produce the kind of festival that we would really like to see. We’re not beholden to any commercial interests. I think there are very few corporations that would sign on to the action we have planned for this Friday [yesterday now]. No one monitors the political messaging that happens during the political parade down Massachusetts Avenue. Were there commercial interests involved, I think that might be different. So we’re very happy and very steadfast about maintaining that freedom.”

Honk Fest West debuts in Seattle in 2008, followed by Honk TX in 2011
Garofalo: “After the second year, we were approached by Seattle in a formal way with them asking whether we would give blessing to their using the Honk name and of course we did. The year after that we were approached by Texas with the same notion that they wanted to do a festival sort of patterned after the one we do here. That to us was a sort of very conscious strategy decision for how you grow the festival and how you grow the movement.”

Jason Fialkoff, plays trombone in the Minor Mishap Marching Band and helps organize Honk TX in Austin: “In the beginning of 2009, this band from Chicago, Environmental Encroachment, came down to Austin and approached the Minor Mishap Marching Band, which is lead by Datri Bean. They approached Datri and said, ‘Hey, we want to do this thing with you guys.’”

“I think they came down on a whim. People have different ideas of what Honk is. And the Environmental Encroachment folks were pretty much like, ‘We’re coming down to Austin and we’re doing a Honk.’ We had no idea what they were talking about. So Datri just put together a parade featuring them, us and a small piece of the Austin Samba School.”

“Datri threw together this parade and these EE bunnies were like, ‘You have to go to Honk in Somerville. You have to see what it’s about.’ We didn’t even know if we were appropriate, but we signed up. Because they were saying activist bands, and we’re not an activist band. But we went, the Minor Mishap Band Went to Somerville, and it was life changing. We went to Seattle shortly thereafter and it was life-changing.”

“When we got back to Austin a few of us sat around and we’re like, ‘Hey, we should bring this Honk to Austin.’ … We’ve all been transformed by this experience and we really feel that it’s something we want to bring to our city.”

Cohen: “Seattle did ask us and Austin did too. And we said, ‘What have we got to lose? Go ahead.’ I remember we had a meeting with the Austin folks before they did their first one and they were sort of apologetic and said, ‘What if we don’t have the same mission as you do, is that still going to be OK?’ And we talked about it and we said, ‘Well, you know what, it’s fine.’ And so I don’t think we care that much. We know them. They know what we think Honk is. So I don’t think they would do something totally different. They had some potential beer sponsor that we were kind of wary of. … But I think it didn’t materialize and ultimately so what. It doesn’t really affect what we do. Or so far it doesn’t.”

Garofalo: “To date we haven’t put any restrictions on anybody’s festival. In fact, Seattle and Texas have developed in ways that are quite different than what we do. Seattle is more club-based, it’s more of a commercial enterprise.”

Mike Antares, plays cymbals for Chaotic Noise Marching Corps. in Seattle and has helped organize Honk TX and Honk Fest West: “I first saw Honk at Honk Fest West in Seattle in April of 2010. I wasn’t a musician. I actually went out as a photographer and as a friend to some people in Minor Mishap Marching Band out of Austin. A friend of somebody in the band was who told me about Honk. She just said, ‘Well, if you really like these guys, and you like taking pictures of them, then I think you should go check out this festival in Seattle because there’s lots of them.’ I went and it truly blew me away. I don’t like to use too many trite phrases to describe it, but it was life changing, it was direction altering. It gave me a new perspective on life. Because I had never known such a thing existed. I had no real formal musical background. I didn’t play any instruments. So this is just me as a spectator just being blown away.”

“When I came back to Austin, some of the folks in Minor Mishap had begun having a conversation of can we bring this festival which is in Boston—and I had heard of the one in Boston, but I’d never been—can we bring this festival that’s in Seattle and in Boston here to Austin. I spoke up early and I said, ‘Look, I want to be involved from the start. I want to be part of this.’ So I was among the co-founders. It got started in June [2010]. We had a kickoff meeting. That started the overall planning process. Later that summer, I tried to audition for Minor Mishap Marching Band. I went to the band leader Datri and said, ‘I don’t play anything, but I really want to be in your band. Do you need a photographer.’ She said, ‘Well, no, we don’t’ really do that. But if you learn an instrument, you’re welcome to come audition and play and we’ll see if it’s a good fit.’ So for lack of anything better, I learned to play the [Egyptian] hand drum, because I was inspired by one of the folks in the band. … So that was my start with Minor Mishap. After a couple months I was performing with them.”

“Honk just made me realize that I had a connection to music. It wasn’t that I didn’t think I did, I didn’t think about it period. So it really inspired that in me, this connection to music and this desire to be around it more and to experience it in a different way. It was all these people playing instruments that I hadn’t seen outside of a concert hall. Or instruments that I hadn’t thought about since high school or college. And they’re playing them just out in the streets for free, just bringing this joyful noise to people, getting them to dance and let go of whatever the cares of the moment are. It was uncanny. It just shifted my perspective to want to understand it and be a part of it. And it seemed so accepting and so communal. And that’s borne out.”

Honk TX debuted in Austin in March 2011 with more than 20 bands playing for three days, including a parade.

Fialkoff: “The organizers from Somerville came down and nobody quite knew what to expect. We didn’t quite know what to expect. There was this outpouring of support from this network of bands that Honk has helped connect. Everybody wanted to come to Austin because so many people had never been. They wanted to see what it was all about. … Thousands of people showed up. When you’re throwing together brand new for a city and your marketing budget is tiny and thousands of people show up on three consecutive days for an event that they’ve never heard of. And to see how people enjoyed it. Folks would show up in the park and they would be like, ‘I think I know what I’m going to see.’ And people dancing with the bands. The following fall a new brass band just popped up. And we’ve seen a new band pop up every year that we’ve put on a Honk.”

Antares: “When we co-founded Honk TX, we had a long discussion about what our collective vision was. We wanted to understand not just our motivations, but what were we going to build. Pretty early on it became a point of observation and even contention that we weren’t interested in doing a festival of activist street bands because half of the people on the committee just that wasn’t their flavor. And it’s Texas, it’s more conservative, even if it’s Austin, Texas. We felt that it might draw the wrong kind of attention, where we say we’re doing this activism locally. The Northeast has this longstanding, proud tradition of community activisms and Texas doesn’t really have that tradition, not in the same way. Of course it exists. We realized that our strength is if it’s not the activism portion of community activism, then it’s the community portion of bringing people together and crossing the divides that might exist. And embracing the communities around our city. We really focused on that. We called it the festival of community street bands.”

Fialkoff: “I think people really like to take advantage of their parks and neighborhoods. People like that stuff, it’s just that we never put things on in these spaces that have typically been community spaces. So when you use community spaces for their actual purpose people come out and they use those spaces. It’s infectious in a way. There’s an enthusiasm to the performers. Everyone is looking for authenticism now and what is real, and when you see these musicians, who often come to perform at great expense, in some sort of collectivized, but homemade uniforms and costumes and there are professionals playing along side people who haven’t played their horn since high school, there’s just this openness that draws people in.”

“There’s something interactive about Honk that I haven’t experienced at any other festival—because there are no stages, because there’s no amplification, because the musicians are often interacting with the crowd and the lines are blurred and we take down that fourth wall. [A music festival is] typically an event were you consume, all of a sudden it becomes an event in which you participate.”

On to Detroit, Rio and Oz
James Hartrick, plays trombone in Detroit Party Marching Band and helped found Crash Detroit: “Every year at Honk they have a teach-in symposium learning day on Monday after the festival. … In past years, they’ve been at Harvard or something. The past couple years, they’ve been more informal table talks at the Dilboy VFW hall [in Somerville]. Two years ago, I sat in on it and they have one subject ‘Creating Your Own Brass Band Festival.’ Then last year, I really came in with a plan. We made promotional fliers up beforehand. We didn’t even have a date, but we were like July sometime, handed that out to other bands. We came in with a lot of big questions for them and there was a lot of advice offered. I got everyone’s contact information. They were definitely supportive from step one.”

The first Crash festival was held in Detroit in July 2014. Friday evening bands spontaneously appeared to play outside downtown bars. Saturday, a showcase of bands performed in a park near an iconic, abandoned train station and attracted 2,000 to 3,000 people, Hartrick says.

Cohen: “There’s going to be a Honk Oz in Australia in January. They’re using a lot of our language. They’re really tipping their hats to us.”

“In Rio, the Brazilian band [organizing the festival there] came here last year. I think they found us on the Internet and said they wanted to come. And they’re the real thing. They’re really political. Pretty exciting to have them. I think they were more exciting politically than musically. I was excited to hear a Brazilian band, Brazilian music, and I was surprised that they’re playing the same stuff we are. They’re called Os Siderais. There had been right before last year’s [Honk] festival a lot of street demonstrations in Rio. Around the World Cup. These big international events were taking support away from the people who need it most. So their public transportation system was being threatened. A lot of housing issues, school issues. I think a million people were in the streets of Rio that summer. We’ve heard from them. They want us to come. They’re talking about [holding Honk in Rio] next August.”

Hartrick: “The founders of the Detroit Party Marching Band actually attended Honk prior to starting the band. So Honk was definitely influential for the formation of Detroit Party Marching Band. … The Detroit music scene is a really big stage show city for any genre of music, any of the soul or funk or garage rock, the punk, the R&B, even the jazz. There is not a huge culture around street performances. … Detroit Party Marching Band kind of formed to fill that hole through a brass band tradition. … We wanted to kind of show the area and the city specifically that this culture exists. You don’t have to quit that trumpet after school, you can start your own band. You don’t have to put into only guitar, drum, bass categories. There’s a place for all musicians.”

Greg Cook is co-founder of WBUR’s ARTery. Share your Honk memories with him on Twitter @AestheticResear and on the Facebook.

Categories: Health Care

Alaskan Soccer Game With Roots In Russian-American Fishing Venture

CommonHealth (WBUR) - Sat, 10/11/2014 - 7:09am

On the first chilly morning of the fall in the Aleutian Island community of Unalaska, Micheal Tesfamarian ventured away from his bunkhouse at Westward Seafoods and into town.

“Maybe this is the third time or fourth time I came to town,” he said.

Tesfamarian, from Eritrea, has been in Alaska since June, processing Bering Sea pollock into imitation crab sticks. But as the summer season was winding down, Tesfamarian and his coworkers traveled to town to play some soccer with the locals.

But this was more than just a pick-up game. Rather, it was a tournament, with three randomly selected, all-ages, co-ed teams.

Carlos Tayag, a community center staffer, organized the event, known as the International Friendship Cup, which was inspired by a trophy from 1987.

“What was going on out here is pretty cool,” Tayag said. “There was a couple of boats: there was a Russian fishing vessel that was in a joint venture with a U.S. fishing vessel. And they played soccer tournaments out here.”

The hand-engraved trophy features a logo of clasped hands and words in English and Russian: “To a crew winning a soccer match, US-USSR Joint Venture, 1987, Dutch Harbor.”

Historic Beginnings

John Henderschedt, a fisheries policymaker in Seattle, used to work for the joint venture, when Americans were catching fish in the Bering Sea and Russians were processing it on ships just off Unalaska’s shores. He remembered bringing the Russians into town to do their shopping and hosting potlucks aboard their vessels.

“They would come back with, like, a boombox under one arm, and, like, a 12-pack of Rainier or Budweiser under the other arm,” he said. “I think this was for Fourth of July — there was a big picnic organized out on the city dock. I remember them playing soccer on the dock, and the mayor of Dutch [Harbor] was Paul Fuhs, and he had a band, and that band played on the deck of one of the boats that was tied up on the dock.”

Fuhs, who was also a vocalist and keyboardist that day, now lives 800 miles away in Anchorage. He recalled that night, too.

“I remember the next day, the port director was quoted in the paper saying, ‘Well, everybody had a great time, and we checked around the next morning and nobody had died, so we’re calling it a success,’” he said, laughing. “It was really a big party.”

Also in 1987, a British navy ship made a fuel stop in Unalaska, with the heads of British Petroleum and Rolls Royce in tow. Fuhs said the crew wanted to hold a soccer match, but the Unalaskans had some trouble finding players.

“At that time in the United States, soccer wasn’t big like it is now,” he said. “None of us — I mean, like, me growing up, I never kicked a soccer ball in my life. So what we had to do to field the team, we had all those cannery workers that were from all over the world. And they grew up playing soccer their entire lives. So that’s primarily where the team was recruited from.”

He couldn’t remember if the U.S. team won — but Alaska’s honorary British consul, Diddy Hitchins, doesn’t think so. Hitchins was there in 1987, and she visited Unalaska again this summer to visit the community center and tell Tayag about how the British sailors played soccer and left trophies all around the world.

“If the other team won, then it got presented to them for winning,” she said. “And if the other team didn’t win, it got presented to them as a friendship trophy.”

Hitchins thinks it’s possible the hand-engraved Friendship Cup is the one the British left behind, reused by the Americans for later games with the Russians.

A Sense Of Community

Either way, it’s now the basis for a new tradition. The fishing industry has changed a lot here — the domestic plants overtook the international joint venture in the early 1990s and the town grew. Now, most of the processors who played this year live in Unalaska year-round.

Ahmed Jama, of Ethiopia, is a Westward Seafoods coworker who joined Tesfamarian to play in the tournament. He’s lived in Unalaska for two years, working 12-hour shifts to send money back to family in Ethiopia.

“We always come to the gym and see people, introduce ourselves,” Jama said. “We come a lot sometimes, when we have time. Mostly we work overtimes.”

Jama’s played for the Bad Aces. In the final round, they faced off against the Raging Bumblebees — a team that included everyone from relative newcomer Tesfamarian to local teenagers, parents and elementary school principal Eric Andersen.

“We used to have soccer leagues, and you just never knew who was going to be here,” Andersen said. “Some years we’d have a ship from Portugal come in and it’d be a Portuguese team that would play against us. And other years you’d have an all-Mexican team, and it’s always been great.”

Santos Quintanilla, a part-time resident who works slinging nets for fishing boats, said the tournament made him feel welcome in a place where it can be tough to get by on your own.

“We come from far away, some of us, and to hang around with the people that live here, that go to school here, and have some fun,” he said. “That’s a great thing.”

And with the Bad Aces down 6-3 in the final minutes, he acknowledged that this really was just friendly competition. The Aces scored one more goal, but in the end the Raging Bumblebees took the win.

Tesfamarian got to drink some sparkling cider from the old trophy and celebrate the victory with his new friends. He’s hoping to return to Unalaska for the next pollock season in January. And, in the spirit of friendship, he’s in discussion with community center staff about teaching a salsa class for locals on his nights off.

Categories: Health Care

Daniel Rodriguez: From Soldier To College Athlete In ‘Rise’

CommonHealth (WBUR) - Sat, 10/11/2014 - 7:06am

Daniel Rodriguez took the long way to his roster spot on the Clemson University football team. He went to Iraq and Afghanistan first. His four years in the U.S. Army left him with a Purple Heart, a Bronze Star and PTSD. He eventually decided that part of his recovery should include playing college football. He tells his story in a new book titled, “Rise: A Soldier, A Dream, and A Promise Kept.”

Bill Littlefield spoke with Rodriguez about his journey.

Highlights from Bill’s interview with Daniel Rodriguez

BL: You say in the book that you joined the Army “on a whim.” When did you begin to understand what you’d signed up for?

DR: I think upon my arrival into Iraq; on the helicopter I was in we took small-arms fire coming into Baghdad. And I think then is when it hit me. It was kind of one of those moments you realize that you’re in it for the long haul and have to be more serious about what you decided to do.

BL: Tell us about the promise that eventually led you to devote so much time and energy to finding a place on a college football team.

DR: It was late September. Me and my good friend, Kevin Thompson, we would just talk all the time. We would tell each other what we wanted to do when we get out of the military, and you talk about how good you had it. And mine was to go back to school and try to play football again. I missed sports. We promised each other that we would get out of the military, for one, and do something that we wanted to do and not let our military careers define us as men.

And two weeks later he was killed in front of me during that Battle of Kamdesh on Oct. 3, 2009. And it was just tough. It was a tough loss for me, seeing a friend killed in front of me and having to send him home in a body bag. What ultimately came of it was me fulfilling the promise, and that’s where I’m at today.

BL: You made a video of your grueling daily workouts that became a bit of a hit on social media.

Tell me a little bit about how you think going public with your goal helped you to achieve it.

DR: Well, it definitely put it out there. And the funny thing about it is, I sent it out to college coaches but it was password-protected. I just put it on YouTube to get a URL. Next thing I know, the dang thing went viral. But going public with it really just made me have an attitude of, “At least I know I did everything I could.” I spent my last penny hiring a friend who owned that production company to shoot that video. When I went public and it started going out there, it was like, “Well, I have nothing to hide behind now. This reality might happen faster than I thought it would, and I just have to make the most of it.”

BL: Your video caught the attention of the head coach at Clemson, where the university applied for an NCAA waiver because your high school transcript was less-than adequate. Just making the team was a major achievement, but you’ve done more than just make the team. At least one highlight came during a blowout against Ball State, right?

DR: Correct, yeah. That was my first catch. My first reception as a college athlete. Standing ovation on a four-yard catch (laughing). It was a great moment, a great moment in Clemson history.

BL: In the epilogue of the book, you write, “I believe in my heart that I can play in the National Football League.” Have you received any encouragement along that line?

DR: Yeah, it’s funny, we go to practice every day and there’s NFL scouts. I’ll make catches or plays and I’ll look to the sideline and you can see an NFL scout writing notes. I mean, it’s encouraging. I do believe that I can play. Will I? I don’t know. Will I get an opportunity? We’ll see. But I believe that I can, and if the opportunity presents itself then, absolutely, I’ll try to make the most of it and give everything I’ve got.

Bill’s Thoughts On ‘Rise: A Soldier, a Dream, and a Promise Kept’

When he was in high school, Daniel Rodriguez was a screw-up. He’d be the first to acknowledge that. He was on and off the football team for various reasons, and his academic performance might charitably be characterized as terrible.

He joined the Army, fought in Iraq and Afghanistan, and came home confused. He’d lost friends in combat. He was suffering from PTSD. He wasn’t sure what he’d accomplished or what he could accomplish. He had no idea what to do with himself, until he decided to try to make good on the intention he’d expressed to a friend who hadn’t made it home: Rodriguez would go to college, and he would play college football.

It was an unlikely plan, but perseverance and the power of social media made it happen. Rodriguez made the team at Clemson, where he is presently a senior. Success may have gone to his head. He’s now talking about playing in the NFL. But given what he’s accomplished, only a fool would bet against him.

 

Categories: Health Care

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